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ORRHES Meeting Minutes
November 16-17,
2000
November 16, 2000
The Agency for Toxic Substances and Disease Registry (ATSDR)
and the Centers for Disease Control and Prevention (CDC)
convened the first meeting of the Oak Ridge Reservation
Health Effects Subcommittee (ORRHES) on November 16-17,
2000. The meeting, which was held at the YMCA of Oak Ridge,
began at 9:00 a.m.
Members present were:
Alfred A. Brooks, Ph.D.
Donald A. Creasia, Ph.D.
Kowetha A. Davidson, Ph.D., Chair
Robert Eklund, M.D.
Edward L. Frome, Ph.D.
Karen H. Galloway
Jeffrey P. Hill
David H. Johnson
Susan A. Kaplan
Andrew J. Kuhaida, Ph.D.
Ronald H. Lands, M.D.
James F. Lewis
Lowell P. Malmquist, D.V.M.
LC Manley
Therese McNally, B.S., B.S.N.
Donna Mims Mosby
William Pardue
Barbara Sonnenburg
Charles A. Washington
Members absent were Robert Craig, Ph.D. and Karen Galloway.
All the liaisons to the Subcommittee attended:
Elmer Warren Akin, U.S. Environmental Protection Agency
(EPA)
Brenda Vowell, R.N.C., Tennessee Department of Health
Chudi Nwangwa, Tennessee Department of Environmental Conservation (TDEC)
Agency staff present were:
ATSDR: Bert Cooper, Rita Ford, Jack Hanley, Sandy Isaacs,
Yahya Muhammed, Theresa NeSmith, Marilyn Palmer, Jerry Pereira,
Robert Williams.
CDC/National Center for Environmental Health (NCEH): Arthur
Robinson
CDC/ATSDR Headquarters:
Office of General Counsel: Kenya Ford, Paula Kocher
Committee Management Office: Helen Kuykendall
Department of Energy: Timothy Joseph
Others present over the course of the meeting included:
Gordon Blaylock, Oak Ridge National Laboratory and SENES,
retired
W.H. Brooks, Oak Ridge resident
Walter Coin, Oak Ridge resident
Jan Connery, Environmental Research Group (ERG)
Edwin A. Farmer, Oak Ridge resident
J.W. Fouse PACE and community representative
Larry Gipson, ORNL retiree, Scarboro resident
Ronnie Griffin, Scarboro resident
Susan Gawarecki, Local Oversight Committee
Ann Henry: RN, Employee Occupational Health Services, Memphis Medical Center
Tim Joseph, Oak Ridge Operations Office point of contact
Bill Murray, A.B. Murray Consulting, LLC
Marie Murray, recorder
Norman Mulvenon: retired physicist, Chair of the Oak Ridge Local Oversight
Committee/Citizens Advisory Panel (ORRLOC -- CAP)
Arthur Nelson, Oak Ridge resident
Robert Peele, was associated with Oak Ridge Health Agreement Steering Panel
(ORHASP).
J.A. Sharkir-Ali, Oak Ridge NAACP
John Steward, PACE health and safety union representative
Janice Stokes, Oak Ridge resident
Debbie West, court reporter
Steve Wiley, Y-12 environmental studies health coordinator
Opening Comments
Rear Admiral (U.S. Public Health Service) Robert Williams,
Director of ATSDR's Division of Health Assessment and Consultation,
welcomed everyone on behalf of ATSDR and CDC. He did so
on behalf of Ms. Loretta Bush, the Subcommittee's Executive
Secretary and Designated Federal Official (DFO), who was
injured in an auto accident on the previous day and was
therefore unable to attend. Mr. Jerry Pereira, Chief of
ATSDR's Community Involvement Branch, sat in for Ms. Bush.
Mr. Williams thanked the members for their willingness
to serve on this Subcommittee, which is a key component
of ATSDR's outreach to the Oak Ridge community. Its purpose
is to provide advice and recommendations to ATSDR and CDC,
particularly in prioritizing and determining how to evaluate
health issues and community concerns, and to determine
the public health responsibilities suggested. He assured
the members that that advice will be taken seriously and
responded to. If ATSDR is unable to respond, it will invite
in those who can to do so.
Subcommittee Chair Dr. Kowetha Davidson then introduced
herself. She has a Ph.D. in zoology, is on staff at the
Oak Ridge National Laboratory, and is a member of the Oak
Ridge Associated Universities (ORAU) Institutional Review
Board. She defined her role on the committee as providing
technical expertise as well as to serve as a liaison to
the African American community.
Dr. Davidson also thanked the members for their willingness
to serve on this FACA committee, and welcomed them, agency
staff and members of the public to this meeting. This meeting's
focus was to be on information and process about committees
formed under the Federal Advisory Committee Act (FACA)
and in particular about the ORRHES. She welcomed this community's
opportunity to provide ideas and recommendations in partnership
to ATSDR at the front end of their work in Oak Ridge; to
bring solutions and ultimately closure to questions about
the laboratory. She called for sensitivity to the people
of the community and their environmental concerns, and
maintenance of an atmosphere of fairness and respect in
dealings among the members and with the community. She
commented on the diversity of the Subcommittee's member,
each providing something different and important to the
committee as a whole. A strong unit could be formed to
deal with and resolve the issues brought before them.
As Chair, she expressed her expectations of the Subcommittee
members: 1) to exert every effort to work together, letting
diversity work for rather than against the Subcommittee;
2) to subordinate personal goals/interests for the good
of the process, considering the entire community; 3) to
remain focused on the specific issues examined while listening
to other concerns of the community as well as ATSDR's missions;
4) to develop a systematic approach to the Subcommittee's
work; and 5) to bring closure to environmental issues problematic
to the community for many years. The Y-12, X-10, and K-25
Areas are geographic units from which environmental contaminants
may have been released. This Subcommittee will be focused
on what the community was or are exposed to, at what levels,
whether those levels are sufficient to cause public health
concerns, and on what can be done.
Dr. Davidson concluded that "this is our Subcommittee;" which
has the means and opportunity to determine how the Subcommittee
will function. The members should communicate with other
members of the community about their environmental health
concerns, because the Subcommittee can influence what goes
into the ATSDR public health assessment.
