Historical Document
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3.3 Issue 3: Reported Illnesses
3.3.1 Health Statistics Review to Address Oak Ridge
Physician's Concerns
Purpose
A health statistics review was conducted to compare mortality rates and
cancer incidence rates of counties surrounding the Oak Ridge Reservation
to rates from the rest of the state.
Findings
Findings of the review are in a Tennessee Department of Health memorandum
of October 19, 1992, from Mary Layne Van Cleave to Dr. Mary Yarbrough.
The memorandum details an Oak Ridge physician's concerns about health
status in the Oak Ridge area. Also available from the Tennessee Department
of Health are the minutes and handouts from the presentation given by
Ms. Van Cleave at the Oak Ridge Health Agreement Steering Panel on December
14, 1994.
Background and Agencies Involved
In June 1992, an Oak Ridge physician reported to the Tennessee Department
of Health and the Oak Ridge Health Agreement Steering Panel that he believed
approximately 60 of his patients had experienced occupational and environmental
exposures to several heavy metals. The physician felt that these exposures
had resulted in increased cancer, immunosuppression, chronic fatigue syndrome,
neurologic diseases, autoimmune disease, bone marrow damage, and hypercoagulable
state including early myocardial infarctions and stroke. Following is
a summation of the concerns expressed by the physician.
- He expects an increased rate of cancer in Oak Ridge and stated that
cancer cases are presenting early and with a more aggressive course.
- He had seen prostate cancer cases with very aggressive growth patterns
in patients of unusually young ages (e.g., 42 years).
- He stated that the cancer best correlated with radiation is acute
leukemia, and that over the last 6 months he has had 3 cases in Oak
Ridge, and the normal rate was 5 per 100,000.
- He noted that there were more cases of lung cancer and colon cancer
than all of the other cancer cases combined. In addition, he noted that
the effect of confounders such as tobacco and diet were not considered,
but if smoking were controlled, the lung cancer rate would be higher
for those with exposure to radioactive elements.
Time Line
The health statistics review of cancer incidence rates was conducted
in 1992, and the health statistics review of mortality rates was conducted
in 1994.
3.3.2 Review of Clinical Information on Persons Living
in or near Oak Ridge, Tennessee
Purpose
The purpose of this review was to evaluate clinical information on persons
tested for heavy metals and to determine whether exposure to metals was
involved in these patients' illnesses.
Findings
ATSDR concluded that this case series did not provide sufficient evidence
to associate low levels of metals with these diseases. The Tennessee Department
of Health came to the same conclusion.
Background and Agencies Involved
In 1992 an Oak Ridge physician reported that he believed approximately
60 of his patients had experienced occupational and environmental exposures
to several heavy metals. He felt that these exposures had resulted in
increased cancer, immunosuppression, and autoimmune disease.
At the request of the physician, ATSDR reviewed the clinical data and
medical histories of 45 patients. The Tennessee Department of Health also
conducted a review of the information.
Time Line
In August 1992, the Oak Ridge physician made a request to ATSDR to review
the data.
ATSDR sent a copy of their review to the physician in September 1992.
3.3.3 Clinical Laboratory Analysis
Purpose
Clinical laboratory support was supplied to Howard Frumkin, MD, to provide
individual clinical evaluations of patients referred by a physician in
Oak Ridge.
Findings
Because of patient-to-physician and physician-to-physician confidentiality,
results of the clinical analysis have not been released to public health
agencies.
Background and Agencies Involved
In 1992 a physician in Oak Ridge reported that he believed approximately
60 of his patients had experienced occupational and environmental exposures
to several heavy metals. He felt that these exposures had resulted in
increased cancer, immunosuppression, and autoimmune disease. At the request
of Howard Frumkin, MD, DrPH, of the Emory University School of Public
Health, ATSDR and NCEH facilitated clinical laboratory support by the
NCEH Environmental Health Laboratory for patients referred by the Oak
Ridge physician.
Time Line
Clinical laboratory support was provided in 1992 and 1993.
3.3.4 Health Statistics Review of Amyotrophic Lateral
Sclerosis and Multiple Sclerosis Mortality Rates
Purpose
Mortality rates were reviewed to find the incidence and mortality rates
of amyotrophic lateral sclerosis (ALS) and multiple sclerosis (MS) in
the counties around Oak Ridge and to compare those rates with the background
rate in the United States.
