ORRHES Meeting Minutes
June 8, 2004
At 4:10 Kowetha Davidson announced the start of Work Group Reports / Discussion / Recommendations.
Bob Craig Public Health Assessment
Dr. Craig apologized that he did not put what has been done since the last ORRHES meeting in his report but he mentioned he has it and would get it to Marilyn Horton to distribute to everyone. He said there has only been one meeting in May since the last meeting and it was an informal discussion of the progress of the cancer incidence review which was lead by Pete Malmquist and others. This was all we did and had no formal resolutions.
Pete Malmquist Ad Hoc (Cancer Incidence Review)
Pete Malmquist confirmed the cancer incidence report should be ready shortly. It is through most of the review process in Atlanta. We will schedule a meeting toward the end of this month with the Ad Hoc group to go over this report and to see how the presentation will be done by the public relations staff. Hopefully we will have the report by the next subcommittee meeting. However, everyone knows the Ad Hoc group and PHAWG was going to look at it prior to bringing it here to make suggestions and make sure the material is correct.
James Lewis asked Pete for the definition of correct, didn't we write a recommendation that was submitted to ATSDR for how we wanted this done? Mr. Lewis said the last meeting he was in the discussion had to do with whether or not they were going to be able to do this in accordance to our recommendation. I raise that point to as it relates utilizing the census track data to help with the plumes. Are they going to be able to do this in accordance with the recommendation as outlined. Mr. Lewis asked Dr. Malmquist if they have notified him or said anything related to that or what is the problem in that area. Dr. Malmquist said it is his understanding that we will not have it by the census tracks: 1) the state has not provided this and when talking to Brenda at the beginning of the meeting, we may have a problem with "hippa" rules as to whether or not the state can release that data by small census tracks or if it has to be larger numbers. Dr. Malmquist indicated he does not know this for sure but his feeling is that they would not receive the information by the 49 census tracks.
James Lewis said he would like to make the point that our indication was combining those tracks to match the plumes. Mr. Lewis thought that ATSDR stepped up and indicated we were subject to have that type of problem and we thought that the state would work with ATSDR to collectively put that together in those areas so we would not be worried about the "hippa" rules. Mr. Lewis reiterated his question as it relates to the recommendation, has ATSDR told us what the problem is; is it written down, what is the problem with the state and how are they going to meet our recommendation. Mr. Lewis said if they are not going to meet our recommendation, they should have told us in advance. Mr. Lewis said he would like to see this in writing so we know where we are going, what we are up against and not wait until the last minute. Dr. Malmquist responded I cannot answer those questions truthfully until after we get it back. Dr. Davidson asked if the subcommittee had voted on that recommendation (census track). Dr. Malmquist answered that he could not remember exactly what the committee asked for in the recommendation. Ms. Horton stated the recommendation was ORRHES recommends that ATSDR have a community strategy in place and it is presented to Ad Hoc and PHAWG before the ORRHES. Mr. Lewis said that was not the correct recommendation. Mr. Lewis said this goes back 6 12 months to the work group when we spun this off. Whatever we put in that recommendation needs to pulled, looked at and validated as that is what they are trying to do. Ms. Horton said she would find the correct recommendation Mr. Lewis is referring to.
Barbara Sonnenburg asked Dr. Malmquist when he was asked to get the cancer data from the state; was it a year and a half ago? Dr. Malmquist said he was not sure but indicated Dr. Craig asked him to be chairman at a PHAWG meeting and unknowingly accepted. Dr. Craig said the data has now left the state and is in review at ATSDR.
Kowetha Davidson indicated ORRHES will expect a report on the cancer incidence review at our August meeting unless there are other unforeseen problems.
James Lewis Communications and Outreach
Communications and Outreach had two COG meetings in which Loretta Bush was involved. We think Ms. Bush did a good job in coming in and giving us a general overview of some of the communication strategies. Both of the meetings centered around what type of communication strategies we are going to use and the content of the communications. Mr. Lewis said he thought that we have had some problems with press releases again and other documents and whether or not they adequately define for the public what the issues are. He also said the timing of getting input has been a problem and he mentioned last nights meeting as an example of that. Mr. Lewis said there has to be something done to accelerate and look at these types of things. This is two cases, when we dealt with DHEP and George Washington University, where the product presented was impossible for the people to understand. There has to be a reason for the lack of information that is contained in these types of releases and something has to be done in that area if you expect participation. Mr. Lewis posed the question, if we cannot communicate what we are going to do in a meeting how are we going to communicate to science? This area has to be looked into to assist getting information out in an orderly manner. In addition, Mr. Lewis stated even when looking at the agenda for last nights meeting, very few people could determine what it was we were going to talk about and something needs to be done in that area if we expect to draw people to these meetings.
Jerry Pereira said it seemed like there were roughly 60 people present at the meeting the night before. It was unfortunate that ORIA was not here. As far as what the press release says, we got input on that and there was a change based on COG recommendations and we made that change back. Mr. Pereira noted we must be doing something right because nearly every chair was full but also said he is not saying we cannot do better. Mr. Lewis said he would like to provide more details in that area. Mr. Lewis said the press did a pretty good job of figuring out what was going on and the article in the newspaper did a lot to bring people out. Mr. Lewis mentioned the efforts of others in the community such as Al Brooks and others that put out numerous communications but what you see is dependent upon the target audiences. Mr. Lewis said that he did not think we could take credit for the product that we put out. When we were given our 15 minutes to put input into that document, I took that document to the pool room which is on one side of your office (addressing Pereira) and to the Investment Club and passed it out and asked those people to come back to me and explain if they could understand what we were talking about. Now in that meeting (Susan and them) put a couple of words in the document to tweak it and sent it to you. Mr. Lewis said he realizes everyone is going through some difficulties but when we have a meeting like we had last night, it is to our advantage to explain it to the public and lay it out in more detail so we can get the public out. Mr. Lewis said that overall it has turned out pretty well but in the future we would like to see more descriptive efforts put into announcements.
