Oak Ridge Reservation: Guidelines and Procedures Assessment Work Group

Guidelines and Procedures Assessment Work Group

May 10, 2004 - Meeting Minutes

Attendance

Members attending:
Karen Galloway (Chair), Peggy Adkins (phone), Don Box, Kowetha Davidson, David Johnson, Susan Kaplan, James Lewis, and Barbara Sonnenburg (phone)

ATSDR Staff attending:
Loretta Bush, Marilyn Horton, and Bill Taylor

ERG Contractor:
Liz Bertelsen (phone)

Purpose

Karen Galloway called the meeting to order.

The purpose of the meeting was to discuss various issues associated with the Agency for Toxic Substances and Disease Registry (ATSDR) and ORRHES, and to review, edit, and approve recommendations prepared to address these issues.

Discussion on Issues Related to ATSDR and ORRHES

Presenters: Karen Galloway, Susan Kaplan, and James Lewis

The presenters provided the group with copies of a timeline, agenda, and letter to fellow ORRHES members about the U.S. Environmental Protection Agency (EPA) issues regarding the Y-12 document. Karen Galloway explained that this meeting was being held as a result of events that took place at the last ORRHES meeting. She said that during this ORRHES meeting, Susan Kaplan had expressed concerns about the EPA issues and also "systemic issues" within ATSDR and ORRHES that were illustrated by the EPA issues. At the ORRHES meeting, Ms. Kaplan read a letter into the record, part of which was related to communications issues. Ms. Galloway explained that though these issues were related to communications, James Lewis did not want to chair the meeting in the Communications and Outreach Work Group (COWG) because he was "too close to the issues." As a result, the GPWG is addressing Ms. Kaplan's issues and concerns.

Karen Galloway read the following "charge to the work group:"

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.

Karen Galloway stated that at this last ORRHES meeting, Kowetha Davidson stated several times that she wanted to meet with Ms. Galloway and Susan Kaplan to discuss the issues assigned to the work group. However, according to Ms. Galloway, this meeting did not take place. Ms. Kaplan explained that she identified several issues and provided her comments to Dr. Davidson since she chairs ORRHES¹.

Karen Galloway referred to the recommendations prepared for the work group. She explained that prior to developing the recommendations, Susan Kaplan had prepared a case study that primarily addressed issues associated with EPA. The case study was attached to the agenda, as well as a downscaled timeline prepared by Ms. Kaplan that included extractions from a larger timeline provided to ORRHES members at the last meeting. Ms. Kaplan stated that she extracted quotations directly from past minutes to include in the timeline and that there was "no interpretation on her part."

Karen Galloway explained that she and Susan Kaplan evaluated and numbered the paragraphs from the case study, and then developed a table to identify actions that have or have not taken place, particularly in relation to EPA issues. These were attached to the back of the agenda provided to the work group. Ms. Galloway detailed that the middle column of the table contained the numbered paragraphs that linked to Ms. Kaplan's case study. She noted that this was not a complete summary; it was a brief example to identify items in the case study that were tied to the agenda. At this time, she turned the presentation over to Ms. Kaplan.

Susan Kaplan said that items for this agenda are issues that have been raised with ORRHES since its inception. She believed that there were "systemic problems" with how ORRHES was first established. She had always assumed that they were conducting business similarly to all other health effects subcommittees under ATSDR. However, she has spoken with members from the Hanford Health Effects Subcommittee (HHES), and they operated differently in some respects. For example, Ms. Kaplan said that the HHES does not have a two-thirds vote rule, whereas ORRHES uses a two-thirds vote in its proceedings. She said that this "drove her crazy," and that the "status quo is easy, change is hard." Ms. Kaplan thought that people who wanted to change something had to work much harder than people who did not want change anything. She encouraged people to read the case study because it illustrated procedures that needed to be changed and issues that needed to be addressed. Ms. Kaplan added that she also had an issue with meeting transcripts.

