ORRHES Meeting Minutes
December 3, 2002

The Subcommittee reconvened at 9:00 a.m. on the following day. Dr. Davidson summarized the previous day's discussions.

ATSDR Public Health Assessment Process

Mr. Jack Hanley, who leads the public health Assessment at the Oak Ridge Reservation, described ATSDR's public health assessment process. The public health assessment was delayed pending the completion of Tennessee's dose reconstruction to avoid duplicating its work.

A public health assessment is an analysis and statement of the public health implications to off-site populations from releases of hazardous substances, after which a triage process determines the need for follow-up public health actions or studies. The resulting document helps federal and state agencies and citizens to decide the follow-up public health activities needed. Of its seven steps in identifying a completed exposure pathway, the third and fourth are potentially the major drivers of the Oak Ridge assessment.

1. Evaluate site information: The Subcommittee will help in developing site-specific information as ATSDR collects data on: background information, community health concerns demographics, uses of land and natural resources, environmental data, and environmental pathways (the physical characteristics that affect contaminant transport offsite).

2. Identify Community Health Concerns. ATSDR will identify the community members actively involved in these issues, as well as involve the overall community in the public health assessment process. GWU's work and the input of the Subcommittee will help this process. A section of the public health assessment will list the concerns collected; another section (Public Health Implications) will address those concerns. Communications will be maintained with the community and all involved parties throughout the process.

3. Determine Contaminants of Concern. This is the first major screening assessment of the public health assessment process. The contaminants used at the facilities will be identified, and any which involved significant releases which may have contributed significantly to off-site health hazards. None of the contaminants are considered a health hazard until the pathway analysis is complete.

4. Identify and Evaluate Exposure Pathways. The Subcommittee's input on exposure pathways is expected to be significantly helpful. Each site has unique characteristics that affect the impact of the exposure pathway. This is a complex process in which, first, each of the five elements of an exposure pathway are identified (a. contaminant source, b. environmental media that transports it to a human; c) exposure point, the d) route of exposure [ingestion, inhalation, etc.], and e) the receptor population). The pathways are then categorized as completed or potential in either the past, present, or future, which determines whether the pathway can be eliminated. If any one of the five elements is missing, a potential pathway is determined; if all are present it is deemed complete. A toxicological investigation is then done to assess the potential implications. Pathway analysis enables the health assessor to focus on completed pathways.

5. Determine Public Health Implications. The pathway analysis provides a systematic methodology with which to identify receptors, and lays the foundation for evaluating the public health implications. The latter is done in three areas: toxicology, health outcome data, and community health concerns.

• The toxicological evaluation estimates media-specific exposures, compares exposure estimates with health guidelines; determines exposure-related health effects; and evaluates other factors that influence adverse health outcomes.

• Health outcome data is evaluated for all identified plausible health outcomes associated with the contaminants that are determined to be of public health concern.

• Community health concerns are evaluated using environmental data, exposure pathways analysis, toxicological evaluation, and health outcome data evaluation. These help determine whether the outcome is plausible. If not, other data and information are explored to explain the likelihood of the outcome. Finally, other issues related to environmental and other concerns are addressed.

6. Determine Conclusions. A public health hazard category will be assigned to the site, the health implications from completed exposure pathways identified, and plausible community health concerns will be defined. Missing or insufficient information will also be described to outline the study's limitations. The public health hazard categories are: a) urgent; b) present hazard; c) indeterminate; d) none apparent; and e) no public health hazard.

The public health assessment document usually has three types of recommendations: to protect public health, to list follow-up public health activities, and to recommend on further characterization of the site to gather additional environmental information.

7. Develop a Public Health Action Plan. The public health action plan identifies actions undertaken or planned, and the agencies conducting/to conduct them. At Oak Ridge, with the Subcommittee's assistance, ATSDR will analyze and evaluate the information, data, and findings from previous studies and investigations on the radiological and chemical contaminants released from the Oak Ridge Reservation.⁽²⁾ The dose reconstruction feasibility study also will help to identify contaminants of concern.