Findings
Because these diseases are not reportable, it is impossible to find the
incidence rate. The mortality rates were not significantly different from
rates in the rest of the state.
Background and Agencies Involved
In 1994 local residents reported that there were many community members
with ALS and MS. In consultation with Peru Thapa, MD, MPH, from the Vanderbilt
University School of Medicine, the Tennessee Department of Health conducted
a health statistics review of ALS and MS mortality rates for select counties
in the state of Tennessee. ATSDR also provided technical assistance to
the department.
Time Line
The health statistics review was conducted in 1994.
3.3.5 Public Presentation on Amyotrophic Lateral Sclerosis
and Multiple Sclerosis
Purpose
A public presentation was conducted to provide the Oak Ridge Health Agreement
Steering Panel and the public with an overview of amyotrophic lateral
sclerosis (ALS), multiple sclerosis (MS), and epidemiologic studies.
Findings
Neuroepidemiologist Dr. Leonard Kurland explained that there are three
kinds of ALS: sporadic, genetic, and Western Pacific. He reported that
in the United States 90% of ALS cases are sporadic and 10% genetic. He
said that approximately 5,000 people each year are diagnosed with ALS
in the United States. He stated that researchers have not yet been able
to identify a cluster of ALS because (1) ALS is easy to misdiagnose and
(2) the incidence rate is approximately 2 ALS cases per 100,000 people
per year. He explained that if someone is genetically predisposed to having
ALS they will develop the disease if they live long enough and that there
is no indication to confirm a causal relationship between mercury exposure
and ALS and MS.
Dr. Kurland showed a video about his research in Guam and indicated that
the Western Pacific cases are probably attributable to a botanic toxin.
Background and Agencies Involved
In 1994 local residents reported that many community members had ALS
or MS. The Tennessee Department of Health sponsored Leonard Kurland, MD,
DrPH, a neuroepidemiologist and senior consultant with the Mayo Clinic
in Rochester, Minnesota, to give the presentation to Oak Ridge Health
Agreement Steering Panel and the public.
Time Line
The presentation by Dr. Kurland was given at the Oak Ridge Health Agreement
Steering Panel public meeting on August 18, 1994.
3.3.6 Oak Ridge Health Agreement Steering Panel: Feasibility
of Epidemiologic Studies
Purpose
A study was conducted to explore the feasibility of initiating meaningful
and valid analytical epidemiologic studies to address potential health
concerns in the off-site populations surrounding the Oak Ridge Reservation.
Findings
A copy of the final report containing the findings of the study may be
obtained from the Tennessee Department of Health.
Background and Agencies Involved
The Oak Ridge Health Agreement Steering Panel recognized that there may
be a need to supplement findings of the main dose reconstruction studies
as they are limited to estimates of health risk in a given population.
Panel members were considering adding epidemiologic studies in the future
to directly evaluate health outcomes. The Tennessee Department of Health
and the Oak Ridge Health Agreement Steering Panel commissioned Puru B.
Thapa, MD, MPH, of the Department of Preventive Medicine at Vanderbilt
University, to conduct the study.
Time Line
The study was released in July 1996.
3.3.7 Physician Health Education Program on Cyanide
Purpose
A physician education program was conducted to provide information regarding
the health impacts of possible cyanide intoxication. In addition, the
program was intended to assist community health care providers in responding
to health concerns expressed by employees working at the East Tennessee
Technology Park.
Findings
- ATSDR provided the employee and local physicians with copies of the
ATSDR Case Studies in Environmental Medicine publication "Cyanide
Toxicity," the NIOSH final health hazard evaluation, and ATSDR
public health statement for cyanide.
- ATSDR instituted a system through which local physicians could make
patient referrals to the Association of Occupational and Environmental
Clinics (AOEC).
- ATSDR conducted an environmental health education session for physicians
at the Methodist Medical Center in Oak Ridge, Tennessee. The medical
staff grand rounds provided the venue for conducting this session. The
workshop focused on providing local physicians and other health care
providers information to help them diagnose chronic and acute cyanide
intoxication and answer patients' questions .