James Lewis commented that he had declined to chair this effort, but wanted to provide his comments and suggestions. He said that when you look at the history of ORRHES, factions have been drawn within the subcommittee depending on peoples' sides. He said it was important to examine past meetings in order to identify the origin of the factions that now exist in ORRHES; he thought this could be achieved by assessing historical issues that were raised among different groups. He added that it is crucial for people who have not always been a part of the meetings to review historical events associated with ORRHES and the work groups.

Susan Kaplan asked the group to go to number 11 on the timeline and look at the date listed. She said that the EPA issue illustrates how slowly actions take place in ORRHES. She explained that a person raises an issue, the Public Health Assessment Work Group (PHAWG) votes on the issue, the issue is sent to ORRHES, and then a faction occurs in the subcommittee. She added that people will agree to draft a letter, but they do not draft letters and the cycle continues. She referred the group to the timeline and used the EPA issue as an example. She said that the concept of bringing EPA to an ORRHES meeting was first mentioned in the June 16, 2003, PHAWG meeting, following the release of the June 6, 2003, article by Frank Munger in the Knoxville News Sentinel concerning EPA's opinion of the Y-12 report. On July 8, 2003, people offered to draft a letter to EPA, and on August 18, 2003, a draft letter had been prepared. However, according to Ms. Kaplan, the letter was not sent to EPA until November 21, 2003, which requested EPA to attend a December 2, 2003, ORRHES meeting. Ms. Kaplan thought that the Agenda Work Group should have taken care of drafting a letter instead of sending the letter to ORRHES. She continued that ATSDR would have needed to approve the letter, but that it never had to go to ORRHES. She noted that sending a letter to EPA right before Thanksgiving did not allow the agency time to address the situation or make preparations for attending the meeting. She added that "a lot of egos got involved with this and it just didn't go well."

According to Susan Kaplan, an additional factor played a role in this situation, which was that many people requested ATSDR to delay its release of the Y-12 report until EPA could came to Oak Ridge, Tennessee, to explain its conclusions. Ms. Kaplan said that there was a sufficient amount of time for EPA to present its findings between June 16, 2003, and February 2004, when the situation "finally blew up." She stated that "now people are ticked at ATSDR because the report went out, but EPA issues were not resolved." She added that people questioned why ATSDR would release the report before these EPA issues were addressed.

Susan Kaplan referred the group to August 22, 2003, on the timeline. She said that at this meeting, Kowetha Davidson raised the EPA issue again. Ms. Kaplan said it "sounded like she misunderstood the issue" or was "trying to steer it away" from the issue. Based on her review of the minutes, Ms. Kaplan believed that Dr. Davidson's perception of the issue was to discuss concerns about the Oak Ridge Reservation (ORR) Site and procedures that EPA uses to interact with ATSDR and ORRHES. However, according to Ms. Kaplan, the issue regarded the Y-12 document. James Lewis added that based on the PHAWG meetings he attended, people wanted to hear why EPA and ATSDR were not working collaboratively; people were not concerned about the agencies' processes.

Karen Galloway thought the most significant problem with ORRHES and ATSDR was that the community assumed that ATSDR was coming to Oak Ridge to evaluate health effects and tell the community about potential past exposures. She added that the community is not particularly interested in present exposures; instead, they had expected and wanted a "health call" on past exposures. For the most part, Ms. Galloway thought that these issues had been avoided.

Karen Galloway explained that they looked at ATSDR's components of a public health assessment (PHA), which consist of exposure evaluation, community concerns, and health outcome data. She did not believe that ATSDR had addressed health outcome data to the satisfaction of most people in the community over the past three years. Ms. Galloway said that ATSDR would state that the cancer incidence review is now part of the health outcome data evaluation, but this was not conducted until the "hand was twisted." She noted, however, that people are not only concerned about cancer and they do not have any health outcome data to bring to the community that sufficiently addresses this issue. She said that they have one PHA, but that ATSDR and EPA are in disagreement about this assessment. She did not think that they were any clearer on the issues, and that the "bottom lines" were no different from those presented in the dose reconstruction. She explained that a section of the March 2000 Reports of the Oak Ridge Dose Reconstruction, Volume 7, Oak Ridge Dose Reconstruction Project Summary Report (available at http://www2.state.tn.us/health/CEDS/OakRidge/ProjSumm.pdf ) discussed various exposure scenarios for different people in the community. She read from the bottom of the last scenario, "It is therefore unlikely that noncancer health effects would be experienced by this individual." Ms. Galloway thought this sounded similar to ATSDR's verbiage of "no apparent public health hazard."