Jennifer Sargentsen responded she works in the communications office at ATSDR and actually writes the press releases. Ms. Sargentsen explained that just because you write a press release does not mean that the press is going to pick it up. The Oak Ridger is very good about that and she said she has established a good relationship with Paul Parson. Typically before we send out a press release or immediately after, Ms. Sargentsen contacts the press to see if they are interested in trying to set up any interviews. Ms. Sargentsen noted that she would have liked to have sent the press release out earlier, the problem was ATSDR had not established with EPA what the agenda was going to be. Therefore we had to wait until the agenda was established and it went out later than we wanted to. Ms. Sargentsen said she had no problems with sharing the press releases in the future with ORRHES and would welcome comments, but she reminded everyone there is a very limited time to do that. Ms. Sargentsen said if anyone had any questions they could always call her at 404-498-0070.
Barbara Sonnenburg Agenda
Ms. Sonnenburg said there was no report.
James Lewis Health Education Needs Assessment
Mr. Lewis said he had no comments.
Karen Galloway Guidelines and Procedures
Ms. Galloway stated at the last ORRHES meeting, Susan Kaplan read a letter into the record about the EPA controversy and also passed around a timeline that detailed what had happened and when with this issue. One bullet of the letter ended up to be the charge to the Guidelines and Procedures Work Group, because it was actually a communication issue. James Lewis declined to chair it because he was close to the issues. It was passed to guidelines and procedures. Reading the charge: "The EPA controversy over the Y-12 uranium releases illustrates systematic problems that exist within ATSDR and how it interacts with the subcommittee, attempts to control it, and how it responds to subcommittee recommendations. Unfortunately it appears the organization's public participation process has broken down. Something that threatens to undermine the public's trust in all the organization's efforts in Oak Ridge and not just for the Y-12 uranium releases. A work group should be established to analyze this subject." Ms. Galloway said this work group was not established it was just passed to Guidelines and Procedures. She expressed how much she appreciated all the work group member's work and said there has been a lot of work done on this. Basically our charge was to analyze the EPA controversy as an example of the systemic problems that have existed in other issues before the ORRHES. Ms. Galloway pointed out that Susan Kaplan worked very hard and developed a case study (which was not included in the handouts.) It is entitled The EPA Controversy, A Case Study Illustrating Systemic Problems within the Oak Ridge Health Effects Subcommittee and the Agency for Toxic Substances and Disease Registry.
From this the group developed three key recommendations. Ms. Galloway instructed everyone to refer to the Draft Recommendations and overheads handouts from the Guidelines and Procedures Work Group. Ms. Galloway explained the group developed the recommendations and worked on the rationale for the three recommendations. Ms. Galloway continued by reading the Rationale section of the Draft recommendations handout. She then asked James Lewis to explain the work group's first slide mentioning that he had done this very well in another group.
James Lewis began by saying we have had so many conflicts and discussions in the various meetings that we figured out there is a conflict in the way we deal with things involved. We identified the three components in a public health assessment: 1) Exposure Evaluation, 2) Community Concerns, and 3) Health Outcome Data. What we found was that in reference to the debates we have had about whether NOG and COG can be combined. We felt like all of that could be combined under community concerns. We felt like the exposure evaluations, which when we have been in the PHAWG groups, have been delayed. There have been challenges made and people are always frustrated that we are talking about health outcome data, issues that people have with illnesses and sicknesses, when the primary focus there has been on exposure evaluation. Mr. Lewis, referring to the first slide, said ATSDR approaches the slides from left to right: 1) Exposure Evaluation, 2) Community Concerns, and 3) Health Outcome Data. However the at large public approaches the topics from right to left: 1) Health Outcome Data, 2) Community Concerns, and 3) Exposure Evaluation. Because of this we feel like there is a built in conflict when we come to the meetings. So we asked how can we separate these two so they can quit blaming individuals for spending time talking about issues that are not related to what they are discussing. We looked at how you are set up and how you are operating. We went to your guidance manuals and looked at organizational charts and said why don't we align ourselves in accordance with the way that you do business.
Ms. Galloway summarized Recommendation 1 as realigning the work groups. Basically it is a recommendation that ORRHES work groups should be realigned to reflect the basic components of any PHA that is given in ATSDR's guidance manual. If we were to do that, we would have these three basic groups: 1) Environmental Data, 2) Community Health Concerns, and 3) Health Outcome Data. In addition we would probably have another group called subcommittee business to take care of agendas and guidelines and procedures. Ms. Galloway explained the Health Outcome Data Work Group is envisioned to be able to inventory and evaluate existing health outcome data, identify gaps, provide advice and input as to what they think should be done to fill the gaps, and this type of data should supplement and strengthen each remaining PHA. The lack of health outcome data (or consideration of this data) has been a source of contention up to this point.
