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Dr DRT Shepherd 7th January 2009

Committee for Finance and Personnel

Damages (Asbestos-Related Conditions) Bill

Written Evidence from Dr DRT Shepherd 7th January 2009

Department of Respiratory Medicine 
Belfast City Hospital 
Lisburn Road , Belfast, BT9 7AB 
Tel: 028 9032 9241

7th January 2009

Ms Laura McPolin 
Civil Law Reform Division 
Departmental Solicitors Office 
Dept of Finance & Personnel 
Victoria Hall 
12 May Street 
BELFAST 
BT1 4NL

Dear Ms McPolin

Re: Consultation Paper: Pleural Plaques

Thank you for sending me the consultation paper regarding pleural plaques and possible ways forward regarding the law of negligence, no fault financial support and issues regarding understanding and reassurance regarding pleural plaques.

I am a Consultant Respiratory Physician at Belfast City Hospital and, as such, I have extensive experience of asbestos-related disease, usually resulting from asbestos exposure in shipyard environment.

In response to the tabled questions in your consultation paper, I would have the following observations.

Question 1: Do You Think Information Leaflets Would be Useful?

It is common to find patients have been told that there is evidence of asbestos on their chest x-ray or CT scan and they have very little knowledge regarding the differences between asbestos-related diseases (namely mesothelioma, diffuse pleural thickening or asbestosis) and asbestos-related pleural plaques. The plaques are a marker of exposure to asbestos and therefore a marker of a small degree of risk of possibly developing asbestos-related disease in the future, but that the plaques in themselves do not interfere with lung function, nor do they become cancerous.

It would therefore be useful to have information leaflets setting out the difference between pleural plaques and asbestos-related disease and to put the risks of pleural plaques in context with other risks that patients may take and accept during their life, such as cigarette smoking and the risks of road traffic accidents etc.

I do not think that the creation of a register of patients who have pleural plaques would be helpful. I do not understand what purpose it would be put to and it is unlikely that it would be comprehensive or maintained on an up-to-date basis.

As regards Question 3, I do not have any information on settlement figures and associated legal costs for pleural plaques, but no doubt the solicitor’s bodies should be able to give an estimate of these figures.

There is no register of the number of people currently diagnosed with pleural plaques, nor the future number of people who are likely to develop pleural plaques. In general, pleural plaques are not usually diagnosed until some 20 years from initial asbestos exposure, at which time they calcify and become more easily visible on chest x-rays. Pleural plaques are not a good measure of intensity of exposure to asbestos.

In response to Questions 4 and 5, I would agree with the medical evidence presented in the Johnston case, namely that pleural plaques do not normally cause any symptoms, nor do they interfere with lung function. Unless asbestos-related disease occurs (mesothelioma, diffuse pleural thickening or asbestosis), pleural plaques in themselves do not give rise to symptoms or cause any interference with lung function and are simply a marker of previous asbestos exposure and a marker for the risks that asbestos exposure conveys.

Medically, therefore, pleural plaques do not give rise to any disability. The knowledge regarding pleural plaques may well give rise to some anxiety if their meaning is not understood. It is for this purpose that information leaflets setting out the meaning of pleural plaques would be useful. From a medical point of view, therefore, pleural plaques do not cause any injury and are simply a marker of some degree of risk of possibly developing asbestos-related disease in the future.

The information that pleural plaques are not compensatible should be made clear in information leaflets for both patients and doctors.

Allowing pleural plaques to be compensatible on legal terms risks development of medically unjustifiable CT scans being carried out, looking to see if asymptomatic pleural plaques are present in those workers who have been exposed or may have been exposed to asbestos in the past.

Medically, therefore, I would not feel that legislation should be introduced to overturn the decision in the Johnston case, that pleural plaques are not compensatible in Civil Legislation.

I realise that this does produce two populations, one of which has had civil compensation for pleural plaques up until the Johnston case and that similar patients following the Johnston case will not get that compensation. It does seem to me, however, sensible that compensation should be for a disability rather than a future risk of possibly developing a disability.

In question 7 you ask, Would I support the option of a payment scheme for pleural plaques?

In view of the fact that pleural plaques do not cause any injury/disability, I would not support a payment scheme for pleural plaques in themselves with the consequent risk of frequent medically unjustifiable CT scans being carried out, looking for pleural plaques that may not be visible on a chest x-ray and may only have minimal plaque disease on CT scanning. I do not have any information as regards how possible legislation would impact on equality questions on the business sector.

In summary, therefore, medically, I do not feel that there is a case for legislation to be introduced to overturn the decision in the Johnston case because pleural plaques in themselves do not cause any disability or impairment of lung function.

Yours sincerely

Dr DRT Shepherd 
Consultant Respiratory Physician

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