ORRHES Meeting Minutes
March 19, 2001
Presentation on Roberts Rules of Order
Presentation of the Public Health Assessment, Steps 1 and 3
Presentation/Discussion of the Health Needs Assessment
Health Needs Assessment Work Group Report
MARCH 20, 2001
Health Effects Subcommittee
Findings: Cross-Cutting Issues
Recommendations on Cross-Cutting Issues
COSMOS Evaluation Findings
Presentation of the HHES Web Page
Work Group Reports
Agenda Work Group
Procedures and Guidelines Work Group
Communications/Outreach Work Group
Health Needs Assessment Work Group
Report on EPA Sampling
Geographic area of interest/phone survey
Seating a DOE Liaison
The Agency for Toxic Substances and Disease Registry (ATSDR) and the Centers for Disease Control and Prevention (CDC) convened the third meeting of the Oak Ridge Reservation Health Effects Subcommittee (ORRHES) on March 19-20, 2001. All but two members were present. All the Subcommittee state and federal liaisons attended, as did agency staff were present from ATSDR, CDC, DOE, and the EPA, and several members of the public. Ms. La Freta Dalton, the Subcommittee's new Executive Secretary, was introduced.
Motions to approve the agenda and the minutes of the last meeting were approved. The Chair reported correspondence to the Subcommittee since the last meeting, and announced ATSDR's solicitation for a worker representative member. The action items from the previous meeting had all been completed.
A presentation was provided and the committee members participated in a demonstrative skit on Roberts Rules of Order to familiarize all with them. Use of these rules is a component of the Subcommittee bylaws. The main concern expressed about using Roberts Rules was that they be used appropriately, and not to stifle the process.
A presentation was provided of Public Health Assessment process, Steps 1 (evaluate site information) and 3 (determine the contaminants of concern - chemicals and radionuclides - and any completed pathways to the public offsite). ATSDR was beginning Steps 1 and 3 as of this meeting. Step 2, identifying health concerns, has been ongoing and will continue. Subsequent steps' work was outlined. ATSDR will use the report of the 1993 Tennessee dose reconstruction feasibility study, which: 1) described historical operations and releases of the X-10, Y-12, and K-25 plant facilities.; 2) identified available environmental data collected and analyzed over the years (by the state, EPA, TVA, and others); 3) identified complete exposure pathways; and 4) evaluated environmental exposure pathways. The findings of these four tasks were outlined .
The released contaminants identified included: 1) for X-10: uranium, argon, plutonium, and various fission products. Particular problems were the unfiltered stack and releases of iodine and fission products of the Radioactive Lanthanum (RaLa) process; 2) Y-12: uranium, mercury and magnesium 99; 3) the K-25 gas diffusion processes released uranium and magnesium 99, and the mid-1940s liquid thermal process had consistent mechanical problems.
The dose reconstruction dropped some contaminants from consideration due to their use of small quantities or in processes believed not to have been released offsite (radionuclides, lithium, benzene, and chloroform), or those of little or no toxicological impact, even in large quantities (Freon, acids and bases like fluorine and fluorine-type compounds).
The Oak Ridge Health Assessment Steering Panel (ORHASP) received a detailed dose reconstruction analysis of the screening's identified four priority contaminants: I-131, cesium, mercury, and PCBs. They also reviewed a screening analyses for other contaminants screened out in Task 4 (uranium, arsenic, beryllium copper, lithium, other radioactive products). ORHASP recommended and reported on a more detailed analysis of asbestos and plutonium. They recommended further evaluation of I-131, mercury, cesium-137, PCBs, uranium, fluorine and various fluorides. The next steps in the Public Health Assessment process were outlined.
In discussion, the Subcommittee:
Requested ATSDR to: consider the cumulative effect from coal burning; offsite releases of carbon tet from Y-12 which blew east; that the gasoline facility was originally on the ORR; check that the ORHASP comments on the dose reconstruction work were addressed; ensure the clear peer review status of anything given to the Subcommittee; and supply a list of peer reviewed documents about offsite effects from ORR exposures.
