A CARBON MONOXIDE UPDATE (Periodic Newsletter on CO)

Vol. 3, No. 1a
April 9, 2001

  • I get so much mail, E-mail, FAXs, phone calls from people all over the world regarding carbon monoxide - approximately 6-10 every day. I estimate that I am now "seeing" more people poisoned by CO than anyone else in the world. COHQ and its satellite (CarbonMonoxideHQ.com) certainly are visible on the internet! I am very pleased with this and hope that they, and I, can be of continued service to you. As you may already know, I am also answering medical / scientific questions about CO at carbonmonoxidekills.com - I thank that website for inviting me to be "the Doctor is in".


    Are you a Toxicologist? - One of the most frequently asked questions is: "Are you a Toxicologist?" I am not a general Toxicologist in the usual sense of the word. The dictionary defines TOXICOLOGIST as: "One who studies the nature, effects, and detection of poisons and the treatment of poisoning". or, "An individual who specializes in what is known regarding poisons; the scientific study of poisons, their actions, their detection, and the treatment of the conditions produced by them". My own definition is that a 'General Toxicologist' is someone who knows a little about a very large number of (poisonous) substances. I am just the opposite, I know a whole lot about Carbon Monoxide, but make no claim to know much about hundreds of other poisons! Thus, I am an expert on Carbon Monoxide solely.

    Can I have any Neuropsychologist do an evaluation following CO Poisoning? - I am frequently asked for the name/phone of a neuropsychologist in the victims' vicinity." There are two parts to this answer. First I do not make referrals to neuropsychologists until I have a good understanding of a case, that usually involves reviewing the CO Questionnaire and Adult History Questionnaire, and some of the relevant medical records. I usually am in a position to make referrals after I have officially become part of the case, ie. I have been retained by the victim(s) and/or legal counsel. Second, most neuropsychologists do not have an adequate understanding of what damage CO does, particularly chronic CO poisoning. Without this understanding, he/she may give incorrect tests, or may not know how to properly interpret the results of the tests given. Exercising my responsibility to my clients, I only refer to Neuropsychologists who have experience and competence in this emerging area of neuropsychological practice. Recently, I have begun assisting local neuropsychologists to do the very best testing possible, and to correctly interpret what the tests mean in terms of the damage that can result from CO poisoning.

    What is my role in Litigation? - I am also frequently asked "what my role is in litigation involving Carbon Monoxide cases?". I usually play a central role in cases - act as the "middle man", if you will. I interpret the medical record, engineering andother assorted data, neuropsychological and neurological testing results, etc., in terms of what CO did when it was present, and what the consequences are in terms of health injury and/or death. In jury trials, a major goal is to usually to educate the jury about Carbon Monoxide Toxicology. In officially becoming an expert in your case, I might do some of the following:

  • Distribute CO Questionnaires, Adult History Questionnaires, etc., then interpret the results
  • Advise on the overall structure/strategy of the case, with regard to the medical & scientific facts
  • Confer with patients/clients, attorneys, and other experts
  • Review medical and other records
  • Write reports
  • Give depositions
  • Visit exposure site(s)
  • Appear (testify) in court
  • Interview patients / clients
  • Do library/literature research
  • Construct mathematical models
  • Make referrals to professional engineers, HVAC experts, etc.
  • Advise on consults by neuropsychologists, neurologists, radiologists, etc.
  • Advise on the wisdom and "how-to" of doing re-creations to gather data.

    I invite you to review the new sections of COHQ dealing with the Neurological effects and Neuropsychological effects of CO poisoning.

    MINI-QUIZ: Would you answer TRUE or FALSE?

    1) Cracks in heat exchangers are usually responsible for the production of CO T or F

    2) Breathing "clean" air for 2-3 hours will eliminate all CO from the body T or F

    3) Everyone responds to CO in the same way, ie. show the same symptoms T or F

    4) Depression and personality change seldom result from CO poisoning T or F

    5) High-tech imaging devices (CT, MR, SPECT) always show areas of brain damage from CO poisoning, if it exists T or F

    6) Neurological evaluation is the best diagnostic approach to determine the extent of CNS damage caused by CO T or F

    7) CO exposure never produces brain damage unless there is a period of unconsciousness T or F

    8) People who recover from CO poisoning are always completely normal T or F

    See the answers below

  • Buy the New Book on CO - CARBON MONOXIDE TOXICITY, by D.G. Penney, Ph.D., CRC Press, 2000. GO TO COBook2.htm


