Community Concerns and Communications Work Group
Community Concerns and Communications Work Group
January 25, 2005 - Meeting Minutes
ORRHES Members attending:
George Gartseff (Chair), Peggy Adkins, Kowetha Davidson, David Johnson, and James Lewis
ATSDR Staff attending:
Loretta Bush (phone), Marilyn Palmer (phone), Bill Taylor, and Maria Teran-MacIver (phone)
DOE Staff attending:
Public Members attending:
Barry Adkins, Beau Camia, Demi Camia, Richard Gammage, Susan Gawarecki, Roger Macklin, and Lynne Roberson (phone)
TA Consulting, Inc. (contractor):
Liz Bertelsen (phone)
George Gartseff called the meeting to order at 5:40 p.m. The purpose of the meeting was to 1) discuss the Agency for Toxic Substances and Disease Registry's (ATSDR) Web site redesign, 2) receive an update on the Y-12 Uranium Public Health Assessment (PHA) video, and 3) talk about the agency's plans for outreach activities in Oak Ridge. George Gartseff noted that there were minutes from the October 27, November 9, November 16, and December 21, 2004, meetings that were not yet approved. Bill Taylor had not received feedback or suggested corrections, and therefore, he assumed that the minutes were fine. Mr. Gartseff approved the four sets of meeting minutes.
During the last CCCWG meeting, George Gartseff explained that there was a discussion about various recommendations made by predecessor work groups that had been passed to ORRHES. According to Mr. Gartseff, people were concerned that these recommendations were never addressed. In response, he said that Bill Taylor, Marilyn Palmer, and other ATSDR staff have been working on agenda items to respond to their questions.
Oak Ridge Web Site Redesign
Presenter: Marilyn Palmer, ATSDR
Marilyn Palmer provided the group with a Web site redesign status report, which Wilma López and Susan Robinson from ATSDR's Division of Health Education and Promotion (DHEP) had prepared. Ms. Palmer explained that the agency missed its "target date" of launching the Web site in January 2005. She explained that Ms. López has been spending a significant amount of time converting the files from the old Web site and sending the files to ERG to post them onto the new Web site.1 ATSDR's goal is to have the site launch at the March 22, 2005, ORRHES meeting. Ms. Palmer said that Ms. Robinson and Ms. López were tentatively scheduled to work with the CCCWG and conduct "usability testing" prior to the ORRHES meeting.
Before the September 2004 meeting, Marilyn Palmer said that they had asked for comments and questions regarding the Web site. Wilma López and Susan Robinson received few comments on the navigation and scenario testing, and wanted to conduct more testing with the March launch. Ms. Palmer added that CDs have been burned of the old Web site because they do not want to delete the material on the old site before having the new site fully operational.
James Lewis thought that Susan Robinson had done an "excellent job" when she presented to the CCCWG. He said that she had created a Gantt chart that outlined the tasks that would be undertaken for the Web site, and added that this was something they had asked "all other groups to do." He wondered why they had not reflected the "slippages" on the Gantt chart and identified the weaknesses.
James Lewis asked if the approved minutes would be posted onto the new Web site. Marilyn Palmer said that the minutes approved during this meeting would be forwarded to ERG to post onto the site. He specifically asked, "When was the Web site last updated with minutes?" Ms. Palmer did not have the Web site up, and was unable to answer Mr. Lewis's question. Bill Taylor did not know the answer either. Mr. Lewis wanted an answer by their next meeting; he questioned how long people have had to wait to obtain this information. He believed that they needed a "corrective action plan" instead of creating a goal because the agency's "goals keep changing" and ATSDR "never has a line in the sand on anything here." He said that it would be helpful to have a presentation during the next meeting on what they are doing, "where they are," and "what's going on."
Kowetha Davidson asked if ATSDR was continuing to update the old Web site while preparing the new site. Marilyn Palmer said that the agency was not updating the old site.
George Gartseff asked if anyone in the room used the Web site, and if so, when he or she last used the site. James Lewis said that he has not used the site for a long time, but that individuals have asked him, "What's going on?" He explained that people have stopped looking at the site because it has been inactive, which was "not our problem." He said that this was a "deficiency that should be noted as it relates to its impact on the public." Mr. Gartseff said that this might not be a tool that they use everyday, but that community members might be interested in using the site. As Mr. Gartseff learns more about past events, he said that it is apparent that the "need for timeliness" is a "continuing issue." Mr. Lewis wanted a formal explanation detailing why this had ceased.