Mr. Hanley distributed time lines (Attachment #7) outlining the major processes at the various Oak Ridge facilities, the public health activities relating to them, and the studies that ATSDR will examine to develop the public health assessment. For example, the past environmental and health assessments that addressed specific materials will be reviewed by ATSDR to develop an overall picture.

Discussion. The Subcommittee's discussion with Mr. Hanley included the following:

• Has ATSDR done any work to address the synergistic effects of multiple combinations of chemicals? Oak Ridge uses all the 92 elements on the periodic chart. An ATSDR toxicologist could attend to discuss this. But synergism is very complex; involving not only chemicals but their ratios and periods of exposure. The pathway analysis will identify the chemicals that people were exposed to off-site, and document those effects. If there is insufficient information (including the state of the science) to determine the latter, the report will state that. As a toxicologist, Dr. Davidson added that all chemicals do not act synergistically. It depends on the chemical and the combination: some are inhibitory, some are additive, some are not; and some have no interaction.

• Only K-25 has medical screening, not Y-12 or ORNL; can periodic screening be done here as by Hanford's Medical Monitoring Program? That could be an ORRHES recommendation subsequent to the study, such as the Libby, MN, program discussed by Dr. Falk. That was based on exposure to asbestos; the same has been done for beryllium workers. Once the exposure information is in place, it supports any recommendation for follow-up work.

• Mr. Lewis thanked ATSDR for the time lines provided, which gives the lay person a better idea of what occurred at Oak Ridge. He stated that the ORRHES should identify the public health impact on off-site populations, including sick workers.

• What is the relationship between assessing health education needs and the public health assessment? The concerns documented in the needs assessment will be included in the public health assessment. ATSDR's public health assessment process focuses on exposure; GWU's focuses on community needs and concerns. ATSDR will use GWU's collected detailed demographic information and needs assessment information to determine how to channel the results of the public health assessment out to the public.

• Once the pathways are identified, can ATSDR do an independent test of the water from the 10 Mile Area's water supplier, about which there is some community concern? Some testing can be done, if indicated to demonstrate an identified exposure or to fill a data gap. But that kind of testing is governed by EPA and state regulations. The water utilities test on their own, with state oversight.

• What if exposures cannot be linked to health outcomes data? If information is insufficient to identify an effect, that will be documented. But if a concentration is found of a chemical linked to effects (e.g., mercury to the kidney), ATSDR will look for an information source to explore whether those effects exist in the community (e.g., a cancer registry). This is a sort of screening process. If a comparison of exposures and outcomes indicates a link, doing an analytic epidemiologic study (comparing outcomes of an exposed versus unexposed group) could be recommended. Some advocate first identifying illnesses in the community/workers, and then working backwards to link that to a site contaminant source. But Mr. Hanley compared this to drawing a bulls-eye after the fact .

• Is there a way to get a baseline of the community's health before beginning, since both higher cancer incidence and better health than the national average have been asserted for the area? This is possible; there are some indicators to do that. Someone could attend to explain for the Subcommittee that process and its limitations, as well as describe what was done at other sites and follow-up with those epidemiologists. But Mr. Hanley cautioned that this raises people's expectations despite its limitations. Both Anderson and Roane counties have looked at those indicators already; ATSDR plans to use and could present that information and others. The problem is that one cannot just relate that information to the site; it can only be stated what is found. Mr. Pardue commented that publicly stating the latter could be of value, since many such statements are circulating.

• A summary of the baseline and its limitations is of interest. Is there a schedule for the public health assessment process and its completion? There is none written down yet, but this can be developed with this Subcommittee and its Agenda Work Group.

• Will ATSDR do exposure investigations such as done at Watts Bar for the fish exposure pathway? Where would that fit in the public health assessment process? And how do existing environmental data fit (e.g., the soil analyses done). Any indicated exposure investigation would follow the public health assessment, but if deemed critical, it would not be delayed. Some of the soil information was used in the state screening process that ATSDR will evaluate, and then again in the more detailed pathway analyses. Dr. Brooks recommended that ATSDR consult the state Health Department's Statistical Profiles of Tennessee (SPOT) for its county-based health data that can be variously delineated (e.g., age, gender, etc.). He also advised caution in reviewing the wording of material that may be provided (e.g., GWU's listed "health effects of brain/kidney damage," should instead state "potential" health effects).