Subcommittee Introductions
The Subcommittee members introduced themselves:
Alfred Brooks is a resident and land owner with a long-time
interest in Oak Ridge. He belongs to many community groups,
some of which address on-site environmental problems, so
he had already reviewed a good deal of data.
Don Creasia is a retired X-10 worker. He is an environmental
toxicologist with a specialty in inhalation.
Bob Eklund is an emergency medicine practitioner. Treating
his patients with chemical poisoning led to an interest
in Oak Ridge, not just of the workers but also residents
living around the Oak Ridge complex.
Ed Frome is a biostatistician in the Computer Science/Mathematics
Division of Oak Ridge, and has worked at the lab since
1966. He was part of the ORAU epidemiologic health effects
studies of Oak Ridge workers, and still works on beryllium.
Jeff Hill is an ORNL worker, a fisherman, and a new grandfather,
therefore with a renewed interest in the environment and
future. He has been the labor union environmental safety
and health representative for the Atomic Trades and Labor
Council.
David Johnson is a member of the Knox County Minority
Health Coalition and has served on numerous community committees.
He is interested in all minority communities and other
disenfranchised individuals.
Susan Kaplan has worked in laboratories since age 16.
She is a chemical engineer and independent business owner
since 1987. She joined the Local Oversight Committee in
1995 and has been Vice Chair since 1996, and Chairs their
Subcommittee on Economic Transition and Workforce Issues.
She is an activist who began the Institute for Technology,
Social, and Policy and Awareness.
Al Kuhaida is the mayor of Oak Ridge. He had a career
in environmental management, first in assessment of uranium
mines, waste storage, and recently in remediation on the
ORR. HE is now semi-retired and is on several environmentally-related
committees. He was born on the Ohio River near the West
Virginia steel mills, which produced air and water pollution.
He moved to Oak Ridge as teenager and recalled when the
East Fork Poplar Creek occasionally ran in colors or with
an oily scum. He fished and camped on the Clinch River
and later discovered the cesium contamination of fish at
that time. As a teenager, a "No Trespassing" sign was a
challenge; and at least once he entered an area exposed
to radiation.
Ron Lands grew up in Roane County until medical school
and the Army, and settled in Oak Ridge 10 years ago. He
is an oncologist and hematologist at the Methodist Medical
Center.
James Lewis is a retired mechanical engineer who worked
for the TVA. for 27 years. He was born and raised in Knoxville.
As Vice President of the NAACP, he heard numerous community
complaints about Oak Ridge pollution. He hoped the Subcommittee
would make a special effort to ensure that the community
is informed in an understandable way about lab issues.
Peter Malmquist is a veterinarian, retired since 1999,
who has lived in Roane county since 1962. He volunteers
with the county commissions, church boards, and a member
and Chair of the county Board of Health. He lives on the
Clinch River, and he has some concern about downstream
pollution.
LC Manley is a retired ORNL lab technician who has lived
in Oak Ridge (Scarboro) since 1958. He hoped to bring to
closure some of the negative reports about his community
concerning mercury and airborne exposures. If there is
no problem, the negative publicity of the recent past must
be corrected.
Therese McNally grew up in Oak Ridge; her father was a
Y-12 physicist. She also played everywhere as a child and
agreed that the site fences were irrelevant.
Donna Mosby is a lay person and community activist with
a particular interest in the issues affecting children.
She was concerned about the divisions in the community
over these issues, particularly in Scarboro.
Bill Pardue is a retired nuclear industry worker (not in Oak Ridge) with an
expertise in facilities design and the handling of toxic materials. He has
been on the Oak Ridge Site-Specific Advisory Board ( SSAB) for 5 years as well
as on the Governor's Panel to Evaluate Toxic Substances in the K-25 Incinerator.
Barbara Sonnenburg lives on Watts Bar Lake, and represents
Meigs County. She is a representative of the LOC Board
and is on the Tennessee Air Pollution Control Board. As
the representative, she had heard much testimony about
health concerns. She was an elected representative on the
Memphis School Board and on the City Council for 16 years.
As the latter's Chair, she began a local Hazmat response
team, the first in the country to bring together the first
responders, representatives of the chemical industry, railroads,
trucks, etc. She formed the same template on the national
level.
Charles A. Washington, Sr. worked at ORNL for 27 years,
and in that time worked with every element on the periodic
chart. He knew of site emissions to the closest community,
which was minority, and which was not informed. He was
present to find out what/how much was emitted, the meteorological
conditions of the time, and what effects would have resulted
in Scarboro. He was President of the National Organization
of Black Chemical Engineers, President of the Inventors's
Forum, a member of the SSAB. He is a strong proponent of
environmental justice, which addresses the economic and
social effects of plant activities. He stated that lakes
and streams within 100 miles of the lab were contaminated,
and that "low levels matter." He hoped to put some definition
to these issues in the course of the Subcommittee's work.
Of the absent members, Robert Craig is an oncologist and
environmental scientist, who is a members of the East Tennessee
Economic Council and Oak Ridge Chamber of Commerce for
2001. Ms. Karen Galloway is a secretary at Battelle/ORNL.
She was born and raised downstream of the ORNL.
The Subcommittee liaisons also introduced themselves:
Brenda Vowell is a nurse and has worked Tennessee Department
of Health for 30 years. She has lived most of her life
in Anderson County, and is currently Director of Quality
Management for the 15-county area surrounding Knox county.
She has worked in the mercury studies and most recently
participated in coordinating CDC's examinations of children
in the Scarboro community.
Chudi Nwangwa is a chemist and the liaison for the Tennessee
Department of Environmental Conservation. He has worked
for the TDEC Oversight Office in Oak Ridge for 10 years.
Elmer W. Akin is the liaison for the EPA. His training
is in toxicology and he is the Region IV Senior Risk assessor.
As a regulatory agency with cleanup authority over Superfund
sites, EPA conducts risk assessments but does not do health
studies. They are very interested in CDC/ATSDR's health
studies relevant to Superfund Sites.
