Oak Ridge Reservation: Health Needs Assessment Work Group

Health Needs Assessment Work Group

August 5, 2003 - Meeting Minutes

Attendees:

ORRHES Members attending:
Donna Mosby (NAWG co-chair), James Lewis (NAWG co-chair), Peggy Adkins, Barbara Sonnenburg, Susan Kaplan, David Johnson, Kowetha Davidson, Pete Malmquist, and Charles Washington

Public Members attending:
Al Brooks, Tim Joseph, Brenda Vowell, and Roger Macklin

ATSDR Staff attending:
Lorine Spencer, Libby Howze, Jerry Pereira, Theresa NeSmith, Terrie Sterling, Bill Taylor, Melissa Fish, and Marilyn Palmer-telephone

Purpose:

The meeting was called to order at 6:00 PM and attendance was noted for the record.

An updated version of the agenda was distributed to the group. James Lewis explained that this is the first time that he has seen the most recent agenda and he read aloud some of the new agenda items which included a discussion of concerns and issues to be addressed by Kowetha Davidson.

Meeting Minutes

The July 14th NAWG meeting minutes were approved unanimously without modifications.

Discussion

Kowetha Davidson expressed concerns about the process and how the Needs Assessment issue has progressed. Kowetha explained that there is a hierarchy involved in which the group operates. ATSDR established the citizen’s Advisory Committee under the FACA for the purpose of providing advice and recommendations. ORRHES is one of the subcommittees under the citizen’s Advisory Committee. ORRHES is the authority under which the work group operates. Kowetha said that the work group serves at the discretion of ORRHES and works to perform the task that ORRHES has tasked the group to perform. ORRHES directs the task of the work group because the work group does not have its own authority; its authority comes from ORRHES. The work group must focus on the task that is assigned by the subcommittee. The work group does not have the authority to refine its task. The work group has the discretion of establishing an Ad Hoc group. However, the Ad Hoc group also does not have the authority to refine its task. The Ad Hoc group should not and cannot go outside of the assigned task. It is important that the Ad Hoc group stays focused on the assigned task because when the group goes off on tangents nothing is accomplished and a lot of confusion is created.

Kowetha Davidson stated that in view of what ORRHES asked the work group to do, she has concerns about the Needs Assessment comments and how the Resolution package has been put together.

Kowetha Davidson said that ORRHES has only one officer and that officer is the ORRHES Chair. Kowetha said that no one else has the authority to speak for the ORRHES outside of a subcommittee meeting. Kowetha added that the primary hierarchy that she explained is established by the ORRHES Charter and the ORRHES Bylaws and that this hierarchy supercedes all others.

Pete Malmquist expressed concerns regarding Kowetha Davidson’s statements. Pete stated that ORRHES referred to the PHAWG to report on cancer incidence. If the group was to report only on cancer incidence then the group would report that there were X number of cases of X cancer per 100,000 people in Anderson County. However, when the group looked at the review, the group did not feel that cancer incidence alone was what should be reported. Thus, the group decided to perform a health statistics review, which was not part of the original request from ORRHES. Pete Malmquist stated that if the group needs to follow these types of rules (limiting the task to exactly as ORRHES originally stated), PHAWG should end its Ad Hoc group immediately. The Ad Hoc group will no longer be able to have Dee Williamson assist in a health statistics review. If the group just reports incidence all that can be reported is X/100,000 by county.

Kowetha Davidson responded to Pete Malmquist by saying that ORRHES has already passed the recommendation regarding cancer incidence. Kowetha Davidson said that the PHAWG should have came back to ORRHES and said that the PHAWG’s task needed to be expanded. Kowetha said that the reason that she has raised this issue is because she feels that things are beginning to get out of control as far as work group tasks are concerned. Kowetha Davidson does not want to see work group’s refining their task without the approval of ORRHES.

Pete Malmquist understands what Kowetha Davidson said. Pete stated that the PHAWG expanded its original assigned task so that the maximum amount of information could be distributed to the subcommittee. Pete Malmquist added that if what the work group has done is not proper, then the work group must stop and go back to ORRHES and get further directions.

Kowetha Davidson reminded Pete Malmquist that the recommendation had already gone through ORRHES.

Susan Kaplan would like to know how ORRHES could possibly dictate every single effort of a work group. Many ORRHES members are not experts and are not qualified to dictate or micromanage a workgroup.