Background and Agencies Involved
In January 1996 a Lockheed Martin Energy Systems employee requested assistance
from ATSDR concerning occupational exposure to cyanide. On January 29,
1996, NIOSH received the request for a health hazard evaluation. Between
February and June of 1996, NIOSH representatives made four site visits
to conduct a medical and environmental assessment. NIOSH released the
health hazard evaluation in July 1996.
In a cooperative effort with AOEC, ATSDR, NIOSH, and the Tennessee Department
of Health followed up on the recommendations in the NIOSH health hazard
evaluation by conducting a physician health education session at the Methodist
Medical Center in Oak Ridge. Lorne Garrettson, MD, ABMT, Medical Director
of the Georgia Poison Control Center, made a presentation at the grand
round entitled "Cyanide Intoxication: Acute and Chronic."
Time Line
The physician education program was held in August 1996.
3.3.8 Governor of Tennessee's Independent Panel on
the DOE Toxic Substances Control Act (TSCA) Incinerator at the East Tennessee
Technology Park
Purpose
An independent panel was appointed to review the operations of the DOE
Toxic Substances Control Act (TSCA) incinerator at the East Tennessee
Technology Park to ensure that the TSCA incinerator is properly and legally
operated and monitored and protective of human health and the environment.
The panel was also charged with addressing the concerns and issues raised
by the public about the TSCA incinerator.
Findings
- The TSCA incinerator facility and operating conditions were in harmony
with its permit and had experienced few operating violations. The amount
of waste actually burned is a small fraction of the volume that the
incinerator is designed and permitted to process. The highest measured
concentrations at the site monitors were a small fraction of the permissible
levels, and most pollutants measured were not primarily from the TSCA
incinerator. Because the incinerator is regulated and monitored and
the permissible levels of pollutants in the environment are deemed adequate
to protect public health, then the TSCA incinerator is not a major contributor
to the illnesses seen in the Oak Ridge area.
- Transportation of hazardous substances to and from the DOE Oak Ridge
facilities is regulated and monitored by the US Department of Transportation
and the state of Tennessee. The record of safety for such shipments
has been exemplary. There have been no highway accidents involving wastes
being shipped to the TSCA incinerator. The transportation of hazardous
substances to the incinerator and from the Oak Ridge site involves risks
well within those accepted on a daily basis in the transportation of
other hazardous materials, such as gasoline.
- The panel found that there are sick workers at the East Tennessee
Technology Park and sick residents in the vicinity of the facility.
The panel also found that the areal distribution of affected workers
and members of the public conforms to no pattern and that the reported
diseases are not unique to specific chemicals. The panel reported that
it is not known whether the incidence and types of illnesses reported
are above normal or a statistical aberration. The panel found no specific
causes for the illnesses suffered by workers and members of the public
or whether they are more numerous than the norm.
- Many of the workers and members of the public were not stratified
with the availability, quality, and extent of medical care. Complaints
received by the panel include reports of doctors refusing to accept
patients, lack of availability of a specialist, lack of coverage of
"preexisting illnesses" for employees continuing to work with
changing contractors, lack of medical care for nonworkers, and lack
of responsiveness.
Background and Agencies Involved
In response to a series of articles in the Tennessean concerning the
impact of the incinerator upon the health of workers at K-25 and hearings
held at the Tennessee State General Assembly on the illnesses in Oak Ridge
and the transportation of hazardous waste through the state to the TSCA
incinerator, the governor appointed an independent panel of environmental
scientists, engineers, and occupational health professionals to investigate
the operations of the TSCA incinerator, currently operated under contact
for DOE by Lockheed Martin Energy Systems. The panel inspected the TSCA
incinerator, investigated allegations at the East Tennessee Technology
Park, visited the SEG incinerator, and held four meeting in Oak Ridge,
Tennessee.
Time Line
The panel was appointed in May 1997. The panel's final report was submitted
in January 1998.
3.3.9 Presentation of the Utah Leukemia and Thyroid
Disease Studies Related to Fallout From the Nevada Test Site
Purpose
This presentation was conducted to inform the Oak Ridge Health Agreement
Steering Panel and the public of the multiple studies related to the fallout
from the Nevada test site, including the study of leukemia and thyroid
disease.