Bob Craig asked Ms. Galloway to clarify what is meant by health outcome data. Ms. Galloway answered that she understands they can only consider health outcome data in registries and there are very few and we are way short of that type of data. Bob Craig asked doesn't this fly in the face of the process that we have gone through to identify contaminants of concern. Then when you do identify a potentially impacted population, then you go look at the health outcome data. Dr. Craig asked how many cancer registries there are and received an answer of one. He stated there are a lot of outcomes that we want to look into at the end of the PHA process. He stressed there are a lot of things we want to find out about and not just cancer. James Lewis said if you go back and look at the flow diagram that was put up for the PHA and ask what information is going to be collected in the area of health outcome data. No one has formally come to this group and reviewed what is out there as it relates to the state, what is available, and what can and cannot be used. What we hear is off the record, that there is a cancer registry and that there may be a birth defects registry. We want to know who pulls all of the information together and tells us what is available, these people have reviewed it and how it is subject to be used. A number of the challenges and the questions that we get in these meetings are associated with things such as illnesses or sicknesses. We feel like the focus needs to be taken away from the technical evaluation and the focus placed on health outcome data. If people have questions about that or the registries or additional epidemiological studies, we need to have a category set aside so when the public comes in they know what work group they need to focus on, collect that information, and then process it through the system. We can put some emphasis on what it is they do in that area of evaluating health outcome data. James Lewis said it is very similar to what I think we did with cancer and asked what else is out there?
Herman Cember said the other thing that is out there is the causes of death on death certificates. He explained that has to be related to the person's age, sex, how they lived, and other demographic information and it would be difficult to get. Assuming the cause of death averages out over time and other things, we can see whether the causes of death are more or less than expected from another community of similar demographic constitution. Dr. Cember said the ordinary population would understand this better.
Sandy Issacs introduced herself as chief of the Federal Facilities Assessment Branch. She said if we go back to Superfund when it laid out what should be in a health assessment, it says we should consider five elements:
- the nature and extent of contamination we had a lot of discussion about data that is out there and certainly with the data that is out there and certainly with the federal facilities assessment agreement, we depend on DOE's lead with the state and EPA's oversight to provide us information as to where the contaminants are.
- susceptible populations (where are the people) these are in our PHA, work groups gather information from people with the knowledge of Oak Ridge: contaminants, practices of facilities, etc.
- the completed pathway here are the contaminants and here are the people. If there is contamination but the people are not exposed then as far as a health assessment we have completed our evaluation from a public health perspective.
- Based on CERCLA if there is a completed pathway based on the levels of exposure, what are the plausible health outcomes associated with that level of exposure Ms. Issacs noted this step is a very important difference between EPA and ATSDR. We look at the epi and the tox data, the studies to say if you are exposed to contaminant X at this level, what do we know about that.
- Are there existing morbidity and mortality data available That is how we use the health outcome data. Unfortunately often it is very limited. Tennessee is struggling to make sure they bring up even their cancer data registry to a quality that we would like.
Ms. Issacs said it is not ATSDR's mandate to bring all those registries up to snuff. We are site focused. In talking with Dr. Sinks, we might can facilitate getting concerns to the right local, state or federal agency. There is a cancer group in CDC with a budget of six million dollars and a lot of that goes to the state to help them work on their cancer registries. When ATSDR does not have a completed exposure pathway we do not look at health outcomes. Mr. Issacs reminded everyone ATSDR is a very small agency. The CDC branch that looks at cancer gets ten times as much money as our whole agency does, therefore it is not our mandate. This is hoe the health outcome data fits into the health assessment.
James Lewis said we heard that same argument when it came to looking at the cancer data. The group got together and asked is that data in the registries. We asked you to go forward and do that. Referring to ATSDR's guidance manual, Mr. Lewis mentions the community concerns and at the top it says completed exposure pathway. Mr. Lewis said if we start a program with this type of concept in place and the community rallies behind you and the concerns are great enough in a particular area; we are not asking you to go search and try to make health outcome data. We would like you to tell us what is available out there and what have you reviewed. If people have issues and questions in that area they can focus them to a particular work group where maybe you have provided the answer so they can come but do not disrupt the process that we have when we are trying to do exposure evaluations. Mr. Lewis said it is our belief that if you establish a focal point for dealing with things like that, regardless of whatever your process is, they come to that group and we share with them the information that is there and that is how it is going to be handled. Taking it out from the umbrella of PHAWG which we have heard numerous complaints about staying focused on the agenda. When someone comes in and disrupts the agenda, everyone gets upset and angry. All we have said is lets create a group that could funnel the information that you are providing us to direct people to the appropriate work group. We think this is simplistic and would cut out some of the roadblocks.
Bob Craig responded to Mr. Lewis by saying he has been at most of the PHAWG meetings and he does not recall the scene Mr. Lewis is describing. Dr. Craig noted the discussions were wide open. We had an agenda that is true and never followed it. The discussion went where the discussion went. James Lewis stressed he thinks some people have felt intimidated with the technical expertise in a room. People have a comfort zone when they bring up an issue and the style in which it is dealt is important. If they can find a place that they can carry those issues, where someone can document them and collect information in an organized manner, then it can be presented back to the subcommittee for processing and handling. If you have a focal point they can come to that group with the correct focus and I think that is what they want to have less fights going on.
Pete Malmquist mentioned he has a problem with some of the definitions of health outcome data. Dr. Malmquist's concern is that some of the data should not be handled by this group at all. This is a problem for the Tennessee Department of Health (TDH) not us, unless it is directly related to one of the contaminants. We should not worry about how many of cases of something there is in the city of Oak Ridge. That is a concern of TDH if there is an increase. We are worrying about whether or not a contaminant is causing a public health problem in this area, and then we work on it. Anything else (such as obesity) is not a concern of this subcommittee; we cannot handle every disease that comes along.