Al Brooks directed his question toward Jerry Pereira as Project Manager. Al Brooks asked if ATSDR wishes to have the Oak Ridge project under the constraints indicated in Kowetha Davidson’s statements, where only one person can speak for ORRHES. Do you want a hierarchy that prohibits individuals from taking initiative, asking questions, investigating, and coming up with ideas?

James Lewis responded to Al Brooks telling him that the issue that has been brought up is a sensitive issue and as a result the group has now begun discussing another Ad Hoc committee. James Lewis feels that the issues surrounding Kowetha Davidson’s comments should be tabled until these issues can be brought together in an organized manner. James told the group that it is important that the group get to the objective of tonight’s NAWG meeting. If not, the group will lose focus.

Al Brooks responded to James Lewis by saying that under Roberts Rules the agenda should have been set. Al Brooks asked if the group is going to abide by the agenda, Robert’s Rules, the bylaws, or the Charter.

James Lewis stated that the work groups have tried to meet the overall needs of the lay public, much of whom are not familiar with Roberts Rules. James stated that it was not until Friday, August 1st that the topic Kowetha Davidson discussed was added to the agenda. James Lewis requested that Al Brooks be willing to delay this topic and push it towards the bottom of the agenda so that the group can work through the other issues that were originally on the agenda.

Donna Mosby reminded the work group that the agenda is set by the co-chairs of the work group and not the Ad Hoc committee.

Al Brooks stated that he would not voluntarily back off on a subject that is essential to the meaningful existence of the entire ORRHES process. Al Brooks would like a response to his original question.

Donna Mosby reminded Al Brooks that the work group does not abide by formal Robert’s Rules of Order.Susan Kaplan wants to know why Kowetha Davidson’s discussion of concerns and issues is on the agenda if the group is not willing to discuss the issue. Barbara Sonnenburg replied that it is on the agenda because the chair lady put it on the agenda.

Barbara Sonnenburg stated that the group could spend the next few hours discussing the concerns and issues that were raised by Kowetha Davidson but the group did not come to this meeting for that particular reason.

Kowetha Davidson said that the reason that she asked the topic be put on the agenda is because she has been concerned about the NAWG process and felt that she should speak up.

A motion to table the current discussion of concerns and issues regarding the ORRHES hierarchy and work group tasks passed. However, the group allowed Jerry Pereira to respond to the question raised by Al Brooks.

There was further disagreement about whether the group had formally adopted Robert’s Rules of Order.

Jerry Pereira told the group that the government has established ORRHES for the specific purpose of addressing community issues. Kowetha Davidson is the Chair of the body and is not an independent entity in terms of the ORRHES. Because Kowetha is the Chair, there are certain activities that she should have knowledge about. In response to Al Brooks’ earlier question, Jerry said that the issue that Kowetha has raised is an issue of work group members performing tasks that are beyond the charge that they were assigned. Jerry Pereira stated that he does not think that Kowetha Davidson means that she is the only person who can speak for ORRHES. Kowetha said that, but Jerry does not believe that she meant that. Jerry Pereira added the decision making process is not Kowetha’s alone, the decision making process belongs to the ORRHES body itself.

Regarding the NAWG agenda, James Lewis stated that he has been frustrated because he—as co-chair of the NAWG—did not have much prior knowledge about the presentation that DHEP would provide. James stated that he did not know what DHEP would talk about or the reasons for attending a NAWG meeting. James Lewis added that both co-chairs had concerns about whether expectations among work group members were higher than what DHEP would actually deliver. It was not until late afternoon Friday, in what James Lewis considered the eleventh hour, that there was a telephone conversation in which DHEP staff explained their purpose for attending the NAWG meeting. James Lewis understands that DHEP would like 10-15 minutes of agenda time and that this is all of the information that he is aware of regarding the DHEP presentation on the agenda.

Regarding the NAWG agenda, Libby Howze told the group that DHEP is not attending the NAWG meeting for the purpose of giving a presentation. DHEP staff is attending the meeting to hear comments and concerns regarding the report as well as comments about the interactions or lack of interactions with the Oak Ridge community. DHEP would like to set a new course with health education and health promotion activities in the Oak Ridge community. As Division Director of DHEP, Libby Howze stated that she wants to provide the necessary resources (staff and energy) that will enable DHEP to work with the Oak Ridge community to get where the group needs to go.

Libby Howze stated she is disappointed in the Needs Assessment report and that DHEP has had conversations with the principal investigator and has laid out some expectations that DHEP hopes they will deliver on. Libby Howze and other DHEP staff are not here to defend the Needs Assessment report. Instead, DHEP staff would like to hear from the community regarding their thoughts about where to go next and what steps the DHEP division should take. Also, at some point, Libby Howze would like to discuss the August 26th ORRHES presentation. Libby Howze reiterated that her primary purpose for attending the NAWG meeting is to listen to the community’s comments, concerns, and issues.

