ORRHES Meeting Minutes
December 3, 2002

The Agency for Toxic Substances and Disease Registry (ATSDR) and the Centers for Disease Control and Prevention (CDC) convened the second meeting of the Oak Ridge Reservation Health Effects Subcommittee (ORRHES) on January 18-19, 2001. 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.
Robert Craig, 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.
L.C. Manley
Donna Mims Mosby
William Pardue
Barbara Sonnenburg
Charles A. Washington

Member Therese McNally was absent.

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, Henry Falk, Michael Grayson, Jack Hanley, Sandy Isaacs, Karl Markiewicz, Bill Murray, Vincent Nathan, Therese NeSmith, Marilyn Palmer, Jerry Pereira (ORRHES Acting Executive Secretary and Acting Designated Federal Official [DFO] for Ms. Loretta Bush), Robert Williams.

CDC/National Center for Environmental Health (NCEH): Arthur Robinson, Henry Falk.

CDC/National Institute for Occupational Safety and Health (NIOSH): Larry Elliott

Department of Energy (DOE): Headquarters: Marsha Lawn, Paul Seligman.

Oak Ridge Reservation: Mary Margaret Brock, Bob Dempsey, Leah Dever, Brenda Holder, Timothy Joseph, Reba M. Rose.

Eastern Tennessee Health Office: Art Miller

Tennessee Department of Environmental Conservation: Robert Macklin, Renee Parker

Others present over the course of the meeting included:

Suzanne Baksash, epidemiologist
Fannie Ball, Oak Ridge
Glenn Bell, HE
Gordon Blaylock, SENES
Louise Boone, Oak Ridge
Romance Carrier, OR Health Liaison (HL)
Walter Coin, Oak Ridge
Donna Cragle, ORISE
Jan Connery, Eastern Research Group
LeRoy Desgranges, DOE worker
Susan Gawarecki, ORR LOC/CAP
Ann Henry, Methodist Medical Center
Katherine Kirkland, AOEC
Fay Martin, Oak Ridge
Marie Murray, Atlanta, GA (recorder)
Norman Mulvenon, LOC/CAP
Shayam Nair, Cadmus Group
Peter Osborne, Bechtel Jacobs
Rebecca Parkin, George Washington University
Jim Phelps, DOE Watch
Willow Reed, SENES
Melanie Russo, Eastern Research Group
J. A. Shaakir-Ali, NAACP
John Steward, PACE
Janice Stokes, SOCM/ORHL
John Stockwell
Debbie West, Nashville, TN (Court Reporter)
Torri Whitmore, Methodist Medical Center

Opening Comments

Chair Dr. Kowetha Davidson welcomed the attendees. She encouraged comment from members of the public during the public comment periods, or in discussion with the Subcommittee members during breaks or outside the formal meeting proceedings. She reported on:

• ATSDR's action items from the last meeting were all completed.

• The November meeting Minutes will be approved at the next meeting, and in future will be provided well enough in advance to allow comments to be returned before the following meeting. (The same was requested for the meeting agenda.)

• Communications to the Subcommittee since the last meeting included:

• Copies of the Oak Ridge Dose Reconstruction Study Summary Report.

• A letter from Mr. Pereira outlining the non-FACA character of work groups, allowing the Subcommittee to decide how they would function, and a calendar of potential future meeting dates. The members' comments on the latter and on their biographies were requested.

• A letter from Dr. Kathy Teeson, commenting on the dose reconstruction study, which was available to the members.
  

Dr. Frome requested that TDEC's DOE Oversight Division report of December 1999 be made available to the Subcommittee. Ms. Sonnenburg asked if more than five Subcommittee meetings could be held per year. Mr. Pereira confirmed that, but expected that budget considerations make 3-4 meetings per year more likely.

AOEC Presentation

Dr. Katherine Kirkland, Executive Director of the Association of Occupational and Environmental Clinics (AOEC), outlined their history and involvement with the Oak Ridge project. Established in 1987, the AOEC is a multidisciplinary network of more than 60 occupational and environmental health medicine clinics and about 250 individual members. Their mission is to advance the expansion and development of clinical occupational and environmental health practice, research (mostly prevention and diagnostic), and education. Their focus is on patient rights, using the public health model. The AOEC is funded mostly through two cooperative agreements with ATSDR and CDC's National Institute for Occupational Safety and Health (NIOSH), and by membership dues.

The criteria for clinic membership include agreement to: 1) abide by an international code of ethics guiding clinic operations; 2) have a physician on staff who is certified by the Board of Occupational Health (there are <3000 occupational physicians in the U.S. and Canada and <2000 practicing). Within the patient-focused care, prevention is regarded as key; and labor, community and business input is invited. Dr. Kirkland noted that part of the reason the AOEC was formed was to fill the gap left by the absence of any nationally recognized Board certification in the field of environmental health. Occupational physicians with patients affected by environmental factors generally must address a low, chronic dose, as opposed to the high, toxic doses seen in an emergency room.