Findings
Dr. Joseph Lyon explained that nuclear testing began at the Nevada test
site in January 1951. Public safety concerns began in the mid 1950s with
all atmospheric testing discontinued by 1961. In late 1961, the US Public
Health Service worked with the Utah Department of Health to conduct a
leukemia mortality study. An excess in leukemia was found using death
certificate records. This study was reported to the Utah Department of
Health and the Atomic Energy Commission, but was not published.
In 1979 Dr. Lyon began studying childhood leukemia associated with fallout
from nuclear testing. His study involved a review of all deaths from childhood
(under 15 years of age) cancers occurring in Utah between 1944 and 1975.
The high exposure cohort was defined as Utah residents under the age of
15 residing in rural counties receiving the most fallout from the 26 nuclear
tests that occurred between 1951 and 1958. Leukemia mortality increased
by 2.44 times in the high exposure cohort residing in the high exposure
counties. No consistent pattern was found for other childhood cancers
in relation to fallout exposure.
In 1965, the Bureau of Radiological Health examined 4,818 school children
for thyroid disease. These children lived in two Nevada and Utah counties
thought to have had large exposure to radioiodine. This cohort was re-examined
annually between 1966 to 1970. No excess thyroid disease was found in
these children.
In 1985, Dr. Lyon was involved in a follow-up cohort study of the original
1960s group. This study included 2,473 of the original 4,818 children.
The study has two major parts, dosimetry and epidemiology. Using the dosimetry
data (the primary pathway was milk consumption), the study found an association
between exposure to radioiodine and thyroid neoplasia.
Background and Agencies Involved
The Tennessee Department of Health sponsored Joseph L. Lyon, MD, MPH,
professor of Family and Preventive Medicine at the University of Utah,
to give the presentation in Oak Ridge to the Oak Ridge Health Agreement
Steering Panel and the public.
Time Line
The presentation was given at the Oak Ridge Health Agreement Steering
Panel public meeting on February 16, 1995.
3.3.10 Health Assessment of the East Tennessee Region,
Second Edition
Purpose
The health assessment of the East Tennessee region was conducted to evaluate
the health status of the population, assess the availability and utilization
of health services, and develop priorities in planning to use resources.
Findings
A copy of the document is available from the Tennessee Department of
Health, East Tennessee Region.
Background and Agencies Involved
In response to the Institute of Medicine's 1988 report on the "Future
of Public Health," in 1991, the Tennessee Public Health Association
encouraged each region of the Tennessee Department of Health to look at
the health status of the population, evaluate the availability and utilization
of health services, and develop priorities in planning to make the best
use of resources. In December 1991, the East Tennessee Region released
the first edition of "A Health Assessment of the East Tennessee Region,"
which included data generally from 1986 to 1990. The second edition included
data generally from 1990 through 1995.
Time Line
The second edition of the health assessment for the East Tennessee region
was released in 1996.
3.3.11 Medical Evaluation of K-25 Workers
Purpose
The purpose of the individual medical evaluations of K-25 workers was
to assess occupational health complaints and symptoms of 53 current and
former Lockheed Martin Energy Systems, Inc. workers at the East Tennessee
Technology Park (formerly called the Oak Ridge K-25 site). These medical
evaluations included reviews of prior health studies, visits to workers'
workplaces, work history interviews, reviews of worker medical records,
physical examinations, medical evaluations by specialists, and diagnostic
testing.
Findings
The physicians determined that several workers have one or more conditions/illnesses
likely to have been exacerbated, aggravated, or directly caused by historical
exposures in the work environment at K-25.
Some of these medical conditions are the result of exposures to hazardous
substances common to other industrial settings, such as organic and inorganic
dust-including heavy metals. Health problems found in K-25 workers associated
with these types of exposures include the following: allergic and non-allergic
rhinitis and sinusitis, acute and chronic bronchitis, occupational asthma,
contributing factors to the pathophysiology of emphysema, irritant induced
vocal cord dysfunction, allergic and non-allergic dermatitis, noise induced
hearing loss, and carpal tunnel syndrome.
Other medical conditions identified that are more unique to the K-25
site include possible beryllium sensitization (2 workers), definite peripheral
beryllium sensitization (5 workers), chronic beryllium disease (1 worker),
peripheral neuropathies, toxic encephalopathy, and autonomic neuropathy.
