ORRHES Meeting Minutes
December 3, 2002

Table of Contents

Opening Comments
AOEC Presentation
Presentation of the ORR Health Education Initiative
Public Comment
Work Group Reports
Agenda Work Group
Communications and Outreach Work Group
Guidelines and Procedures Work Group
Discussion of Subcommittee Voting Protocol
Round Table Discussion With Agency Management Staff
ATSDR Comments
NIOSH Comments
DOE, Oak Ridge Operations Comments
DOE, Headquarters Comments
Discussion
Public Comment

JANUARY 19, 2001

ATSDR Public Health Assessment Process
Discussion
Public Comment
Subcommittee Discussion
Housekeeping Issues
Unfinished Business
New Business
Activity of the Communications/Outreach Work Group
Public Comment.
Closing Discussion
ATTACHMENTS

Summary of the Meeting

The second meeting of the Oak Ridge Reservation Health Effects Subcommittee (ORRHES) was held on January 18-19, 2001, under the auspices of the Agency for Toxic Substances and Disease Registry (ATSDR) and the Centers for Disease Control and Prevention (CDC). All but one member was present, as well as all three state agency liaisons, representatives of federal agencies, and several members of the public.

ATSDR's action items from the last meeting were all completed; one item by CDC/NCEH was pending. The November meeting Minutes will be approved at the next meeting. The agenda for the next meeting was requested in advance for member comments.  Communications to the Subcommittee since the last meeting were outlined.

A presentation was provided by Dr. Katherine Kirkland, Executive Director of the Association of Occupational and Environmental Clinics (AOEC), outlined the AOEC's history, membership, and processes. They focus on patient rights and use a public health model in their work. They are primarily funded by two cooperative agreements with ATSDR and NIOSH. They conduct research, health promotion, and education to improve the infrastructure, in order to address health concerns. They also consult, including clinical evaluations and collaborations with community members and medical practitioners.

Dr. Rebecca Parkin of George Washington University, the AOEC's contractor to conduct the Oak Ridge Reservation (ORR) Needs Assessment and Health Education Needs Assessment, presented her own and her two co-Principal Investigators' credentials, outlined the project work done to date, and discussed future site work with the Subcommittee.

In a multi-phased process requiring the subcommittee's input, GWU will conduct interviews with key informants to explore community concerns about the ORR's effects. They then will conduct seven (more if needed) focus groups on topics specific to those community concerns, and one group more general in scope. The resulting information will be used to develop a questionnaire for a telephone survey of a representative sample of the entire "community", however that is defined.  Data from existing records also will be researched (vital statistics, reports, articles). Also with the Subcommittee's input, GWU will then explore how the answers obtained can best be interpreted for educational planning, to help the community make sound decisions about health questions. A summary of the documents already reviewed for this project was distributed.

The Subcommittee provided specific input to GWU in planning its work, which is detailed in the Minutes. This included a resolution to use as the geographic health effects study area the counties of Anderson, Knox, Roane, Loudon, Meigs, Rhea, and Morgan; and the city of Oak Ridge. A Health Assessment Work Group was formed to help define the descriptors to be used in forming the focus groups.

Public comment was solicited at regular intervals in the meeting. The responses included:

• A recommendation that the members read the 1999 Oak Ridge Dose Reconstruction Study Report, which included an additional county (Blount) thought to be at risk from I-131 exposures. The report's listed chemical releases from the ORR also should be compared to ATSDR's toxicological profiles.
• Still another comment urged the inclusion of Blount County 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.
• A request that the Subcommittee attend to the effects of depleted uranium (DU), and hydrogen fluoride leaks from the ORR.
• A welcome for the committee's work, and expressed hope that something will be done to help the sick workers before they all die.
• A recommendation to identify and separately seat the non-voting liaisons.
• It was charged that the negative findings produced from public health activities at the Oak Ridge Reservation were based on faulty science, biased beliefs, and political influence.
• A call was issued for research on the synergistic, multiplicative, additive, and concurrent effects of exposures, and on diagnosis and treatment to address the results of toxic exposures in a scientifically credible and rapid response mechanism. A multi-disciplinary team to develop recommendations on such protocols was requested.
• DOE was asked about the likelihood of a health clinic being opened in Oak Ridge. Dr. Seligman reported DOE's consideration of convening an environmental workshop of pertinent agencies and organizations to combine information on offsite contamination. Congress must be convinced that such clinical care is needed, and he would be happy to do so. He also noted that Congressional mandate began the current medical monitoring of DOE workers; they could do the same with other agencies. Dr. Falk reiterated ATSDR's intent to help other PHS agencies to think "out of the box," to try to deliver such needed services within existing programs.
• A statement of pride in some of the Subcommittee members, but not others, was made. The resignation of these "Judases," who formerly doubted any ill effects from Oak Ridge, was advised, or they would be exposed.
• Comment noted an expected common perception that CDC has tracked environmental illnesses for a long time, and the frequent difficulty of participating in CDC's studies of such illnesses. Many physically disabled people cannot do so; they are in wheelchairs and/or have lost everything.
• An e-mail sent to the EQAB was read. The writer threatened to mount an Internet campaign to deter anyone from moving to Oak Ridge unless the area's environmental problems are addressed within one month.