• A Subcommittee vote was taken on the geography to be addressed in identifying and evaluating exposure pathways. If that seems exceeded, is the process flexible enough to follow it? Yes, but what was voted upon is a reasonable starting point.

• There already are dose reconstruction and health effects outcomes documents; what's wrong with them? Why does ATSDR need to go beyond them to do more? To review those and all the other material, and to put all this in context before any further studies are done, as well as for ATSDR to interpret those materials and use them ourselves.

• Inevitably, the public health assessment process won't satisfy everyone. For example, evaluating health outcome data for "plausible" health outcomes based on the scientific data will not match what some community members perceive as plausible. That will need to be addressed. Agreed. The report will not leave that as an unanswered question. ATSDR will answer by explaining that the data are insufficient. Mr. Pereira suggested the Communications/Outreach Work Group work with ATSDR to discuss how to convey to the community from the beginning the uncertainties in all this work, as early as possible and incrementally throughout the work.

• Agreed! It is incredible, with the amount of money spent and work done, that the lessons learned have been so lacking that the understanding of all this is still so low. Something is seriously wrong with how study results are communicated. This is the difference between doing research and public health. For the latter, the information provided must be adequate to allow a person to decide on subsequent actions. This has to be checked on periodically.

Dr. Davidson suggested the Communications/Outreach Work Group advise the Subcommittee on a communications strategy that ATSDR can use to communicate to the public the results of the assessments (needs and public health), and to evaluate if that communication is effective.

• People hear what they want to hear. Getting information out to the community is no easy task, and doing both communications (ensuring information is accurate and understandable) and outreach (to get them to commit to the success of the program) is huge. Re-thinking the process of combining both tasks (including identifying the focus groups' topics) was suggested.

• Ms. Galloway asked what would happen if a person were exposed to a material but evidenced effects not known to be related to that material. Will a database record be kept of that effect for comparison to others at other places and times? Some of these materials are new enough that all the effects may not be known. Most of this process is "weight of evidence" decision making. The public health assessment report will document that concern and explain why/why not there is a plausible link, and describe other plausible causes. If there is a resource to address that, the person can be so referred.

• Where does ATSDR get the numbers regarding the materials' effect? The American conference of Governmental Industrial Hygienists' (ACGIH) standards can be converted to 24-hour exposures, and estimated doses can be compared to EPA reference doses as well as ATSDR's own minimum risk levels.

• What is the reliability of estimated synergistic effects, since only 10-15 have been examined? Information can be provided on how ATSDR approaches the toxicological issues related to synergism. Dr. Davidson stated that not all chemicals have a large database on their characteristics and effects; but some inferences are possible from the data of other similar materials.

Public Comment

Dr. Fay Martin was pleased to hear that synergism would be discussed, but as a toxicologist, she quoted the truism that "all substances are poisons... it is the concentration which poses the effect."

Subcommittee Discussion

Ms. Sonnenburg asked why, if Watts Bar is safe for PCBs, the state had not taken down the warning signs. Mr. Hanley acknowledged that it was probably poorly communicated in the pre-meetings why PCBs and mercury, and not other contaminants, were addressed. That should be explained in the media.

Mr. Hill advised that the data collection process should include the worker screening programs (PACE and the Building Trades), and the database on prevalent medical conditions. Mr. Hanley commented that presentations on that material could be arranged. It provides perspective, although not related to the public health assessment.

Mr. Pereira stated that the Oak Ridge ATSDR office, staffed by Bill Murray, will have direct communication to the logistical support in Atlanta for whatever is recommended for communication/outreach (e.g., for publishing/layout of a newsletter, etc.), as well as the use of a Website. He encouraged the Subcommittee to "think out of the box" beyond paper outreach (e.g., to perhaps have a public availability session the day before the meeting).

Dr. Brooks commented that several groups doing community outreach had found that there is no one answer to doing that and building trust. In his experience, outreach is a long-term intensive effort to present a point to the public. He recommended letters to the editor as an effective format of communication and outreach.