Various types of neuropsychological changes were identified in some workers.
These neuropsychological changes are consistent with toxic encephalopathy
from heavy metal and solvent exposures, cerebrovascular problems, and
with significant anxiety and depression. In some cases it was not possible
to determine whether the neuropsychological changes resulted from workplace
exposures or non-work related physical conditions, such as cerebrovascular
abnormalities
Factors that had a significant impact in creating anxiety and depression
in workers include: being informed that urine thiocyanate levels were
elevated indicating possible cyanide exposure; being tested for heavy
metal exposure and chelation therapy; developing medical symptoms and
conditions during work activities; having concerns about potential hazards
and exposures in the workplace and about emissions from the TSCA incinerator;
feeling stressed by downsizing at the K-25 facility; and being distrustful
of exposure information provided by contractors and the Department of
Energy. Anxiety and depression in some of these workers manifested as
work-related depression and anxiety that subsequently resulted in a physical
abnormality.
No trends with regards to workplace exposure and health impacts were
determined for the following: hypersensitivity pneumonitis, IgG and IgE
antibody testing against diisocyanates, lyme disease, heavy metal screening,
lead and serum ZPP/FEP, postural sway balance testing, peripheral vision
symptoms and abnormalities in peripheral visual field testing, serum PCBs,
dioxin and furan levels, and asbestos. Further study was recommended,
however, for postural sway balance and peripheral vision symptoms and
abnormalities in visual field testing. Increases in postural sway and
visions problems were detected, but clinical epidemiological studies are
necessary to determine possible causes.
Serum PCB levels were higher in workers with prolonged occupational exposures
at the K-25 facility; however, the elevations were not marked and were
not a level that would clearly cause health impacts.
Background and Agencies Involved
In the fall of 1995, workers for Lockheed Martin Energy Systems and residents
living near East Tennessee Technology Park reported illnesses they believed
to be associated with possible exposure to hazardous substances from the
East Tennessee Technology Park site. In the fall of 1996, Lockheed Martin
Energy Systems arranged for James Lockey, MD, MS, and Andrew Freeman,
MD, MS, from the University of Cincinnati, Occupational and Environmental
Medicine Clinic and Richard Bird, MD, MPH, from the JSI Center for Environmental
Health Studies and the Beth Israel Deaconess Medical Center at the Bowdoin
Street Health Center in Boston, Massachusetts to conduct a medical evaluation
to determine whether work related factors could be playing a role in the
symptoms and conditions of these K-25 workers.
Time Line
The Summary Report of Findings of K-25 Worker Evaluations was released
on July 31, 2000.
Individual final medical reports were sent to each of the 53 workers.
These reports provided summaries regarding medical conditions which the
physicians determined were most likely work related or which the physicians
could not state within a reasonable degree of medical probability and
certainly were work related, based on the currently available clinical
information and what is available in the scientific literature. For individuals
that the physicians believed had a condition that was either directly
caused by workplace exposure or significantly exacerbated or aggravated
by workplace exposures, the physicians prepared a separate "Work
Related Abnormalities as Determined to Date" summary. This summary
includes all pertinent medical information, occupational history, symptomatology
over time, and previous medical records and laboratory test as applicable
to the work related condition.
3.3.12 Scarboro Community Health Investigation
Purpose
The Scarboro community health survey, which included a medical evaluation
of children under age 18 years, was conducted to investigate a reported
excess of respiratory illness among children in the Scarboro community.
Findings
The participation/response rate of the health investigation was 83% (220/264
households), and included 119 children. The asthma rate was 13% among
children in Scarboro, compared to national estimates of 7% among all children
aged 0-18 years and 9% among African American children aged 0-18 years.
The Scarboro rate was, however, within the range of rates reported in
similar studies throughout the U.S. and internationally. The wheezing
rate among children in Scarboro was 35%, compared to international estimates
which range from 1.6% to 36.8%. No statistically significant association
was found between exposure to common environmental triggers of asthma
(i.e., pests, unvented gas stoves, environmental tobacco smoke, and the
presence of dogs or cats in the home) or potential occupational exposures
(i.e., living with an adult who works at the Oak Ridge Reservation, living
with an adult who works with dust and fumes and brings exposed clothes
home for laundering) and asthma or wheezing illness.