Susan Kaplan expressed concern because they have not addressed the issues identified by the dose reconstruction. According to Ms. Kaplan, this report suggested that additional sampling efforts take place. However, Ms. Kaplan thought they were in the same place now as before they began the PHA and that they were basing the PHA exactly on the dose reconstruction's findings.

James Lewis explained that he went to ATSDR's Web site to locate the agency's definition for health outcome data. He said that they know what these types of data cannot provide, but he wanted to know what the data could provide. He said that people in the community have always had these issues and concerns, and that there are still so many questions because the needs assessment was not completed. He noted that the TDOH report identified cancer as the highest priority issue. However, he said that the needs assessment effort was not completed and now ATSDR said that they would not be conducting this assessment. Mr. Lewis said that this leads to a "breakdown in trust" because people want a formal review of available information and information that can be used in the public health assessments. He added that "technical reviews are good for technical people," but that they needed to conduct "parallel efforts" and cautioned them to be careful of making a call that relates to this issue. He had brought in a newspaper article during the previous COWG meeting to show the group that cancer had previously been addressed. According to Mr. Lewis, Henry Falk had spoken with the group at a previous meeting and had said that the health needs assessment would be "the basis for ATSDR work" and "guide their effort." Mr. Lewis was concerned because they have not received these questions back and they were "so generic and so bland." He thought that this was why they had difficulty with people attending meetings and said that people attended meetings when the subject was cancer.

Karen Galloway read another excerpt from the Oak Ridge Dose Reconstruction Project Summary Report to illustrate several of the frustrations among some of the ORRHES members and many people in the general public. She read the following: "While the contaminants studied in this project were to a large extent studied independently, people who have lived in or near Oak Ridge could have been exposed to several contaminants at the same time. When individuals are exposed to several contaminants at the same time, there are a number of possible ways that the individual contaminants can combine. The four most common types of toxicologic interactions are additivity, synergism, potentiation, and antagonism." Ms. Galloway noted that these authors had doubts about the combined effects of contaminants, but "at least they acknowledged this."

Karen Galloway explained that she had read a report by the University of Colorado, and until reading this report, she had thought that the groups at Oak Ridge were different. However, she realized that the groups in Oak Ridge are not different from other public groups throughout the country, which also have people with many varying opinions. She noted that many documents suggested having a facilitator at these types of meetings. Ms. Galloway noted that they have really "factioned off" as the larger group and she believed that they needed to facilitate these issues instead of allowing stronger voices to dominate the meetings, which has happened within their groups.

James Lewis added to Karen Galloway's discussion about the University of Colorado report. He said that they also looked at trust issues related to federal agencies and communities to decipher possible reasons for trust problems within their Oak Ridge group. Mr. Lewis thought that Oak Ridge shared many of the same issues as mentioned in the University of Colorado report, such as "mutual trust" and "position of trust." Mr. Lewis said that in their meetings, trust was based on a person's credentials or position, and that it had become a "follow me blindly" type of scenario. Mr. Lewis thought that they needed to combine different aspects to gain trust within their group; the factors would be a combination of the person, data collection methods, and manner in which the information was presented.

Karen Galloway read an excerpt from the University of Colorado's report that discussed a concept of trust that she thought was appropriate for the group: "In a sense, when we ask to be trusted, we are really saying listen carefully and do whatever we say. Well, if people are going to do whatever we say, they do not have to listen carefully. When the public has power and opportunity to meaningfully contribute to a decision as to what is to be done, then it becomes extraordinarily good at understanding probability and uncertainty, and at grappling the complexities of the risk. In asking to be trusted, we make a serious mistake. If we would trust the public more and ask to be trusted less, citizens would understand a great deal more of what we have to say."

