ORRHES Meeting Minutes
November 16-17, 2000

November 17, 2000

The meeting resumed on the following morning at 8:30 a.m., with introductions of those present and a summary of the previous day by the Chair.

Presentation of ATSDR Needs Assessment

Ms. Theresa NeSmith, of ATSDR's Division of Health Education and Promotion, outlined her agency's process of conducting a community needs assessment. Based on the science of community health, the process assesses the concerns, strengths, and resources in a community. By identifying those, it also can serve as an empowerment tool (e.g., that information can be used to address traffic patterns, apply for grants, etc.).

A needs assessment involves several steps, to: assess community needs and resources, define problems and/or identify resources. A program is designed in response, which is pretested (e.g. to a focus group in the community) to ensure its appropriateness, and then a follow-up is done based on the pretest results. When final, the program is implemented, monitored, and evaluated. Part of the process is the definition of what the "community" is, by the persons in the area.

Information is collected through interviews with community members or leaders, literature and computer searches, focus groups, telephone surveys, attendance at formal and informal community meetings, from census data, and school and occupational records. Part of the information collected is used to indicate routes of communication back to the community (e.g., company picnics, sending information in children's school take-home folders).

Ms. NeSmith outlined the areas of investigation: 1) knowledge (about subjects related to the site, such as about science or disease), 2) attitudes (that influence message delivery: trusting, suspicious, or overwhelmed by the situation), and 3) behaviors (that contribute to healthy or unhealthy lifestyles, such as children eating dirt). Also explored are the community, social, and local political structures, accessibility and adequacy to health care, opinions of the local media, local social services available, and identification of key community leaders (to get information out and facilitate community access).

The data from all these areas are very important in developing health information about a community. This provides a snapshot of the community; helps to target health education efforts by indicating what information needs to be delivered and how; and helps to uncover what else has occurred/is occurring in the community (e.g., people feeling they've been overly studied already). It enables the agency and community to determine the priorities for health education; issues other than environmental ones may need to be addressed first. Importantly, the needs assessment helps to develop relationships, prevents mistakes being made based on assumptions, promotes successful educational strategies, and serves as a decision-making tool.

As an example, she presented a community in which ATSDR is working in Colorado. The community, which is Hispanic and African-American, is concerned about arsenic contamination in the soil, in particular about children's ingestion. The source of the contamination is unclear. ATSDR is planning a health assessment and study, and EPA is doing soil sampling.

The needs assessment there indicated mistrust of government; strong family, religious and community ties, and cultural practices around soil ingestion (e.g., grandparents making mud pies with kids; pottery brought in from Mexico). Many of the families are long-time residents, and gardening is very popular. English is a second language; there are few healthcare facilities or schools in the area.

ATSDR plans to: 1) address community concerns about government by working with community representatives to develop/implement health education, and have them review all communications to be sent to the community residents; 2) inform family daycare providers about the issues of soil ingestion; 3) discuss dirt ingestion with the community (e.g., explaining why that is being explored first) and provide alternatives (e.g., get soil from elsewhere as opposed to their own yards); 4) focus on homes with preschool children and grandparents; 5) provide information about safe gardening (soil amendment and washing vegetables that do not take up arsenic through their roots, etc.); 6) work closely with religious and community leaders (send information to them, hold meetings at churches, etc.); 7) provide information in Spanish and English through newsletters; and 8) work with area health care providers and schools to educate about the health issues of concern.

The steps in the process at Oak Ridge site involve a cooperative agreement with the AOEC. They identified George Washington University (GWU) to conduct the needs assessment, which is now in the early stages. The GWU researchers will come to Oak Ridge to discuss their assessment plans with this Subcommittee. The needs assessment plan will be revised as necessary, and the process will begin with data collection. GWU will continually validate the process over the course of its work. Once the report is developed, it will be presented to the community and Subcommittee members.