Kowetha Davidson asked James Lewis about his use of the word "cease." She said that ATSDR is creating a new site, and is not updating the old site. Because the public has no access to the new site, she noted that there is no mechanism to put the minutes onto the current site. Mr. Lewis replied that "reasonable people" do not "shut down" because they are working on other things. He thought that it made sense to keep the old site operating.
David Johnson asked if they should request a formal explanation from ATSDR. George Gartseff said that the new site would be presented at the ORRHES meeting in March 2005, and therefore, making a recommendation could be a "moot point." Mr. Gartseff preferred that ATSDR noted these comments and was prepared to provide answers when the site is launched in March. Bill Taylor said that the comments were noted.
Susan Gawarecki would find it helpful to have the minutes on the Web site, as she cannot open the attachments with the minutes and meeting agendas. Bill Taylor asked if anyone else had this problem, and if so, to let him know. ATSDR is looking into the problem.
James Lewis said that the "public is interested in what we're doing" and he thought that the community should be aware of their efforts. He believed that it was a weakness that they were not publishing their "hard work." He thought that this was a "problematic breakdown that needed to be looked at."
Y-12 Uranium PHA Video
Facilitator: Marilyn Palmer, ATSDR
Marilyn Palmer said that she had seen the video last Thursday, and that Bob Safay (ATSDR) had showed the video to several ATSDR staff members today. He had obtained additional film footage by working with Tim Joseph, who helped Mr. Safay obtain more photographs and aerial footage. Mr. Safay received referrals for people to interview as well. In her opinion, Mr. Safay had done an "excellent job" in capturing the concerns and comments expressed by the CCCWG. She believed that Mr. Safay planned to show the video at the next CCCWG meeting. Also, she said that he has looked at footage from some of the past ORRHES meetings when the Y-12 document had been discussed.
Loretta Bush said that staff and management had reviewed the three sections of the video that day. She believed that Bob Safay received positive feedback and some suggested changes. She stated that Mr. Safay would present at the next CCCWG meeting to obtain feedback from the work group before presenting the video to ORRHES. In addition, Ms. Bush said that there was some discussion regarding clearance from ATSDR management. The plan was to show the video to top-level management, including Henry Falk and Tom Sinks. She added that Mr. Safay planned to attach a survey to the DVD to obtain feedback.
DiscussionGeorge Gartseff asked Tim Joseph about the content changes that were made. Dr. Joseph said that he had made some changes to the script long ago, but could not provide specific details.
James Lewis asked for a specific purpose of the video. Marilyn Palmer replied that Jack Hanley and Bob Safay had discussed this during the November 2004 CCCWG meeting. She said that the video is another tool that ATSDR can use to reach the community and to explain ATSDR's activities. The video will also explain the PHA process and the findings of the Y-12 PHA. Ms. Palmer explained that the video has three main parts that: 1) discuss the PHA process, 2) provide general terms and findings of the PHA, and 3) present more scientific details, including charts and graphs. Bill Taylor added that the Y-12 PHA is the primary subject matter, but that the video would be in different parts to reach different audiences. Loretta Bush said that the video totaled 34 minutes.
George Gartseff noted how Bob Safay had explained that he was basically preparing the video on his own time. He asked if the process had changed and if ATSDR's technical staff was more involved in the project. Bill Taylor explained that the agency has a formal process for all ATSDR products, and therefore, the video has to go through ATSDR clearance. Mr. Gartseff asked about the level of involvement from ATSDR in Atlanta. Marilyn Palmer replied that Mr. Safay is working with Jack Hanley to ensure that the video statements and facts are accurate. Mr. Gartseff asked if Mr. Safay was prepared to show the video at the next work group meeting. Ms. Palmer said that this was correct.
David Johnson asked if the video would be produced "DVD-style" with different options depending on people's levels of interest. Marilyn Palmer explained that the video would contain menus for people to select. Ms. Palmer had told Bob Safay that if she had no prior knowledge of the site, she would be well informed after watching the video.
George Gartseff asked how long the clearance process would take after they view the next version. Loretta Bush said that the process varies, and that management would decide who needed to see the video. She noted that the information contained in the video was already approved. However, Ms. Bush said that because ATSDR considers the Oak Ridge Reservation (ORR) a "high profile site," it has to undergo a more in-depth clearance process. Bill Cibulas (ATSDR) wanted Tom Sinks and Henry Falk to see the video. Once Mr. Safay makes the changes suggested today, he would set up a time to show the video to Dr. Falk and Dr. Sinks. In addition, the Office of Communications, including the Public Affairs Office and Media Relations, would have to review the video. Ms. Bush anticipated the process taking a couple of weeks to a month or longer.
