VanderbiltCenter for Occupational and Environmental Medicine
MEDICALSCIENTIFIC EXPERTSERVICES
Tel – 615-936-0422
Fax – 615-936-0423 / Jonas Kalnas, MD, MIH, MSc / 3319 West End Avenue – Suite 930
Nashville, TN 37203-1035

Occupational and Environmental Medicine is primarily a preventive medicine specialty which attempts to identify and prevent adverse health effects from exposure to hazards at work or in the environment. An expert is a person invited to educate, provide opinions and testify about scientific, medical, technical or other specialized circumstances involved in a dispute in order to bring special training, knowledge, skill or experience where matters in legal dispute are beyond the average person’s knowledge.

Dr. Jonas Kalnas has a bachelor’s degree in chemical engineering from McMasterUniversity (1971) and a M.D. from the University of Western Ontario (1976) in Canada. He obtained a Master of Industrial Health (1978) for occupational medicine physicians, and a Master of Science in Environmental Health Sciences (1979) with majors in Industrial Hygiene and Air Pollution Control, from the Harvard School of Public Health, and did a research fellowship in lung physiology at the Mayo Graduate School of Medicine (1980). Dr. Kalnas has practiced occupational and environmental medicine in pharmaceutical and petrochemical companies, in a government regulatory agency, and as an independent consultant. He is board certified in occupational medicine, and is a Fellow of the AmericanCollege of Preventive Medicine and of the AmericanCollege of Occupational and Environmental Medicine. In 2002, Dr. Kalnas joined the VanderbiltCenter for Occupational and Environmental Medicine (VCOEM) where he provides expert services on complex medical or scientific issues in administrative, regulatory or legal proceedings. There is no doctor-patient, treatment or health care relationship. Reports and opinions are treated as confidential and privileged, and released only to the requesting agent unless further disclosure is required by law or medical necessity.

EXAMPLESof SERVICES

Toxicology Epidemiology

Hazard
Assessment / A worker asks if exposure to silica dust over many years might have caused her stomach cancer. You know that that silica causes silicosis of the lung. The Material Safety Data Sheetstates that silica has been recognized to cause lung cancer, but does not state anything about other cancers such as stomach cancer.
Cancer / Disease
Causation / A worker reports neurological symptoms that he thinks are related to his job. He works with solvents and grinds heavy metals, but he also uses pesticides on his vegetable farm. All of these exposures are known to have the potential to cause neurological problems. You need to determine which exposure is the most probable cause of his symptoms.
Medical
Monitoring / You want to implement a medical monitoring program for workers exposed to lead and mercury. Your occupational medicine clinic / provider can provide this service, but you need help in designing a protocol.

Causation Impairment Issues

Causation
& Impairment / An injured person (from work, product exposure or other accident) receives substantially different causation opinions or impairment ratings from two medical evaluations, and you need anexpert to evaluate the case and help to resolve the differences.
Plaintiffs
& Claimants / You suspect that exposure to a substance at work (or in the environment, or in a product) may have caused your client’s illness. You need to evaluate the claim, and to assemble the medical and scientific information that may support the claim.
Defendants
& Respondents / Your client has been sued by a worker (or a customer using a product, or a person living near the plant) claiming that an illness was caused by your client’s operations or product. You need to decide if there is merit to the claim, and to assemble the medical and scientific information to defend your client’s position if the available evidence does not support the claim.

Risk Management

Special Programs
& Oversight / You identify a need for a program to provide medical monitoring or other preventive interventions to address toxic, physical or ergonomic hazards in your workplace. You need medical input for program development and ongoing oversight.
Hazard & Risk Communication / You receive a bulletin warning that a certain chemical has been found to be associated with cancer in a study of workers in another industry. Your company has been using this chemical for several decades, and you need to determine what to communicate to your employees, and / or your customers.
Public
Relations / Residents near your plant think that emissions from your site are contaminating their environment and have caused illnesses in the community, and you need to address their concerns.