Presentation on the FACA
Ms. Helen Kuykendahl, of the CDC/ATSDR Committee Management
Office, outlined the history, procedures, and membership
aspects of federal; advisory committees. Since 1794, when
George Washington enlisted an advisory committee to investigate
the Whiskey Rebellion, such committees have been used to
obtain outside expertise not available within the federal
government. They have addressed a wide variety of subjects,
such as labor laws, government housing, vaccines, etc.;
most recently, the Three Mile Island and Space Shuttle
Challenger events.
The Federal Advisory Committee Act (FACA) was enacted
by Public Law 92-463 in October 1992. It defines a FACA
as "any committee, board, commission, council, conference,
panel, task force, or other similar group, or any Subcommittee
or other subgroup thereof for the purpose of obtaining
advice or recommendations on issues or policies which are
within the scope of his or her responsibilities." The FACA
was created to prevent advisory committees from being dominated
by any one viewpoint or special interest. It is the only
way that consensus advice can be provided to an agency,
which must respond to the advice and recommendations.
In 1997, the General Services Administration (GSA) assumed
responsibility for FACA and further defined committee guidelines.
Each agency is required to have a committee management
officer; the agency is accountable to GSA, and GSA accountable
to Congress.
Ms. Kuykendahl explained that the Oak Ridge Reservation
is a Subcommittee of the Citizens Advisory Committee on
Public Health Service Activities and Research at Department
of Energy (DoE) sites. It is an umbrella committee consisting
of the Subcommittees at the Savannah River Site, Hanford,
Fernald, Idaho National Engineering and Environmental Laboratory
(INEEL), and now Oak Ridge, DoE sites.
She outlined the basic FACA guidelines, which provide
strict procedures in establishing and operating an advisory
committee. (Further information on FACA is available at
the GSA Website: www. policyworks.gov).
The committee's function is only advisory.
- The FACA And Government in the Sunshine Act require
open access to committee meetings. The meetings planned
are Published in the Federal Register and must be open
to the public unless closed with prior permission.
- Membership must be fairly balanced in terms of the
points of view represented and the functions to be performed,
composed of equitable geographic, ethnic and gender representation
(as long as the effectiveness of the committee is not
impaired). The members are selected without discrimination
based on age, sex, ethnicity, gender, sexual orientation,
disability, or cultural, religious, or socioeconomic
status.
- Members cannot serve continuously as a member of any
single advisory committee for more than 4 years, serve
on more than one committee within an agency at the same
time, or serve concurrently with another person from
the same organizations in the same city without a DHHS
waiver.
- Each committee must have a Designated Federal Official
(DFO), who is Ms. Loretta Bush for the ORRHES. She supervises
the day to day operations of the committee, provides
direction, control, and assistance to ensure that the
committee operates as required. She ensures: that the
committee fulfills its mission, calls or approves the
calling of committee meetings and the final meeting agenda,
that the meeting notices are published in the Federal
Register 15 calendar days in advance, attends each meeting,
ensures that detailed minutes are kept of each meeting,
and ensures new member orientation.
- The Committee Chair, Dr. Kowetha Davidson, is responsible
to preside at meetings and ensure that all rules of order
are maintained (Roberts Rules of Order are suggested).
She manages the committee with the DFO, ensures that
public comment periods are held, and certifies the accuracy
of the meeting minutes.
- DHHS policies require federal advisory committees to
hold meetings with the advance approval of the DFO, who
must approve the agenda. A quorum (50% + 1) must be present
to vote. The advice given by the committee must be within
the scope of its charter (for the ORRHES, these are public
health activities at the Oak Ridge Reservation).
- Members are compensated at $250/day of Subcommittee
meetings, but not for time spent in preparing for meetings.
The members' roles involve them as private citizens engaged
as temporary special government employees. They represent
only their personal opinion or view, not that of any
organization.
- Special government employees must comply with government
conflict of interest regulations and standards of ethical
conduct for employees of the Executive Branch. They must
protect confidential information and procurement integrity,
file an annual confidential financial disclosure form,
and recuse themselves from participating in any meeting
to provide advice that would affect their financial interests.
Discussion. Further
clarification provided in discussion included: 1) The committee's
scope addresses health issues inside and outside the site
fence line, all of which interest ATSDR. However, any worker
issues directly involved would be addressed by the National
Institute for Occupational Safety and Health (NIOSH); and
2) FACA requires detailed minutes. Any transcripts done
in addition are also publicly available. Both minutes and
transcript will be distributed to the members, certified
by the Chair, and placed in the DoE reading room, as well
as made available for public distribution and use. Overview of the Subcommittee
Charter
Ms. Marilyn Palmer, of the ATSDR Committee Management
Office, provided an overview of the Subcommittee's charter.
The ORRHES can have up to 30 members; 20 are currently
seated. The members are technical experts knowledgeable
about the site area's concerns, represent diverse community
viewpoints. Consultants and nonvoting liaisons are involved
as needed. The members have overlapping 4-year terms and
serve until replaced. The meetings are determined by ATSDR's
needs and are announced through outreach to the public,
which the members were asked to assist. The minutes repose
at the ATSDR archives and in the DoE Reading Room. Aside
from the $250/day, the members are paid a per diem and
travel expenses. The charter must be renewed every two
years (current expiration is July 2, 2002). Ms. Palmer
provided her contact information and e-mail address (myr4@cdc.gov). Ethics Video and Discussion
Ms. Paula Kocher, Senior Coordinating Attorney for CDC's
Office of General Counsel (OGC), introduced a video tape
developed by the U.S. Office of Government Ethics that
discusses the general rules and ethical aspects of serving
on FACA committees. It explains the seven rules applicable
to FACA members as special government employees, which
address: 1) conflict of financial interest, appearances
of same, use of..., acceptance of gifts, outside activities
in which the members may or may not engage while a member,
restrictions on seeking employment while a member, and
post-employment restrictions. There were no questions from
the members after the video. Letter from NIOSH to the ORRHES
Dr. Davidson read a letter from Mr. Larry Elliott of the
NIOSH Health Effects Research Branch. He conveyed his congratulations
on the ORRHES' first meeting, which he was unable to attend.