George Gartseff asked if Loretta Bush was involved in the clearance process. She replied that all staff who produce materials have to go through the agency-wide clearance process. She said that Bob Safay, and probably Jack Hanley, would be responsible for ensuring that the proper paperwork is completed and sent to the necessary individuals. Tim Joseph noted that Bob Safay would also have to contact him. Mr. Gartseff thought that the clearance process sounded potentially lengthy. He noted that the Y-12 PHA has already been out for a year, and he believed that "timeliness is important." He said that after the process has been completed, they would have a "nice video tool of old information." He encouraged Loretta Bush to expedite the process as much as feasible.
Tim Joseph reminded Marilyn Palmer that he needed a copy of the video before it could leave the agency. He said that the aerial footage has to go through the U.S. Department of Energy (DOE) classification before it can be released. James Lewis said that he would not "gamble" on this and that Dr. Joseph should send a letter to ATSDR. Dr. Joseph disagreed and replied, "I trust ATSDR." After Bob Safay showed the video to Henry Falk and Tom Sinks, Ms. Palmer asked if she could send a copy to Bill Taylor for Dr. Joseph to review. Dr. Joseph said that this was alright, but that the video could not stay in the office for review until DOE approved the aerials.
James Lewis suggested having the video in the Oak Ridge Field Office so that people could view the video while still under ATSDR's control. He believed that they would lose input if they only showed the video on one night.
James Lewis asked if ATSDR would show the video to other agencies, such as the U.S. Environmental Protection Agency (EPA). Marilyn Palmer thought that this was a "great point," and said that she would discuss this with Jack Hanley and Bob Safay.
Kowetha Davidson did not think that the video should be released to the general public until ORRHES had reviewed the product. George Gartseff said that if the video was presented at the ORRHES meeting, then public members might attend. Dr. Davidson believed that the general public should not view the video before ORRHES. She realized that the work group would be seeing the video during a work group meeting.
James Lewis explained that people like to make sure that their comments are captured. He said that if these minutes are not on the Web site, it creates "weaknesses and deficiencies." Kowetha Davidson asked if James Lewis wanted ATSDR to wait to produce the video until the meeting minutes were posted onto the Web site. Mr. Lewis said that he was telling ATSDR that if the agency had challenges, then it needed to acknowledge the reasons for these challenges. He added that everything should be "up to speed" and that the gaps, which he believes have existed, should not have been allowed.
Marilyn Palmer wanted to clarify James Lewis's request. She asked if he wanted to make sure that the November CCCWG meeting minutes were on the Web site so that the group could ensure that all its comments were reflected in the video's changes. Mr. Lewis said that this was one part of his request, but that there may be others. He said that people needed "something to put their hands on." Ms. Palmer noted that they needed to speed up the process to put the material on the new site if it is not on the old site.
George Gartseff asked if other work groups were meeting around the time that they would like to meet with Bob Safay. Bill Taylor said that the Exposure Evaluation Work Group (EEWG) would likely meet on February 14, 2005. Mr. Gartseff said that the communications portion of the video was under the purview of the CCCWG, but that the health assessment portion was under the purview of the EEWG. After Tim Joseph receives DOE approval of the video, Marilyn Palmer suggested sending a copy of the video to the Oak Ridge Field Office so that the EEWG could watch the video during its February 14 meeting and the CCCWG could view the video on February 15. Ms. Palmer said that she and Dr. Taylor would discuss these dates with Tony Malinauskas (EEWG Chair) and Bob Safay.
Physician and Community Education Related to the Cancer Incidence Study
Presenter: Maria Teran-MacIver, ATSDR
Maria Teran-MacIver explained that the purpose of this education was in preparation of the cancer incidence study. She said that people will want to go to their physicians after the study is released. Therefore, physicians need to be prepared to answer questions about radiation effects on health. In addition to physician sessions, ATSDR also plans to have two evening community sessions with the doctor.
Maria Teran-MacIver said that ATSDR plans to have Robert Brent, M.D., Ph.D., D.Sc. (Hon), give a presentation to area physicians. He is a Distinguished Professor of Pediatric, Radiology, and Pathology at Thomas Jefferson University, A.I. DuPont Hospital for Children, in Wilmington, Delaware. Dr. Brent was recommended by Herman Cember (ORRHES) and Paul Charp (ATSDR), who have both heard him give presentations. Dr. Brent has experience in explaining radiation effects on health, particularly with children, and he is highly recruited throughout the country to make presentations on radiation effects.