Susan Kaplan said that this quote "talks to EPA." She said that James Lewis should not have to go outside of the group system to accomplish tasks and she should not need to write a case study to "beat them over the head with it." Mr. Lewis explained that they have prepared these recommendations for actions to mend the trust issues and gain back the trust of people in the community. Mr. Lewis said that it would "take something special to bring technical and non-technical people together if dominated by individuals saying we're not going to do anything about that" when an issue arises.

Discussion

Bill Taylor asked Karen Galloway for clarification. He asked if the EPA issues functioned as an example for part of the agenda items. Ms. Galloway stated that Dr. Taylor was correct.

Barbara Sonnenburg asked Bill Taylor what transpired between the letter that was drafted on August 18, 2003, and the letter that was sent to EPA on November 21, 2003. She wanted to know what happened during this 3-month period. Dr. Taylor responded that he was unsure what took place during this time period, and that he would need to discuss this with people who were involved. He knew that an internal phone conversation had transpired, but he did not participate in the call and did not know what was discussed during the phone meeting. Ms. Sonnenburg asked Dr. Taylor if the drafted letter was the same letter that was sent to EPA in November 2003. Dr. Taylor was not sure, but would find out the information.

Kowetha Davidson said that her statement referred to two different sets of comments that were supposedly in disagreement, but then were supposedly in agreement. She said that some people were saying things were in agreement, but some were saying the opposite. As a result, they were getting two different stories and going around in circles. She added that she did not know how EPA would address the situation because EPA was not communicating with anyone. Susan Kaplan said that this was the reason that they were asking EPA to come talk with them—to clarify these issues. James Lewis added that he had asked for an EPA representative to come speak to them, but the subject matter did not fall under the representative's expertise.

Loretta Bush asked if issues about more sampling, as presented in the dose reconstruction, were addressed when the Y-12 document was released. Kowetha Davidson replied that the agencies stated that they would not conduct additional sampling for the area until the PHAs were completed. Bill Taylor was not clear on this issue, but said that at an April meeting, John Richards said that EPA would not conduct additional sampling until the completion of the PHAs because EPA is going to conduct sampling efforts based on ATSDR's conclusions and recommendations. Barbara Sonnenburg asked why EPA would "wait until they say there is no problem and no one is going to get sick." Susan Kaplan added that this could be four years away. Dr. Davidson noted that this was not ATSDR exclusively. She explained that there were multiple agencies involved in this decision-making process, which included the Tennessee Department of Health (TDOH) as well as ATSDR, EPA, and perhaps other organizations. Ms. Kaplan understood this, but this was why she had questions for EPA as well. She wanted to look at the "big picture." She did not want them to only "focus on their little mission" and ruin other efforts.

In response to James Lewis's comment that people come to meetings when they discuss cancer, Kowetha Davidson replied that they do not talk about cancer at every meeting. Mr. Lewis said he did not say this. Dr. Davidson continued that when they spoke about a potential clinic in the area, people attended meetings and were extremely interested. She said that when they did not qualify for a clinic based on the assessment, people stopped attending the meetings. Mr. Lewis said his point was that they needed to make people aware of their mission and actions. He thought they should "flag" types of issues (for example, thyroid issues) that people are concerned about and that this would improve community involvement. He added that they did not have any focus groups on the community's issues or feedback from the needs assessment. He noted that when they have referenced documents in the past that conducted these types of activities, they were told that these were out-of-date. Susan Kaplan said that in addition to the methods mentioned by Mr. Lewis, they needed to go to churches and conduct marketing activities to gain community participation.

Peggy Adkins responded to Kowetha Davidson's comment about people attending meetings during discussions on a clinic. Ms. Adkins said that community members viewed those meetings as more than just "discussions about a clinic." She said it was a "bigger issue" because people viewed this issue as the "idea of a diagnostic clinic." Ms. Adkins said that people were not disappointed that they were not going to have a clinic; they were disappointed that they would not be able to receive diagnostic testing and that they were not "going to help them find out if they were sick because of Oak Ridge."