The AOEC's activities encompass health promotion and education to improve the infrastructure to address health concerns; consultations,⁽¹⁾ which include clinical evaluations and collaborations with community members and medical practitioners; research. They developed nine Pediatric Environmental Health Specialty Units (PEHSU) in the U.S. and one in Canada to fill the knowledge gaps of pediatricians and AOEC physicians about each other's areas. They are developing educational materials and are available by telephone to health care providers and community members. Callers can dial a toll-free Region 5 office number, in cooperation with George Washington University (GWU - toll-free at 1-866-622-2431); be referred to an AOEC office at 202-347-4976; or e-mail the organization at <aoec@aoec.org>. Their Web page links to other resources, provides the clinic listings, and the AOEC educational resource library listing (including selected presentations). They also are working with NIOSH to develop a comprehensive occupational and environmental exposure database, to hold coded data summaries of occupational exposures nationwide.

Clinics are selected for projects following certain steps. Upon receiving a Request For Proposal (RFP) from ATSDR, the AOEC will work with an area clinic. If one is not available, an RFP is issued to all AOEC member clinics. The responses are reviewed by at least three health care professionals for their ability to match the needed expertise (e.g., in Oak Ridge, to reach out to the community as well as to conduct clinical work). The Oak Ridge work will be a multi-phased project, beginning with a needs assessment to determine community concerns, which will then be incorporated into ATSDR's health assessment. Thereafter, GWU will meet with ATSDR and the ORRHES to discuss the possible next steps.

Presentation of the ORR Health Education Initiative

Dr. Rebecca Parkin, a faculty member of the GWU School of Public Health and Health Services, presented the Oak Ridge Reservation Health Education Initiative (ORRHEI) on behalf of her two research colleagues, Dr. Tee Guidotti and Dr. Grace Parazino, who were unable to attend. Both have worked on similar projects previously.

She presented the qualifications of the research team in detail, and described the goal of the ORRHEI: to facilitate the health decision-making of residents living near the Oak Ridge Reservation. The project purposes are to:

1. Develop new knowledge/insights about the Oak Ridge communities' current health concerns and needs (e.g., by reviewing existing documents and through dialogues with community residents).

2. Provide an effective summary of findings for the timely implementation of a community health education plan.

3. Develop a sound foundation for the needs assessment

4. Conduct the Health Education Needs Assessment.

5. Report the results to the community and sponsors.

6. Make recommendations for a community health education action plan.

The project is based on the underlying principles that effective program planning requires sound information, which is collected by a needs assessment. An effective project involves a comprehensive and collaborative approach, complementary methods, and community input from beginning to end. She described the methods to be used (and the related information needed from the Subcommittee), with each step building on the previous work: 1) interviews (who should be interviewed?); 2) focus groups (who should be polled; should any be prioritized?; how to identify and contact residents?); 3) a telephone survey to investigate pertinent issues (who to survey; address any priority areas?; how to identify and contact residents?). The latter will be conducted to a representative sample of the entire "community", however that is defined.

The fundamental questions requiring the Subcommittee's input include: 1) what are the most important questions to ask the community; 2) who needs to be asked these questions; 3) determining the community's answers; and 4) judging how the answers can best be interpreted for educational planning.

The community information needed includes its: 1) perceptions (about health effects, environmental hazards); 2) knowledge (what is known/not known about the site and any related effects); and 3) interpretations of risk (from potential and actual exposures). The data sources come from existing records (vital statistics and reports/article), the interview with key community informants, health officials, and health care providers, from the focus group discussions with residents, and from the telephone survey of current residents. The resulting information to be analyzed will be based on and help to prioritize the health concerns and educational needs of groups of people (not individuals).

GWU has already begun this work. They have reviewed existing reports, published articles and print media coverage; and have begun summarizing those recorded past concerns. However, not much more can be done without discussion with this Subcommittee. Dr. Parkin asked how best to obtain community input on the: 1) project design (defining "community" e.g, by geographic boundaries?; "resident", groups of concern, methods); 2) questions to be asked (priority issues); and 3) final report or product desired (goal, contents, type of report).

1. How should "community" be defined? Geographic scope? Level of "community" groupings? The subcommittee's responses were:

• This depends on the pathway. The primary sources of transport are expected to be by water downstream from the Reservation through the Clinch River into the Watts Bar Reservoir. The airborne transport by easterly and westerly winds went in the opposite direction of the valleys; use the NOAA studies of wind movement between ridges and valleys. The Watts Bar dam halted the transport, but perhaps its sediment should be considered.

• In view of less use of personal protective equipment (PPE) in the past; 1) consider transport home to families, 2) geographic communities such as Scarboro, and 3) those at a distance that dispersion modeling indicates could have been affected, including through their vegetable gardens. A noted rise in allergies in individuals free of them before moving to the Oak Ridge area led to speculation about the role of steam plants' particulate emissions.

• Since at one time, <40% lived of Reservation workers lived in Oak Ridge (no longer true), guide the constructs from area employers information.

• Define the community as the 7-8 counties served by the Oversight Committee as a starting point, and include direct and indirect impact.

• Make use of the $14 million spent by the state, and use the map in the Oak Ridge dose reconstruction project (Figure 1-1 map) of locations of interest for the dose reconstruction and screening calculations. And, superimpose a geologic map to address, for example, rapid absorption of the porous limestone surface under K-12.