Mr. Kuhaida reported that a class-action federal lawsuit was filed in the last week on the impacts of the Oak Ridge Reservation on the public. He asked what the legal implications this might entail to the Subcommittee's work, the public health assessment, etc. (e.g., should the members be cautious in their statements?). Mr. Pereira expected none. As an independent government agency, ATSDR is often at sites involving litigation, but stays clear of that in its mandated work. Mr. Hanley added that, as the members work as special government employees, their comments are protected. The Justice Department would intervene to block any use of that as evidence in a case.

Housekeeping Issues

Mr. Malmquist moved to begin the next meeting at noon on the morning of Monday, March 19^th and to end at 4 p.m. on Tuesday the 20^th. With all in favor, the motion passed, and the members adjourned for lunch.

Unfinished Business

Subcommittee Composition. Mr. Hanley reviewed the steps taken to select the current Subcommittee membership. In 1998, CDC, ATSDR, and DOE met in Oak Ridge and other sites to discuss the launch of a process to set a coherent, national research agenda across agencies. Based on the information collected, the need for a Subcommittee in Oak Ridge was identified, which ATSDR was charged to lead. An Oak Ridge Reservation Public Health Work Group was formed of seven federal and two state/local agencies. Meetings were held in April, June, and September 1999 with community members and stakeholders. The interest in having a group with members representative of the community and without conflicts of interest, to provide consensus advice to the agencies, was expressed.

Subcommittee membership criteria were provided by the community: 1) local health care providers, 2) organized labor, 3) local government, 4) technical experts, 5) lay community members, 6) Chamber of Commerce/business community; 7) Scarboro; and 8) surrounding communities; 9) community health advocates; 10) workers with high risk of exposure; 11) workers or local citizens self-Identified as having health concerns; 12) retirees, and 13) civic organizations. Using these criteria, members were selected by ATSDR and CDC from the nominees submitted, in a process observed by community members. An additional criterion developed by ATSDR addressed individuals with potential high risk of off-site exposures based on the dose reconstruction reports.

One nominee was a worker with high risk of exposure and who self-identified as having health outcomes, who decided not to join (and reiterated that when asked again recently), so one seat can be filled. Although other present members fulfill that category, ATSDR decided to try to fill this position one more time. ATSDR knows of another candidate.  Although not a worker, s/he meets the additional criterion of being potentially at risk of off-site exposures based on the dose reconstruction reports. One consideration is that, although the FACA charter allows up to 30 members, that is an unwieldy number for effective committee function. Mr. Washington knew of a likely candidate, and agreed to check on that person's interest and to advise ATSDR. However, he also thought that adding other members should re-open the process to other people. Mr. Pereira recalled the last meeting's lengthy discussion about including a sick worker, the one representation lacking on the Subcommittee. If the ATSDR pool of nominees doesn't meet that criterion, they could re-open the process, unless that is no longer of interest to the present members. Dr. Brooks expanded this from a "sick worker" to one who blames an illness on their occupational exposure, and suggested ATSDR just fill it by following the same process as previously used.

Mr. Pereira agreed to ask the CDC/ATSDR committee management office if they would support an announcement to seek a worker as a new member with health concerns attributable to the Oak Ridge Reservation exposures. He will advise the Subcommittee, and if so, when the nominations would formally be opened.

New Business

Health Effects Presentation. Dr. Eklund asked for a presentation on health effects expected to be seen among children as well as adults.

Activity of the Communications/Outreach Work Group; focus group scope decision. Dr. Brooks moved that the Subcommittee reconsider the motion passed on the previous day, assigning the work on focus groups to the Education and Outreach Work Group. He suggested, instead, forming a long-standing work group to follow the health assessment and the work with GWU, since the focus groups leads naturally to the next stage. Dr. Davidson allowed that, if subsequent work is assigned to a different group, the work flow would be discontinuous. Mr. Lewis agreed that outreach, education, and communication entail different work and should not be addressed by a single group. He thought the first effort would be Outreach to draw the community in to the Subcommittee's work.