Barbara Sonnenburg asked what they would do about evaluating the combined effects of contaminants. Kowetha Davidson replied that because every mixture is different, nothing could really be conducted scientifically to evaluate these effects. She said that there is "acknowledgement" of these effects, but that there is not anything established in the science field to address the effects of mixtures. Peggy Adkins thought that they could "create science" to evaluate these combined exposures. She provided an example of two people in a small neighborhood who have the same unusual symptoms and contaminants in their bodies. Ms. Adkins thought research could be conducted in this area. James Lewis thought a health education program should have been initiated to verbalize this outstanding issue, which discussed the logic and reasoning that supported why ATSDR could not conduct these specific efforts.

Bill Taylor explained that they know more about mixtures now than five years ago and that there is ongoing research in this field. Dr. Taylor said that ATSDR has not conducted work in this area because the agency has not completed its evaluation of individual contaminants, and as a result, ATSDR will (unfortunately) not be able to comment on exposures to more than one contaminant until it nears the end of the PHA work. Barbara Sonnenburg asked Dr. Taylor why this type of evaluation would need to wait until close to the end of the project. Dr. Taylor answered that ATSDR scientists and contractors have not completed their exposure evaluations, but that ATSDR will address the synergy/mixture issue in the future. He added that ATSDR is evaluating data beyond those used in the dose reconstruction, but added that ChemRisk/TDOH conducted a very thorough investigation of numerous amounts of data. He explained that the dose reconstruction evaluated data until about 1990, and therefore, ATSDR is evaluating data until 1990 as past exposures and data after 1990 for current exposures Dr. Taylor continued that ATSDR has reviewed more recent environmental data and has located additional past data in a few cases that the dose reconstruction did not evaluate. For example, ATSDR is looking for data related to areas that were not previously searched, such as Happy Valley. ATSDR is trying to obtain data for this area, but Dr. Taylor is not sure if data will be available. Dr. Taylor added that ATSDR has to review the data itself and conduct an independent evaluation; the agency cannot make conclusions based on other reports.

Kowetha Davidson pointed out to Mr. Lewis that many of the issues being discussed were under his jurisdiction as the chair of the COWG. Dr. Davidson said that she had been urging them to use the work group more and to function in its capabilities, instead of only meeting the night before an ORRHES meeting. She thought they needed to "start peddling faster." To respond, Mr. Lewis said that he is having difficulty obtaining information from ATSDR's Division of Health Education and Promotion (DHEP). He has voiced his concerns with DHEP and recommended that the division generate a document to present all of the outstanding issues with the data collection. Although, Mr. Lewis said that the co-chairs notified him that he could not insist that DHEP conduct activities related to the data collection.

Kowetha Davidson responded to James Lewis's comment about "technical and non-technical people." Dr. Davidson said that these types of statements "have to stop because they are causing factionalization." She said that these statements have caused more factionalization in ORRHES than any other factor. Mr. Lewis replied to Dr. Davidson by saying that people have learned over time that "ORRHES is the customer" and when ORRHES asks for something, then they should receive it; he did not think they should "run from the issue." Dr. Davidson said that this was not related to Mr. Lewis "putting technical people against lay people." She noted that he made this comment on several occasions and that he was putting one group against another group. Mr. Lewis responded that the proposed recommendations should help with these types of situations. Dr. Davidson said that Mr. Lewis needed to "stop the name calling."

Kowetha Davidson explained that there has always been a formal way of addressing the minority opinion, and added that a vote against an issue is not a minor opinion. She said that there are specific steps to take, which are described in the ORRHES bylaws. Dr. Davidson noted that the minority group is supposed to join together and prepare a minority opinion. Susan Kaplan replied that they have never had a minority leader to write an opinion. Dr. Davidson said that this process has been in place all along. Ms. Kaplan responded that they would take advantage of the process this time.

Recommendations Developed by Karen Galloway, Susan Kaplan, and James Lewis

Presenters: Karen Galloway, Susan Kaplan, and James Lewis

Six recommendations were developed and presented to the work group for comment and approval. Based on the work group's suggestions, one sentence was added to recommendation six. The six recommendations as passed by the work group are presented below:

1. We recommend that ORRHES work groups be reorganized to align themselves with the ATSDR Guidance Manual and organization structure as follows:
   • Exposure Evaluation Work Group
   • Community Concerns Work Group
   • Health Outcome Data Work Group
   • Subcommittee Business Work Group
   
   
   
2. Selection and/or removal of work group chairs. In order to improve the facilitation and consensus efforts within ORRHES work groups, we recommend that the bylaws be modified to allow the entire subcommittee to select or remove the work group chairs. It is our belief that if the selection process can identify individuals who have the capability to improve the mutual trust between the various factions, this will result in improved productivity and harmony within ORRHES.