In trying to not overstep the group’s charge, Barbara Sonnenburg asked Libby Howze if it is DHEP’s desire to hear the group’s comments. Libby Howze responded that she would like to hear the comments.

Terrie Sterling concurs with Libby Howze that the Needs Assessment report is disappointing. Terrie Sterling stated that DHEP will need community guidance when going further with health education. Terrie said that DHEP will probably need other sources of information and that she does not feel that the Needs Assessment can be used. However, Terrie would like the subcommittee to have the opportunity to provide comments and feedback, although she would be surprised if anyone was excited about the Needs Assessment report being used as a sound foundation for a health education program. Terrie Sterling said that she is interested in the advice that ORRHES and other community members might have.

Theresa NeSmith would like the group to provide guidance as to what information the group would like DHEP to discuss at the August ORRHES meeting.

Susan Kaplan is upset that the Needs Assessment process was able to get to the point that it is currently at. At the beginning of the Needs Assessment process some ORRHES members screamed that ORRHES wanted to have input and be involved. However, GWU did not want ORRHES input. GWU would not listen to us, nor would they provide any feedback. Susan Kaplan feels that GWU should return the money that was spent. Susan feels that the Needs Assessment is absurd and is a total waste of government money/taxpayer dollars. As a taxpayer, Susan Kaplan is frustrated and feels completely ripped off.

Donna Mosby had two questions that she would like DHEP staff to respond to. Donna’s first question is in regards to additional public comments concerning the Needs Assessment document. After the work group follows the process through ORRHES, will the Needs Assessment ever be released for public comment? Donna Mosby’s second question for DHEP is how will the Needs Assessment fit into the Public Health Assessment effort?

Al Brooks asked if DHEP is interested in receiving comments from individuals as well as through the hierarchical process. How would DHEP like to receive comments regarding the Needs Assessment?

Both Libby Howze and Terrie Sterling responded to Al Brooks’s question. Libby Howze stated that she does not know what the rules are, but DHEP would certainly be interested in individual comments. Libby Howze is willing to accept the comments. Terrie Sterling added that if members of the community want to make comments the comments will be accepted. However, work group comments must go through the ORRHES process before going to ATSDR.

There was some discussion among work group members as to whether or not the Needs Assessment document was a public document or not.

Jerry Pereira clarified that the Needs Assessment document is FOIA-able. Essentially, once a document has gone outside of the agency it is considered a public document. The agency will accept and consider letters and comments from all people regarding any document. However, if a person is a member of the ORRHES then comments should go through the ORRHES process.

Donna Mosby reiterated her two questions. Will the Needs Assessment document make an appeal for additional public comments and feedback? How will the Needs Assessment work with the Public Health Assessment effort?

Libby Howze asked for additional clarification as to when a document is considered public. Jerry Pereira said that when a document is out of the agency it is considered public at that point and that people can respond. The agency would most likely honor the responses that it receives.

Libby Howze stated that it is her understanding that documents that are released to the work group and ORRHES are considered proprietary until the decision is made to release the document to a larger audience.

James Lewis stated that he is does not think that everyone understands the process that is referred to in a letter from Libby Howze. James Lewis explained that the PHA process is clearly established. James explained the PHA process. Anyone who comes into the office and becomes part of a work group has access to the Red cover PHA document. At this point there is no formal distribution but if someone comes into the field office and requests a copy of the document the document is made available. After a Red cover PHA document is approved by ORRHES the document goes back to ATSDR and then released to the public for a 90-day Public Comment period.

Kowetha Davidson said that Barbara Sonnenburg initiated the review of the Needs Assessment document. The Needs Assessment document was to be reviewed by work group members. Work group members are not suppose to distribute the document to the public. However, Kowetha understands that the distribution cannot be prevented.

Jerry Pereira and others commented that anyone can become part of the work group and this type of situation cannot be avoided.

Donna Mosby stated that since the Needs Assessment document was released the Needs Assessment work group has grown. Sometimes work groups are used to a person’s advantage or disadvantage to document a particular position that a person has. Donna Mosby feels that the Ad Hoc document went beyond the intent and scope of the task that was assigned by ORRHES. Donna wondered if comments from other groups or other members of the public will be considered and if additional comments will change anything.

James Lewis stated that when a PHA document reaches the work group the document is available to the public. The public is always allowed into the PHA process. Work groups are open to the general public and that is the key to getting the public involved.