Mr. Pereira distinguished between health education and communication. Health education is product-driven (e.g., children eating dirt that contains lead); but communication is a process of conveying information. Optimally, they are done in concert, but communication can be done alone. Education would cover GWU's needs assessment for educational purposes. Dr. Brooks agreed that, with tasks continually assigned, the work group's burden will be too large. He advocated a separate work group for the GWU effort and another for the health assessment as well.

Ms. Kaplan reported her initially-considered strategy of just sending some thoughts to the entire Subcommittee and interested members of the public. She felt, though, that this work should not be limited to just this small Subcommittee. There is no way for four people to do all that had been assigned, unless she could draft other people to contribute. Additionally, all the work could not be done in meetings; that would be too slow a process; but the initial work could be done by e-mail. On Mr. Hill's question, Mr. Pereira confirmed that a sit-down meeting is paid as a half-day of FACA work, but 10 minutes to send an e-mail would not be. He also reminded the members that an ATSDR staffer must attend work group meetings.

Upon a vote to reconsider assigning the focus groups to the Communications/Outreach Work Group, 16 were in favor, none opposed, and one abstained. The motion passed.

Dr. Brooks then moved to re-vote on Mr. Hill's original motion. Ms. Mosby stated that, as a member of the Work Group, she had voted against it, favoring instead a separate work group to handle this task. Mr. Lewis agreed. Upon a vote, none were in favor; 14 were opposed. With no abstentions, the original motion failed.

Mr. Malmquist then moved to form a new work group to work on the health needs assessment, with the first task be to address the composition of the focus groups. The motion was seconded by Ms. Mosby. The vote was 16 in favor and none opposed, with one abstention. The motion passed.

The volunteers for the Health Needs Assessment Work Group were: Brooks, Lewis, Mosby, Sonnenburg, Washington, Lands, Craig, Vowell, and Johnson.

Clarification/Description of Focus Groups Methodology. Upon a question, Dr. Parkin clarified that the focus group methodologies would assemble 6-12 people to discuss a topic of concern in qualitative (not quantitative) research, guided by a list of questions, with a moderator to ensure the questions are covered with in the time allotted, and with a note-taker. Typically, the issues of concern are identified that the group can address comfortably even though in a disparate groups. Difficulty arises if the groups are too mixed, so a random selection process is usually used. Another issue identified on the previous day was the ability of participants to attend the group. No record is kept of who participated or who said what. Group characteristics might be reported (e.g., general themes, concerns, perspectives, etc.). In this project, the focus groups are intended to collect a richer understanding of community concerns before structuring the instrument for the phone survey. Seven work groups will be formed for seven counties; for example, one could have one nurse from each county if that could be managed geographically. GWU will identify the individuals after the Subcommittee identifies the groups of interest with appropriate descriptors. But GWU will also need help to know how to identify them (e.g., Scarboro or Watts Bar residents, or sick workers). Dr. Parkin offered to meet with the Work Group, ideally at its first meeting; and in future could also meet by conference call.

Concern was expressed that the Work Group be able to do this without delaying to the next meeting. Dr. Davidson expected the work groups to meet and formulate their recommendation and send it to ATSDR. The agency in turn will send out the Subcommittee members and liaisons for their review and comment. However, GWU cannot act on anything until the Subcommittee approves it.

Public Comment

After a short break, public comment was solicited.

Ms. Romance Carrier, of the Oak Ridge Health Liaison, was discomfited by the references to a "self-identified sick worker." She asked what was different about that category, thinking that it sounded as if it questioned the legitimacy of the identification. Dr. Davidson responded that ATSDR would respond in writing to the comments, which Ms. Carrier appreciated. She continued that she was happy to read that CDC will begin to track environmental illnesses, something she suspected that many people assumed it had done for years. She herself had participated in a CDC study at Emory University with Dr. Frumpkin. She stressed the difficulty of doing so; she could not have managed it if not for her husband. Many physically disabled people cannot do so; they are in wheelchairs and/or have lost everything.