3. In order to ensure that minority opinions get fair representation, we recommend that the two-thirds majority rule in the bylaws be revisited as to what its impact is (tonight or in the immediate future).



4. Need for an ATSDR technical facilitator. Some members of ORRHES feel that ATSDR should provide a technical facilitator to assist the ORRHES chair in order to aid in the deliberations of complex technical issues. It is also our position that ORRHES should have some input in identifying potential candidates for that position.



5. In order to assure that people will feel open and unrestrained and have confidence that anonymity will be maintained, we recommend that a quantitative assessment be performed by someone who commands the trust and knowledge of the issues that have previously created the separation and/or division within ORRHES. This person must have the best interest of ORRHES and the community at heart.



6. In order to improve the communications process between the various work groups, ORRHES members, and ATSDR, we recommend that detailed minutes or verbatim transcripts be produced for all work group and ORRHES meetings. These should be housed in the ATSDR field office and posted on the ATSDR Web site.

Discussion

Regarding recommendation one, Barbara Sonnenburg asked if passing these recommendations would also mean changing the bylaws; Karen Galloway said that Ms. Sonnenburg was correct. Ms. Sonnenburg also asked if everyone would be provided an opportunity to sign up for different work groups. Ms. Galloway said that everyone would be able to choose a work group and vote for the person who they wanted to chair each group (as detailed in recommendation two).

Based on the charter, Kowetha Davidson said that they needed to add a rationale to number one to detail how the recommendation would facilitate the public health assessments. Dr. Davidson added that they needed to meet with ATSDR and align themselves with the agency by creating recommendations that help ATSDR. Barbara Sonnenburg thought one of the recommendations dealt with this issue. Susan Kaplan replied that recommendation one defines an exposure evaluation work group that would deal with the PHAs; the new Community Concerns Work Group would handle the same issues that were previously sent to COWG and the Needs Assessment Work Group (NAWG).

Barbara Sonnenburg asked if they would work with Bill Taylor to decide the responsibilities for each committee (renamed in recommendation one). Karen Galloway said that Ms. Sonnenburg was correct. Ms. Sonnenburg added that they should list each group's responsibilities in the recommendation.

Kowetha Davidson pointed out that when changing an amendment, the work group had to prepare a rationale for the recommendations. Susan Kaplan said that they did not have time to prepare rationales.

James Lewis said that he reviewed other PHAs prepared by ATSDR. He wanted someone to explain why all of the PHAs he reviewed included health outcome data and how the PHAs were organized and structured. Mr. Lewis said that his point was that they were now working with Dee Williamson, which seemed to be effective; they were not "violating anything." Kowetha Davidson said that they still needed to prepare a rationale.

In reference to recommendation two, James Lewis said that he did not mind stepping out of the way so that ORRHES could evaluate this situation and the individuals who chair the work groups. Barbara Sonnenburg asked if this was in the form of a formal motion. Mr. Lewis responded that the recommendations were in the form of a formal recommendation. Mr. Lewis noted that they were concerned about the minority opinion, but that certain items could be prioritized.

Kowetha Davidson reiterated that the work group needed to work with ATSDR and not work "in a vacuum." She said that this needed to be a collaborative effort and that they needed to meet with Jack Hanley, Bill Taylor, and other involved ATSDR representatives. Susan Kaplan asked if Mr. Hanley had to be involved. Dr. Davidson replied that Mr. Hanley was the task leader and that they needed to talk to him.

Barbara Sonnenburg asked if any of the recommendations mentioned the co-chairs. Karen Galloway said that the recommendations did include this information, but they would add it into the full recommendation.