    The following is a "Check List for Victims of CO Poisoning Who Wish to Seek Compensation"
    Infomation Sheet 101, Version 2.0, Dec. 1, 2000

    1) Fill out a new Diagnostic Carbon Monoxide Questionnaire available on-line (COHQ/COStudy/coStudy1.htm) or get the NEW EXPANDED vers. 6.2, qualitative and quantitative, CO Questionnaire directly from the author, and mail/FAX it to Dr. D.G. Penney (1209 West Twelve Mile Road, Royal Oak, MI 48073 / 248-547-4634). Also, ask about the Adult History Questionnaire and CO Source/ Measurement Questionnaire.

    2) Do not allow the CO source (furnace, water heater, etc.) to be removed/replaced. Keep the evidence! Do not sign any papers waiving your rights if a party offers to install a completely new unit. MOVE QUICKLY or you could lose an important piece of leverage in your case.

    3) As of RIGHT NOW, develop a chronology of what happened and how you felt during and after the exposure. Be as detailed as possible and attempt to afix exact dates as to when specific things occurred.

    4) Do not assume that because your physician(s) can find nothing wrong with you or members of your family, that you are/will be ok. The effects of CO poisoning can be and are, usually quite subtle, especially the effects of chronic CO poisoning. Individuals exposed, or their loved-ones, are usually those who notice the deficits and changes first. Again, use of a CO Questionnaire at this point is a highly recommended.

    5) Unless you are looking for a "cure" only, DO NOT visit one physician after another looking for help. Many physicians know little about CO poisoning, especially chronic CO poisoning and its after-effects. Establishing a trail of medical records with practitioners who know little about the condition and who cannot testify to the seriousness of your health deterioration can only damage your case in settlement negotiations and in court.

    6) Seek out an expert on CO exposure/poisoning who can guide you and your legal counsel in WHAT and WHAT NOT to do in developing your case. Obviously, this professional should have a long experience with CO poisoning and its consequences.

    7) Gather all the relevant documents in your case:

  • CO levels measured at the site of exposure.
  • Photographs, maps, drawings of the site, comments of witnesses, etc.
  • Carboxyhemoglobin levels in blood drawn within 2-3 hours of leaving site of exposure.
  • All relevant medical records prior to, during, and after the exposure. Prior to records should generally extend back 4-10 years before exposure.

    Impotant: Keep photocopies of all original and other records you distribute to your attorney, experts, etc.

    8) Select your legal counsel with care. He/she should have a track-record in personal liability and/or toxic tort law. He/she should be very interested in your case and willing to give it the attention it deserves. The first interview with attorneys is free - use that time to determine whether he/she is right for your case. It may be necessary to have your CO expert do a preliminary review of your case and a brief report in order to convince your attorney that the case has merit. If he/she is still not really interested, seek elsewhere.

    9) In most cases decline physicians requests that you undergo high-tech scanning studies such as CT (CAT), MRI, SPECT, PET, etc., especially if your exposure was chronic and at a non-lethal CO level. Such studies are usually negative and only provide arguments for the defense. Under some circumstances, however, studies involving MRI, SPECT and PET are justified. Consult your expert first.

    10) Consider the possibility of doing a "re-creation". That is, under controlled conditions with the well-planned monitoring of gas conc., set up the site of exposure as identical as it was during your original expos-ure. Your expert on CO should be a member of the team who plans the re-creation. Remember that all data from such a re-creation is discoverable by the defense and a poorly done re-creation can work against you. I will be happy to advise you in how this should be done.

    11) Neuropsychological evaluation data are KEY to demonstrating damage from CO poisoning. A neuropsychologist is not a physician, but rather a Ph.D. psychologist with special training, who objectively measures loss of brain, motor, and sensory function by administering many tests over a period of hours. It is very important that you hire the correct neuropsychologist, one with previous experience with CO poisoning victims. I will be able to make referrals to the best of such professionals.

    12) When assembling a packet of documents for your attorney or experts to review, organize them carefully, labelling each sub-group for easy access. Remove duplicate documents coming from different sources (eg. doctors' offices), as this requires more time of the reviewing party and increases the cost to you. Well-organized documents will work strongly in your favor.

    13) For answers to other questions relating to your case, contact me immediately - use the E-mail address below.

    Mini-Quiz Answers: All items are FALSE

    Direct all mail to
    Dr. David G. Penney
    E-mail dpenney@cmb.biosci.wayne.edu

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