Karen Galloway said that Dr. Malmquist is right and she apologized for the wording in her first slides if it caused confusion. She noted the second page refers to the ORR and those contaminants are the only ones of concern.
Herman Cember asked if the public knows which health affects are associated with this. He stressed the general public does not know which effects are associated with radiation and which are not. He gave an example of how people think all leukemia is associated with radiation when in fact chronic lymphoma is not.
Ms. Galloway agreed with Dr. Cember and said the public does not know who we are, what we do, or what is associated with the contaminants. She also stated we have not done a good job in communicating and involving the public. There is more than one issue. The purpose of this is to bring about an easier way for us to complete the remaining jobs and also involve the public if that is possible, but also to take out the level of frustration with the work groups and ORRHES.
Bob Craig responded that he agrees 100% when we have a completed pathway. If we can see that we have excess fluorine over thirty years and we are able to show that there is a population downwind, then we better go look and see if there is asthma in that group, but until we have a completed pathway that will not be done. Dr. Craig referred to Ms. Issacs comments and the lack of money to handle uncompleted pathways.
Peggy Adkins said she interpreted the first slide as showing the three major categories of contact that people might have with this group. She said Mr. Lewis is right when he said the public works from right to left and we work from the left to right. She expressed this was a wonderful explanation. Ms. Adkins also referred to Dr. Malmquist mentioning that the obesity problem is not a concern, but there are a lot of people who wonder if the obesity problem is related to thyroid problems that are related to iodine or other contaminants and it could be related. There needs to be a place where people can connect with this group and maybe we have not done any research on it but could tell them if there has been anything that we have found and if not we can put it on the list to consider as we do our work.
Jerry Pereira said to keep in mind the first two recommendations in the handout are really internal ORRHES decision making processes. Any work group that is formed is formed by ORRHES and there has to be a charge for that work group, basically what you have been doing, reporting back and so on. Mr. Pereira said he thinks the first consideration in the first recommendation of forming a new work group is to give a specific charge and expectations for that work group. Regarding the second recommendation Mr. Pereira said the bylaws were established internally by this body and can be changed by this body. He asked if these recommendations were meant for ATSDR decision making or for this body to be made. The committee told Mr. Pereira that they were not meant for ATSDR decision making.
At 5:00 the public comment period was announced but there was no public present.
Continuation of Work Group Reports/Discussion/Recommendations
Charles Washington said he thinks this speaks more to process. He recalled three people who came to the committee in the past, talking about iodine, and said we did not know what to do with these people. These three people said they could get many more people with thyroid problems and we did not know what to do. So whenever you have the meeting we will invite them back, however we did not get their names because we did not know what to do. Mr. Lewis was right that chart gives us a road map as what to do when they come to us. If we find out they have been affected by the known contaminants then we can move on from there.
George Gartseff said he has a couple concerns about the health outcome work group as a stand alone. One of the larger concerns is that we may be creating a bias. It is almost if we are presuming that the outcome is related to the site whereas there is no proof of that and we are trying to establish whether there is a link or exposure pathway. Another concern is that we are opening the door to anyone and everyone coming in with every concern they have looking for compensation. Are they worker exposures, public exposures, or environmental exposures and there is no way to screen that out. If you think the 18 month discussion on the 5000 millirems was fun, wait until we get to all of this. Mr. Gartseff noted we do have our community concerns database and we are able to collect this stuff now. We have collected health concerns and that is how we have the Ad Hoc group established on the cancer data. We are not ignoring it now.
James Lewis said he thinks the problem still exists today. Mr. Lewis does not think anything is being done differently other than identifying a place where people can come with issues. If we understand what it is and people come there, we can tell them that this is not what we are dealing with and it helps the entire group. Mr. Lewis said if we invite people to a meeting and it is something unrelated they do not come back. If you bring people to a meeting and say we have heard that before and here is the response but we do not do that, then it helps the public understand where we are. We (PHAWG) are not trying to create anything new, we are just taking advantage of what we have learned and are trying to help people understand. Quit bringing them to a group that is not designed to address the issue and give them a place to go.
Kowetha Davidson commented that ORRHES has established the work groups, but ORRHES established the work groups to work with ATSDR with the PHAs. She stressed this is what we do. We work with ATSDR, we do not work against them. Dr. Davidson asked if the reorganization of the work groups had been discussed with Jack Hanley (the site lead) because we still have to work with them. Karen Galloway answered to her knowledge it has not been discussed with Mr. Hanley. Ms. Galloway noted they brought this directly from the guidance manual from ATSDR. Dr. Davidson said a guidance manual is guidance and is not regulation and everyone will use guidance differently.
James Lewis said we never got the concerns from the nine counties (referring to the concerns Mr. Gartseff mentioned.) That is a failure to capture those issues and concerns. Mr. Lewis also referred to a meeting in which Herman Cember was present and Ms. Galloway was shocked that we are not looking at birth defects registers. There is something wrong here when you have been on a committee for some time and do not know these things. There is something wrong with the organizational structure. The information coming out of this work group is would either supplement PHAWG or go to ATSDR just like any other concern.
Herman Cember said it is his belief and the belief of his circle of friends in this business that the number one concern of the public is birth defects in the context of radiation. The number two concern is cancer. Dr. Cember indicated this is an opinion not a scientific study.
Karen Galloway noted they were discussing the concerns database at the time. She said Dr. Cember had asked a question about birth defects and there are no concerns in the Oak Ridge concerns database regarding birth defects. She thinks that summarizes the quality of the concerns database. Efforts to communicate with the public through focus groups and through the needs assessment failed and so we are left with concerns that have been brought up in our meetings almost exclusively.