Discussion.The Subcommittee's discussion with Ms. NeSmith included the following points:

• How will ATSDR begin to reach everyone in this diverse community? The process involves referrals, with community members identifying others to be interviewed. Mr. Pereira added that a Subcommittee Community Outreach Work Group could help as well.
• If it turns out that the arsenic came from a company, what would the agency/Subcommittee's response be? ATSDR would refer this to the EPA as the regulatory authority. Mr. Hanley added that ATSDR can identify an exposure and source, inform the community, and educate on how can the exposure can be minimized. Given certain criteria, an analytical epidemiology health study can be done, to define and measure exposure, determine health outcomes and measure them, and using statistics to investigate any association between exposure and outcomes). The needs and exposure assessments identify the contaminant and source; the health study is a possible next recommendation. Mr. Akin noted that EPA Does most of the work of finding the source in their exposure investigations' air, soil, and water sampling.
• If done well, the health assessment will be valuable, but if not, it won't help. How long will it take? ATSDR is also doing an assessment around the Savannah River Site (SRS), which is more similar in complexity to Oak Ridge. The planning up to the present point of going out into the Oak Ridge community to interview has taken about 8 months.
• ATSDR was asked to provide a completed needs assessment as an example and to ensure that the surveys are statistically valid and that the sampling method and survey reflects the needs of the community. The concept of a pre-test was well received, and doing this in various community neighborhoods was advised, to ensure the survey will meet needs. Finally, the need was cited for a way to validate that a person claiming to be a "community leader" actually is, even if they head up an organization (e.g., ATSDR should examine the meeting rosters to see if only three people actually come).
• Who is conducting the SRS needs assessment? The Association of Environmental Health Nurses (AAOHN) and the Oak Ridge Institutes of Science and Research (ORISE).
• Why isn't ORISE doing the Oak Ridge work? They would probably have a shorter learning curve than GWU will need? When this work was funded last year, ATSDR requested and received proposals to work at SRS and Oak Ridge. The cooperative agreement signed with the AOEC included their identification of their partners, partly to avoid appearance of too much government interference in the selection process. They chose GWU, which will be able to explain fully the work already done at Oak Ridge when they come to meet with the committee. But they also will be looking to the committee for information, as would any contractor. This will be a two-way process. Dr. Brooks found GWU to be an excellent choice, and even expected that they may know more about the work in the trenches at Oak Ridge than ORISE.
• Will the needs assessment address of the community's
  perceptions and fears (e.g., an unreasonable fear of radiation)? Yes, a component of the "knowledge" assessment is determining if the present community information is accurate about exposure or diseases, explores fear of government/agencies, etc. Experts who are also good risk communicators can help to allay some fears.
• Mr. Washington reported that gold mining is again underway in the Denver area, which may affect a number of deep wells. He also commented that a study is valid if it measures what it is supposed to; and is reliable if it consistently Does so. He advised using the same community as the SSAB (the five counties closest to the ORNL, plus two more since lakes/streams win 100 miles have been contaminated). He also observed that many local groups that have done work lack credibility as well. While he did not believe that DoE deliberately tells people to stack the deck, some (not just scientists, but workers) believe that they want it done; do it; and have been rewarded for it. That is one reason why people don't believe the data. There are also members of the general public who refuse to believe that a threshold of danger has been passed for a contaminant. He expected that the public would continue being divided.

ORRHES Guidance Document Presentation/Discussion

After a short break, Ms. Jan Connery, of the Environmental Research Group (ERG) engaged in a thorough review with the Subcommittee of a draft operational guidance document developed by Dr. Davidson, ERG, and ATSDR staff. She suggested forming a Procedures work group to incorporate the comments received so far into another draft to be returned to the Subcommittee. This is a living document of five sections; Sections 1-3 provide the purpose and history of the Subcommittee (the latter is charted on Attachment #2); Section 4 addresses its organizational structure and roles (charted on Attachment #3), and Section 5 provides process guidelines. Sections 4 and 5 are appended to these minutes as Attachment #4, rather than reported here for the reader's review, since much of the information in the guidance replicates that already provided in this meeting and reported in this document.