ATSDR agreed to provide: an overview of the NTS I-131 and I-133 exposures inclusion in the analysis, and their effects, and to present the potential calculated impact of altering the initial assumptions about scrubber efficiencies.
Comments were that: the report's comparison of PCBs to beryllium may be inappropriate; peer review of the ORHASP studies is needed; concern was raised about the porosity of the limestone bedrock below the ORR and the sparse documentation of buried waste; the relative importance was raised of the "significance" of early releases was raised, based on poor early disposal methods and the still-unknown effects of multiple combinations' synergism, which will skew the data.
The roles of the Subcommittee and the Public Health Assessment in evaluating the health effects of the ORR were delineated (the latter will be one of the products of the former's advice given to ATSDR). A Public Health Assessment Work Group was formed to provide that advice.
The presentation of the Health Needs Assessment Work Group was altered by the Subcommittee's selection of a new course of action subsequent to the Work Group's meeting with the project contractor, George Washington University. Two of the Principal Investigators (Drs. Parkin and Paranzino) reviewed the project's status. They particularly defined the work of: 1) the key informant interviews of groups and individuals (with open-ended questions about their experience of health problems); 2) the focus group interviews (to learn about sub-groups with health issues, identifying the information needed and how they want to receive it); and 3) the telephone survey of a representative sample of the general population. It was the latter that caused the alteration. Concern was expressed that the random digit dial method described would place most calls in Knox County, the least impacted but with most of the phone numbers. The Work Group re-examined the ORR area map, consulted with experts and proposed that the geographic area of the survey be altered. The new area, including Blount county, will be redrawn and described in text.
The work group also suggested changing the term "key informant" to "key resource", and modifying the original plan of work to conduct the focus groups before the telephone survey. The Subcommittee approved all these changes. A subgroup of volunteers was formed to help pilot-test the questions to be asked by GWU to ensure that the terminology is correct and that the questionnaire captures the information needed.
In discussion, the Subcommittee warned GWU that those interviewed might expect GWU to do something about those health issues, expectations that were dashed in the past. GWU will identify available health information resources for people to access, and ATSDR has funded the AOEC clinics to do some follow-up. Dr. Parkin in particular is committed to do science that is useful, and pledged to do all she can to provide ATSDR with information it can use to move forward on the community's behalf. The Subcommittee also noted that many of the agencies on the GWU resource/advocacy list are underfunded and cutting services. That will be determined in the data gathering phase, but the focus groups can use this opportunity to advise what services are desired. GWU will avoid telling people specifically where to go until Phase II, the implementation of the health plan. Phase I is only to research information and combine it in such a way as to guide services to the community.
ATSDR stated that the focus on community health education need not be primary; the health needs assessment is more to the community's interest and will be done first. And, while ATSDR cannot provide health care, they can recommend to other agencies. A suggestion was broached to invite HRSA to describe their criteria for placing a clinic in underserved areas. However, ATSDR warned that its past efforts to place HRSA clinics at Superfund site areas have yet to be successful in meeting their very strict criteria.
A report on the CDC/ATSDR evaluation of the Health Effects Subcommittees was provided by the contractor, COSMOS Corporation. An Evaluation Work Group was formed of two representatives from each of the four Subcommittees and agency representatives. They developed four evaluation questions, for each of which COSMOS presented its findings. The questions and COSMOS recommendations were as follows:
1. Are the Subcommittees effective in providing relevant and timely advice? Recommendations: Agency development of activity-specific plans identifying the issues on which they need consensus advice; the Subcommittees' establishment of procedures to help them determine when and on what issues they need to provide consensus advice; and both groups' collaboration to set goals and time lines and to develop procedures to promote accountability. Keeping a log to track Subcommittee advice was advised.
How effective are CDC and ATSDR in using the advice? Recommendations: Agencies should provide complete and detailed explanation of why a consensus recommendation is not implemented; agency need to determine whether priority is given to consensus advice (and if so, communicate such priorities to the Subcommittees); and 3) both Subcommittees and agencies should hold to a zero tolerance policy for personal attacks.
What is the effect of the advisory process on the credibility of public health activities and research, and the public's trust in the federal government? Recommendation: Joint exploration by agencies and Subcommittees of the Subcommittees' current lack of trust in the federal agencies, and proposal of ways that trust can be enhanced. This stood out to both COSMOS and the Work Group as a big issue.