• Identify exposures in the community that may not be in workplace. Dr. Parkin noted that GWU will not do exposure assessments in Phase I, or seek retirees who may have moved elsewhere; they will only identify community concerns. Workers can be included in that, if recommended by the Subcommittee, but this was not the focus of the initial proposal submitted. Guidance will be needed on how much time/work GWU should devote to this aspect. Related issues are of staff available, not funding, and properly scoping the work to produce answers in specific period of time. Future phases could include further work.

• Be sure to note if the phone survey or focus groups show no community concern.

Dr. Brooks moved that the geographic scope for health effects studies include the Oversight Committee's represented 7-8 county area: Anderson, Knox, Roane, Loudon, Meigs,Rhea, and Morgan; and the city of Oak Ridge. Mr. Craig seconded the motion. This spurred discussion of whether or not to include Blount county, as was done by the dose reconstruction project. Dr. Brooks noted Blount's absence of downstream waterways and felt that it was too far for potential airborne exposures. Dr. Sham Nayad, who had participated in the dose reconstruction, reported that they had considered airborne dispersion to a 50 km area, which included Blount county, and the Watts Bar River area. Dr. Davidson called for a vote, in which a majority carried the motion to include the seven counties.

2. How should "community" be defined; how finely should the 7-county area be defined? The answer would alter the selection participants in the focus groups and the phone survey (i.e., to pursue targeted pictures of selected areas, or a random sample). The Subcommittee responded:

• Use the dose reconstruction data in the first cut, surveying the counties randomly; then focus on specific areas. Dr. Parkin responded that the eight focus groups are planned to address specific topics, with one being a general population group (needed to determine community knowledge) and the other seven areas being discretionary. The focus groups' data will be used to develop the phone survey questions.

• Oak Ridge, Anderson and Roane counties have groups already meeting; follow up with their Chairs, and consult with the counties' Health Councils, which have already done diagnostic work.

• The Scarboro community has already been addressed by multiple studies, producing much data already on those concerns.

• Special consideration in forming focus groups should be given to seniors, and perhaps an intergenerational group. For seniors, telephone interviews may be required.

Mr. Pereira thought it may be important to use the same logistical treatment in a standard approach in each county, since the community's expectations will rise with all of this work, posing implications to the project's credibility. He suggested that the Communications/Outreach Work Group address this; or, Dr. Davidson suggested, a separate group could address only this. However, Dr. Brooks disagreed. He noted that the geographic area chosen includes several communities of interest, 15-20 miles adjacent to the Reservation, which have expressed concerns about airborne, waterborne, and close-in soil contamination. Since little interest has been expressed historically by the more distant counties, this suggests the address of certain groups, rather than allocating equal time to all the counties. Dr. Parkin clarified that the focus group individuals will reflect targeted areas of concern, as long as geographic parity can be maintained in all the groups.

Dr. Parkin answered several questions from the Subcommittee:

• What is the work time line? The time line for the completion of the needs assessment, originally May, can be flexible, depending on the design. The GWU Institutional Review Board (IRB) must approve the instruments to be used and normally requires 2-3 weeks to do so for each piece of the work. Therefore, the time line can be extended 1-2 months, but not for example, 6-12 months.

• What is the focus groups' purpose? They are intended to gather the information that, for logistical reasons, GWU cannot collect in a door-to-door survey. That data will help to define key questions with which to survey the overall population; and the latter can inform the design of educational programs to help community members make effective health decisions. The focus group moderators listen for themes (e.g., the issues that worry these particular types of people) as opposed to specific concerns (e.g., heart disease or cancer).

• How will you collect information already gathered in past? GWU hopes to find them in the project's discovery phase, which also will solicit such information from community leaders. Dr. Parkin welcomed all suggestions, and provide a tabled list of the documents being reviewed (Attachment #1), which is continuously updated.

• How will you select focus group participants? Various methods; for example, if teachers are desired, their meetings will be attended to invite their participation.

• Does the recommendation on the seven focus groups go straight to GWU, or through the Subcommittee? ATSDR will forward that information to GWU, after the Work Group channels it through the Subcommittee to the agency; but that need not be delayed to March.

Mr. Hill moved that the Communications/Outreach Work Group explore what issues the focus groups should address, and return with a recommendation to the full committee. Ms. Sonnenburg seconded the motion, asking for the Work Group's recommendation prior to the March meeting. Ms. Kaplan, the Work Group Chair, urged all the members to participate in this work. Upon a vote, the motion passed, with 15 in favor and 3 opposed. Ms. Kaplan called for a clear mission statement for the Work Group, and noted that questions had already arisen about sick workers as well as community residents. Dr. Brooks noted that the Communications/Outreach Work Group's task would also indicate the scope of the survey. Mr. Pereira stated that if more than eight focus groups are needed, they will be formed. The importance of this initial step calls for inclusiveness to ensure the end result is not flawed. Dr. Kirkland noted that the AOEC focuses on both environmental and occupational health effects, so workers could be the subject of one focus group. The AOEC will report their final findings to the community, not ATSDR. While the Subcommittee's mandate does not involve addressing worker issues, recommendations on those could go to NIOSH or DOE.