However, he requested agenda time at the second meeting
to outline NIOSH's mission and research agenda at Oak Ridge,
and its role in the Energy Employees' Occupational Illness
Compensation Program. Overview Presentation of
ATSDR
Mr. Williams is also the Public Health Service's Chief
Engineer, advising on public health engineering matters
to the Surgeon General and >1100 PHS engineers. As Director
of the Division of Health Assessment and Consultation,
he ensures that public health assessments are conducted
at every site listed on the National Priority List (NPL)
nationally.
He explained that ATSDR's mission is to conduct public
health assessments, establish and maintain toxicological
databases, disseminate information on exposures, and provide
medical education to health care providers on the health
effects of environmental contamination. ATSDR has about
500 employees and an annual budget of $80-90 million. Most
staff are in Atlanta, although some are assigned to each
of the EPA regions. The agency was created by the Comprehensive
Environmental Response, Compensation, and Liability Act
(CERCLA – the Superfund) Act), in response to the
events at Love Canal and the barrel fire in Elizabethtown,
NJ. In 1986, ATSDR's responsibilities were expanded by
the Superfund Amendments and Reauthorization Act (SARA).
This made ATSDR the lead public health agency under Superfund
to identify the extent/nature of health hazards at NPL
sites, help prevent further exposures/illness, and establish/expand
the knowledge of health effects related to exposures. This
work is done with state and local health departments and
other federal agencies, particularly EPA and CDC. He shared
an organizational chart showing its placement under the
DHHS.
Public Health Assessment Activities. ATSDR's primary goals
are to: 1) identify people at health risk from exposures,
2) evaluate the relationship between hazardous substances
and adverse human health outcomes, and 3) to intervene
to prevent or mitigate the adverse health outcomes from
such exposures. Their activities are either site- or substance-specific
in four main areas:
- Public health consultations respond to narrow or specific
health questions. They normally provide a rapid response
(verbal or written), with a recommendation on what to
do about that concern.
- Public health assessments are used to triage sites:
who's been exposed, to what, and what more rigorous activities
might be needed. It examines environmental, medical,
and community population information to decide a course
of action. It examines exposure pathways (how a contaminant
is released and then proceeds through air, water, or
soil to reach/affect people.). This could result in a
public health assessment recommendations such as health
education, medical monitoring, exposure investigations,
health studies, research, exposure/disease registries,
toxicological profiles, health surveillance, and health
advisories. A public health assessment would be used
by the health department, EPA, etc., to help inform decisions
about sites to protect their communities and workers
around or in the sites.
- Exposure investigations: collect a limited amount of
data to better define the exposures in a community (e.g.,
blood and urine samples to get snapshot of current health
status. They do not indicate past or future events or
effects. Unfortunately, there are few tools available
to detect exposures.
- Health investigations look for any association between
an exposure to a contaminant/hazardous substance and
an health outcome. These could result in other activities
such as a disease registry, medical monitoring, etc.
Toxicological
Profiles. From lists of hazardous substances,
ATSDR develops toxicological profiles ("tox profiles"),
now totaling about 200 of 275 identified chemicals of
concern at sites (e.g., lead, benzene, arsenic, cyanide,
etc.). They initiate substance-specific research to fill
data gaps. In a manner easily understood by anyone, the
tox profiles summarize information to explain how the
material could affect individuals/communities. While
the agency also can do hazardous substance research to
fill data gaps, they do not conduct lab analyses; instead,
they work with partners such as CDC, academic institutions,
etc.
Health education/health promotion activities are conducted
with medical and other health care professionals, to help
them diagnose and treat patients with symptoms related
to exposures. Case studies, published in environmental
medicine journals to train in the diagnosis, treatment,
and tracking of progress after exposure, also provided
Continuing Medical Education (CME) credits. To date, the
agency has addressed only 33 substances in this medical
education activity.
Community health education is done after it has been determined
what a community needs and/or wants to know. A responsive,
program is developed to convey that, which can also involve
experts external to ATSDR. Health promotion activity blends
health education; risk communication; environmental, medical,
and promotional activities, to give the community information
and access or referral to other services to promote health
and prevent disease.
Among their partners are the Association of Occupational
and Environmental Clinics (AOEC), which have technical
laboratory abilities. The AOEC is setting up pediatric
environmental health specialty units to provide pediatricians
knowledgeable in environmental health in every EPA region.
ATSDR is also working with NACCHO to build/ensure the capacity
of local health agencies to continue work on these issues
after the federal agencies leave.
Discussion. In
response to Subcommittee questions, Mr. Williams explained
the following points:
- What interactions among chemicals is ATSDR exploring?
Work is beginning on mixtures of contaminants and within
different media, using a pharmacokinetic model to predict
what effects may occur in people. While the listed chemicals
are only 275 of the thousands used, they are those most
prominent at sites, and the list is routinely reviewed
to see if others should be added.
- Why was Oak Ridge not assessed, as is required of every
Superfund site? Since the Oak Ridge Health Assessment
Steering Panel (ORHASP) study and the state's dose reconstruction
work was underway, ATSDR delayed beginning the public
health assessment to avoid potential duplication of work.
Congress agreed to this plan, as long as ATSDR addressed
the most important NPL work within a year.
- How is an area chosen for an environmental health clinic;
and areas being considered now; and is this an ongoing
process? The AOEC is a private organization of health
clinics located predominantly at university settings
throughout the U.S. ATSDR's cooperative agreement with
the AOEC enables them to refer people to those clinics.
They are also implementing the pediatric environmental
health specialty units in each EPA regions. And, while
ATSDR does not set up clinics, the Health Resources and
Services Administration (HRSA) Does. They could be invited
to explain that process.
- Can ATSDR apply information on classified materials
and their production? ATSDR staff with clearances can
review such records, but that information has to be declassified
before it can be used. And, since ATSDR is not a regulatory
agency, it cannot require companies to record and report
malfunctions leading to releases, in order to relate
that to environmental aspects such as wind, temperature,
etc. and evaluate potential community exposures. But
that is the type of information they seek and use, and
they can strongly0 recommend in support other agencies'
appropriate address of such issues (e.g., EPA). If ATSDR's
Division of Toxicology can identify the chemicals used
in a plant, they can work to model/duplicate those processes
to explore synergistic effects.