Donna Mosby feels that the Needs Assessment review process went beyond the work group to an Ad Hoc group where the process built momentum. Donna stated that the Ad Hoc group was added to the NAWG.

Both James Lewis and Barbara Sonnenburg disagree with Donna Mosby’s last statement. James Lewis stated that the Ad Hoc is part of the work group and that Ad Hoc groups have been used in the past.

Barbara Sonnenburg explained that at the July 14th NAWG meeting there were four people who had submitted written comments regarding the Needs Assessment. Barbara suggested that the four people get together as an Ad Hoc group to try to merge the comments.

In response to Donna Mosby’s first question Libby Howze explained that her group welcomes comments. Libby stated that a serious flaw in the Needs Assessment process is that the process did not engage people. Libby can see that the process was extremely antiseptic and that the Needs Assessment document cries out for involvement, experience, and comments.

Libby Howze stated that Donna Mosby’s second question regarding how the Needs Assessment will fit into the PHA process is a question that ATSDR staff discussed prior to this meeting. The Health Education plan must fit with the PHA process and DHEP needs to work with the community as the PHA reports are being released. Libby Howze added that the PHA process and the Health Education process should not operate on independent tracks.

Pete Malmquist directed his question to DHEP staff. Are you going forward with the Needs Assessment report to ORRHES? This Needs Assessment report does not reflect this community at all. If you go forward with this report at ORRHES I will ask that Jerry Pereira sit at the front of the room as well as Theresa NeSmith. The questions that will be asked of you at ORRHES will be bad. Pete Malmquist stated that he does not know how ATSDR will answer the questions. Pete provided an example regarding the telephone exchanges. Pete said that he will ask that ATSDR stand up in front of the press, god, and all while trying to answer the questions. Tell us, are you going to kill this Needs Assessment report or are you going to move forward with it? If ATSDR is planning to move forward with it I will ask that the NAWG vote on its recommendation and that the recommendation be sent to ORRHES and god help everybody after that.

Charles Washington stated the process that he is familiar with is one that the Site Specific Advisory Board follows. Because the Needs Assessment has not gone to the Federal Register, the document has not been officially released to the public. Charles Washington also reminded the group that the entire reason for reviewing the Needs Assessment document was to obtain feedback stating specific concerns and comments.

Susan Kaplan responded to Donna Mosby’s comment about the Ad Hoc group getting out of control. Susan believes that the goal of any group is to maximize public participation. Isn’t ORRHES trying to increase public participation rather than stifle public participation?

James Lewis referred the group to the steps of the Oak Ridge Area Health Education Needs Assessment process on page 16 of the Needs Assessment document. James Lewis stated that he expected ORRHES input at each arrow. Instead, most interaction was eliminated and ORRHES has had 2 ½ years of sketchy presentations. The lack of interaction and sketchy presentations are some of the reasons that ATSDR staff and ORRHES members are in this situation today.

Two things strike Jerry Pereira as being critically important. One item of importance is that all of ORRHES must see the Needs Assessment document, have an opportunity to read it, and have an opportunity to make comments regarding the document if they wish to do so. Secondly, it is critical for tonight’s purposes that DHEP get the work group’s assistance and ideas as to what avenue, what approach, and what discussion points should take place during the August 26th ORRHES meeting. Jerry Pereira added that members of ORRHES who have not read the Needs Assessment report are owed this process.

After much confusion about where the group was on the agenda Pete Malmquist moved that the work group adopt the Resolution packet presented by the NAWG Ad Hoc group. Barbara Sonnenburg seconded the motion.

Al Brooks provided an outline as to the information that the Resolution/Recommendation document contains.

[The Resolution/Recommendations is one page, with attachments that include individual and group comments, letters, and selected ORRHES meeting minutes. The original one-page Resolution/Recommendations, as presented for discussion, is appended to the end of these meeting minutes, with the corrections and additions as approved by the Work Group—see below. Approved changes are marked with strike-though and highlight.]

Al Brooks read the recommendation into the record.

Al Brooks summed up the group’s recommendations into three general points.

• The group is saying that the report is so bad that it should not be used.
• The group has provided somewhat of an outline as to how the Health Education effort can be moved along as the PHAs develop.
• The group is saying that ATSDR should look at its procedures to determine why and how the Needs Assessment reached this state.

Barbara Sonnenburg had a comment regarding the third recommendation text, which reads, “could have remedied its shortcomings.” Barbara Sonnenburg indicated that ORRHES members could not have changed the Needs Assessment outcome because ATSDR and/or GWU did not listen to ORRHES or the Oak Ridge community. ORRHES comments were ignored.