Susan Kaplan asked where is the concerns database. She mentioned she has never seen any analysis or printouts. What do we have; is it just on a computer and no one has ever dumped it. Dr. Davidson said Mr. Hanley had discussed it with the uranium PHA and the different categories of concerns and this information came from the concerns database. It was in the Y-12 report and that information is being used.
Barbara Sonnenburg asked Bill Taylor if he would object if committee titles were switched and could ATSDR still work with DOE? Mr. Lewis asked if Mr. Taylor would also speak about the concerns database.
Bill Taylor told Susan she may have missed Jack Hanley's presentation on the concerns database at an ORRHES meeting. He discussed what it contains and how we use it. Mr. Taylor offered to pull up that information for Ms. Kaplan. Mr. Taylor then said he could work with the work groups however the committee arranges them.
Kowetha Davidson clarified to Ms. Sonnenburg that her concern was Jack Hanley, the site lead for the PHAs. James Lewis said that he has had discussions with Mr. Hanley many times. Mr. Hanley told him that as a general rule, we do not do anything in this area unless we have a completed pathway. They prefer not to get involved with this other side. If concerns are so great in a particular area, it may cause ATSDR to look to see what is there, but it has to be something that comes from the group. Mr. Lewis said in his opinion, if we have questions with birth defects registries and you are saying that you are not going to do it unless you see a pathway, all we can do is pull the information together and present it to you. If you decide not to do it then that is fine, we just want to collectively pull it together. Mr. Lewis said that Mr. Hanley indicated that we should not be doing the cancer registry. The site lead is very aware of this issue and Mr. Lewis said there has been a reluctance to say this is not the way we do business. Mr. Lewis said we are just an advisory panel and stressed we are just trying to pull this information together for others to decide.
Kowetha Davidson announced a 15 minute break at 5:15.
Continuation of Work Group Reports/Discussion/Recommendations
Barbara Sonnenburg requested the committee wrap up the ongoing discussion. She proposed making a motion and bringing it to a vote.
However, Kowetha Davidson said before doing so she had to make a comment. Dr. Davidson directed the groups attention to the Draft Recommendations handout from the Guidelines and Procedures Work Group. Dr. Davidson said her concern deals with the text of "the work group's concern of an appearance of an improper relationship and undue influence existing between the Agency and the ORRHES chair." Dr. Davidson said where she works, an improper relationship refers that the person has been unethical and she takes issue with this. Dr. Davidson said she has expressed to this subcommittee before that she does not see ATSDR as her adversary; she sees them as someone whom she works with and that will not change. She said if that is seen as an improper relationship then there is nothing she can do about it. Dr. Davison said it was uncalled for to put a statement like this out there and not question her about it first. She stressed she is not unduly influenced by anyone. Dr. Davidson is concerned about how this ended up in a formal document for ORRHES.
Karen Galloway responded this was a statement that the work group felt needed to be said. Ms. Galloway added she thought this was something that certain individuals had discussed with Dr. Davidson privately. Ms. Galloway said the work group felt it needed to be said but said personally she would be willing to strike it from the text. Dr. Davidson clarified that this issue has not been discussed with her by anyone privately.
Dr. Cember added he has seen no evidence in support of this statement.
Dr. Craig remarked the statement was not only un-business like, it was also unprofessional to say that kind of thing in public. Especially regarding someone who has worked so hard and there is no evidence of that.
Barbara Sonnenburg requested that item be removed from the text. Mr. Lewis said that if the committee wanted to do that he does not have a problem with that. He clarified that the perception of an improper relationship was not only addressed to Dr. Davidson but also the way things have been organized and managed. Mr. Lewis said this is not an attack on your integrity. One of the examples is why we wanted a public meeting to discuss the EPA issues. He suggested Dr. Davidson needs to learn to champion the minority's side and not lean so much to the support of the Agency's position. Mr. Lewis said when we try to address issues internally, such as the way we communicate, we have even argued about the minutes. Mr. Lewis stated he does not think the committee needs the detailed minutes and thinks they are being used to slam people. He said if you read the minutes in their entirety they are an honest representation of what is going on. We are asking everyone to look at themselves and determine how we look in the public's eye. Mr. Lewis noted that if we took the time to look back at some of the cases, it sometimes appears you (referring to Dr. Davidson) are more aligned with the agency's philosophies, policies, skirting issues, etc. and this is the ideas conveyed in those groups. He said Dr. Davidson may have a different understanding of that but the intent is not to. Mr. Lewis said this can be dropped but the point has been made that we need to look at how we are doing. Mr. Lewis commented that some people used to think he was too close to Jack Hanley and that was an improper relationship. Also some groups appear to be too close to certain issues and it does not appear that we are being independent. Mr. Lewis thinks we need to get back to addressing that and look at how we are interacting in order to being about some cohesiveness in this group.
Susan Kaplan noted that a piece of private correspondence was distributed to the group and went to Bill Taylor and then evidently went to Atlanta with the understanding it was within the Agency. It then ended up with a member of the public and everyone wondered how he got it and why did he distribute it to ORRHES. Ms. Kaplan implied this could also be seen as an improper relationship and cautioned everyone to be careful about whom they are passing information to. She said maybe it is the assumption that anything that goes into the office is free reign to everyone. If it is I am warning people be careful with the information you share with the office and other folks because members of the public get it.