Dr. Frome asked to read a comment from the public, sent to the Environmental Quality Advisory Board on September 2 from <andyh987@aol.com>. Andy urged the board to "face the facts" that no one wants to move to Oak Ridge because of the environmental problems; he himself is ready to move. He stated that the real estate values are too high, and that those moving in don't know the problems. He charged that is DOE stalling any action until the affected workers die. He challenged the EQAB to address these issues within one month, or he would start an Internet campaign to deter anyone from moving to Oak Ridge. Dr. Frome e-mailed him back asking him to come to this meeting and express those concerns, or offered to read his message if he could not. Mr. Craig asked if the e-mail could be distributed. Mr. Pereira was unsure, since it was not sent directly to the ORRHES. However, Mr. Kuhaida thought that possible, since Tennessee's open meeting law would release the e-mail after being sent to the EQAB.

Dr. Davidson also read comments received the previous day in writing from Ms. J. Shaakir-Ali. She urged that Blount County be included in the study's geographic area; the use of the Internet to deploy educational materials; and the use of TV Access Channel 12 in Oak Ridge, as many elderly people watch that.

Closing Discussion

Outreach. Ms. Sonnenburg personally thanked Ms. Carrier for coming to talk with the Subcommittee. She hoped to find a way for the committee to be more welcoming and responsive to those who take the trouble to come and address it. Dr. Davidson noted the charge to the Outreach/Communication Work Group to discuss how to be more responsive; and noted that ATSDR will respond to each person's comments and that the minutes will include a summary of each person's remarks.

Website. Mr. Pereira invited the Subcommittee's recommendation to ATSDR as to how they would like to use its Website. He offered to provide as a model the site of the Hanford Health Effects Subcommittee. The Outreach/Communication Work Group was asked to consider this question.

Roberts Rules. Mr. Malmquist requested that Dr. Brooks give a short presentation on Roberts Rules at the next meeting, and provide that information before the meeting.

Registries. Mr. Akin suggested addressing the public misperception that ATSDR will track everything as part of its disease registry. The latter's cost and limited activity (diseases related to 3-4 contaminants) should be made known. Mr. Hanley recalled media reports that a commission funded by the Pew Charitable Trust (<health-track.org>) recently recommended to President Bush that CDC set up a tracking system.

Action Items. Dr. Connery summarized the action items she had noted in the course of the meeting. These are listed appended to this report in Attachment #8, along with the meeting recorder's list of the meeting's motions and action items.

Meeting Dates: In discussing future meeting dates, the Subcommittee considered that the second Tuesday is the CAB's meeting day; that two Monday nights per month are City Council meetings; and that June 5 is election day. The members agreed on the following tentative schedule of meetings, on Mondays (noon to evening), and Tuesdays (8-4:30 p.m.), on the following dates: June 11-12; September 10-11; and December 3-4.

Meeting Records: ATSDR will continue the video- and audio-taping of meetings, and FACA requires detailed minutes which will be available on the Website. When asked about continuing the verbatim transcript, Mr. Malmquist moved to discontinue the verbatim transcript. Ms. Sonnenburg seconded the motion, which passed unanimously.

Meeting Location: The Agenda Committee and ATSDR are investigated other locations (e.g. the Mall) for future meetings.

Finally, the members were asked to provide changes to their biographies (which will be made public) to Marilyn Palmer, and to sign the meeting roster before leaving. With Dr. Davidson's thanks, the meeting then adjourned at 3:50 p.m.

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

Kowetha A. Davison, Ph.D., Chair

Date

ATTACHMENTS:

Review of AOEC document regarding Oak Ridge Reservation and Reported Health Effects

Agenda Work Group report

Communications/Outreach Work Group report

Guidelines and Procedures Work Group report

DOE Information: Energy Employees Occupational Illness Compensation Program Act of 2000

Memorandum from Save Our Cumberland Mountains, Roane County Chapter/Oak Ridge Health Liaison

ATSDR information: time lines of Oak Ridge Reservation facility histories

Motions passed and action items listed at the January meeting.

Attachment #8

Motions passed and Action Items Listed by the Meeting Recorder

Motions passed during the January 2001 meeting:

• Include in the geographic scope for health effects studies the Oversight Committee's represented 7-8 county area: Anderson, Knox, Roane, Loudon, Meigs, Rhea, and Morgan; and the city of Oak Ridge.