Kowetha Davidson stated that she would like to amend the text to read: Whereas, the collected comments reveal serious deficiencies in the report as a further basis for any Public Health Education Program (PHEP), be it therefore Recommended that the subject report be given close scrutiny before being used as the basis for any future public health education program conducted in the ORR region.

Kowetha Davidson felt that the recommendations should not include the recommendation of rejecting the Needs Assessment report. Kowetha Davidson said that ATSDR should be the one to make the call. After reviewing the Needs Assessment comments it is ATSDR’s responsibility to decide whether or not the agency wishes to pull the document.

Al Brooks stated that Kowetha Davidson’s proposed modifications to the wording of the recommendations would be a complete reversal of the proposed recommendation.

Peggy Adkins did not want the Needs Assessment to be perceived as a document that ORRHES views as acceptable.

Kowetha Davidson felt that because the recommendations include rejecting the report, nothing in the Ad Hoc recommendation packet is useful.

Pete Malmquist agreed with Peggy Adkins and Al Brooks. Pete Malmquist said he read the Needs Assessment report many times. Pete felt that the group needs to request that the Needs Assessment report not be used. The group wasted a lot of time attempting to provide comments about the document. ATSDR can follow the group’s recommendations or not follow them. ORRHES asked for the work group’s advice and this is the group’s advice. NAWG can either agree or disagree. Regardless, the recommendations are following the ORRHES process.

After reviewing the recommendations, Jerry Pereira stated that if the “whereas” statements are deleted, the recommendations are there and they stand-alone. Al Brooks responded saying that the “whereas” statements serve as reasons for the recommendations.

Jerry Pereira said that he believes that ORRHES as a body must have the opportunity to review the recommendation package collectively. Jerry stated that Libby Howze [sic] has already stated that the Needs Assessment document as it stands now is not a basis to continue on with any health education purposes. Jerry would like the ORRHES as a body to make its own decision and judgments. Thus, Jerry does not know if the whereas statements are needed.

Roger Macklin stated he feels that the proposed amendment waters down the essence of the recommendation. Rodger feels that the recommendation is excellent work and should not contain the proposed amendments. Barbara Sonnenburg concurred.

Susan Kaplan commented that the remainder of the ORRHES would probably not read the entire report. With that being stated, why should the experts on the subject be watered down? Watering down the experts would basically create a meaningless recommendation. Susan added that the people who care about this topic are present at tonight’s meeting.

David Johnson commented that it is because of Barbara Sonnenburg’s tenacity that the group was given the opportunity to review the Needs Assessment document. David wonders if the group had not insisted on reviewing the Needs Assessment document, if it would already be rubber-stamped.

Responding to Donna Mosby’s comment that she does not understand David’s comments, David Johnson explained that he feels that Barbara Sonnenburg is indirectly responsible for Libby Howze being present at tonight’s meeting. David feels that until Barbara recommended that the document be reviewed, the work group had been relatively inactive.

The group voted on Kowetha Davidson’s amendment and the amendment failed.

James Lewis discussed some modifications that he would like to see incorporated into the recommendation. After much discussion, James Lewis and group members had two modifications to the proposed recommendation.
· In the first paragraph of the recommendation, the last word should read as Registry rather than Control.
· The third bullet under the second recommendation should include the terms public health. The third bullet should read as “The degree to which the existing Public Health and medical services establishment can supply any substantive unmet public health education needs in both the rural and urban areas,”

Al Brooks would like any motion regarding the resolution to include being subject to editorial changes.

Libby Howze asked that someone elaborate about the term previous efforts as it is mentioned in the fifth bullet of the second recommendation.

Al Brooks responded that the fifth bullet under the second recommendation is referring to past distrust. Al pointed out that there is a long-standing distrust from certain groups in and around the reservation. Some organizations that people do not trust include DOE, ATSDR, EPA, and CDC. Al Brooks added that the distrust in particular agencies might shift and because of that it is important that when dealing with the topic of distrust, ATSDR pay attention to which organization a particular group or person does not trust.

Pete Malmquist made the motion to adopt the recommendations with the two modifications, which include replacing “Control” with “Registry” and adding the words “public health and” to the third bullet of the second recommendation.

Donna Mosby asked for clarification as to what would go to ORRHES. The group explained that the recommendations and entire packet would go to ORRHES if NAWG approves the package. If ORRHES approves the package, the package (including the recommendations) will be forwarded to ATSDR.