Susan Kaplan wanted to make sure that everyone understood her use of the word "minority" in recommendation three because ORRHES viewed this term in two different ways.

James Lewis thought that they needed to evaluate the two-thirds vote discussed in recommendation three and assess how it has impacted past decisions. Susan Kaplan asked if they could look at minutes from all past meetings to evaluate the votes and check the numbers. She would like to assess other groups also, but wanted to evaluate the major recommendations and the number of votes. She wanted to see how many votes failed because of the two-thirds vote requirement. Kowetha Davidson said that very few votes had not passed. Ms. Kaplan said that this might be true, but she wanted to know if "few" was "two or three" or "five or six."

Bill Taylor said that it would be difficult to review the minutes for all of the work groups and added that they do not necessarily use the two-thirds vote in work groups. Though reviewing subcommittee minutes would be difficult as well, Dr. Taylor thought this could be done. Dr. Taylor added that it would be interesting to see how other subcommittees worked at other sites. He noted that there were five subcommittees under the U.S. Department of Health and Human Services (DHHS), but he thought three were presently closed. Ms. Kaplan said that this would not matter; she could still obtain beneficial case studies. She thought that Oak Ridge was "being abused by the two-thirds" voting system.

Loretta Bush suggested that the group also look at the Federal Advisory Committee Act (FACA). Marilyn Horton noted that FACA details "consensus," but does not address a two-thirds vote.

Susan Kaplan asked how the two-thirds vote came to fruition in Oak Ridge. Bill Taylor said that based on past meeting minutes, he learned that the idea was for ORRHES to approximate a consensus vote. They felt it was a good compromise between Robert's Rule of Order and a true consensus system. Based on this, the group felt a two-thirds vote was an appropriate compromise and suitable consensus to give to ATSDR.

Karen Galloway elaborated on recommendation four. She wanted the group to know that this recommendation was not intended as a personal gesture; everyone in the process was "dedicated," but some people were simply "equipped to do some things more than others."

In reference to recommendation four, Kowetha Davidson asked what a technical facilitator would do for ORRHES and about the process for selecting work group chairs. Susan Kaplan responded that a facilitator should be a non-partisan individual, whereas the chair could have opinions and participate in the meeting. James Lewis added that if they wanted to "draw output" from people, then they needed someone who they could trust. Dr. Davidson said that she had a vote, but chose not to use it in meetings. She continued that many people do not come prepared to meetings, and as a result, have nothing to contribute. She asked how a facilitator would help people talk if they are still not prepared. Ms. Kaplan replied that she wanted a neutral party at the meetings because arguments and other incidents need to be controlled. She noted that if the meeting facilitator was part of the discussion, then he or she should not moderate the discussion.

In response to recommendation five, Bill Taylor asked what type of assessment was being referenced. James Lewis replied that the statement referred to a type of assessment that could evaluate the causations of factions within the group. Dr. Taylor said that this should be added to the recommendation. Mr. Lewis continued that during the discussion of the needs assessment, he had conducted research on qualitative and quantitative assessments. He said that qualitative assessments gave a lot of control to individual(s), whereas quantitative assessments relied on developing lists of issues that people could rank by importance. Basically, Mr. Lewis wanted feedback and input from the group. Peggy Adkins asked Mr. Lewis if he was referring to a "group climate assessment." Dr. Taylor was still not clear on the intent of "assessment" in the recommendation.

Regarding recommendation five, James Lewis said that they needed to review the mechanics of how they handle situations. He thought they needed to prepare a quantitative review that would involve speaking with different work group members. Susan Kaplan asked what would be quantitatively assessed. Mr. Lewis replied that they needed to evaluate different aspects in a quantitative and qualitative manner. Kowetha Davidson said that this was not making sense to her; she asked if Mr. Lewis was referring to some sort of "number crunching." Mr. Lewis responded that he thought they should tabulate different items by using a list of 10 or 12 questions and "weigh in" on these different items. Peggy Adkins asked Mr. Lewis if he was referring to a "group climate and group process" type of effort where they would assign numerical value to each question and evaluate the numbers against a spectrum scale.