Discussion: ORRHES members provided input in writing prior to this meeting (which was discussed) and during the review itself, as follows:

Organization

• Why is DoE not on the organizational chart? This was a conscious decision, since the MOU requires DoE to provide ATSDR/CDC with any information needed, and many communities want to avoid any DoE influence on the agency's or Subcommittee's activities. Including them on the chart might infer that DoE has some influence over the recommendations or studies, which they do not.
• Won't DoE provide the data and fund the work? Mr. Bert Cooper of ATSDR confirmed that most of the data used will be DoE's, but ATSDR will also look for other sources (e.g., EPA data) to validate it. ATSDR's sampling capacity is very limited. And, although DoE Does fund the work, the MOU specifies ATSDR's independent execution of DoE-funded studies. The intent was to correct the lack of credibility of DoE's self-conducted studies.
• Dr. Frome suggested placing community groups and unions on the chart as well.

Work Groups

• How does conflict of interest relate to work group members? How are community members selected to participate in a work group, and can they be co-chaired? Mr. Hanley reported that conflict of interest is not applicable to community members, only to Subcommittee members, because they will deliberate and recommend to ATSDR. Community members are not paid for their work. Mr. Hanley will check with CDC's Office of General Counsel for the formal regulations relating to work groups (e.g., whether non-Subcommittee members can vote in the work group, which the Subcommittee members thought should be all right). Mr. Pereira stated that the Subcommittee can invite members of the public to participate in a sanctioned ORRHES work group. He agreed to check on the co-Chair, but suspected this should be a Subcommittee member, since a citizen has no responsibility to either the work group or the Subcommittee. Ms. Kuykendahl, of CDC's Committee Management Office, agreed to check and report back on the work groups. Since they are not subject to FACA, their requirements could differ.
• The Subcommittee members felt the member of the public should be able to vote on work group questions to check for consensus. Dr. Brooks stressed the need for open work groups, and of acknowledging those who consistently participate as a work group member. Ms. Sandy Isaacs appreciated that advice and requested more on what works best at Oak Ridge. While only the Subcommittee can vote and provide consensus recommendations to the agencies, the work groups can help this group explore and settle issues. The only legal limitation on the work group is that there must be a DHHS staffer present.
• Ms. Connery summarized that flexibility and openness are to be desired on the work groups, and that perhaps semantics are related to the work group's "consensus".

Process Guidelines

• Mr. Pereira noted that, in order to not violate FACA, the Agenda Work Group can form and disband at the will of the Chair, rotating members.
• Dr. Brooks moved that the Procedures Work Group, when appointed by the Chair, consider the Draft Operational Guidelines and the comments received, and recommend on them to the full Subcommittee. The motion was seconded and, with 12 in favor and one opposed, the motion passed.
• With note that a simple majority is a long way from consensus, the Subcommittee discussed whether to require a super majority (i.e., two-thirds) to pass a vote on a motion (the process is charted in Attachment #5). Alternatively, Dr. Davidson suggested referring the question to a work group for further discussion and then returned to the Subcommittee. Straw votes could be taken during Subcommittee discussion to assess where the members stand, which would also help to ensure all sides are represented in any work group created. It was agreed to add a box to show referral to the work group for further discussion.
• Dr. Brooks noted that Robert's Rules considers calling for an end to discussion an infringement on members' rights, and requires the super majority to pass a motion. Ms. Connery noted that the guidelines borrowed from Roberts Rules in some respects, this being one, and that consensus is not always possible.