Maria Teran-MacIver stated that Robert Brent will make one presentation to physicians and two presentations to the community. ATSDR will also ask to videotape Dr. Brent so that the tapes can be made available. ATSDR has slated Dr. Brent for April 18 and 19, 2005. ERG will contact a local hospital to reserve a time and place for Dr. Brent's presentation. ERG will then mail out invitations to the physicians on the mailing list, which ERG compiled based on physicians located within the eight counties. Ms. Teran-MacIver noted that physicians with cardiology and other non-related specialties would probably not receive invitations, but general practice physicians, internists, oncologists, and pediatricians would be included.
Maria Teran-MacIver is in the process of applying to the CDC for Continuing Medical Education (CME) credits. ORRHES will provide input on the site and time of the two community education sessions; one will be held in Oak Ridge and one in Kingston. ATSDR can have more sessions later, but these are the activities scheduled at this time. A flyer and other meeting materials will be completed by the week of March 7, 2005.
Susan Gawarecki asked why ATSDR believed that people would go to their physicians following the release of the Cancer Incidence Study. Maria Teran-MacIver replied that one of the recommendations of the study indicates that people will speak with their doctors when they are worried about an increased incidence of cancer.
Based on the state statistics that she has seen, Susan Gawarecki said that Roane and Anderson Counties had lower incidences of cancer than major metropolitan counties. Maria Teran-MacIver said that this was probably true, but that she did not know all of the study's findings at this point. Bill Taylor said that ATSDR has not completed its particular analysis at this time and added that there will probably be some incidences of cancers that are elevated and some that are lower when compared with the state.
Kowetha Davidson asked if the county data were compared to Nashville or Memphis. Bill Taylor said that the data would not be compared to those metropolitan areas. Maria Teran-MacIver added that the data would be compared to the state of Tennessee.
Susan Gawarecki asked if ATSDR planned to use other data that the state has collected. Bill Taylor said that they would not be using other data for this analysis. Maria Teran-MacIver believed that the data were all from the Tennessee Cancer Registry.
James Lewis recalled that originally, they discussed looking at the plumes, using data at the census tract level, and evaluating cancer in certain areas. He added that, "Nothing has been clearly delineated." He said that they should anticipate some challenges if they keep the data at the county level. Once the Cancer Incidence Study is released, Maria Teran-MacIver said that ATSDR will conduct small group education on the findings, Dee Williamson will make a presentation, and ATSDR will have more follow up activities.
Kowetha Davidson believed that the ORRHES recommendation did not discuss the plumes. She said that Brenda Vowell (Tennessee Department of Health [TDOH]) had indicated that the state would not allow ATSDR to evaluate data based on small census tracts because this would violate individuals' privacy. James Lewis said that it had been discussed later that data could be provided at that level. Dr. Davidson said that this was not what ORRHES requested.
Bill Taylor explained that cancer data can be requested at the census tract level. However, ORRHES recommended that ATSDR look at the selected nine counties separately and compare those data with the state as a whole. In addition, ORRHES requested that ATSDR conduct an aggregate comparison of 49 census tracts from those nine counties with the state as a whole. The area of the 49 census tracts was selected by ORRHES. This was also Kowetha Davidson's understanding. She said that other discussions might have transpired in work group meetings, but that this was the request from ORRHES.
James Lewis said that they needed to be concerned with the public's interests. He thought that ATSDR would have looked at the areas of concern, the wind direction, and the plumes. If this was not the case, then he thought that someone needed to "write it out and explain it and say it." He believed this was a potential issue. George Gartseff believed that the "notion of plume" originated when they were designing the areas of concern. In broad terms, he said that this was the "downwind, downstream area of ORR." Mr. Gartseff recalled Dee Williamson presenting that she had to deal with many confounding factors, including technical and legal factors. He noted that privacy cannot be preserved with some individual census tracts. Mr. Lewis said that they had taken this into account. He added that Susan Kaplan had found an article in Memphis that looked at three census tracts. He questioned why the state could do this in Memphis, but not in their area.
Susan Gawarecki asked if the Cancer Incidence Assessment would breakdown the incidences of cancer into types. Bill Taylor said that this was correct.
Susan Gawarecki was "uneasy" that ATSDR was identifying radiation as a cause of cancer when exposure to low-level radiation has not been shown to result in observable health effects. She said although radiation can cause cancer, it is considered a "rather weak carcinogen compared to many chemicals." She believed that making this association would "perpetuate a myth about radiation." Maria Teran-MacIver said that Herman Cember and Paul Charp recommended Robert Brent because of his radiation expertise. Dr. Gawarecki questioned why radiation and cancer were being linked. She added that some incidences of cancer, such as thyroid cancer, are slightly correlated with radioactive iodine, but other cancers have no known correlation to radiation.
