American Journal of Industrial Medicine 21:293-294 (1992)

EDITORIAL

Cornpensating Byssinosis Neil w. White, MBChB, MD, FCP (SA), and Halton Cheadle, BA (Hons), BProc, LLB

Key words: workmen’s compensation, diagnostic guidelines, disability evaluation, chronic respiratory disease

Compensation of byssinosis has been established for almost fifty years in Great Britain. Despite this there are enduring uncertainties around what constitutes byssinosis and what should be compensated. This has resulted in social, medical, and legal controversies, particularly in the United States during the early 1980s. Since that time very little has been published with reference to the compensation of byssinosis, particularly in Africa, Asia, and South America, where millions of persons are occupationally exposed to cotton dust. Experience of problems associated with the compensation of byssinosis is relatively recent in the Republic of South Africa (RSA). RSA has a well-developed indigenous textile industry. Cotton is grown locally and cotton textile manufacturing (accounting for about one third of textile production) employs approximately 45,000, predominantly black, workers. The first black industrial worker with byssinosis was compensated in 1982. Subsequent cases were detected between 1982 and 1984 when the first epidemiological investigation of byssinosis was conducted in the RSA [White, 19891. As a consequence of our involvement with these cases, we were party to initiating a process that led to the development of “state of the art” presumptive criteria defining compensable byssinosis for South Africa. This definition was largely based on previously published work on this subject from the United States. We hoped that a precise set of guidelines would effectively cut the Gordian knot of the apparently complex technical issues involved. The RSA compensation authorities and their medical advisors saw fit not to implement these criteria and continue to evaluate individuals on an ad hoc basis. This is an unfortunate situation. Through a carefully documented series of cases, we have shown [White et al., 19921 the consequences that, apparently, stemmed directly from the lack of a regular method of evaluating cases. More than 50% of claims were Respiratory Clinic, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, Republic of South Africa (N.W.W.). Center for Applied Legal Studies, University of Witwatersrand, Republic of South Africa (H.C.). Address reprint requests to Dr. Neil W. White, Respiratory Clinic, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Rochester Post Office, Cape Town, Republic of South Africa 1925. Accepted for publication August 20, 1991.

0 1992 Wiley-Liss, Inc.

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adversely affected by inconsistent or arguable decisions, unfair refusals, and unnecessary appeal proceedings. These findings raise serious questions about the objectivity and fairness of the evaluation of byssinosis compensation claims in RSA. Similar problems have been encountered elsewhere. In analyzing over 200 examinations by an expert medical panel in North Carolina, Hughes [19811 found that, in many cases, panel members had openly ignored both prevailing medical knowledge and the symptoms manifest in the claimants, while substituting their own preconceived notions about byssinosis and its diagnosis. In similar fashion to ourselves, hhghes argued that, in order to avoid a legislative and administrative fiasco, some t,ype of consensus had to be reached within the medical profession concerning the characteristics and definition of byssinosis. The problems that Hughes relates occured in a setting where considerable resources are devoted to periodic medical examinations of cotton textile workers and where medical expertise is available for the evaluation of byssinosis cases. This is not often the case in the RSA and in many other countries where there are many people occupationally exposed to cotton dust but where only limited resources exist for their medical evaluation. In both contexts, simple and easily applied consensus medical definitions of impairment in byssinosis are important since they promote easier, more uniform and fairer medical evaluations for comipensation purposes. In RSA, we are encouraging the compensation authorities to consult with a broad range of medical experts in determining consensus medical definitions of impairment in compensable occupational disease. This is the case for byssinosis and other currently scheduled or unscheduled diseases. These medical definitions could be developed in much the same manner as RSA’s occupational hygiene standards. Thereafter, they would be incorporated into the usual compensation procedure, being freely available to claim assessors, applicants and their representatives, and could be subject to review as experience accumulates. We have identified additional problems in the RSA compensation system that need to be addressed. These include problems of access into the system, low awards, and difficulties in initiating appeals. It appeared that receipt of an award could result in a worker’s employment being terminated, although we were not able to quantitate this observation. These problems are certainly riot unique to South Africa; indeed, some countries with large cotton textile industries simply do not recognize byssinosis as a compensable occupational disease. Medical surveillance of cotton textile workers is a futile exercise if its effect is only to document a progressive decline in function. The development of defined levels of dysfunction should be accompanied by actions such as job transfer and environmental improvements. Defined levels of dysfunction should be easily related to appropriate medical definitions of what constitutes impairment in byssinosis. Accordance with this medical definition alone should become recognized as sufficient evidence on which to base a compensation claim.

REFERENCES Hughes JT (1981): Diagnosing byssinosis: the medical controversy. Chest 79: 129s-132s. White NW (1989): Byssinosis in South Africa. A survey (of 2411 textile workers. S Afr Med J 75: 435-442. White NW, Cheadle H, Dyer R (1992): Workmens’ compensation and byssinosis in South Africa: A review of 32 cases. Am J Ind Med 21:295-308.

Compensating byssinosis.

American Journal of Industrial Medicine 21:293-294 (1992) EDITORIAL Cornpensating Byssinosis Neil w. White, MBChB, MD, FCP (SA), and Halton Cheadle,...
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