Public Comment

Mr. Peele suggested a procedure that, if work groups come to any kind of agreement, this be put in the public record; and 2) if the group has approved a recommendation, that should be reportable in any media interview of a member. He stressed the importance of handling work groups sensitively, something not done early in the SSAB's work, leading to "disastrous" results. People working on a work group must be recognized. They resolved this by letting anyone who wished to sit at the table and participate; the work group produced letters to the agencies and those present signed them. Finally, he suggested a dotted line on the organizational chart to show DoE's relationship. Since individual DoE scientists might have high credibility, hearing about their work from that individual who did it might be helpful.

Mr. John Steward posed several pointed questions. He began by noting that Dr. David Michaels, Assistant Deputy Secretary to DoE Secretary Richardson, had observed that DoE spent $27 million in the last year studying workers. He observed that this committee seems ready to do so again, with the needs assessment. He asked when the local people get the benefit of this committee? Will this be more production of papers to be placed in the Reading Room? He called for a start in defining the destination of all this work, to indicate why the public should contribute. He stated that the union's help in previous work had been provided before, but would not be this time. They want some results; they want to know why people are dying.

Ms. Janice Stokes said that she had considered, but could not, participate on this committee due to her disability. It looked to her like a well-oiled machine. While she respect the knowledge present, she felt it to be heavily weighted to the DoE perspective. She asked where the common citizens were on this board, suspecting that they were absent partly by choice and partly by protest. Not only workers but also off-site residents had been damaged by documented contamination, carried by wind, water, and soil. She and citizen's groups had asked ATSDR, CDC, and DOE for 9 years to provide Oak Ridge with something tangible to hold on to about the work and making a living, and to address unusual cancers and other diseases in concert with the health department. Many people see the Subcommittee as a way to keep Oak Ridge economically viable. Unless the members can help the people, they will not have credibility, and will have wasted the taxpayers' money. The citizens must be able to provide input and impact to the work group meetings. While she had little hope for gains from this board, she challenged it to get something positive done to give the community a product useful to help the public's health.

Mr. J.W. Fowlkes stated that the assessments and studies had already been done, and the community can say by whom, of what, and where. He wished this committee would move to validate what is already known, because the community does not need 9 more years of people from GWU to tell them what they already know.

Dr. Frome asked Ms. Stokes if she was one of those in the community who would not trust this Subcommittee's findings. She responded that while she had learned not to trust much after 9 years of ATSDR's condescension, the ORRHES could earn her trust if it does a good job (e.g,. establishes a clinic to screen people for toxic exposures, inviting public involvement in the meetings). The experience of the past 9 years has made doubters of her and the community that anything but inconclusive studies will be done.

Dr. Frome responded that he is an ORNL employee, but both he and his wife also have medical problems and the members represent themselves and the community. He was involved in the worker studies and had never seen any hint of DoE interference. Ms. Stokes believed him, and recognized independent representation on this board. It they can do anything solid, it will be appreciated. Mr. Pardue stated that public participation in the ORRHES' activities is of concern to the members, and asked her to attend.

Mr. Steward knew that several committee members are independent members of this committee (e.g., Mr. Washington and Ms. Kaplan), and found that to be a big step forward in Oak Ridge's process. Ms. Sonnenburg asked that the speakers from the public to leave their phone numbers so the committee members could talk to them further.

Ms. Kaplan wondered if Ms. Stokes was not on the committee because she would lose her disability benefits if she is paid to participate. She confirmed that. Ms. Kaplan stated that a person to represent those who are ill is needed on this committee and suggested a waiver be procured for her. She also asked if GWU could act as an impartial observer for a local outfit to do the work to ensure the data aren't corrupted, rather than wasting 3-6 months getting set up. She commented further that $500,000 had already been paid to a group in Washington who issued a report the community found to be not worth it.