Thirty-six children were invited to receive a physical examination. These
36 included the children identified in the November 1997 media report.
The other children were those identified in the questionnaire as having
physician-diagnosed asthma that was incompletely controlled or those who
had not been diagnosed with asthma but had experienced more than three
exacerbations of wheezing episodes. Of the 36 children invited, 23 participated;
all were generally healthy and no urgent health problems were identified.
Only one child had any presence of lower respiratory illness, and none
were wheezing at the time of the physical examination.
Background and Agencies Involved
In November 1997, the Tennessee Department of Health received notification
of an unusual number of children affected by chronic respiratory illnesses
in the Scarboro community, a predominantly African American neighborhood
in Oak Ridge, Tennessee. The CDC was invited to participate in an investigation
of these health complaints in early December 1997.
The Scarboro community lies in close proximity to the Y-12 plant, part
of the Oak Ridge Reservation. This plant has been in existence for more
than 50 years. Although requested to provide assistance in the investigation
of respiratory illnesses among children, CDC also investigated a variety
of other health complaints.
In December 1997, a team of investigators from CDC and ATSDR responded
to the request. With the assistance of the Scarboro Community Environmental
Justice Oversight Committee, a study protocol was developed, and a questionnaire
was administered to the members of each household in the community. The
questionnaire was used primarily to assess household environmental exposures
and the prevalence of respiratory diseases and associated symptoms among
children. In addition, information regarding occupation, occupational
exposures, and general health concerns was collected for adults. A number
of children were selected to receive a physical examination to document
the presence of respiratory disease.
Time Line
On May 16, 1998, questionnaires were administered to community members.
In September 1998, CDC released the preliminary results of the survey.
On November 14, 1998, medical examinations were given to 18 children from
the Scarboro community. On January 5, 1999, a team of physicians representing
CDC, the Tennessee Department of Health, the Oak Ridge medical community,
and the Morehouse School of Medicine thoroughly reviewed the findings
of the physical examinations and the community survey. The results of
this review were presented January 7, 1999, at a community meeting in
Scarboro.
Status
The final report was released during July, 2000.
3.4 Issue 4: Community Involvement
3.4.1 Oak Ridge Health Studies Bulletin
Purpose
The Oak Ridge Health Studies Bulletin was published to provide information
to the public on the Oak Ridge Health Studies.
Background and Agencies Involved
The bulletin was published by the Tennessee Department of Health.
Time Line
The bulletin was published from the fall of 1992 to the winter of 1997.
3.4.2 Technical Workshop for Phase I of Oak Ridge
Health Studies
Purpose
A technical workshop was held in Oak Ridge to receive comments and suggestions
from current and former workers of DOE facilities on the draft Phase I
Oak Ridge Health Studies report (dose reconstruction feasibility study).
Findings
Comments were received and used to help refine the final Phase I Oak
Ridge Health Studies report.
Background and Agencies Involved
The Tennessee Department of Health, Oak Ridge Health Agreement Steering
Panel, and the TDEC sponsored the workshop.
Time Line
The workshop was held on June 23, 1993.
3.4.3 Community Feedback Sessions for Phase I of Oak
Ridge Health Studies
Purpose
Community feedback sessions were held to receive comments from the public
on the draft Phase I Oak Ridge Health Studies report.
Findings
Comments were received and incorporated into the final Phase I Oak Ridge
Health Studies report.
Background and Agencies Involved
The Tennessee Department of Health and the Oak Ridge Health Agreement
Steering Panel sponsored the community sessions.
Time Line
Sessions were held in Kingston and Oak Ridge on May 19, 1993, and June
24, 1993.
3.4.4 Public Meetings in Scarboro
Purpose
Public meetings were held in the Scarboro community to update the residents
on Phase II of the Oak Ridge Health Studies and the ATSDR exposure investigation.
Findings
Many residents from the Scarboro community and other Oak Ridge areas
attended these meetings.
Background and Agencies Involved
The Tennessee Department of Health and the Oak Ridge Health Agreement
Steering Panel held two meeting in the Scarboro area. The first meeting
was held at the Oak Valley Baptist Church at the request of Reverend Thomas.