Public Comment

Dr. John Stockwell recommended the1999 Oak Ridge Dose Reconstruction Study Report as reading material to the members. He specifically pointed out the isopleths ("risk contours") provided in Volume 7 (page 24), which indicated areas that the contractor (Chem Risk) thought to be at risk for I-131-caused cancer. That area included Blount County, which had three times the risk of Morgan county.

Mr. Jim Phelps related that he was part of the staff that "covered up" incidents at Oak Ridge. He stated that the concentration of depleted uranium (DU) in bones and the lymphatic system has affected Gulf War veterans, knowledge held but not released by Oak Ridge scientists. Rather, they suggested using urine tests to detect DU, which is an inadequate diagnostic method. DU and fluorides act similarly to the capacity of beryllium oxide in lungs and lymph nodes to shut down lung immune defenses, causing calcification and death. He equated fluoride to the toxicity of rat poison, and stated that hydrogen fluoride leaks are known to have occurred. The oil well and power systems blown up by Allied forces in the Gulf War also contained the same materials as used at Oak Ridge, and the exploded nerve gases also released fluorides. Finally, Mr. Phelps challenged the committee to uncover such important information and to report it accurately.

Dr. Faye Martin expressed her pleasure that the committee is in place, and hoped that something could be done to help the sick workers before they all die.

Ms. Janice Stokes considered iron-clad adherence to Robert Rules to be counter-productive, and recommended that the liaisons from the EPA, Health Department, and TDEC be identified and separately seated to allow the public to know who they are.

Work Group Reports

After the lunch break, the work groups reported on their activity.

Agenda Work Group.Aside from working on this meeting's agenda with ATSDR, Dr. Brooks outlined and distributed a draft Program of Work (Attachment #2) to facilitate development of future agendas. Comments by ATSDR, the Subcommittee and the researchers were invited. It is meant to be a living document to be refined over time with input, the progress of the public health assessment process, and other work.

Communications and Outreach Work Group. Ms. Kaplan reported the Work Group's meeting on January 9, and distributed its draft Purpose and Statement of Work. (Attachment #3).

The Subcommittee members' feedback included:

• Identifying new members is not a Work Group role, although groups with potentially interested individuals could be identified for ATSDR to contact. Mr. Pereira outlined the member solicitation process. The Communications/Outreach Work Group was invited to participate in publicizing member vacancies, or in suggesting the type of person who should be selected. ATSDR then conducts a rigorous selection process involving the multiple criteria discussed at the last meeting.

• Dr. Brooks moved to refer the draft back to the Work Group for rewording (e.g., to "attracting" or "advertising for," rather than "identifying" new members). The motion was seconded, and with 16 in favor and one opposed it passed.

• Ms. Sonnenburg moved to approve the balance of the report, was seconded by Mr. Pardue, and the motion passed unanimously.

Guidelines and Procedures Work Group. Mr. Pardue reported that the Guidelines and Procedures Work Group's draft Statement of Work (Attachment #4) was not approved by the whole Work Group due to the press of time. He first provided the draft, to no comments, and reviewed the development of the Subcommittee's guiding documents to date.

A draft of the "ORRHES Purpose, History, Structure, and Process," that was developed by the Eastern Research Group (ERG) and discussed/modified at the last meeting, was reviewed by the Guidelines and Procedures Work Group in November. They met again on December 12, reviewed the ORRHES members' comments on the ERG document, discussed alternate approaches, and asked ERG's Dr. Jan Connery to prepare revised documents. Those revisions were discussed on December 28, and minor adjustments were made. The Work Group members agreed that the process document and by laws should have equal standing and be considered together. Dr. Brooks revised the documents, which Dr. Connery finalized, and they were sent to the members on January 9, 2001. Their purpose is to: 1) provide structure and consistency, 2) promote a free and open exchange of information, 3) develop defensible and understandable output, 4) allow maximum public input, and 5) provide consistency with FACA.

Topics still requiring refinement and discussed were:

1. Equivalence of the Process document and the by-laws. Committee discussion included:

• Avoid confusion by prioritizing the guiding documents for the Subcommittee's operation (e.g., 1) FACA regulations; 2) by-laws; 3) procedures document to inform the by-laws' described process).

• Include the process document by reference, giving it equal weight.

• Recombine the two documents, structured to be clear that the two sections are independent (i.e., FACA requirements and by-laws). Refer back to the Work Group and redraft.

• Dr. Brooks moved to change the Procedures document's appendix to become Chapter 6. The motion was seconded by Mr. Johnson and all agreed.

2. Need for a Vice Chair. Mr. Hanley was still checking as to whether a Vice Chair could serve, and asked what that position's role would involve. The Work Group agreed to discuss this and advise ATSDR. Mr. Pardue suggested text such as "The Vice Chair acts and performs in the absence of the Chair and performs other duties as decided by the Chair." Mr. Robinson advised the Subcommittee that, two years earlier, CDC's Committee Management had determined that the Idaho Subcommittee could not have a Vice Chair, and that the DFO would so serve in the absence of the Chair.

Dr. Brooks moved to refer this back to the Work Group subject to the response of the ATSDR Legal Department. The motion was seconded and unanimously passed.