Continuation of Process Guideline Discussion

• Ms. Sonnenburg suggested that the Work Group on Organizational Structure consider setting a time in advance of the next meeting by which the work group would submits its recommendations.
• Ms. Sonnenburg moved that the Subcommittee recommend to ATSDR that they consider getting a waiver for Ms. Stokes to serve on this Subcommittee. Frome seconded. However, Mr. Pereira reported that ATSDR had explored this with the Social Security Administration, and providing such a waiver is not within the jurisdiction of DHHS. However, such a person could serve on the committee without pay. Mr. Hanley added that one nominee's attorney advised her not to participate, and there is an outstanding invitation to participate to someone who self identified as a "sick worker." In addition, some members are here because the ORHASP findings indicate them to be at high risk.
  
  Mr. Hill stated, as the union health and safety representative and one who works on compensation issues (SSI, worker's compensation, disability), that any disabled person would risk all their benefits if they accepted payment for participating on this committee. They really do need to listen to their attorneys. Ms. Sonnenburg: withdrew her motion. However, Ms. Kaplan still wanted to take this question to the upper agency levels, finding it logical that the SSA office to which ATSDR refers such questions will tell them that they cannot participate. With that, the committee adjourned for lunch.

Discussion of Work Groups

Mr. Pereira presented an overview of the work groups formed by the other Subcommittees and outlined what they address.

The Hanford Subcommittee (HHES) has four work groups, addressing: 1) Public Health Activities (focuses on issues affecting the public health and is developing an exposure registry and medical monitoring program with ATSDR); 2) Health Studies (focuses on related health effects research, considers the development of new health research proposals, and advises ATSDR and CDC); 3) Public Health Assessment (focuses on ATSDR's Hanford site assessment); and 4) Outreach (develops procedures to keep the public informed of the HHES' communication activities).

The INEELHES has five work groups: 1) Agenda (develops meeting agendas in cooperation between the members, the DFO, and CDC; 2) Education; 3) Membership, (recommends the criteria to use in seeking a replacement for a vacancy or additional membership position); 4) Procedures (develops definitions, action guides, and rules to facilitate the deliberations and decisions of the Subcommittee. These can be modified as necessary by consensus and acceptance by the INEELHES and CDC for the Subcommittee's operation); and 5) Public Communications (develops and monitors public involvement activities and proposes a public communication plan for INEELHES consideration/approval, to outline the role of public participation in the Subcommittee's work). Mr. Robinson added that these can be flexible; some of them have been combined.

The ORRHES had already considered three work groups to address the Agenda (developing and prioritizing agenda items/issues to present to the Subcommittee); Procedures (finalizing the guidelines document), and Education (recommending to the Subcommittee requests from members/work groups to invite interested individuals, community members, or technical experts to participate directly in a discussion or to make a presentation).

Mr. Pereira asked that no one be invited to join the work groups until those related questions are resolved (which he committed to do within 30 days). Further discussion of the Subcommittee included the following points:

• The Agenda and Education work group seem to overlap in procuring assigned speakers, and should be combined. Education also overlaps with Outreach.
• Forming work groups to seek out the information the needs assessment would require was suggested, but Dr. Davidson advised patience until GWU can present their plans for the Subcommittee's input. The CDC and ATSDR staff agreed. Mr. Robinson thought that the information needs would become apparent over time, and advised against forcing a framework based on ATSDR's. Mr. Pereira also noted that much of the institutional knowledge was available through this committee's members.

Dr. Brooks moved that standing work groups be appointed by the Chair: 1) a Guidelines and Procedures Work Group; 2) a Program of Work and Agenda work group; and 3) a Communications and Outreach Work Group; and that 4) other ad hoc work groups be appointed as needed. Dr. Malmquist seconded the motion. Dr. Brooks explained that the first would be limited in scope, only occasionally needing to meet for work; the second would plan out what would be done, when, and receive suggestions from members, and work with the Chair to assemble program of work and agenda; the third would communicate to the Subcommittee members, and carry out outreach to the public, and the last would allow others to address specific issues.