Kowetha Davidson stated that ATSDR was not trying to link specific cancers in its study. She said, "Radiation is one thing that people have been exposed to that has the potential to cause cancer." Susan Gawarecki said there are much stronger carcinogens, such as smoking. She asked why ATSDR was pursuing this when the Oak Ridge Dose Reconstruction indicated that hardly any dose exists. George Gartseff said that ATSDR's "intent is not to link radiation and cancer." Dr. Gawarecki said that, "You have linked it!" Mr. Gartseff explained that this was "not a cancer due to radiation study." He said that this was a corollary study that deals with the general incidence of cancer in this area, which was all prefaced on early community concerns expressed to ORRHES. He stated that they wanted the agency to establish the baseline of cancer in this area.
Maria Teran-MacIver said that ATSDR could also have someone talk about environmental contaminants and cancer at a later date.
Susan Gawarecki asked what would happen if ATSDR found no significant increase of cancer incidence. She wanted to know if the agency would cancel its plans. Kowetha Davidson replied that this would not stop people from being concerned.
James Lewis said that if ATSDR had put this into the PHA, then they would not have to discuss it now. He said that the University of Tennessee indicated that this was the foremost issue, but it was not explained. He said that the public requested that ATSDR collect the data, present the data, and explain the data.
Peggy Adkins asked if the 1975 cancer data were used. Bill Taylor believed that it was 1990s data. Ms. Adkins said that this "won't show anything" because of the number of people who have moved into the area since regulations were tightened. She believed that they could only create an "accurate picture" if they evaluated data for people who lived in the area during the 1940s and 1950s. However, from her experience, most of these people are deceased. Bill Taylor said that cancer registry data dating back that far do not exist. Dr. Taylor explained that ATSDR is looking at these data because people were interested in what the available data show.
Susan Gawarecki said that Oak Ridge has a "good population" of people who have lived there since the Manhattan Project. She added that cancer data are age-adjusted, and therefore, a high incidence would be detected. She did not believe that they would find anything; Peggy Adkins said that they would not find anything by looking at 1990s data. Dr. Gawarecki explained that cancer takes many years to develop. Kowetha Davidson added that when dealing with cancer, you are usually looking at low-level exposures that occurred over a long period of time.
George Gartseff hoped that Robert Brent's presentation would also focus on some of the existing realities. He noted that Dr. Brent was an expert who could provide recent information and put the data into a "proper perspective." He said that they have discussed the epidemiologic flaws for over a year, as well as the risks involved with giving a presentation containing this type of information.
Susan Gawarecki said that they needed to look at any cancers that have higher incidences, and ask about the factors that cause those types of cancers. She said that every cancer is a different type of disease, and that not all of these cancers would be caused by radiation. She said that ATSDR needed to determine the cancers with a higher incidence, and then at that point, plan for experts to come and discuss what might cause those particular cancers in the community. She believed that this was a better direction to take for "proper outreach" efforts instead of "assuming upfront that it's radiation-related." George Gartseff responded that, "We've not assumed that up front." Dr. Gawarecki said that all of their outreach efforts were centered on radiation. Mr. Gartseff said that she was incorrect; they were looking at the incidence of cancer.
George Gartseff explained that ATSDR is releasing several PHAs that deal with health effects of radiologic contaminants. He said that some people will make this link, and that they have to be prepared to answer the community's questions and put the information into the "proper perspective." Susan Gawarecki hoped that this would occur, but believed that the plan looked as though they would be focusing only on radiation. Kowetha Davidson suggested changing the way that they introduce the continuing education. To respond to Dr. Gawarecki, James Lewis said that they originally looked at available health outcome data. He said that they tried to "push ATSDR to look at all health outcome data," but they found that the state only had "reasonable information" on cancer.
Susan Gawarecki believed it would be beneficial to have someone discuss how cancer incidence happens, such as the fact that it is typically age-related. Maria Teran-MacIver thought that Dee Williamson would include this in her presentation.
James Lewis said there is a "difference between telling and selling." He stated that the agency needed to "learn how to package it and sell it" and that if ATSDR did not "sell it," then the "myth will stay there." Susan Gawarecki added that it would be a challenge for ATSDR to put the data into terms that the "average person" would understand. George Gartseff agreed that the information should not "come across as presumptuous." He added that ATSDR had been hesitant about this study for this exact reason. Peggy Adkins noted that they did not want to be presumptive on the opposite end, and show bias that they do not believe any harm could have been done until the "science proves otherwise." She continued that "people feel they've been lied to." She said that her mom was 1 of 14 women who died on her street. From her experience, Ms. Adkins thought that all women died in their 50s until she moved to Georgia, where she saw women who lived beyond age 52. She added that ATSDR has "a lot of convincing to do."