3. Life of the Work Groups. The life of a work group is up to the Chair and the Subcommittee, according to its task. It is not covered by FACA because it does not decide policy.

4. Designation of a Parliamentarian. Since the Chair is too busy running the meeting to interpret Roberts Rules, Dr. Brooks volunteered to serve as Parliamentarian. The Subcommittee discussion included:

• Concern was expressed that all the members be familiar with Roberts Rules, to ensure that no one is intimidated from fully discussing any topic. A rigid adherence to the Rules, as occurred earlier in the day, and their use to cut off communication was opposed.

• But is was also noted that Roberts Rules are very flexible. Votes can suspend the Rules or limit the debate; most address the use of motions to conduct work, not to enforce decorum.

• Mr. Johnson moved to refer the item back to the Work Group for further research based on this discussion, recommending on which Roberts Rules are likely to be applied and how. On Mr. Robinson's suggestion, the consensus process will also be considered. The motion was seconded by Mr. Kuhaida and unanimously passed.

5. Agenda inclusion of the public comment period and adjournment.  Dr. Brooks moved to include the public comment period and adjournment in the agenda. The motion unanimously passed, and this was referred back to the Work Group for inclusion.

6. Specification of agency liaison relationships to this committee. The question discussed at the last meeting of having a DOE liaison present to participate in the Subcommittee's discussions (as opposed to a resource person), was reviewed by the Work Group, which recommended having that liaison. The Subcommittee's opinions were divided:

• This may be perceived by the public as bending to DOE intimidation. Since it is in DOE's interest to always be present, they need not be added to the table.

• On the other hand, the Subcommittee could be seen as failing if it bends to that perceptual pressure and does not take advantage of that liaison relationship. Altering the guidelines' Figure 2 already had been proposed to show DOE's working relationship. CDC and ATSDR involvement has also been perceived as "tainting" the process; the committee should structure itself to optimize its work. DOE is a major player which should be actively involved. They could provide the Subcommittee with information about which it is unaware (and therefore cannot ask for it). Having them at the table also can ensure that everything is above-board.

• Ms. Mosby moved to accept Figure 2, altered to show all the non-voting liaison relationships with the Subcommittee, including that of DOE. Mr. Pardue seconded the motion. Eleven voted in favor and seven were opposed, which led to the following discussion.
  

Discussion of Subcommittee Voting Protocol

Ms. Sonnenburg noted that the by-laws suggest that a super majority (2/3 vote) be used. She felt that, since this last discussion addressed a very controversial issue, 2/3 should be required, but noted that the by-laws had not yet been approved. In view of that, Dr. Davidson felt that this vote should follow the simple majority required by Roberts Rules. Dr. Brooks moved to table the discussion to the next meeting and the Subcommittee's agreement on what constitutes an affirmative vote. The motion was seconded by Ms. Sonnenburg. With 14 in favor and two opposed, the original motion was tabled to the next meeting. Dr. Eklund requested a copy of Roberts Rules for each committee member. (Mr Hanley provided an abbreviated Robert Rules pamphlet issued by the League of Women's Voters to the committee members later in the meeting.) Mr. Akin asked that the Figure be clear that the liaisons are nonvoting members. Dr. Eklund moved to designate the liaison agencies and their nonvoting status on the table name plates. Mr. Washington seconded the motion, which passed with 14 in favor and one opposed.

Round Table Discussion With Agency Management Staff

A round table discussion was held with the Subcommittee by agency management representatives: Dr. Paul Seligman of DOE; Dr. Henry Falk and Dr. Robert Williams of

ATSDR; and Mr. Larry Elliott of NIOSH.

ATSDR Comments

Dr. Henry Falk, Assistant Surgeon General and ATSDR Assistant Administrator, is a pediatrician and environmental epidemiologist. He was the Director of CDC's National Center for Environmental Health, and has been for the last 18 months ATSDR's Assistant Administrator (the CDC Director is also ATSDR's Administrator).  Working at 500-1000 sites/year, ATSDR's work is complex and its service is occasionally hard to define. Their most important work is related to the sites of the National Priority List (NPL) and those of the Departments of Energy, Defense, and Interior; NASA, and others.

Dr. Falk appreciated the member's service, and looked forward to its help in pulling together the work at Oak Ridge and in evaluating the public health work and research done. He hoped the Subcommittee would also help facilitate the necessary cross-agency discussions, since ATSDR deals with communities near the sites rather than the workers (NIOSH addresses worker issues). He reported that Mr. Bill Murray, recently retired from a long history with the Public Health Service, had been hired by ATSDR to staff its Oak Ridge office, which is soon to open.

ATSDR's activities will include: 1) the needs assessment, to help clarify issues and focus agency work; and 2) the public health assessment, in which the Division of Health Assessments and Consultations evaluates all pathways in a global fashion to indicate the public health activities needed. ATSDR's wide range of activities address the very disparate characteristics of all the sites. Its multidisciplinary staff includes environmental scientists and engineers, epidemiologists, health educators, toxicologists, community program specialists (e.g., health education, physician education), etc.