Mr. Lewis asked to share an example. He said the last time we tried to put a recommendation out that started with me and then Dr. Cember modified about getting EPA here and whether or not you (referring to Dr. Davidson) were going to go before the press as outlined. Mr. Lewis said we have been chastised so many times by going around the system. ATSDR did not deliver on that recommendation as written. They did not come back and tell us anything in advance of that. Mr. Lewis said when we see ATSDR not following a recommendation, not writing things down or not explaining to us the logic and the reason, he expects to see Dr. Davidson step up and say that was not in accordance with the recommendation. We would appreciate when we put out a recommendation that you tell them they did not meet the requirements of that recommendation. Dr. Davidson responded to Mr. Lewis and said that her not telling ATSDR that they did not meet requirements of a recommendation does not address the issue of an improper relationship. Dr. Davidson added that comment should be explicitly stricken from the record because she does not like anyone questioning her integrity or ethics without coming to her personally.
The work group agreed to remove this comment from their Draft Recommendations handout while leaving the rest of the text unchanged.
Karen Galloway wanted to continue by addressing the community health concerns group and what we envision it might entail, for the record. Presently a person with an ORR related health concern has two places to take those concerns: PHAWG and ORRHES. The focus of both groups is exposure evaluation and this may leave individuals frustrated. Their concerns may not be given the attention they deserve and Ms. Galloway noted that everyone has seen examples of that. This new group should be dedicated to providing that necessary attention to those health concerns associated with the ORR. It would also allow the member of the exposure evaluation work group to stay focused on their task.
Dr. Cember remarked Ms. Galloway only mentioned two places in which they could take their health concerns, but Dr. Cember thought most people would take their concerns to their physicians.
Dr. Craig said if they have other questions they could take them to the State Public Health Office.
Ms. Galloway reminded them they are concerns related to the ORR.
George Gartseff commented he has no problem with reorganization to make things more efficient. He added he must confess he is not intimate with the guidance manual. He referred to Figure 2.1 Ms. Galloway used in the slide presentation and handout, and asked does it really reflect the process of the risk assessment that we should be organizing against and suggested that may be a better model than the image of the three circles. Mr. Gartseff explained restructuring against these different functions will not necessarily give us the outcome we want. We did have a health needs assessment work group, yet that is sited at the number one failure of this subcommittee.
Ms. Galloway responded that is absolutely correct and it is still impacting us. It complicates our problems now since we has still not given the public a voice.
Peggy Adkins addressed Dr. Cember and said he has not had the opportunity to be doctored in this area. A lot of people in the community are especially challenged to get medical help because of the stigma involved with a past doctor who was belittled and lost his practice for finding a correlation with the metals in Oak Ridge and certain kinds of cancer. Ms. Adkins explained there is a stigma here and all the doctors are not open so the public does not necessarily trust all of the doctors in this community and they do not know who to trust. Ms. Adkins mentioned she personally had two doctors drop her when her labs came back showing high levels of metal contamination because they will not be connected to anything negative in Oak Ridge. This special problem that you may not have been aware of make this third group, this third box (referring to Figure 2.1) very important and relevant because people need a place to turn, compare notes, and find out where they can get medical help. Dr. Cember clarified that he did not mean to delete those, just to add a physician or nurse practitioner to it.
Sandy Adkins stated she thinks part of the frustration ATSDR is facing is we have some groups set up that have very focused purposes like the health assessment guidance manual. So we can be transparent and discuss issues, we have to have a forum where we can have very technical discussions. She said since the three circle in that slide were pulled out of our health assessment guidance manual, she hoped she explained how one leads to the next. Ms. Issacs stated she did not see all three of those, relevant to the health assessment process, where ATSDR would interact with all three. She said truthfully their health assessment has to start on the left-hand side and she sees the health assessment work group as the one on the left side. What she sees the other two doing is trying to struggle with a need that exists here on giving out information about what we know regarding the links between disease and contaminants. This can be done as health education independent of ATSDR's health assessment process but it can eventually feed into it. Ms. Issacs gave the example, if someone comes into this group and says I am a diabetic, what do we know about the links between being a diabetic and environmental exposures, it is an education issue. You look at what is published and decide if there is a link or not and give that information to that person. She noted she does not think ATSDR is really taking the health assessment process and dividing it into three, they just focus on the left hand side and that is what the law says. ATSDR is seeking a way to try to give information about what is know about some diseases. She noted when trying to use registries, there are concerns that other people in different areas will have nothing to do with a site perspective.
James Lewis said Ms. Issacs said health education rather that health outcome data, and this is really what our group was saying. Mr. Lewis said he personally did not mind going down to two groups because health education is really dealing with concerns. In this phase we are doing two things, we are focused on doing the exposure evaluation or the PHA and trying to handle concerns and issues. The majority of the concerns and issues have to be addressed via a health education program. So where is the health education group and people to assist us with that; they never completed their task. Mr. Lewis told Ms. Issacs that in his opinion, they need to address these issues, educate people to tell them what we know and suggest what can be done by the committee so we can move on with our lives. Ms. Issacs responded that we are all frustrated because people come in and we would like to give them answers. The EPA is depending on us for this process so that we do not delay their 2006 goal. She said she believes there are educational needs here but does not see how ATSDR can do that.
Bob Craig responding to Ms. Issacs frustrations, said he tends to think when the committee is going down the list, there is a role for health education that would state here are the potential outcomes and what we do know about this contaminant of concern. This way we are ahead of the game if we do get a completed pathway and then people can come in and talk to that group. Dr. Craig said he thinks Bill Taylor is an expert when it comes to the health effects of uranium, fluorine, iodine and mercury, etc.