Kowetha Davidson explained that this request was a result of Toni Bounds's presentation about the state's cancer registry. As a result, ORRHES asked ATSDR to present the data on different types of cancer from the registry for this area.
Marilyn Palmer asked if she could provide Susan Gawarecki's number to Maria Teran-MacIver so that Dr. Gawarecki could express more of her concerns and suggest other potential presentations. Dr. Gawarecki said that she would be "happy to talk to her." Ms. Palmer also commented on James Lewis's statement about needing to "package the science." She wanted to bring sample flyers to the CCCWG when they are developed to obtain their feedback. ATSDR also wants to collect questions from the community for Robert Brent to respond to during his public forums. She added that Dr. Brent is only "one source of education" that ATSDR plans to carry out in the community.
James Lewis said that the way in which ATSDR presents the information will determine the community members who attend. If ATSDR uses technical language, then a large portion of the population will not grasp the concepts. He added that education is important to him. He wanted to know, "What are we educating them on?" and "What for?" He believed that physicians already understood this information, but noted that they have not done a "good job" of educating people within ORRHES or disseminating information to the community. He was unsure why ATSDR was educating physicians.
Kowetha Davidson said that this was brought up in an ORRHES meeting. Marilyn Palmer explained that on a couple of occasions, people have expressed that no information exists in doctors' offices to explain ATSDR and its health findings. She added that Robert Brent would tailor his presentations to answer the public's questions. James Lewis said that Herman Cember had discussed this issue with Karen Galloway 18 months ago. He added that there is "nothing new about this." He said that they received "excellent presentations," but no follow up ever occurred. He said that there is "nothing out there for the general public to grasp and understand." Dr. Davidson asked if Mr. Lewis was suggesting that ATSDR cancel the presentations.
Tim Joseph suggested possibly separating the physician and public education. He asked how ATSDR proposed to draw the physicians into the hospital. Maria Teran-MacIver said that ERG developed a mailing list of physicians in all eight counties. Dr. Joseph asked if ATSDR had conducted this type of presentation before. Ms. Teran-MacIver was unsure. She said that physicians will come to the presentation to listen to an expert and if they offer CMEs. Dr. Joseph thought that they should assess the tools that they could leave in physicians' offices in case a patient inquires about radiation. Kowetha Davidson stated that you have to educate the physicians on the materials that you give to them. Dr. Joseph had his doubts, but he was "all for it" if ATSDR could reach a large number of physicians. Ms. Teran-MacIver could send out a tool inquiring if physicians would be interested, and proceed with the presentation accordingly.
George Gartseff was hearing that Robert Brent should also discuss the PHA process and why he is there to present. Mr. Gartseff thought they could possibly work with the Health Outcome Data Work Group (HODWG) to prepare flyers and other information.
Roger Macklin said that ATSDR should schedule experts in environmental toxicology to address chemical carcinogen issues, and recommended possibly having this expert prior to Robert Brent's presentation. Tim Joseph believed that this was a "very good suggestion" because it is well known that exposure to chemical carcinogens can result in a higher frequency of cancer than radiation.
George Gartseff asked when the Cancer Incidence Study would be released. Bill Taylor said that this was unknown. Mr. Gartseff asked if it was premature to plan a presentation in April 2005. Loretta Bush said that Dee Williamson was currently in the process of finding someone in TDOH to validate information. Although it was previously thought that the study would be released in April, Ms. Bush said that this would probably be "pushed back a couple of months." Mr. Gartseff asked if this meant June or July. Ms. Bush said that there has been a change in staff at TDOH, and that Ms. Williamson was having a difficult time finding individuals. If she has not already, Ms. Williamson planned to speak with Brenda Vowell to help her find the correct contact within TDOH. She anticipated a May release for Ms. Williamson's study.
Loretta Bush said that the communication plan was submitted to Dee Williamson, and Ms. Bush incorporated Ms. Williamson's suggested changes. Ms. Bush and Maria Teran-MacIver planned to meet with Ms. Williamson tomorrow to go over the changes based on Ms. Williamson's comments. The plan will then undergo an ATSDR Oak Ridge Site Team review. Once Ms. Bush receives feedback from the site team, the plan will go to the CCWG for review, and then it will be presented to ORRHES (hopefully at the March 22, 2005, meeting). Bill Taylor said that they do not have all of the data. Ms. Bush replied that this was correct, but that the CCCWG had requested a plan of how information would be disseminated, who would receive the information, a time line of the plan, and other details. She said that the plan would be missing pieces of information, which would be incorporated after the study's completion.