Bill Taylor explained that if the group conducted this type of survey, it would likely take several months and this type of survey instrument might need to go through several agency channels before receiving ATSDR approval. However, Dr. Taylor said that the group could conduct this type of survey outside of ATSDR and then the group would not be under the restrictions and guidelines of the agency.

Peggy Adkins said she would be willing to work on the assessment and suggested the following recommendation, which was approved by the work group:

Volunteers in ORRHES design a group climate and group process evaluation that attaches numerical values (weighing factors of 1 to 10) on relevant issues.

Bill Taylor said that Peggy Adkins did not need to make a formal recommendation if the work group was conducting the survey independently. James Lewis replied that they had to put the recommendation in the work group so that it could be sent to ORRHES.

Kowetha Davidson thought that it would be difficult for people within the group to objectively evaluate the subject matter. Peggy Adkins replied that she was currently preparing a survey for a coalition to evaluate its group climate and group process. She would base their survey on this objective instrument that she was already creating.

Kowetha Davidson commented on recommendation six because it suggested the production of minutes from chair meetings. Dr. Davidson explained that these meetings were held so that chairs could have a "free exchange of ideas." She added that this was not a formal group under ORRHES. Susan Kaplan said that the ORRHES Web site suggested that these meetings were part of ORRHES. James Lewis said that when "those in certain arenas speak, they don't want it documented." Dr. Davidson replied that minutes are only used to "slam people." She did not think this should happen when people are meeting to freely exchange ideas. She said that any action items developed during these meetings were recorded.

James Lewis said that they "get chastised because they are not doing what has been outlined," but that ATSDR does not follow a formal recommendation and Kowetha Davidson does not "get on them."

Don Box suggested adding more detail to recommendation six about the minutes. Susan Kaplan said that she wanted them available on the ATSDR Web site and through the regular channels. As a result, "they should be housed in the ATSDR field office and posted on the ATSDR Web site" was added to the end of the recommendation.

Peggy Adkins asked if it was an appropriate time to discuss the "additional presence of Bill Taylor." James Lewis said that this meeting was not the appropriate forum.

Karen Galloway adjourned the meeting at 8:15 pm.

Please see the last page of these minutes for a list of the recommendations passed during this meeting.

On May 10, 2004, the Guidelines and Procedures Work Group (GPWG) passed the following recommendations: We recommend that ORRHES work groups be reorganized to align themselves with the ATSDR Guidance Manual and organization structure as follows: Exposure Evaluation Work Group Community Concerns Work Group Health Outcome Data Work Group Subcommittee Business Work Group Selection and/or removal of work group chairs. In order to improve the facilitation and consensus efforts within ORRHES Work Groups, we recommend that the bylaws be modified to allow the entire subcommittee to select or remove the work group chairs. It is our belief that if the selection process can identify individuals who have the capability to improve the mutual trust between the various factions, this will result in improved productivity and harmony within ORRHES. In order to ensure that minority opinions get fair representation, we recommend that the two-thirds majority rule in the bylaws be revisited as to what its impact is (tonight or in the immediate future). Need for an ATSDR technical facilitator. Some members of ORRHES feel that ATSDR should provide a technical facilitator to assist the ORRHES chair in order to aid in the deliberations of complex technical issues. It is also our position that ORRHES should have some input in identifying potential candidates for that position. In order to assure that people will feel open and unrestrained and have confidence that anonymity will be maintained, we recommend that a quantitative assessment be performed by someone who commands the trust and knowledge of the issues that have previously created the separation and/or division within ORRHES. This person must have the best interest of ORRHES and the community at heart. In order to improve the communications process between the various work groups, ORRHES members, and ATSDR, we recommend that detailed minutes or verbatim transcripts be produced for all work group and ORRHES meetings. These should be housed in the ATSDR field office and posted on the ATSDR Web site. Recommend that volunteers in ORRHES design a group climate and group process evaluation that attaches numerical values (weighing factors of 1 to 10) on relevant issues.

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¹ This sentence was amended and approved at the 5/27/04 GPWG to read, "Ms. Kaplan explained that she identified several issues and provided her comments to Ms. Galloway since she chairs GPWG, which is the work group this task was given to."