Al Brooks said he feels that if ORRHES approves the recommendations, ATSDR should seriously consider the recommendations.

Kowetha Davidson told the group that she does not see any of Brenda Vowell’s comments included in the recommendation package.

James Lewis responded to Kowetha Davidson by saying that the Ad Hoc attempted to extract comments from meeting minutes. However, the comments extracted from the meeting minutes are not 100% complete. James told Kowetha that she should not look for the comments extracted from meeting minutes to be 100% complete.

Kowetha Davidson feels that Brenda Vowell made some key comments during NAWG meetings and would like to see those comments included in the recommendation package.

Al Brooks told the group that all of the comments that he has received to date are included in the recommendation package. Al told the group that the Ad Hoc group is willing to fold in any late comments.

Donna Mosby told the group that she thought that the Needs Assessment comments should go to GWU so that they could respond to the submitted comments. Kowetha Davidson reminded Donna of the process, which includes the comments going from the Work Group, to ORRHES, and then to ATSDR, who can submit the comments to GWU if they wish to do so.

Libby Howze told the group that DHEP has already initiated discussions with the principal investigators and have requested data, which is one of the central failings of the Needs Assessment document. DHEP will follow the process that Kowetha Davidson just outlined. However, DHEP has already initiated a process with GWU because of its own dissatisfactions with the report.

It was decided that any additional comments regarding the Needs Assessment must be sent electronically to Bill Taylor by August 7th so that the comments can be included in the ORRHES pre-mailing packet.

The group voted on Pete Malmquist’s motion to adopt the recommendations with the two modifications. In addition, any further comments regarding the Needs Assessment will be included (including Donna Mosby’s comments, which she handed out during this meeting) in the recommendation package. The motion passed.

Barbara Sonnenburg stated that the Agenda work group is meeting on August 7th. Barbara stated that the work group needs to know what DHEP wants regarding the agenda.

Libby Howze told the group that she would like to have a discussion regarding the August 26th ORRHES meeting. Libby would also like to discuss the process for future work and the process of ATSDR and the community working together.

Pete Malmquist told the group that the ORRHES meeting on August 26th is a complete waste of time. The only item on the agenda of any substance is the NAWG recommendation. Pete feels that ORRHES members will be able to leave the ORRHES meeting by 2:00 PM. Pete Malmquist agreed that ORRHES members need to look at the recommendation packet. However, do members need to look at the packet on August 26th? ATSDR is two years behind on the PHAs and ATSDR is going to hold a thousand dollar meeting to discuss a document that many people do not believe should even be used. Pete Malmquist said that the August ORRHES meeting is a waste of time because the only thing that will be settled is that ORRHES will recommend that the Needs Assessment report not be used. In two years all that has been accomplished is a Y-12 Uranium Public Health Assessment. Nothing else has been done. At ATSDR’s current rate, most members of ORRHES will be dead before the project is completed. Pete Malmquist added that when the PHAs are completed and if it is determined that there is a public health concern, then, ATSDR can address those concerns. The PHAs need to be completed before Public Health Education can begin.

Susan Kaplan reminded Pete Malmquist to not assume anything as far as a vote on a recommendation is concerned. Susan reminded the group that in the past, an uninformed ORRHES group overturned a recommendation regarding risk.

James Lewis likes DHEP’s pro-active approach. James explained that the time needed for an ORRHES meeting and the overall need for a meeting is determined by the amount of agency resistance. After listening to DHEP, James Lewis feels that it is questionable as to whether or not there is justification for an ORRHES meeting.

Kowetha Davidson feels that the August ORRHES meeting is important and should be held so that the Needs Assessment issue is not delayed any longer. Barbara Sonnenburg agrees with Kowetha that the August meeting should be held because until the ORRHES votes, the recommendation and work completed today can all be disregarded.

James Lewis asked if something could be added to the agenda to make the August 26th ORRHES meeting worthwhile.

Jerry Pereira stated that at the August ORRHES meeting Jerry intends to present the original PHA timeline to ORRHES. Jerry plans to show where the project is ahead and why it is ahead as well as where the project is behind and why it is behind. Jerry cannot speak about all of the PHAs. However, he would like to take a logical piece of time (6-9 months) and say what should be completed by X time. Jerry Pereira said that he would work with Jack Hanley, Burt Cooper, and Sandy Isaacs so that he can provide ORRHES with three or four pages of material that is related to the PHA timeline.