George Gartseff asked if Maria Teran-MacIver's physician and community education was part of Loretta Bush's communication plan. Ms. Teran-MacIver replied that it is the education portion of the plan. Mr. Gartseff thought that the sequence and timeliness of Robert Brent's presentation might be premature. Ms. Teran-MacIver said that they had thought it would be beneficial to educate physicians prior to the release of the Cancer Incidence Study so they would be prepared for any questions that arise. Mr. Gartseff asked ATSDR to look at this carefully so that the information is still timely once the study is released. He asked if agreements had been signed with Dr. Brent. Ms. Teran-MacIver said that this was a tentative schedule. Mr. Gartseff asked ATSDR to keep this discussion in mind before confirming Dr. Brent. He said that they should not have an expert come and then have the report released 2 or 3 months later. He said that instead of answering the community's questions, this would result in creating controversy.
James Lewis said that when speaking to Herman Cember, Dr. Cember indicated that most people are interested in birth defects. Mr. Lewis said that this was where they had started. He added that he was surprised with "the way this is being presented." Maria Teran-MacIver noted that in addition to cancer, Robert Brent can also speak about birth defects.
George Gartseff wanted to ensure that Robert Brent's presentation was appropriate for the material being released at that time. Kowetha Davidson noted that they needed some "lead time" to plan for Dr. Brent's presentation in advance.
George Gartseff said that he has heard much discussion on the steps that ATSDR needs to take before these plans can be delivered to the public. With this knowledge, he said that ATSDR is capable of planning public presentations in relation to when these studies come out in order to have the "optimal effects." He said that they keep hearing "delay, delay, delay." He wanted ATSDR to evaluate what is needed to complete the various products, and then work to a planned schedule.
James Lewis thought that Dee Williamson had said that she was "ready to go" with the county-level data, and that she had everything reviewed and had received approval. Mr. Lewis said that someone noted that she could obtain data by census tract, and then "everything went to pieces." Kowetha Davidson believed that the work group had suggested that Ms. Williamson go back and look at census tract data. Mr. Lewis did not disagree with Dr. Davidson, but his point was that they had requested this initially.
Maria Teran-MacIver asked if the group wanted her to check on "how close" the study was to being released before setting the date for the physician education. George Gartseff responded that it was not just "how close," but also that Loretta Bush had a communication plan that they had not seen yet. If they had constructive comments to make, then he wanted the CCCWG to have this opportunity. He thought that ATSDR needed to figure out the "best times, places, and content for these public presentations relative to the PHAs and the Cancer Incidence Study." Kowetha Davidson thought that they should also have input on places; Mr. Gartseff thought that this was a good point.
George Gartseff was aware that ATSDR was making these efforts to respond to their suggestions, but he wanted the activities incorporated into the communication plan as appropriate. Kowetha Davidson asked if the group preferred to have the education portion before or after the study was released. Mr. Gartseff thought that it would be best to have presentations after the study is released to ORRHES and it has been discussed among the subcommittee members, but before the study is released to the public. Loretta Bush believed that this would be a problem because, based on her direct conversations with Dee Williamson, Ms. Williamson planned to present the information to the ORRHES on the same day that the report is released to the public.
George Gartseff questioned that they would have no preview of the study before it is released to the public. Loretta Bush said that these were Dee Williamson's plans. Ms. Bush said that this is a Division of Health Studies product, and therefore, Ms. Williamson's management and clearance are completely different than for the Division of Health Assessment and Consultation. Bill Taylor stated that Ms. Williamson had agreed to share her results with the work group and then with ORRHES. He asked if the report would be shared with the work group. Maria Teran-MacIver also believed that Ms. Williamson did not intend to release the results until the study was released to the public. Dr. Taylor said that this was not Ms. Williamson's original agreement with the group.
Loretta Bush said that she has "gone back and forth with her on this." Ms. Bush said that she will clarify this issue with Dee Williamson tomorrow. She said that Ms. Williamson was concerned that the information would be released to the media. She explained that Ms. Williamson planned to share the report with ORRHES once it is released, and later that afternoon, the Office of Communications would submit its press release to the general public. Bill Taylor said that if this is the case, then Ms. Williamson has changed her plans and she needs to speak with the work group chair. Ms. Bush would ask Ms. Williamson for clarification during her meeting tomorrow. Marilyn Palmer suggested that Ms. Bush ask Ms. Williamson specifically if she plans to share the findings with Pete Malmquist's small Cancer Incidence Ad Hoc Work Group (CIAHWG).
James Lewis noted that they have had this same problem in the past. He said that they have "always asked to have a project manager" and "have screamed" for one. He asked, "Where is our project manager?" He said that they run into these conflicts because the divisions and branches do not get along, and consequently, the public suffers.