In discussion, two opinions were expressed: 1) that the members needed to get more guidance from ATSDR about what is expected of them, so forming work groups was premature; and 2) that most of the information dissemination on the agenda was complete, and it was preferred to move forward. Since the first two issues (agenda and guidelines) are critical to the agenda for the next meeting, it was agreed to vote on all the work groups as moved. Dr. Davidson called for a vote on the motion. With 16 in favor and one opposed, the motion carried.

Volunteers signed up for the work groups as follows:

• Guidelines and Procedures Work Group: Davidson (who suggested sending the draft to Ms. Connery for incorporation of comments and distribution), Pardue, Johnson, Manley, Brooks.
• Program of Work and Agenda Work Group: Hill, Eklund, Creasia, Sonnenburg, Malmquist, Brooks.
• Communications and Outreach Work Group to develop methods for internal and external communication: Kaplan, McNally, Lewis, Creasia, Mosby, Brooks, Frome, Washington.

Public Comment

Mr. Robinson referred to a comment by Mr. Lewis which suggested that close contact with the University of Tennessee might be negative. He related that CDC had contracted with them to conduct a door-to-door survey in Scarboro, which was done by students from the UT College of Social Work. He stated that they did a creditable job and turned in the data, which CDC tabulated and analyzed. He added that this also was a good opportunity to involve the community.

Mr. Lewis did not debate that, clarifying that his quarrel was with the approach taken. Each agency focuses on their own particular sphere of interest, but communities frequently have issues that will not be addressed in an all-inclusive survey. In his opinion, the overall impact of that method did not satisfy the needs of the community, and made subsequent work more difficult.

Committee Planning Discussion

Mr. Pereira announced that by January 1, 2001, ATSDR will have a permanent storefront office. It will be open for normal hours of operation, five days a week, in Oak Ridge at Tulane and Wilson, across from the Bank of America.

Meeting Site. He then asked the members their opinion of the YMCA as an ORRHES meeting site. While the location was found to be fine in general, it is long distance for some of the members to call home, and there is only one phone; and it is difficult to make a left out of the parking lot in the evening. Alternate sites suggested were the mall, which also has multiple eating places, or the Hazmat facility at the old Aubrey Springs shopping center.

Action Items. Mr. Pereira: summarized this meeting's action items for ATSDR to do:

1. ATSDR will provide a copy of the ORHASP studies' summaries.
2. CDC and ATSDR will provide a listing of the recommendations made over time by the other Subcommittee s/cs, and what happened in response.
3. ATSDR will provide an example of a completed needs assessment to the Subcommittee.
4. CDC/ATSDR Committee Management and the Office of General Counsel will explore the regulations and procedures of what Subcommittee work groups can and cannot do. Mr. Pereira will advise the members within 30 days of any formal procedures found.
5. The Procedures Work Group will consider the draft operational guidelines and the comments received earlier and at this meeting (including the revision of Figure #2), and recommend on them to the full Subcommittee. A new draft will be provided with the initial member changes and the Work Group's changes redlined.
6. ATSDR will try to provide copies of the independent East Tennessee Technical Park investigation study report provided by Norman Mulvenon (two bound volumes).
7. A PCB toxicological profile for will be provided to Dr. Eklund and Mr. Akin.
8. Dr. Brooks will meet with Ms. Bush on a compendium of Oak Ridge-related data.

Mr. Robinson advised that these action items always be clear at the end of the meeting so that ATSDR can address them. He noted in particular that action items are created by consensus; everything else is an individual request. He also suggested that at least an outline of the next agenda be created before disbanding.

Next Agenda. Dr. Davidson summarized the next meeting's potential agenda items: 1) a NIOSH report by Mr. Larry Elliott; 2) provision of more detail from ATSDR on the public health assessment; 3) GWU presentation/discussion of the needs assessment; and 4) reports of the Standing Committees. In addition, it was reported that Dr. Henry Falk, ATSDR's Administrator, may attend; as well as Dr. Paul Seligman, Deputy Assistant Secretary for Environmental Safety and Health and Director of the Office of Health Studies. Mr. Tim Joseph added that Dr. Leah Dever, the DoE/Oak Ridge Operations Manager, is also interested in attending to welcome the committee.