- It was noted that the Resource Conservation and Recovery
Act of 1984 (RCRA) requires active facilities to address
releases. This could be discussed in the Subcommittee.
- Complex mixtures have been of interest for some time,
but are hard to study. What combinations Does ATSDR study
and in what ratios? The outcomes change with each variation.
Experts could be invited to discuss with the Subcommittee
what is doable.
- Mr. Washington recalled reports by many old site chemists
that 2-3 boxcars of mercury were released, but Scarboro
residents were never warned of air releases or about
using produce from their vegetable gardens. He had heard
that the Savannah River study had indicated that metal
mercury can be released under the right conditions, and
that the synergistic effects could be more damaging than
thought.
- Could any exposures (e.g., to multiple materials) have
put the community in more danger than workers and vice
versa? Since workers might have had more shielding from
protective equipment, it is possible that the community
could have greater effects. That will be examined. Mr.
Akin stated that regulatory levels for the public are
higher to provide greater protection, since workers are
presumed to be healthy adults.
- Can ATSDR look at cumulative impacts from low background
(e.g., TVA's present 2 tall stacks used to be 8 small
ones and their emissions are fairly well known. Since
their primary purpose was to supply power to ORNL, those
cumulative impacts should be considered. ATSDR's predominant
work will focus Oak Ridge releases' potential affect
on the communities, but other such materials that could
have impacted the public health will be addressed as
possible in the toxicological discussion, as well as
those to workers. Mr. Akin explained an epidemiological
study's use of control and test communities to compare
health outcomes, which could manifest effects from the
synergism resulting from different exposure sources.
A pure research study would have to factor in each contaminant
specifically, a very different task.
- The relationship of the pediatric clinics to the U.S.
clinics of the National Institute of Environmental and
Health Sciences (NIEHS), which study health impacts,
was inquired by Ms. Kaplan. Mr. Williams was unaware
of NIEHS clinics, but was interested to know more about
that.
- Are the elements of the public health assessment conducted
simultaneously (yes), and how were the 275 chemicals
selected? They were selected by EPA and ATSDR, according
to the frequency with which they were found at sites,
whether their exposure pathway was complete, etc. The
two agencies created an algorithm considering a number
of factors to prioritize and decide which to profile.
- If not on the list/profiled, how is this material addressed?
ATSDR and EPA would do a limited toxicological profile
on a chemical in a smaller, focused document.
Public Comment
Mr. Robert Peale is an Oak Ridge resident and was a member
of the former committee, the Oak Ridge Health Agreement
Steering Panel. They oversaw a DoE-financed study started
prior to the HEW study that was grandfathered to be conducted
by the state of Tennessee. They produced 7 reports through
three contractors (ChemRisk, SENES/Oak Ridge, and Tchonka?
Research/Atlanta) which detailed histories of contaminants,
pathways, and likely risk. They tried to do the highest
priority work. Comments received expressed a wish that
other work was included, such as on-site exposures. He
hoped that this Subcommittee and others will make the best
use of this work, at least its summary, which might help
indicate where something might be found. He expressed his
and other ORHASP members' willingness to help the Subcommittee.
Mr. Ephraim Farmer was 38-year K-25 worker, now retired
for 10 years. He worked with many different chemicals without
knowing what they were or what they would do. Many were
still not even labeled when he left. He asked how to find
out what and how much he might have been exposed to, and
whether the mercury project was completed. He also noted
that two decades of radiation monitoring never found anything.
But the radiation counters of the researchers from Pittsburgh
alarmed constantly and people kept being moved out of areas,
including in a lunchroom used to cook/serve food for 20
years. He has been diagnosed with asbestosis and berylliosis,
and wondered about other conditions as well. Dr. Davidson
invited him to return to the next meeting, when Mr. Larry
Elliott of NIOSH would address occupational exposure issues.
She was also confident that the Subcommittee would be addressing
mercury exposures as they help ATSDR develop their health
assessment. Ms. Kaplan told him of a report from a DOE
Headquarters Oversight Office to DOE/EH, which discusses
worker areas and exposures; and the ORHASP report, although
fairly controversial, included a tremendous amount of research.
She is preparing a white paper on off-site releases and
risk, and is summarizing the EH report.
Mr. Larry Gibson, a 35-year employee at ORNL, 10 of those
in the coal program, testing compounds, chemicals, etc.
He hoped this committee would help facilitate closure of
the debate about health effects in Scarboro. Testing has
been done of the soil, the children, etc. but no subsequent
closure resulted. It is greatly needed to reduce the community's
anxiety, and any further tests must be very careful on
how they are conducted and reported to avoid further damage
to the reputation of the Scarboro community. He would prefer
reference to the "greater Oak Ridge area," stressing, for
example, that Poplar Creek Does not run through the Scarboro
community; it runs by Scarboro Road. He lamented that no
tangible good had resulted from the millions spent; in
fact, he felt that more harm had been done. He asked the
Subcommittee to try to ensure that future studies do as
little harm as possible. Dr. Davidson expected that this
Subcommittee would remain sensitive to the concerns of
the entire Oak Ridge area and make every effort to be fair.
She reiterated that the opportunity to give input to the
front end of the ATSDR public health assessment can influence
what it addresses and concludes.
Mr. Lewis commented that meaningful communication needs
to be facilitated between community leaders, residents,
and the Subcommittee to avoid domination by an interested
few. Dr. Frome and Mr. Hill noted that these public comments
were from people who are both residents and workers. The
workers of decades past probably were less protected from
exposures and were more highly exposed, so exploring effects
with workers exposed to high levels of contaminants seemed
logical.
Dr. Brooks observed the amount of distress in this area
about the data, the reports issued, and the issuing organizations.
Closure involves more than an understandable, well-done
report, but also the community's faith that they have received
factual information worthy of confidence. It takes constant
work with the community to explain what these complex problems
mean to them as individuals. The casual issuances of reports
has been done for over 20 years now, with unsatisfactory
results.