After Oak Ridge Health Agreement Steering Panel members consulted with
Scarboro community leaders, the Oak Ridge Health Agreement Steering Panel
held the second meeting at the Scarboro Community Center. At this second
meeting, ATSDR staff members discussed the ongoing exposure investigation
on serum PCB and blood mercury levels in consumers of fish and turtles
from the Watts Bar Reservoir.
Time Line
Meetings were held on in Scarboro on November 17, 1995, and September
24, 1997.
3.4.5 Knowledge, Attitude, and Beliefs Study
Purpose
A knowledge, attitude, and beliefs study surveyed the eight-county area
surrounding Oak Ridge, Tennessee. The purpose of the survey was (1) to
investigate public perceptions and attitudes about environmental contamination
and public health problems related to the DOE Oak Ridge Reservation; (2)
to ascertain the public's level of awareness and assessment of the Oak
Ridge Health Agreement Steering Panel; and (3) to make recommendations
for improving public outreach programs.
Findings
A complete list of findings is in the report on the study, which is available
from the Tennessee Department of Health.
Background and Agencies Involved
The Social Science Research Institute at the University of Tennessee
in Knoxville, Tennessee, conducted the study from October through November
1993 for the Tennessee Department of Health, the Oak Ridge Health Agreement
Steering Panel, and the Oak Ridge Reservation Local Oversight Committee.
Time Line
The report was released on August 12, 1994.
3.4.6 Community Diagnosis Status Reports-Anderson
County and Roane County
Purpose
The community diagnosis process was conducted to analyze the health status
of the community; evaluate the health resources, services, and systems
of care within the community; assess attitudes toward community health
services and issues; identify priorities, establish goals, and determine
the course of action to improve community health status; and establish
a baseline for measuring improvements over time.
Findings
These reports, with a complete list of findings, are available from the
Tennessee Department of Health, East Tennessee Region.
Background and Agencies Involved
The Anderson County Health Council, established in 1968, in cooperation
with the East Tennessee Regional Office of the Tennessee Department of
Health, identified Anderson County as a pilot county for the community
diagnosis process. This process included conducting a community survey,
reviewing various data sets, and evaluating resources in the community
to identify areas of concern that could affect the health of Anderson
County citizens.
The Roane County Health Council, established in 1990, began implementing
the community diagnosis process in 1996.
Time Line
The reports were completed in 1997.
3.4.7 Oak Ridge Health Agreement Steering Panel
Purpose
The Oak Ridge Health Agreement Steering Panel was appointed to direct
and oversee the Oak Ridge Health Studies and provide liaison with the
community.
Findings
Based on what is generally known about the health risks posed by exposures
to various toxic chemicals and radioactive substances, the Panel concluded
that past releases from the Oak Ridge Reservation were likely to have
impacted the health of some people. Two groups most likely to have been
harmed were local children drinking milk from a "backyard" cow
or goat in the early 1950s, and fetuses carried in the 1950s and early
1960s by women who routinely ate fish taken from contaminated creeks and
rivers downstream of the ORR.
The Panel made eight recommendations in their project summary report:
# Three specific initiatives directed to public health intervention should
be undertaken:
- In partnership with a local college or university, a series
of workshops should be periodically conducted for local physicians and
other health professionals who need to be educated on ORR environmental
and occupational health issues arising from the Oak Ridge Health Agreement
studies and other related health studies, as results become available.
- In partnership with a local community college or community outreach
program, a public information colloquium should be conducted to provide
continuing dialogue and education on environmental and occupational
health issues relevant to past, current, and future ORR operations.
- A partnership working group of local, state, and federal public health
officials, health care professionals and representatives of the greater
Oak Ridge community should be established to evaluate the need for a
formal clinical evaluation process. If such a process is determined
to be feasible, the group should formulate recommendations for the development
of: (1) a goal for a formal community clinical evaluation process; (2)
the types of and qualifications for health care professionals who would
be involved in the clinical evaluations of concerned members of the
community; and (3) protocol guidelines for individual clinical evaluations
and referral for follow-up examinations. The Panel suggested that the
results contained within this report and the other reports published
as part of the Oak Ridge Health Agreement studies serve as a basis for
the development of such protocol guidelines.