Mr. Brooks suggested that the Chair appoint the Work Group Chairs, and she agreed.

Future Meetings. The members tentatively agreed to meet on January 18-19, 2001, when almost all can attend. Dr. Eklund cannot meet on Tuesdays, nor Ms. Kaplan on Wednesdays. Ms. Sonnenburg will be abroad at the end of January. Mr. Lewis suggested attention to the timing of presentations related to public participation (e.g., have Drs. Falk and Seligman present when the public could participate). Mr. Cooper also suggested the Agenda Work Group's consideration of the other Subcommittees' schedule, which may involve a full day plus an evening session, and then ending at noon on the second day.

Mr. Hill asked how soon the work groups could begin meeting, and Dr. Davidson said any time. An ATSDR staff member must attend, but could do so by conference call which ATSDR can set up with a toll-free dial-in. Dr. Brooks asked what the full time staff person in the Oak Ridge office would do. Mr. Pereira listed meeting attendance in the area (other local groups, work groups, and the Subcommittee), staffing the office, providing publications and computer access, providing drop-in consultations, etc. The office also will have a small conference room that could host work group meetings.

Mr. Pardue said that the Guidelines and Procedures Work Group would probably will have to meet the first week in December, in order to provide the draft guidelines to Subcommittee before the January meeting. Dr. Davidson committed to appoint the Work Group Chairs by the next Friday. Mr. Pereira suggested that those Chairs then contact him or Ms. Bush and they will begin to set up the meeting times and places. Ms. Sonnenburg suggested an ATSDR staffer be in Oak Ridge for 2 days in December, and scheduling all the work group meetings on those days.

Ms. Kaplan asked how the Subcommittee could address enlisting a sick worker as a member, to surmount the difficulties to date. Mr. Pereira responded that the first order of action would be to identify such a person. Since there is one such invitation pending, Dr. Davidson suggested holding on that action item until the next meeting to give that person an opportunity to respond to the formal invitation. Mr. Lewis suggested the Subcommittee write a letter to request that person's participation. Since ATSDR cannot reveal his/her name, it could be sent through the agency.

Dr. Eklund proposed also pursuing Ms. Stokes or someone else in parallel with checking on that pending invitation; if 2 rather than 1 new members result, that would be fine too. He also suggested seeking support from a congressman to overcome the disability payment/Subcommittee service problem. But before the Subcommittee does anything like that, Mr. Pereira reiterated his suggestion that her interest in being a member be ascertained first. Mr. Hanley added that, if the invitee declines, member nominations would be re-opened.

Dr. Brooks strongly felt that sick workers should be represented, and recommended ascertaining as soon as possible (e.g., within 10 days) if the outstanding offer will be accepted. If not, another person not so constrained should be found. Mr. Akin wanted to ensure that "sick worker" is not an offensive term. Ms. McNally agreed; the label of "sick worker" also worried her. Since health exists in a continuum, and unless that term was volunteered by a group of individuals, she would not agree with it. She also wondered if the disabilities-benefits problem could be resolved by enlisting community members who were adversely affected just by living in the Oak Ridge area.

Mr. Pereira reported a suggestion voiced at the break that the Subcommittee invite representatives of SSI, Workers Compensation, etc. to discuss what is allowed or not. Mr. Hill's suggestion of parallel solicitations also could be done, with the same formal nomination process to ensue. Dr. Davidson referred this to the Agenda Work Group.

However, Mr. Hill was loathe to address SSI, workers compensation, long- and short-term disability, and litigation issues, because they do not pertain to the ORRHES charter. Dr. Davidson noted that people can self-nominate; the Subcommittee does not have to notify ATSDR of a nomination to fit a category. But the Outreach Work Group could ask community members about their interest in being on the Subcommittee.