Ms. Kaplan commented the importance of the point that,
although flawed, worker protection and compensation at
least exists, but nothing similar for Oak Ridge residents.
Among the questions to be dealt with is how to address
the residents not being attended to? Scope of the Subcommittee
After lunch, Mr. Jerry Pereira stated his expectation
that the agency's work will be greatly assisted by the
institutional memory, technical knowledge, and commitment
of the Subcommittee. He presented for Ms. Bush the aspects
of communications to the Oak Ridge National Laboratory
and the Subcommittee.
He emphasized the importance that everyone be aware that
the science is insufficient to provide all the answers;
this is critical to credibility. The ORRHES will be successful
if after reviewing whatever documents are produced through
this process, they can have confidence in the findings.
He advised conducting regular reality checks along the
way to ensure that communication remains clear to produce
a credible, coherent result that all can understand.
To provide a forum for that, the Oak Ridge Reservation
Public Health Work Group was formed in 1998, with representation
from 7 federal and 2 state/local agencies. A series of
meetings were held with community members and stakeholders
in April, June, and September 1999. The process of developing
a plan is critical to ensure that communication is maintained.
The ORRHES was officially established on December 28, 1999,
as the fifth Subcommittee of the Citizens Advisory Committee
on Public Health Service Activities and Research at Department
of Energy (DoE) sites. Its members were selected from the
pool of nominees by ATSDR and CDC in a multi-tiered process
based on the selection criteria developed with input from
the three Public Health Work Group meetings: 1) the members
must be balanced in terms of points of view and function
to be performed, provide equitable geographic, ethnic and
gender representation as required by law, and be nominated
from the community.
The purpose of the ORRHES is to provide advice and recommendations
concerning public health activities and research conducted
by ATSDR and CDC at the Oak Ridge Reservation site. It
provides advice on the selection, design, scope, prioritization,
and adequacy of ATSDR's public health activities for the
Oak Ridge Reservation. It will provide critical input to
the public health assessment process, community needs assessment
process, and any recommendation for follow-up public health
activities. However, recommending on activities of any
other federal, state, or local agency are not within its
charter.
ATSDR is committed to take a proactive approach in establishing
and maintaining good communication among all parties: the
ORRHES; community members; federal, state, and local agencies;
and other identified stakeholders. Mr. Pereira added that
the community should not need to be present to remain updated
on the work being done, but should be able to remain informed.
Whether by Internet, media, outreach to the community,
or other venue, ATSDR will support that process.
Discussion. The
ensuing discussion with Mr. Pereira included the following
points:
What is the relationship of the ORRHES to the other agencies
that were on the Public Health Work Group? ATSDR will invite
any other agency to address any issue becoming an agenda
item that requires another agency's input.
Is there a listing of the recommendations made over time
by the other Subcommittees, and the response to them? CDC
and ATSDR will arrange that.
Will you forward recommendations pertaining to another
agency? (Yes) NIOSH should have a liaison member. That
will be raised with Mr. Elliott at the next meeting.
There seem to be different points of view on the Subcommittee
and in the community; has anyone surveyed the ORNL community
asking if people are concerned about their health? Not
scientifically, but the needs assessment will explore this.
Most communities have people knowing of many ill people;
those disturbed that their property values might be affected;
and those undecided without further information on which
side they belong. For all of them, trust is earned incrementally.
Losing it even once will send you back to square one, and
take twice as long to regain it, if you even can. For that
reason, ATSDR staff is urged never to deviate from communication
based on a solid strategy and consistency in delivering
what is promised.
Ms. Kaplan noted great distrust of DoE and its contractors'
data. If a committee such as the ORHASP discovers discrepancies,
some community members will see a conspiracy, but others
will see this as part of the scientific process. It is
a challenge to deal with that.
Mr. Brooks suggested review of a 1994 survey of the 8-county
area, the report of which cited about 3400 concerns. He
also expected that some will say the wrong people were
appointed to the ORRHES. The appointment process must be
conveyed to reach the people hearing those opinions.
With Oak Ridge's history and the magnitude of composition
of this committee, a) once it's bonded, do you think this
will serve to support trust; and b) how can consensus be
reached? Although no one expects universal agreement, everyone
should leave satisfied that their opinion has been voiced
and heard. Continuing engagement and communication with
the agency staff until that satisfaction is reached was
urged. And, reasonable people can disagree. An evenly-divided
committee indicates insufficient information, but ATSDR
will not ignore advice given in a minority report if a
division persists. But hammering the issues out to minimize
disagreement, and discuss why the difference of opinion
exists, is greatly preferred.
Several of the members addressed the trust issue, noting
a lack of trust over the "knowns" and the "unknowns." Scientists
often seem arrogant in how they interpret the latter when
reported by the community, perhaps perceiving it as "unscientific." Emotions
as well as numbers have to be dealt with. People are afraid.
Many of the scientists have taken a lot of abuse, and the
Subcommittee members may have to as well. The degree of
trust depends on the area being addressed; the information
needs of the community have to be addressed in a targeted
fashion. Expectations should not be raised; the lack of
knowledge base in some areas of science must be acknowledged.
Presentation of the Public
Health Assessment Process
Mr. Jack Hanley, an environmental scientist in the Division
of Health Assessment and Consultation, discussed the public
health assessment process. As background, he related the
ORNL's addition to the NPL in 1989. In 1990, ATSDR and
DoE signed a Memorandum of Understanding (MOU) making ATSDR
responsible to conduct public health activities and follow-up
at NPL sites. ATSDR planned to use the dose reconstruction
and other studies underway in their public health assessment.
In 1992, they began their public health activities with
a focus on current exposures, specifically in East Fork
Poplar Creek and Watt's Bar Reservoir. That work was completed
in January 2000, and will be presented in detail at subsequent
meetings. ATSDR is now ready to begin the public health
assessment with this Subcommittee's help.