NIOSH Comments

Mr. Larry Elliott, Chief of NIOSH's Health-Related Energy Research Branch (HERB), conveyed the greeting of NIOSH's Acting Director, Dr. Larry Fine. CDC's only Institute, NIOSH is also its occupational research agency. Their established research agenda of studies across the DOE complex includes work at Oak Ridge's three sites. The research agenda, with study summaries, has been published in a program book. It will be updated shortly and will be provided to the committee and public. NIOSH also has a service support mission at various DOE sites.

The NIOSH "worker days" held on sites have proven effective in maintaining communication and interaction with both organized and unorganized labor. While NIOSH's interaction with the Subcommittees differs from that of ATSDR and NCEH, since their responsibility is directly to the workers, the Subcommittee's comments on worker issues will be welcome. As required by FACA, NIOSH will respond to the committee's consensus advice, which they look forward to receiving. And, while NIOSH does not do medical screening of workers (DOE does that), a NIOSH screening specialist coordinates with DOE's work as able. Finally, Mr. Elliott noted that the Energy Employees Occupational Illness Comprehensive Program Act of 2000, to be described further subsequently, was passed to compensate DOE workforces. Its provisions include a NIOSH role in addressing future compensation claims.

DOE, Oak Ridge Operations Comments

Ms. Leah Dever, Manager of DOE's Oak Ridge Operations Office, welcomed the members and also appreciated their time and effort in this work. Having worked with previous FACA groups, she could testify to ATSDR's serious reception of the public's input, and the tailoring of work to public issues. She hoped that all the communities' concerns can be evaluated and addressed, to move forward to the future.

In DOE's missions, Oak Ridge is a microcosm of DOE work. It conducts defense work at Y-12, refurbishing weapons to replace in the stockpile; manufacturing; scientific work at the Oak Ridge National Laboratory (ORNL - e.g., source neutron work to be developed in next few years); environmental, nuclear physics, etc., laboratory work; and cleanup work (e.g., at K-25, now the East Tennessee Technology Park - ETTP). Since it must be ensured that the work is done safely, securely, and reliably, ATSDR's work is well aligned with DOE's.

Ms. Dever expressed the DOE's support this Subcommittee's work, whose diversity makes it DOE's "healthy eyes and ears" to the community as a whole. She asked Mr. Tim Joseph to be her designated representative to this committee.

She also acknowledged that past mistakes, mismanagement, lack of good information to the community, etc., had contributed to the decline of trust in DOE. For that reason, she welcomed the independent nature of this study process. It enables this committee to be open with each other and to further inform DOE of the communities' perspectives. She pledged that DOE will respond to the Subcommittee's communications. She requested the opportunity to work together with its members, and anticipated excellent results from this work.

DOE, Headquarters Comments

Dr. Paul Seligman, Deputy Assistant Secretary for Health Studies, Office of Environmental Safety and Health, explained that his office conducts/monitors all programs and studies pertaining to the weapons program. Among those are the studies of Japanese A-bomb survivors and health effects studies in the Marshall Islands and at Chernobyl. Domestically, under interagency Memoranda of Understanding (MOU), their largest program supports CDC and ATSDR studies of the impact of weapons production upon surrounding communities and site workers. They also support medical monitoring and surveillance programs such as: 1) a pilot program to identify former DOE workers with significant exposure and to screen them for occupational illnesses. At Oak Ridge, the first 5-year cycle is in completion, focusing on construction workers at the Gaseous Diffusion Plant (GDP) and K-25. DOE is considering extending this to all former DOE workers/sites. And 2) the beryllium monitoring program of exposed Rocky Flats and Y-12 workers was extended nationally two years ago to all DOE facilities that used beryllium. Other programs collect occupational surveillance data on current injuries/illness. His introduced his office's program manager, Ms. Marsha Lawn, who attended this meeting (telephone 301-903-3721; e-mail at <marsha.lawn@eh.doe.gov>).

Dr. Seligman expressed his great expectations of this committee to serve as a unified voice for the community, or at least to help develop some consensus of what should be done.

Dr. Seligman then outlined the Energy Employees Occupational Illness Comprehensive Program Act of 2000, distributing a summary of the bill (Attachment #5) and a copy of the President's related December 7^th Executive Order. The first major government entitlement program in decades, this is a billion-dollar-plus program to compensate exposed DOE workers. It was strongly supported by his Deputy Assistant Secretary, Dr. Michaels, who has met with Oak Ridge residents.

The Act addresses three diseases (beryllium disease, radiation-induced cancer, and silicosis), two groups of people (DOE workers and contractors), and establishes one operational process. It provides for 1) compensation of $100,000 for confirmed beryllium disease (and medical care payment if sensitization is determined); 2) $150,000 and medical monitoring for silicosis; and 3) the compensation process for radiation-attributed cancer, which is now being developed.

The covered groups include a special exposure cohort (GDP employees, K-25, Portsmouth, Paducah, and Amchitka) who worked for a year or more at sites with potential exposures, and who wore dosimeters or should have been badged. Another process will determine if other groups should be included. In the second group, equal compensation is provided for uranium miners and millers.