• The Communications/Outreach Work Group was asked explore what issues the focus groups should address, and return with a recommendation to the full committee.

• The Communications/Outreach Work Group will reword its

• draft report (e.g., to "attracting" or "advertising for," rather than "identifying" new members). The balance of the report was approved.

• The Procedures document's appendix was changed to become Chapter 6.

• The Guidelines and Procedures Work Group will review the issue of the Vice Chair after the CDC/ATSDR Legal Department responds, and will discuss the relationship of the process documents and by-laws.

• The Guidelines and Procedures Work Group will discuss the use of Roberts Rules of Order, including which are likely to be applied and how. The consensus process will also be considered.

• The Guidelines and Procedures Work Group will include the public comment period and adjournment in the agenda.

• A vote was taken to accept Figure 2, which was altered to show all the non-voting liaison relationships with the Subcommittee, including that of DOE. The vote was 11 in favor and 7 against. (See the next bullet)

• The Guidelines and Procedures document will not address voting protocol until what constitutes an affirmative vote is agreed upon by the Subcommittee.

• The liaison agencies and their nonvoting status will be designated on their table name plates.

• The next meeting will begin at noon on the morning of Tuesday, March 19^th and to end at 4 p.m. on Tuesday the 20^th.

• The previous day's motion, assigning the work on focus groups to the Education and Outreach Work Group was withdrawn. A new work group to address the health needs assessment was formed, with its first task to be addressing the composition of the focus groups.

• The tentative schedule of meetings is to be held on Mondays (noon to evening), and Tuesdays (8-4:30 p.m.), on the following dates: June 11-12; September 10-11; and December 3-4.

• The verbatim meeting transcript will be discontinued; the audio and video taping and note taking to generate Minutes documents will continue.
  

January 2001 Meeting Action Items, as noted by the Meeting Recorder

Day 1:

1. ATSDR will make copies available of the 12/99 TDEC report on the DOE Oversight Project.

• NIOSH/Mr. Elliott will convey to NIOSH's Acting Director, Dr. Larry Fine, the committee's desire to have a NIOSH representative at every meeting.

• ATSDR will provide comments on the Work Group's Program of ORRHES Work.

• A progress report was requested on the interagency meeting regarding the Scarboro soil sampling analysis and a general sampling strategy.

• Ms. Vowell will provide a definition of what constitutes a "medically under-served" population to ATSDR for distribution to the Subcommittee.

• NIOSH will provide a listing of the accomplishments for workers that stem from their research, as well as the concerns expressed by the workers. A program booklet and other information on present and past studies will be provided.
  

Day 2:

• The Subcommittee requested a baseline report on the community's health. ATSDR could present the results of previous community health status reports (e.g., Anderson and Roane counties) and on the implications of making statements based on such information.

• The Communications/Outreach Work Group was asked to develop advice to the Subcommittee on a communications strategy that ATSDR can use to communicate the results of the needs and public health assessments to the public, and to evaluate if that communication is effective.

• ATSDR was asked to provide information on how they approach the toxicological issues related to synergism.

• Mr. Pereira will ask ATSDR management, and should be able to advise next week, if the agency will support an announcement to seek a worker as a new member; and if so, when the nominations will be formally opened.

• The Health Needs Assessment Work Group's first task will be to address the descriptors with which to form the GWU focus groups. Work Group volunteers were: Brooks, Lewis, Mosby, Sonnenburg, Washington, Lands, Craig, Vowell, Johnson.

• The Agenda Work Group will consider a short presentation on Roberts Rules by Al Brooks at the next meeting.

• The Communications/Outreach Work Group was asked to consider how best the ORRHES can use the ATSDR Website as a resource.
  
  

ACTION ITEMS, "PARKING LOT" ISSUES, AND DECISIONS [INCOMPLETE LIST]

As Noted by the Meeting Planner, Eastern Research Group

OAK RIDGE RESERVATION SUBCOMMITTEE

JANUARY 18-19, 2001

• ATSDR will send a copy of the minutes of the first meeting to Al Brooks.

• ATSDR will send copies of the 2000 TN Dept. of Environment and Conservation DOE Oversight Division, Status Report to the Public to the subcommittee members.