James Lewis stated that he would like time on the agenda set aside to discuss lessons learned regarding all ATSDR divisions. James Lewis feels that there are areas of concern in other branches that need to be resolved. James said that two examples of concerns needing to be discussed is the preparedness of the chair as well as ATSDR management issues.

Lorine Spencer reminded the group that time will need to be spent laying the Needs Assessment foundation. ATSDR cannot formally move on any recommendation until a formal ORRHES vote occurs.

Regarding the August ORRHES meeting, Libby Howze told the group that she will not have extensive comments and that she would appreciate the group’s guidance as to what should be included in an ORRHES presentation.

Al Brooks told Libby Howze that it is important that she explain what will take place from this point forward. Al said that if DHEP has made the decision to not pursue the Needs Assessment report, then the group must have some future ideas in mind. DHEP should talk to people and find out what the Oak Ridge community is like and design a health education program that the community will find acceptable.

Libby Howze told the group that she is reluctant to follow GWU’s course of operating independently. Libby said that she wants to work with the community in establishing the appropriate health education course.

James Lewis stated that Phase 2 has never been fully explained. James would like to see DHEP provide information regarding Phase 2 or an example of a successful Phase 2 project that DHEP performed.

Jerry Pereira said that for the purposes of the August 26th ORRHES meeting someone from the agency needs to stand up and say this is what we were looking for and this is what we received. Before ORRHES can vote, the members need to hear something about the Needs Assessment besides the Recommendation comments. ORRHES should hear from the agency.

Regarding the August ORRHES meeting, Libby Howze told the group that she is not going to provide a spirited defense of the Needs Assessment report. Nor is she going to describe a Phase 2 because Libby feels that describing a Phase 2 would be presumptive on her part. Libby is anxious to change how DHEP interacts with Oak Ridge. As Division Director, Libby wants to do all she can to change the way that DHEP operates. Soon, Libby Howze would like to hold a discussion about how DHEP and the community can work together, the direction to go, what needs to be done, and what resources (staff) are needed.

James Lewis requested that an example/overview of a successful Health Education plan be presented to the ORRHES.

Kowetha Davidson told James that if an example is provided the example will need to be taken in context and that the example might not be comparable to Oak Ridge. Kowetha is supportive of James Lewis’s request as long as no comparison to Oak Ridge is made.

Al Brooks stated that at some point, DHEP must discuss the process of what went wrong with the Needs Assessment so that a similar incident does reoccur. If the steps in a process are only discussed and not actually tested to see that the process is actually working, then the process itself might not prove to be useful or successful, it might only sound appropriate.

Charles Washington wanted to clarify that the work group is not asking DHEP to slam another investigator. However, the group would like DHEP to be consistent with the scientific methods and to show the shortcomings of the Needs Assessment report.

James Lewis told the group that he wants everyone to have the opportunity to provide feedback about the Needs Assessment process. James Lewis respects Al Brooks and respects that Al has worked very hard. With Al Brooks’ help, a lot has been accomplished. Al Brooks has had a lot of input and James Lewis would like the input of other people as well. James feels that everyone should have an opportunity to provide feedback and he apologized for interrupting Al’s comments.

There was much discussion about the exact place on the ORRHES agenda in which the NAWG recommendation will be presented. It was also discussed that someone needs to provide a general overview of the Needs Assessment.

Kowetha Davidson stated that one of her concerns is that ATSDR does not give its conclusion regarding the Needs Assessment document before the ORRHES presentation and vote.

Kowetha Davidson asked if GWU would be brought to the ORRHES meeting.

James Lewis stated that he does not see a need for GWU to make any comments regarding the Needs Assessment.

Libby Howze indicated that GWU would not be brought to the ORRHES meeting.

Kowetha Davidson indicated that before voting, ORRHES members must have some objective background information about the Needs Assessment document itself.

Jerry Pereira stated that the group is currently in a unique situation. The agency has made a decision on the document aside from the work group comments, based on their own reading. To some degree, the agency has publicly stated a position.

Regarding the Needs Assessment document, Kowetha Davidson and Donna Mosby would like members of ORRHES to receive an objective presentation outside of the work group presentation.

Tim Joseph said that everyone understands that ORRHES only makes recommendations to ATSDR and that ORRHES does not tell ATSDR what to do. Tim Joseph has listened to tonight’s discussion and has heard Jerry Pereira suggest that ATSDR is wise enough to reject the Needs Assessment document. Tim wonders if it is fair at this time to ask ATSDR what they view the next step to be in the process. And if in fact, the work group and people in the room agree with ATSDR’s position, why does anything need to be made into a recommendation? Tim Joseph asked whether the group might save the embarrassment and have ATSDR make a statement about their position. Tim Joseph said he feels that an ATSDR statement would save a lot of trouble and ultimately be less painful for everyone involved and the work group would still get their way.