The DOE Office of Advocacy will work to counter DOE contractor disputes of claims related to diseases not covered by the Act. They also will assist former DOE employees to get state compensation benefits through a physician panel to determine if toxic DOE work-related exposures contributed to the disease in question. This direct DOE/state process should ensure smooth processing of those claims. The Department of Labor will ultimately run the Claims program. The DHHS is charged to develop guidelines and criteria to help identify radiation-related cancer and to explore whether other groups can be included. DOE will manage the assistance/advocacy program.

On January 11, 2001, the final set of amendments attached to the Bill was submitted to Congress by the administration. One significant addition provides an option for workers to choose a more a traditional compensation package (i.e., lost wages and medical benefits, training, and rehabilitation), rather than the lump sum payment. Whether Congress will pass this or not is unknown, but the October 2000 original legislation had bipartisan support, led by Senators Thomson (TN) and McConnell (KY).

Discussion. The Subcommittee thanked all these representatives for attending. The following discussion included:

• Without defined eligibility criteria, when will people be able to file claims? Seligman: The filing process is being set up. While the law is fairly specific on eligibility criteria, work on radiation-induced cancer and silica disease is underway, but people can call in now to be included on their database.

• What about workers' families who were exposed? Seligman: The current legislation has no provisions for spouses or dependents, although it does address survivor benefits.

• If this committee recommends activities ATSDR cannot do, what is the likelihood they will be acted upon? Falk: ATSDR hopes that the Subcommittee process can at least leverage and facilitate a dialogue with other appropriate agencies to ensure the communities' voices are heard, and the Subcommittee's combined voice carries more weight than that of individuals.

• What local examples are there of the reversal of the former DOE policy that encouraged its contractors to oppose such claims?  Seligman: A Field Operations Directive was issued on the previous day to formalize that reversal of DOE policy. And specifically, his staff has a workers' compensation expert (Ms. Kate Kipman) who works directly on the claims, and to date has procured compensation for 20-30 individuals who were already in the system. But every case is different. Ms. Sonnenburg asked for a copy of the new policy, and wished news like this would be headlined in the local newspaper.

• The lay public has trouble separating the issues by on- or off-site and by the multiple agency mandates. The ORRHES is primarily to address offsite issues, but onsite questions need to be answered. To whom do we refer these people? Elliott: NIOSH welcomes consensus advice/recommendations to the NIOSH Director at any time, about issues relating to workers, including interaction between the Subcommittee and the agency. While NIOSH would like to have a representative at every meeting, resource limitations prevent that in addition to addressing their prime constituency, workers. Dr. Davidson asked NIOSH to try to allocate the resources needed to allow attendance at every meeting, in order to answer the questions sure to arise. Mr. Elliott agreed to convey that to Acting NIOSH Director Dr. Larry Fine.

Seligman: DOE also hopes to always have someone present at meetings who can call headquarters to seek the answer needed. Mr. Tim Joseph had also providing the Subcommittee with a description of DOE's programs and contact persons.

• With the now-multiple (130) contractors at Oak Ridge, as opposed to the previous single major contractor, how can DOE ensure that safety and health is secure at all facilities? For example, a recent avoidable accident at Y-12 injured workers; and one at K-25 exposed (unaware) workers to fluorine. Dever: About 550 federal employees oversee the contractors' work. The Reservation has three major contractors: BWXT (at Y-12), UT/Battelle (at ORNL), and Bechtel/Jacobs (cleanup). While no one can be omnipresent, a cadre of facility representatives are on site daily to act as her "eyes and ears" and promote worker safety. The site also is strongly promoting the contractors' implementation of a fully integrated safety management system, to plan work with universal understanding of its hazards, to design safety features, and to arrange feedback. The Reservation also has a zero accident philosophy of doing everything safely, couched in the understanding that accidents are preventable. The onsite safety statistics show improvement, which she attributes to better safety consciousness.

• The TDEC monitoring program/sampling plan that was to follow the Scarboro soil study is undone because no interagency meeting has been scheduled. The credibility of the soil study remains under a cloud; it should be simple to validate a few samples. Mr. Joseph reported the agencies' awaiting EPA's response. Mr. Stockwell reported that Marina Redfield, of the Oak Ridge Energy Remedial Section, is planning a February meeting around President's Day, depending on DOE's availability to attend. EPA, TDEC, and ATSDR also will be invited. No completion date can be estimated until the agencies meet. Dr. Davidson requested a progress report on this meeting on sampling strategy.

• Could Mr. Bill Murray, as a former NIOSH employee and now with ATSDR, serve as an informal NIOSH representative? Falk/Elliott: Mr. Murray certainly has the occupational expertise, but the Subcommittee needs to deal directly with those in the agencies currently working. The Agency Coordinating Committee and Energy Oversight Committee also meet quarterly enable an interagency dialogue. Questions on NIOSH work or the compensation program should be directed to Mr. Elliott; and NIOSH is certain to request agenda .

• EPA is the regulatory agency outside the fence, but OSHA is inside, and they are not represented here. Falk/Dever: DOE is the regulator inside the DOE fence. OSHA takes over when, for example, a facility is turned over to a community or private owner. Seligman: Congress gave DOE that responsibility in the Atomic Energy Act.