Public health assessment is defined as "an evaluation
of data and information on the release of hazardous substances
into the environment in order to assess any current or
future impact on public health, develop health advisories
or other recommendations, and identify studies or action
needed to evaluate and mitigate or prevent human health
effects." Basically, it is an analysis and statement of
the public health implications posed by the release of
hazardous substances into the environment. Its purpose
is to assesses the public health impact on off-site populations
from releases of hazardous substances, and determine the
need for public health actions or studies. It can trigger
several possible recommendations (e.g., medical monitoring).
One future challenge could be to explain why some activity
that the public might desire is not done.
The Oak Ridge Reservation is a very complex site with
numerous public health issues and environmental concerns
addressed by various agencies over the years in separate
approaches. In the end, the public health assessment will
identify and characterize exposures of off-site populations.
It will identify people exposed at levels of health concern,
identify increased rates of health outcomes, address community
health concerns, and recommend follow-up public health
actions or studies.
In the Oak Ridge public health assessment, ATSDR will
analyze and evaluate the information, data, and findings
from previous studies and investigations on the radiological
and chemical contaminants released from the Oak Ridge Reservation.
They will be reviewed one by one with the Subcommittee
for their strengths and weaknesses, and to determine what
can be used in the public health assessment.
The primary sources of information for the public health
assessment will be environmental and health data and the
expressed community concerns. Environmental data is used
to identify and characterize exposure to releases of hazardous
substances in off-site populations. A pathway analysis
is used to determine if people have been exposed to material
causing health effects. This evaluation helps narrow down
the contaminants of concern and enable a focus on the most
important exposures.
Past exposures will be explored by reviewing the dose
reconstruction and the CDC mercury studies' data. The health
data (e.g., cancer and birth defects registries) will be
used as possible to identify excess health outcomes associated
with contaminants of concern. The limitations of using
this type of information will be discussed, but there is
some potentially available (the Tennessee Cancer Registry
and clinical data from CDC's Scarboro investigation).
Expressed community concerns help to help prioritize public
health issues and focus work to address specific health
concerns. These are collected in public meetings, availability
sessions, in the conduct of a community needs assessment,
in previous surveys conducted, etc. The Subcommittee will
be another primary route to collect the community's concerns
and to communicate back to them.
Assessing and characterizing the exposures will be tough
choices. Assistance from the Subcommittee will be needed
to make the right decisions down the line. Mr. Hanley compared
the public health assessment process to assembling a puzzle
until the picture is clear. Remaining gaps are likely,
but ATSDR will work with the Subcommittee, other agencies
and organizations, to try to resolve those.
Discussion: The
subsequent discussion with Mr. Hanley included the following
points:
- The cancer registry only specifies a number of cancers
per county; how can that health data be associated to
contaminant outcomes? This is part of the limitations
that will be explained. But sub-county data levels such
as census tracts can be accessed, but registries are
still problematic small areas need to be addressed.
- Can you give examples of follow-up actions? ATSDR finished
a consultation on the Watt's Bar Reservoir contaminants
in the late 1990s, indicating only PCBs in fish as of
concern. This was also concluded by two other DoE assessments
with oversight from EPA and the TDEC. A subsequent consultation
determined a high risk (1:1000) of cancer to those eating
a lot of those fish. About 116 persons at moderate- to
high risk were found, and their blood serums were compared
to CDC's national range levels. (Ms. Sonnenburg commented
that with only 1-2 people finally affected, the Watts
Bar residents want those advisories changed now; but
that is a state decision. ATSDR suggested methods to
minimize exposure from fish and turtles to minimize the
risk.) In another example for education, a national expert
from Chicago was brought to Spring City to address about
40 people about the risks. Physician education was done
on the ORNL cyanide issues, and medical monitoring work
has been done at other sites. The exposure is key, guiding
the focus on what needs to be looked for, and how to
mitigate any further exposures and potential outcomes.
- Oak Ridge-specific surveys have been done by the Tennessee
Health Department (telephone surveys), and focus groups,
and random and two door-to-door surveys were also done
in Scarboro. An ORHASP region-wide telephone study done
by the University of Tennessee staff, perhaps one of
the encompassing survey of all of Oak Ridge and surrounding
areas previously questioned, was to be addressed on the
following day.
- What is the relationship of the ORRHES and the development
of the public health assessment? Are we a peer review
group, or consultants, or to sanction the final report?
Will the public health assessment be done before this
committee is done? Mr. Hanley expected to go through
this evolving process step by step with the full involvement
of the Subcommittee (e.g., to review the studies that
have been done and advise whether they may have missed
a pathway unique to this community). The health assessment
should be completed in this committee's tenure, because
it will help to implement the resulting recommendations.
- If ATSDR offers no medical treatment, what do we tell
those members of the community who don't want any more
surveys/research, but practical help? Ideally, this process
will identify who might have been exposed and potential
ensuing health problems, which will help to direct people
to their physicians based on their exposures, help to
educate physicians about the patient's higher risk, suggested
screening and treatment, etc. The outcome might be so
specialized as to enable referral to the specialty clinics.
When asked if that would allow referral for screening,
as done by the PACE and Building Trades programs, Mr.
Hanley was unsure. He hoped to have an answer by the
next meeting. One certainty was that the exposure must
have occurred to focus on particular screens. And, while
ATSDR Does not do medical care, they can offer referrals,
screening, education, discussion of insurance options,
referral to proper local agency, etc.
- What is expected to be found from the survey? Small
numbers of cancers? Further discussion of model, data,
limitations of the science involved, etc., is needed
before jumping to such a question. For example, the registry
only begins in 1990 and Does not go back to previous
years. Once the pathway analysis identifies a risk, and
a cohort potentially affected, one of the Subcommittee
recommendations could be to locate that cohort for follow-up.
- Some in this frustrated community, with a history of
being sampled and studied, are unlikely to cooperate
fully. How can that be addressed? ATSDR hopes not to
re-interview unless that is unavoidable, but rather to
use the information already there; to carefully explain
what is being done, assembling the pieces to provide
clarity and focus on the issues needing to be addressed.
ATSDR also will rely on the Subcommittee, if it agrees
a study is needed, to communicate with the community
and convey what ATSDR needs to do to be successful in
doing that.