1. Formal epidemiologic studies of populations exposed to iodine-131,
mercury, PCBs, and radionuclides from White Oak Creek are unlikely to
be successful and should not be performed at this time.
2. The Department of Energy, the Environmental Protection Agency, the
state (and perhaps other agencies) should undertake a coordinated program
to obtain needed information and satisfy stakeholder concerns. A soil
sampling program is vital to gain information relevant to the historic
contamination levels in residential areas closest to the ORR plants. Detailed
sampling is recommended in all of the most closely situated neighborhoods
and also in a few residential areas at greater distances. Any decision
about additional dose reconstruction studies should be deferred until
the results of the recommended soil sampling program have been obtained
and carefully interpreted.
3. DOE should undertake a program to measure the atmospheric dispersion
of controlled tracer releases from representative stacks and vents at
Y-12. The primary goal of these measurements would be to define the transport
of a non-depositing tracer such as SF6 from Y-12 to populated areas of
Oak Ridge, including the Scarboro and Woodland communities, which are
both relatively close to the plant.
4. More definitive information is needed to better understand the potential
toxic effects of exposures to mixtures of contaminants - mercury and PCBs,
for example - on the same organ systems. Studies relating to this topic
should be undertaken by one or more appropriate government-sponsored public
health research agencies.
5. DOE should take action to assure that copies of the important documents
used in the health effects studies are properly indexed and retained at
a secure location, irrespective of future shifts of contractor responsibility
at the ORR facilities.
6. DOE should assure the long-term continuation of the ORR environmental
monitoring program. The program should include routine measurements in
critical media for those materials found to be most important in the health
agreement studies, if the material in question could still be present
in the local environment. Specifically, the ORR program should: (a) continue
to monitor the remaining environmental burden of mercury in East Fork
Poplar Creek within the Y-12 plant, in the lower East Fork Poplar Creek
floodplain, and in sediment in the downstream watercourses, tracking the
resulting methyl mercury risk to consumers of fish taken from downstream
fisheries; and (b) assure that the program continues to monitor uranium
contamination originating from Y-12, with due consideration of isotopic
form.
7. In the area of statewide health effects registries, (a) the State
should continue efforts to improve the accuracy and completeness of the
cancer incidence registry, and (b) the State should continue to seek funding
for a statewide birth defects registry.
Background and Agencies Involved
As part of the health studies agreement between the state of Tennessee
and DOE, the Tennessee Department of Health established the Oak Ridge
Health Agreement Steering Panel. The panel is composed of scientific and
community representatives appointed by the commissioner of the Tennessee
Department of Health. In addition to the nationally recognized scientists
and local community representatives, the panel has one representative
each from the state of Tennessee, the Environmental Quality Advisory Board
of the city of Oak Ridge, the Oak Ridge Reservation workers, CDC, and
DOE.
Time Line
The panel was formed in 1992 and oversaw the Oak Ridge Health Studies
until its completion in December 1999.
Status
Between January 1992 and December 1999, the Tennessee Department of Health
and the Oak Ridge Health Agreement Steering Panel held open meetings in
Oak Ridge (over 40 meetings), Nashville (5 meetings), Harriman (2 meetings),
and Knoxville (3 meetings).
4.0 POINTS OF CONTACTS FOR THE AGENCIES
4.1 Agency for Toxic Substances and Disease Registry
Jack Hanley 404-639-6024
4.2 Health Resources and Services Administration
Wade Kirstein 404-562-4146
4.3 National Center for Environmental Health
Jim Smith, PhD 770-488-7040
4.4 National Institute of Environmental Health Sciences
Freja Kamel 919-541-1581
4.5 National Institute for Occupational Safety and
Health
Larry Elliott 513-841-4400
4.6 Tennessee Department of Health
William Moore, MD 615-741-7247
4.7 Tennessee Department of Conservation, DOE Oversight
Division
Earl Leming 423-481-0995
4.8 US Environmental Protection Agency
Camilla Warren 404-526-8519
4.9 US Department of Energy, Health and Epidemiologic
Studies
Barbara Brooks 301-903-4674
4.10 US Department of Energy, Oak Ridge Operations
Timothy Joseph, PhD 423-576-1582
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