• GWU will provide a list of the documents they are reviewing to all members of subcommittee via ATSDR. [DONE]

• ATSDR will get information on whether it is possible under FACA to have a vice-chair to the G&P work group within a week or so.

• ATSDR will distribute the letter from Save our Cumberland Mountains to all members of the subcommittee and to all panelists who were present on the first day.

• Brenda Vowell will get information on medically under-served communities to subcommittee members via ATSDR.

• The Needs Assessment Work Group will develop recommendations for the descriptors for the seven focus groups that are not the general focus groups. ATSDR will distribute these recommendations to all subcommittee members prior to the next meeting.

• The Communications and Outreach Work Group will reconsider and revise the first bullet of their purpose statement.

• The Procedures and By-Laws Work Group will consider and recommendation a resolution of 1) the relationship of the process document and by-laws, 2) vice chair (subject to information from ATSDR).

• The P&G Work Group will determine and clarify what aspects of Roberts Rules will apply to the subcommittee and how they will be used.

• The P&G Work Group will add public comment period and adjournment to the list of agenda items in the by-laws.

• ATSDR will check and get back to Bill Pardue/subcommittee on work that has already been done on and limitations of comparing health effects rate in people in the Oak Ridge area to the general population.

• ATSDR will get copies of Community Diagnosis Status Report for Anderson County etc. to subcommittee members.

• ATSDR will look into developing a list of steps for the needs assessment comparable to the seven steps for the public health assessment process.

• ATSDR will work with the Agenda Work Group to develop a schedule for the public health assessment.

• The Communication and Outreach Work Group will work on: (1) a communication strategy for ATSDR and CDC to communicate to subcommittee members and the public regarding work on and results of the needs assessment and public health assessment; and (2) a strategy for evaluating whether communication by the subcommittee has been effective within the community.

• Jerry Pereira will check with ATSDR management about making an announcement of a vacancy on the subcommittee for a member who is self-identified as having health impacts as a result of exposure at work.

• ATSDR will respond in writing to questions asked by public commenters (if the commenters have provided their names and addresses).

• Al Brooks will give a brief presentation at the next meeting on Roberts Rules of Order.

• ATSDR will information on the URL for the Hanford web site to Al Brooks.

• ATSDR will create name tags and placards for the liaison members that indicate the affiliation of the liaison members and that there are liaison members (rather than voting members).

• THREE ITEMS ADDED BY RECORDER RE NIOSH

• ATSDR will provide comments on the program of work as soon as feasible.

• A progress report was requested for the next meeting on the sampling strategy.

"PARKING LOT" ISSUES

• Al Brooks: wants clarification on issue of who will decide what will be the scope of the focus groups.

• Al Brooks would like subcommittee to consider the issue of how health effects are reported - issue that needs assessment draft materials indicate certain things are heath effects that are not.

• Split duties of outreach work group.

• Dr. Eklund's point.

DECISIONS [INCOMPLETE LIST]

• Decided to keep agenda as is rather than shift the agency section to 3:30 p.m. from 4 p.m. 17 yes/1 abstention.

• For a new work group for the health needs assessment and the first task will be to develop input to GWU regarding the seven focus groups that are not the general focus group. Members are Ron Lands, Barbara Sonnenburg, James Lewis, Donna Mosby, Bob Craig, Brenda Vowell, Charles Washington, Dave Johnson, Al Brooks.

• Decided to refer first bullet of communications and outreach group statement back to the group for further refinement. Approved the rest of the statement.

• Refer the issue of 1) the relationship of the process document and by-laws, 2) vice chair (subject to information from ATSDR) back to the Procedures and By-laws Work Group.

• P&G work should further determine and clarify what aspects of Roberts Rules will apply to the subcommittee and how they will be used.

• Public comment period and adjournment should be included items in the agenda items in the by-laws.

• Decision to table motion of adding DOE as a liaison until by-laws are adopted.

• Placards of liaisons shall be displayed to indicate agency affiliation and a designation that they are nonvoting.

2. At the last meeting, a summary of the public health activities at Oak Ridge in the last 15-20 years was distributed.

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