Is the advisory system helping to deliver appropriate prevention services? Recommendation: NCEH and ATSDR should jointly assess the value of Subcommittee outreach activities. If supported, identify outreach as an expected activity in the next FACA charter and allocate resources to support it.
Is the FACA-chartered Subcommittee process the best mechanism for obtaining public involvement? Recommendation: Both agencies and Subcommittees should acknowledge from the beginning that the Subcommittees will eventually end, and plan early on for their discontinuance and for sustaining public involvement afterward.
Four cross-cutting issues were also explored: 1) adequacy of resources, 2) role of the Subcommittees in conducting community outreach; 3) composition of the Subcommittees and rotation of members; and 4) continuation of the Subcommittees. The findings were reported, which supported the following recommendations: joint review of the FACA charter by agency staff and Subcommittee members to reach agreement on their appropriate purpose and functions; provision of periodic training on the FACA charter; and consistent agency application of its provisions' implementation.
COSMOS' final finding was that this evaluation is a first step. The evaluation's findings suggest ways to improve effectiveness and accountability. Their final recommendation was that CDC and ATSDR, in collaboration with the Subcommittees, continue to evaluate and assess the effectiveness of the Health Effects Subcommittee advisory process. ATSDR is planning a meeting of the Subcommittee DFOs on May 17-18 to review these recommendations and the next steps.
The Subcommittee discussion with the COSMOS representatives included the following: agreement that time lines and implementation procedures are needed to gauge progress and success; that the most important things to discuss are why the members are involved and what they want out of this process, to find common goals; then to agree what the Subcommittee wants to accomplish and track it along a time line to assess progress (advice given, agencies' response). If the advice is not implemented, the members should ask why, to avoid a vague feeling of dissatisfaction about advice not taken. A Subcommittee discussion of its mission statement was advocated, and it was felt that communication between the Subcommittees would be helpful.
The Agenda Work Group was asked to arrange a facilitated discussion of why the members participate individually, and the individual and collective goals and expectations of the Subcommittee; how those fit with ATSDR/CDC's missions; how to envision and track the ORRHES' progress and accomplishments, and what benchmarks to use to track progress.
A presentation of the HHES Web page was provided for the consideration of the ORRHES home page suggested by some members. Two members volunteered to help built the site, which is being coordinated through the Communications/Outreach Work Group.
Work Group reports were provided. The Agenda Work Group provided a broad overview of its Program of Work for the next 2-3 years. The Subcommittee accepted this. The Procedures and Guidelines Work Group reported on changes made to the bylaws document since the January meeting. The Work Group made the Procedures and Guidelines an appendix of the bylaws, noted with an asterisk all the bylaws that cannot be changed (by law, agency rule or Subcommittee charter); consolidated all the work group information into one Article; provided for Subcommittee meeting by conference call if this is published in the Federal Register and open to the public; modified the general order of business according to Subcommittee recommendations (including the public comment period); and added a Section to specify a two-thirds affirmative vote on all major recommendations.
Committee discussion included the need to defined what constitutes a "major recommendation" (this was remanded back to the Work Group), and clarification about when a member can and cannot discuss Subcommittee matters with the media. The bylaws were accepted with two changes, 1) to allow mon-members full participation (except voting) in discussion germane to the topic, by a simple majority vote of the Subcommittee, and 2) deleting "only" from Article 10, Section 13.
The Communications/Outreach Work Group reported changes to its purpose and statement of work, which were accepted. A formal Work Group response will be sent to a letter suggesting better ways to communicate with the public. The Work Group will further consider an ORAU-proposed workshop for the Subcommittee on conflict resolution skills, understanding personality types, etc. One suggestion was to involve the community in this as well. A proposed ORRHES mission statement was distributed for the members' consideration before the next meeting's discussion. The Health Needs Assessment Work Group requested other suggestions for the key informant or focus group lists. The key resources list was referred back to the Work Group for further refinements. A conference call will be held on April 24th to review that list.