• The timing of information released by the various agencies working in this community is occasionally downright odd. The absence of effective communication of past efforts' results, their evaluation, and coordination, continually confuses the community. How will you address that? Falk: The Subcommittee can facilitate this (e.g., the last discussion resulted in an action item for the agencies to report back at the March meeting). Seligman: Communicating study results has often been ineffective in the past, and evaluation of that communication must be improved. But since the agencies' work is done on different schedules, timing the information releases cannot always be controlled, although coordination can be pursued.

• What constitutes a "medically under-served" population? Dr. Williams, Director of ATSDR's Division of Health Assessment and Consultation, promised to provide the DHHS definition.

• Can the committee recommend, as done at Hanford, on medical evaluations? Williams: Some medical activities are DOE-related, rather than ATSDR's work. Dever: DOE has received communications that it is high time the other workers were addressed as are PACE members and the construction trades. This is being taken seriously.

• DOE's roles of management and worker safety are opposing, leading to a credibility problem. To proactively build trust, DOE should consult OSHA. Dever: External versus internal regulation is a continuing source of concern. OSHA only governs industrial safety side, and the Reservation uses its rules, but the Nuclear Regulatory Commission (NRC) governs nuclear safety. DOE has invited OSHA to advise at some small pilot sites. The Defense Nuclear Facility Safety Board also was created about 8 years ago to regularly to advise DOE on improvements. Although they cannot fine DOE, their advice is strong on nuclear issues, and is attended to by the agency.

• Can NIOSH provide information on what it has accomplished for workers with its research, nationwide but particularly at Oak Ridge? And what is heard from the workers on Worker Days that should also concern the ORRHES?  Elliott: I will provide that information, although the latter may be somewhat restricted by security concerns.

Dr. Davidson thanked the agency representatives for attending, and assured them that the Subcommittee would like them to return, singly if not in a group.

Public Comment

Ms. Janice Stokes submitted a letter (Attachment #6) on her organization and its concerns about the Oak Ridge area. She asked the committee to familiarize itself with the offsite contamination that had occurred in the last 50 years. She recommended that the Subcommittee read the 1990 report that listed Oak Ridge's released chemicals, and compare that to ATSDR's toxicological profiles. She felt that the negative findings produced from public health activities at the Oak Ridge Reservation were based on faulty science, biased beliefs, and political influence. The ORNL's own audit identified weakness in their industrial hygiene records, exposure data and occupational history, the very data on which the epidemiologists based their studies. The bodies of many Oak Ridge residents who never worked onsite have toxins that could only have come from the Reservation. Research is needed on the synergistic, multiplicative, additive, and concurrent effects of exposures. Diagnosis and treatment is needed to address the results of toxic exposures in a scientifically credible and rapid response mechanism. She requested a multi-disciplinary team to develop recommendations on such protocols. Finally, she asked Dr. Seligman about the likelihood of a health clinic being opened in Oak Ridge.

Dr. Seligman reported DOE's plan, if able with the new administration, to assemble an environmental workshop of all those agencies and organizations who have worked on Oak Ridge matters to combine information on offsite contamination. If the community is ever to have compensation, remediation, or benefits, the case must be made to Congress, and he would be happy to do so. The Compensation Bill resulted from the Secretary's strong support and DOE's strong case that their sick workers required address.

Dr. Falk stated that, while ATSDR's mandate does not allow medical treatment or the establishment of clinics, they have been trying to act as a catalyst to the health care delivery agencies to find services to address health care needs. For example, to address the health issues related to vermiculite mining in Libby, Montana, ATSDR invited DHHS agencies (e.g., the Health Resources and Services Administration - HRSA, and the Health Care Finance Administration - HCFA) to a community meeting to explore those issues as related to existing programs, and to encourage those agencies to think "out of the box." Dr. Seligman added that the Congressional Act that directed DOE to do medical monitoring of its workforce led to the current worker program. Congress could do the same to direct other agencies' work on site issues.

Dr. Davidson stated that some of Ms. Stokes' issues would be discussed as the committee decided on its recommendations to ATSDR (e.g., on the public health assessment). She hoped to actively involve the community through their participation on the ORRHES Work Groups that will recommend to the full committee, as well as through the public comments at the full ORRHES meetings and in private discussions with the members.

Ms. Fannie Ball thanked the agency managers for attending. She stated that, while she was proud of some of the Subcommittee members, she could not say the same of others. Without naming anyone, she related her grief in the past to hear some members discount that there are people sick from Oak Ridge effects. She asked, if they disbelieved then, why they believed now. She credited Dr. Michaels for listening to the community in his roundtable discussion, and producing a real response. She hoped to be alive to see the results of ATSDR's work. Finally, she stated her wish to see the departure from this committee of the "Judases" now on it. She hoped they would voluntarily resign; if not, she swore to expose them.

With no further comment, the meeting adjourned at 6:20 p.m.

1. For example, under the ATSDR cooperative agreement, the AOEC has investigated homes and a school built on a former waste disposal site in New Orleans, conducting clinical evaluations to document any health outcomes. In Fort Valley, GA, they investigated skin problems related to arsenic exposure from a former pesticide manufacturing facility.

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