Susan Kaplan said she does not believe that Tim Joseph’s idea would be fair to the ORRHES. Charles Washington did not agree with Tim Joseph because the Needs Assessment document has been so widely distributed and Charles feels the document requires broad conversation rather than just an ATSDR position statement.

There was much discussion about the term “objective” and who could present an objective overview of the Needs Assessment document. The group seemed to reach a consensus that Donna Mosby would provide the Needs Assessment overview/summary.

James Lewis stated that the Needs Assessment has created a hole in the Oak Ridge program. James feels that the group assumed information would be collected and that the Needs Assessment would present concerns in a way that would help to guide the PHA process. If all of the concerns from the various areas are not captured, ORRHES is leaving itself wide open for people to say that ORRHES did not address community concerns.

Barbara Sonnenburg stated that there is a 1994 report titled the Report of Knowledge, Attitudes and Beliefs Survey of an Eight-County Area Surrounding Oak Ridge, Tennessee that did an excellent job of capturing community concerns.

[Either Libby Howze or Terrie Sterling] indicated that she would like a copy of the document which Barbara referred to.

Brenda Vowell indicated that the entire ORRHES should have an outline as to what is in the Needs Assessment report.

Tim Joseph said that it is the responsibility of ORRHES members to read the documents before attending the ORRHES meeting. Unprepared members should not vote because an ORRHES meeting is not the time to bring members up to speed on an issue that they should already be familiar with.

Peggy Adkins appreciated Libby Howze’s comments about a fresh approach. Peggy feels that the theme of the upcoming ORRHES meeting should be about the future so that the community as a whole can decide where we are going and what we will do. Regarding ORRHES involvement, Peggy Adkins feels that there is a disproportionate amount of people connected to contract positions. It is important that people who have illnesses which they feel are connected to the site get involved in the ORRHES process.

Libby Howze said she appreciated people taking the time to attend the NAWG meeting. Libby regrets the past lapses and past problems. Sooner, rather than later, Libby Howze would like to meet with the group to discuss a fresh start.

Pete Malmquist asked that DHEP bring forward examples of successful Health Education events from other sites so that the Oak Ridge community can have some idea as to what has worked in the past. Libby Howze stated that she would be happy to do so.

The meeting was adjourned at 8:30 PM.

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RECOMMENDATIONS
To the ORR Health Effects Subcommittee
By the Needs Assessment Working Group
On
Assessing the Health Education Needs of Residents In the Area of the Oak Ridge, Tennessee
– Final Report May 23, 2003

The Needs Assessment Working Group (NAWG) of the Oak Ridge Reservation Health Effects Subcommittee (ORRHES) recommends that the ORRHES adopt the following recommendations and submit them to the Agency for Toxic Substances and Disease Control Registry:

" Whereas, the report, Assessing the Health Education Needs of Residents In the Area of the Oak Ridge , Tennessee – Final Report May 23, 2003, has been received by the NAWG and has been reviewed by members of both NAWG and the broader ORR community, and

Whereas, the totality of the many and diverse comments have been collected in detail and summarized by an ad hoc NAWG committee in an attached report , Summary and Compilation of All Comments on the GWU Health Education Needs Report, and

Whereas, the collected comments reveal serious deficiencies in the report and generally reject the report as a further basis for any Public Health Education Program (PHEP), be it therefore
Recommended that the subject report not be used as the basis for any future public health education program conducted in the ORR region, and be it further,

Recommended that any future ATSDR/PHEP activities related to PHA be based upon the findings of the Public Health Assessment Program (PHAP) which should, with the advice of ORRHES, ascertain the following:

1. The degree to which releases of contaminants from the DOE sites contributed to regional public health problems,
   
2. The degree to which there is a need for additional public health educational services,
   
3. The degree to which the existing medical services establishment can supply any substantive unmet public health and medical education needs in both the rural and urban areas,
   
4. The degree to which ATSDR might meet any additional needs by augmenting the current system by printed material or presentations by experts. Not to do this will very probably result in the duplication of much effort as well as be an affront to the existing health care system,
   
5. The degree to which any necessary educational effort can avoid the onus of distrust that has cursed all previous efforts,
   and be it further,

Recommended that ATSDR examine the project structural and management components which enabled the report and project to reach this state without ATSDR overview and without subcommittee or working group review that could have remedied its shortcomings."