Unfinished business discussed included a report on EPA sampling in the Scarboro community, which was postponed when EPA staff were reassigned to address the Paducah issue. An Interagency Work Group will prepare a work plan for sampling in Scarboro and offsite the entire Oak Ridge Reservation. A February meeting on this was held. The Subcommittee will be updated on the progress of this work. The seating of a DOE liaison with the Subcommittee was discussed. The perspectives offered included that while a bureaucracy may not be trustworthy, individuals can be trusted. There was general agreement that resolution of trust issues with DOE is needed. The main issue was whether such a formal liaison relationship would damage the ORRHES' credibility.
Points cited in favor of seating a DOE liaison were that: 1) the public is unlikely to learn to trust DOE if the ORRHES will not even have them at the table; 2) DOE is a major player in all the issues of importance to the Subcommittee and will be here long after DHHS leaves; 3) the current staff are felt to be trustworthy and the best way to solve a problem is to talk about it, particularly since some mistrust may be based on simple misunderstanding; and 4) having DOE at the table will allow direct communication in both directions. The negative views were that: 1) a DOE presence would prevent people from speaking about things they know occurred; 2) that some community perception will be that DOE's presence would fatally bias the Subcommittee's work; and 3) that seating DOE will not gain the ORRHES anything, but cost it the community's confidence. The discussion was tabled to the next meeting.
New business included announcement of the new ATSDR Oak Ridge office (at 197 South Tulane Avenue; hours are 12-7, Monday-Thursday; 7-3 on Friday; telephone is  220-0295; or -0457 for fax). The office will be open on another evening, perhaps Tuesday. ATSDR was urged to adequately support this field office, which is still under-supplied. There was discussion of ORR tours (e.g., the ETTP, K-25, and X-10) by the members to provide a better understanding of the site and its environs. A plan to tour 1-2 sites (no preference) at the next meeting will be will be arranged with DOE. Finally, an impending ORISE presentation was reported.
Public comment was requested at regular intervals of the meeting. The responses included:
Dr. Bob Peele, an ORHASP member, commented on their work. He welcomed its review and agreed that the Subcommittee may want to address further contaminants of concern; addressed the differentiation and overlap of worker/resident contamination; commented that at certain times different isotopes were more important than others; and that mercury was both an air- and waterborne hazard, particularly in the contamination of the fish in Poplar Creek.
Mr. John Stewart reported that the PACE union is doing a medical surveillance survey which would help to identify the problems needing assessment. He stated clearly that Oak Ridge physicians are loath to define any problem as occupationally related. The workers need financial and medical help. The DOE worker compensation legislation will benefit only the few current and former workers who have one of the eleven specified types of cancer. It is of concern that this may now be the sole source of redress; this program may eliminate the previous option of litigation or compensation by other state or federal programs. The DOE-funded worker medical survey has been one positive step to date, providing a Catscan (able to detect lung cancer ~2 years before it appears) at the union hall, but only about 300 of the already-1000 persons requesting it can be scanned in the two weeks it is available.
Mr. Mike Napp asked several questions about the area included in the telephone survey, whether the members self-identified as having health effects from the ORR (they declined to do so), and what site contaminants would be addressed. The Chair explained the survey area selection and said the contaminant list would be provided to him.
Ms. Linda Lewis urged the Subcommittee members, rather than asking an organization for what it cannot provide, to proactively explore the areas of potential help (e.g., disseminating information about the R.W. Johnson Foundation funding to help cancer patients). She offered her help to the Subcommittee. She also suggested that something be facilitated on how the Subcommittee interacts and relates with DOE and others, as related to the concept of trust.
Mr. Bert Cooper, of ATSDR's Division of Health Assessment and Consultation, reported that the COSMOS recommendations are now before with the senior CDC/ATSDR managers, and anticipated that the recommendations will be well received. The DFO/Chair meeting also may lead to another national meeting such as was held in Salt Lake City. Mr. Jerry Pereira of ATSDR stated that Ms. Dalton and Dr. Davidson will maintain a tracking log for the ORRHES.
After attention to a few administrative details including the need to maintain a quorum in both the full Subcommittee and Work Group meetings, the meeting adjourned.