David Johnson said he is hearing health education and health outreach referring to people coming in. He asked why can we not go to the people. If you want to help and educate people you go to them, such as symposiums which do not really cost much because you have health care providers that will collaborate with you to do just that. Mr. Johnson referred to Dr. Cember mentioning people's doctors, but reminded everyone that a lot of people do not have medical insurance because of circumstances beyond their control. He noted they may go to the emergency room and hospitals are looking for an alternative to minimize that. This would be an excellent time to address the needs of the public. Empowering individuals will allow the committee to get more for their money without a lot of stress, but would also be self gratifying as well.
Herman Cember noted that church groups, Kiwanis and Lions clubs are always looking for speakers and in those meetings are talking to the representative populations. Dr. Cember said the committee should promote that type of outreach instead of waiting for people to seek out other sources.
Barbara Sonnenburg made the motion to adopt Recommendation #1 (from the Draft Recommendations hand-out) that "ORRHES work groups should be reorganized as follows: 1) Exposure Evaluation Work Group, 2) Community Concern and Communications Work Group, 3) Health Outcome Data Work Group, and 4) Subcommittee Business Work Group."
Charles Washington seconded the motion.
Herman Cember clarified that this was a recommendation to ORRHES and therefore it requires only a simple majority to pass.
The motion passed with nine votes in favor, five opposed.
Kowetha Davidson said the next item would be to establish charges for these work groups. She summarized the committee now has four work groups but have no charges for them.
Mr. Lewis said the group can look back at the rationale in the handout and consider what Dr. Malmquist has done in one particular area and set that up as a "Ad Hoc" committee because it is basically the same type of thing. He noted the only difference is that issues other than cancer would come to that group which is a simplistic way of handling and managing all of that. Dr. Malmquist recommended the writing of the charges be passed back to the Guidelines and Procedures Work Group to be brought up at the next meeting because of the lack of time in this meeting. Several people verbally agreed with Dr. Malmquist but Tony Malinauskas asked if the motion meant that all work groups no longer exist. Dr. Davidson said yes, they no longer exist.
Susan Kaplan asked if the committee could make a motion that PHAWG continue under the exposure evaluation work group temporarily until the group comes back to the next meeting. Also that COG should go under community health concerns and communications work group temporarily. David Johnson summarized Ms. Kaplan's comments as meaning all work groups continue with business as usual until the next subcommittee meeting. Ms. Kaplan agreed and recommended that a motion be made to postpone the previous motion until the next meeting.
Pete Malmquist modified his motion to say the present work groups stay in existence until the next meeting and the Guidelines and Procedures Work Group will come back with the charges for the new work groups. James Lewis seconded this motion.
The modified motion passed with 14 in favor.
Continuation of Work Group Reports/Discussion/Recommendations
Karen Galloway specified the next step is to modify the bylaws to allow the subcommittee to select or remove work group chairs. This democratic process in which every ORRHES member has a vote will allow us to effectively manage and complete our remaining tasks and bring about a better consensus. We may also consider electing co-chairs for every work group so that it will not overwhelm any one person and so that the work group can continue if the chair has a problem.
Barbara Sonnenburg asked if that last statement was a motion and Ms. Galloway said she would make it a motion. Barbara Sonnenburg seconded it but asked to make an amendment if allowed. Ms. Sonnenburg added if this motion should pass it would not take effect until the next meeting. Dr. Davidson said she did not think Ms. Sonnenburg could make the amendment.
David Johnson suggested the subcommittee table this and send it back to the Guidelines and Procedures Work Group to clean up because of all the grey area at this point in time. Mr. Johnson said there needs to be some additional research with regard to the bylaws and constitutional procedures in terms of the co-chairs and what their responsibilities are, rather than just rushing to vote on something.
Barbara Sonnenburg said she is not saying whether the people should pass it or not, she thinks there should be a meeting before it takes place because it is a bylaw. Ms. Sonnenburg noted she is not sure about what the bylaws say about changes to the bylaws and would like that to be presented before they are voted on. She stressed it may require notification before a vote. Dr. Davidson said there is a notification and when changing the bylaws you have to write your specific wording for the bylaw that you are changing and bring that before the subcommittee. Dr. Davidson clarified that is not what this is. In addition to that if you are going to put in a change of electing chairs, you have to put in a procedure for how the entire process will be done even before voting on anything. If not you are going to end up with a situation like we just did and end up with something but not know how it is going to proceed.
Barbara Sonnenburg said assuming that we have four new committees at our next subcommittee meeting. We are going to need four chairs and the corresponding co-chairs. Ms. Sonnenburg made a motion that we modify the bylaws to change the selection of the subcommittee chairs from Dr. Davidson to the entire group by nomination and vote. Ms. Sonnenburg added that she does not even want it voted on tonight. However, Dr. Davidson responded this is something that does not even require a vote because when the body that is responsible for making a modification to the constitution, that group should make the modification and bring it back to the subcommittee to vote on. She clarified you do not have to ask the subcommittee if you can make an amendment or a change to your constitution. That is a responsibility of the Guidelines and Procedures Work Group; therefore they should come back to the subcommittee with the exact wording of the modification to be voted on.
Pete Malmquist asked isn't the motion to table on the floor and it has been seconded. Dr. Malmquist said if he remembers correctly the motion to table is not debatable. Call the question.
Dr. Davidson apologized and recognized the motion to table the recommendation was moved and seconded. The recommendation was tabled with nine in favor, five opposed.