Closing Comments

Dr. Davidson requested a one-sentence meeting assessment from the members, most of whom responded in one word: interesting (Dr. Kuhaida); still learning (Dr. Lands and Mr. Lewis); great day (Mr. Manley); eye-opening (Ms. McNally); the Subcommittee has its work cut out for it, but hoped they could all be friends (Ms. Kaplan); the tasks are challenging, but he hoped something positive could be accomplished (Mr. Pardue); challenging (Ms. Sonnenburg); fantastic (Mr. Washington); invigorating (Mr. Johnson);
"Did I mention I'm a grandfather?" and his rising interest (Mr. Hill); good job (Mr. Nwangwa); good meeting (Dr. Frome); worthwhile (Dr. Eklund); still ambivalent (Dr. Creasia); still learning and interested (Ms. Vowell); very good (Mr. Akin); predicted a storm at the next meeting (Dr. Brooks).

Mr. Lewis was impressed with the comments offered by Mr. Farmer on the previous day. He stressed the critical importance of how such issues are addressed, particularly to people who can only come once or twice. Their issues, telephone numbers, and names need to be recorded. As Mr. Pereira had done, the Subcommittee needs to make a commitment to the public. If it is to be a go-between or liaison, a process must be in place to ensure that feedback occurs.

Dr. Davidson reported having spoken with Mr. Farmer outside of the meeting and reiterated the invitation that he return when Mr. Elliott attends the January meeting. She suggested that follow-up with the public be discussed by the in the Communications/Outreach Work Group.

Mr. Henley noted that all the material sent to the Subcommittee members also was sent to the mailing list (100+ people), with a form to fill out if they want to continue to receive this material. Mr. Pereira appreciated what had emerged as a passion and interest in doing a good job. He applauded the good groundwork done at this meeting.

Dr. Davidson thanked the Subcommittee members for the past two days' work. She had learned a lot, expected to continue to do so, and hoped to continue to improve as Chair. She thanked the members of the community for their comments, which will be taken under advisement. Finally, she noted that Ms. Bush's address is on the committee list for those who wanted to communicate with her. With no further comment, the meeting adjourned at 4:00 p.m.

I hereby certify that, to the best of my knowledge, the foregoing Minutes are accurate and complete.

Kowetha A. Davidson, Ph.D., Chair

Attachments

Attachment #1
Motions and Action Items, 11/2000 Meeting

Motions passed during the November 2000 ORRHES meeting:

12. The Procedures Work Group, when appointed by the Chair, consider the Draft Operational Guidelines and the comments received, and recommend on them to the full Subcommittee.
13. Standing work groups will be appointed by the Chair: 1) a Guidelines and Procedures Work Group; 2) a Program of Work and Agenda work group; and 3) a Communications and Outreach Work Group; and that 4) other ad hoc work groups be appointed as needed.

Action Items Created at the November, 2000 ORRHES Meeting:

1. ATSDR will provide a copy of the summary of the Oak Ridge Health Assessment Study Panel.
2. CDC and ATSDR will provide a listing of the recommendations made over time by the other Subcommittees, and what happened in response.
3. ATSDR will provide a completed needs assessment to the committee as an example.
4. Committee Management and CDC's Office of General Counsel will explore the regulations and procedures of what Subcommittee work groups can and cannot do. Mr. Pereira will advise the Subcommittee within 30 days of the formal procedures found, if any.
5. ATSDR will try to provide copies of the independent investigation of the East Tennessee Technology Park study report provided by Norman Mulvenon (two bound volumes).
6. A PCB toxicological profile will be provided for Dr. Eklund and Mr. Akin.
7. Dr. Brooks will meeting with Ms. Bush on a compendium of Oak Ridge-related data.

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