- Dr. Frome asked directly if the viewpoint of not wanting
just more studies, but also care, was represented on
this Subcommittee? Mr. Hill and Ms. Kaplan said yes.
He stated that uninsured people probably won't care if
their illness is related to ORNL or not, except that
a link might allow for some emotional or financial relief.
Mr. Hanley responded that one individual who did not
accept membership on this committee probably was in that
category.
- Mr. Akin raised the proof of causation for discussion.
An association might be provable, but probably not causation.
What can this Subcommittee conclude without one or both
of those? Most cancers are not associated with any known
genetic or environmental exposure, and for example, a
PCB's 1:1000 link to cancer cannot be shown epidemiologically.
The Subcommittee will have to deal with such issues.
- Ms. Kaplan noted the science-based public accountability
reflected in the new compensation bill before Congress.
But the only relevant data available are on radiation;
what is being done to develop similar information on
chemicals? If the bottom line is a minimum level of health
care, people should be able to access a clinic, state
their exposures, and get care.
- Frustration at the delineation of work in surveys that
only tell part of the story at a time was expressed.
A comprehensive survey whose data could be shared was
preferred.
- The scope of this committee must be made very clear.
Great care must be exercised to avoid raising expectations,
while at the same time doing everything possible to refer
people with needs that the ORRHES cannot meet to appropriate
sources. The degree to which this Subcommittee can clarify
the causes of risk and perhaps health outcomes also will
help the community, or it will be seen as just another
committee that said it would help and didn't.
Public
Comment. Mr. Peele appreciated the interesting
and important points of the discussions. He expressed
his hope the Subcommittee would neither exaggerate nor
disregard risk in its work, but rather "just play it
straight."
Closing
Discussion. Each member provided an assessment
of the day's meeting:
Mr. Kuhaida and Mr. Lewis came with interest and a willingness
to listen. The meeting's organization was helpful in conveying
what the committee members need to know. The afternoon's
touching on the issues was not only interesting, but indicates
that the members can differ and still move ahead.
Dr. Lands, a clinician, felt the need to learn the "language" clearly
well known by the experts on the Subcommittee.
Dr. Malmquist
expressed the hope that the Subcommittee could help the
area to address its problems, but had no illusion that
they could heal all of society's ills.
Mr. Manley appreciated the information provided. He was
unsure that all the ideas raised could be brought together,
but hoped they could. With such a diverse group, he expected
that to be difficult.
Ms. McNally hoped to learn enough to be helpful, and to
impact the future of this wonderful community.
Ms. Kaplan was just thrilled to have gotten to this point,
after 5 years of work, and was gratified to be moving forward.
Mr. Pardue compared this meeting to that of another FACA
on which he serves, which was contentious in both subject
and group. He appreciated and was very encouraged by this
group's civility and honesty.
Ms. Sonnenburg was impressed with knowledge of the Subcommittee
members. She thought that much could be accomplished, and
was interested to see how often they would meet, the kind
of work groups set up and their activity. She expressed
concern that meeting only 3-4 times a year would prevent
accomplishing much.
Mr. Washington was encouraged that everyone seemed to
believe that science works and provides some truth to what
is being done. If disagreement arose, he expected it on
be on the depth of the science, not the methods to get
there. Ultimately, the community and the Subcommittee just
want to know if contaminants were emitted with potential
to cause illness to the public or damage to the environment.
Overall, many believe that possible, and he hoped to get
to the root of many sick workers' health problems. He was
also impressed at the expressed concern about synergistic
effects, which have differing impacts between people. He
believed that the committee could get to the bottom of
what Oak Ridge has faced for over 50 years, and expected
the effects to be shown as ranging over 100 miles from
the site. The final question will be, what can be done
about all this?
Mr .Johnson also appreciated the discussions and was glad
they touched on community capacity building.
Mr. Hill hoped to learn, and felt he was doing so already.
Mr. Nwangwa appreciated the Subcommittee's work.
Dr. Frome related the overriding factor for him that trust
is important within the group and with the community. He
agreed that first step from a scientific point of view
would be to determine if hazardous substances affected
community health.
Dr. Eklund was ready to be educated, and hoped this process
would result in clarification for the community. He also
was glad at the absence of contention, anger and righteousness;
but rather the offering of information.
Mr. Creasia appreciated the ATSDR presentations in to
provide him direction on what he was supposed to do.
Ms. Vowell stated that this was a learning process for
her as well. She was amazed at the knowledge represented
on the committee and appreciated hearing it. From a public
health standpoint, she expected challenges to getting the
answers desired.
Mr. Akin welcomed the good groundwork laid for this process,
including the Subcommittee's operational guidelines. He
related EPA's experience, in conducting community relations,
to never underestimate the speed with which lay people
become knowledgeable in addressing technical issues; and
appreciated this day's experience as another example of
where diversity works.
Dr. Brooks said that he is normally unimpressed with first
meetings, but he was impressed with this committee's member
selection and its chairing. His only disappointment was
that ill workers are not represented, but it appeared to
him that the members had enough understanding of and compassion
for the ill worker problem. He hoped that their needs as
well as others could be met. While this will be a big effort,
he had heard it said that this is the last hope for Oak
Ridge to reach a reasonable understanding of its problems.
If this Subcommittee cannot do it, he did not expect the
community to achieve a resolution.
Mr. Pereira reported his good impression of the reception
to much of what he had said, some of which was deliberately
controversial to gauge the members' response. He felt that
the committee was off to a good start.
Mr. Robinson commended this committee for an exceptional
day's work, and the staff for facilitating that. He appreciated
Mr .Manley's expression of doubt but hope. As a Designated
Federal Official for the Idaho Subcommittee, he expected
that the members would have to struggle to learn how to
work with one another, but nothing is worth having without
a struggle.
Dr. Davidson appreciated the members' different experiences,
and expressed her confidence that they could work together.
She accepted that arguments may happen, as long as they
occur in an atmosphere of dialogue and respect for each
other.
With no further comment, the meeting adjourned at 4:17
p.m., followed by a social meeting at the Oak Ridge Museum.
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