Continuation of Work Group Reports/Discussion/Recommendations
Karen Galloway continued with recommendation number three. "ATSDR should provide a technical facilitator to assist ORRHES at future subcommittee meetings and highly technical and/or sensitive discussions. ORRHES should have input in selecting potential candidates for that position."
James Lewis said there was a good example of that in the meeting last night. He explained last night we brought in a facilitator to handle what we thought was going to be a pretty contentious meeting. However we did not get to the meat of the technical issues, there was not a lot of need for a facilitator. When you have meetings with sensitive issues, we need to have the capability available to us to bring in these individuals that understand what is going on that can assist in explaining the issues to us. This depends on the meeting and how it is being handled. Mr. Lewis said he thinks the committee is making some improvements but we need someone that helps the lay public to clarify the issues and facilitates issues on their behalf.
Tony Malinauskas said the Chair really acts as the facilitator of our ORRHES meetings. Dr. Malinauskas said he sees no need for a Chair and a facilitator for meetings such as this. Bob Craig added DFO as well. Dr. Malinauskas said he takes an exception to the statement that our meetings are getting more contentious; he thinks they are getting more collegial. He said the fact that you disagree with me does not mean I am being contentious.
James Lewis said sometimes we get bogged down on procedural issues and a facilitator can help us work through some of these things. When you have a good facilitator they get involved early in the game, they figure out what is going on and they know the issues and they move this kind of stuff forward. We need this to move us along so we are not sitting here arguing whether technical or just for meeting management.
James Lewis made the motion to have the ability to have a technical facilitator for key issues. Susan Kaplan seconded the motion.
Pete Malmquist commented that he thinks the problem with technical issues is that the speaker is either not prepared or is not a very good speaker and we get lost. He thinks if the speaker knows what they are talking about and can present it in an orderly fashion and in a language that this committee can understand then there is no problem. If the speaker cannot do that then ATSDR was poor in providing that speaker. Dr. Malmquist said a facilitator is just going to add to the confusion. When is the facilitator going to speak? Is the facilitator going to interrupt the speaker? Dr. Malmquist asked that the committee does not pass the motion.
Peggy Adkins asked Kowetha Davidson if this recommendation would lighten her load in any way. Dr. Davidson said no because she still has to stay focused.
Charles Washington said he is inclined to agree that in some cases the committee needs a facilitator because many times the person giving information and presenting the information on we are going to vote on has a biased view or has incomplete knowledge. Too often that view is presented to the entire board. On the other hand a facilitator will present an unbiased opinion, both pros and cons regarding whatever technical issue you are voting on. Mr. Washington said this is what we have not been getting in the past.
Don Box suggested the same thing is going to happen with this motion as the two previous ones. We are requesting a facilitator, but we need to define what we want a facilitator to do. He suggested the committee postpone this vote until the next meeting and the group should come back and delineate exactly what functions a facilitator would serve and when they would step in at our meetings. Mr. Box said he did not think we could vote on this until we know more about these issues.
Mr. Box made the motion to table this recommendation (#3) as well. Ms. Sonnenburg seconded the motion. The recommendation was tabled with nine in favor, five opposed.
Continuation of Discussion
James Lewis remarked that Bill Taylor has done an excellent job in helping our work groups facilitate a number of meetings that we have had. We have seen this talent that brings us together and believe that same type of talent and understanding of our problems needs to be brought to ORRHES. Mr. Lewis said this is what we have seen, there is a comfort zone there, and we are looking for more involvement in that particular area. We see that people are willing to go talk to him and share information. He is familiar with the issues and he may be able to summarize it and present it in a way where we do not waste all our time here. What we are getting at is when we do not use that kind of expertise, you are wasting your time and money and we are tired of that too. Mr. Lewis said he thinks most people around the table, from the technical and lay side, have enjoyed working with him and suggested the committee needs to use him when it has contentious issues and he might be able to help bring the committee together. This is what we would like management to look at and see how they can factor that in, whether it is a recommendation or not.
Jerry Pereira said hopefully the nomination packets for approval of all the current members will be going Dr. Falk. Mr. Pereira said we are holding our breath for approval and he does not think the worry is with Dr. Falk approving it, but he does have some concerns with HHS and their overall track record of late, in terms of approving existing members. Mr. Pereira said our ace in the hole is our presentation in terms of our approximate sunset timeframe and that it would make no sense to try to bring on almost a whole group of new members. He said he did not know where it might go or how much success they would have, but ATSDR would keep the subcommittee posted.
Herman Cember asked when is the projected sunset. Mr. Pereira said sometime in 2006.
Mr. Pereira stated the PHAWG (or the new group) will really have their hands full between now and the August meeting. He noted K-25, the TOSCA Incinerator, groundwater, and probably iodine will be discussed in PHAWG. Not necessarily in one meeting, but between now and August those are the health assessments that are on the table. The health assessors that are respectively working on those would be or should be presenting some portions of that information to the PHAWG as we go along. Mr. Pereira reiterated Dr. Charp would not be here in August but assumed he would make some sort of presentation to PHAWG on iodine.
Mr. Pereira said ATSDR is still working on a replacement for Melissa Phish (sp?) in Bill Taylor's office. He noted they should have the finances to do a backup on that and are meeting this week. Mr. Pereira said they did not have any people to look at yet, but it should happen soon.
Herman Cember asked Mr. Pereira if the groundwater involved radioactivity only or will it involve trichloroethylene or other contaminants. Bob Craig answered that it was all of the above. It is everything in the groundwater.
With that Kowetha Davidson declared the meeting adjourned at 6:22 p.m.