George Gartseff suggested that Marilyn Palmer have Jerry Pereira (ATSDR) become involved with this issue and check the minutes to see how the agreement was worded between Dee Williamson and the group. Mr. Gartseff explained that everyone had understood that Ms. Williamson would share her findings of the report with ORRHES before it was released to the public. Ms. Palmer understood the work group's frustration because this has been a yearlong project, and specific promises have been made.
Kowetha Davidson explained that Dee Williamson was always concerned about the results of the report being released to the public without her having a chance to explain the study. Dr. Davidson remembered that the plan was for a small, select group of people to review the study at the field office.
George Gartseff said that the main point is that ORRHES had planned to review the study and discuss the report with Dee Williamson prior to its public release. He noted that the Ad Hoc Work Group is a subset of ORRHES. Loretta Bush asked if this was a different group than the one that Kowetha Davidson described. Marilyn Palmer said that Ms. Williamson promised to share the results with the CIAHWG. Dr. Davidson did not want the terms of ORRHES to be confused. Ms. Bush said that she would confirm with Ms. Williamson tomorrow that she still planned to share the results with the CIAHWG only.
James Lewis said that they have a "lack of communication" because the CIAHWG decided it would work on the communications of the technical portion of the study, but did not work out the logistics with the CCCWG. George Gartseff said that Pete Malmquist has been involved with the technical aspects of the Cancer Incidence Study since the beginning. He did not believe that there was "as big a disconnect" as Mr. Lewis suggested. Mr. Gartseff believed that they needed to look at the overlaps between the different work groups and handle them accordingly.
David Johnson pointed out that, since Pete Malmquist's committee became involved, TDOH has selected a different chair. He believed that this "denotes a change in styles, commitments, and priorities." He thought that they should create a recovery plan in case the initial plan is not successful. George Gartseff asked if Mr. Johnson wanted to have a contingency plan or wait to develop a recovery plan. Mr. Johnson believed that these could be developed simultaneously, but he hoped they were unnecessary.
Bill Taylor introduced a visitor at the meeting, Beau Camia, and asked if Mr. Camia had any comments. Mr. Camia thought that there was "stuff going on with radiation" and he had "seen how it affects Peggy [Adkins] with metal poisoning." He said, "Peggy Adkins has some metal poisoning that came from well water in her neighborhood and it's affecting her real bad and he hasn't heard much being done about that."
James Lewis said that it was "interesting" to him that they had discussed the recommendations to DHEP at the last meeting, which he had thought would be the focus during this meeting. Marilyn Palmer asked if she should respond off line to Mr. Lewis since it was so late in the evening. George Gartseff agreed.
Kowetha Davidson said that ATSDR should prioritize its list of items that they would like to accomplish considering the staff and remaining time. She added that it is not beneficial to label something as a "high priority" if they do not have time to accomplish the task.
James Lewis said that if they had the support of the ORRHES chair when the "recommendation was on the table," then they "would be a lot further along than they are now." Kowetha Davidson told Mr. Lewis, "You are out of line." Mr. Lewis replied, "Then I am out of line, but I said what is a fact to me."
George Gartseff asked about the date for the next meeting, as he is no longer available on February 8, 2005. Marilyn Palmer suggested having the next meeting on February 15, 2005. Mr. Gartseff asked if meetings on February 15 and 22 would be alright with the CCCWG. He said that these would be the meeting dates unless Bob Safay is unable to attend on February 15.
George Gartseff adjourned the meeting at 7:50 pm.
After the meeting, Susan Robinson (ATSDR/DHEP) provided the following:
Factors in the Web Site Launch Delay
1. The DHEP project manager, Wilma López, presented a status of the Oak Ridge Web site redesign project to the ORRHES on September 14, 2004. During the review, members of ORRHES directed ATSDR to delay the launch. Members requested that the site be launched after additional content was added to the site, specifically the calendar of events and the committee and work group minutes for 2003 and 2004.
2. It took the ATSDR team from both Divisions from September through December 2004 to get this new content together (the minutes for 2003 and 2004). The team had difficulty confirming final versions of the minutes, due to the need to double-check versions and because some of the work group minutes had not been finalized. The first group of minutes was sent to ERG (contractor) for posting on the Web on December 29, 2004, the second on 1/03/05 and the third group on 1/18/05. A final set of minutes were identified on February 2, 2005 and sent to the contractor for conversion.
3. During the September ORRHES meeting, the ORRHES work groups were significantly reorganized. This change needed to be reflected in the content of the Web site. The team needed updated descriptions of work groups to insure the site was not out-of-date prior to launch.