Work Group reports and draft statements of work were provided by the Agenda Work Group, the Communications/Outreach Work Group, and the Guidelines and Procedures Work Group. The Subcommittee provided specific edits for refinement. Outstanding issues remaining to be addressed include the equivalence of the process document and the by-laws; the need (and -permissibility under FACA) of a Vice Chair position; designation of a Parliamentarian (and how much to adhere to Roberts' Rules of Order to run the meetings); and final Subcommittee agreement on a voting protocol.

A round table discussion was help with the management staff of ATSDR (Dr. Henry Falk, Assistant Administrator), NIOSH (Mr. Larry Elliott, Branch Chief) and DOE (Dr. Paul Seligman, Headquarters, and Ms. Leah Dever, Oak Ridge Operations).

ATSDR reported the imminent opening of a permanent office at Oak Ridge, to be staffed by Mr. Bill Murray. NIOSH's Acting Director will be informed of the ORRHES' desire to have a representative at each meeting; even if not, they expected to be attend to make presentations, or otherwise to respond to the Subcommittee's needs. DOE/Oak Ridge acknowledged that past mistakes, mismanagement, lack of good information to the community, etc., had contributed to the decline of trust in DOE. This independent study and Subcommittee were welcomed to further inform DOE of the communities' perspectives. DOE's response to the Subcommittee's communications was pledged. DOE/Headquarters' health-related work was described, as was the Energy Employees Occupational Illness Comprehensive Program Act of 2000. The Act addresses beryllium disease, radiation-induced cancer, and silicosis, among DOE workers and contractors. It provides for 1) compensation of $100,000 for confirmed beryllium disease (and medical care payment if sensitization is determined); 2) $150,000 and medical monitoring for silicosis; and 3) a compensation process for radiation-attributed cancer, which is now being developed. The DOE Office of Advocacy will help workers answer DOE contractor disputes of claims and to procure state compensation benefits for diseases not addressed by this Act. An amendment to the Act also allows an option for workers to choose a more a traditional compensation package (i.e., lost wages and medical benefits, training, and rehabilitation), rather than the lump sum payment. Congressional scrutiny and decision is pending.

In discussion, the Subcommittee asked when claims filing could begin; about workers' families who were exposed, the likelihood that recommended activities that ATSDR cannot do, will be done (Dr. Falk hoped the Subcommittee could advance previous ATSDR efforts to involve other federal health agencies whose programs may be able to respond; e.g., HRSA, HCFA); examples of DOE's new proactivity for workers; how DOE can ensure that safety and health is secure at all facilities; the need to validate the Scarboro soil study samples (progress toward an interagency meeting will be reported at the next ORRHES meeting); the need for better timing of study result releases and for evaluation of the success of that information dissemination; a request for the definition of a "medically under-served" population; the committee's ability to recommend medical evaluations; the need for DOE, to rebuild its credibility regarding worker safety, DOE should consult OSHA as well as the NRC; and request that NIOSH provide information on what its research has accomplished for workers. The agencies were invited to return for further dialogue.

The steps of the ATSDR public health assessment process were described. The public health assessment analyzes and states 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 assessment's seven steps, ranging from evaluation of site information to development of a public health action plan, were described. Also distributed were time lines outlining the various Oak Ridge facilities' major processes, the public health activities relating to them, and the studies ATSDR will examine to develop the public health assessment.

The Subcommittee's members discussed: the need to address the chemicals' synergistic effects; the need for periodic worker screening; the relationship between assessing health education needs and the public health assessment; the likelihood of ATSDR's independent testing or exposure investigation; what could be done if exposures cannot be linked to health outcomes data; how to get a baseline of the community's health; the public health assessment process' schedule; how existing environmental data fit in with the study; why ATSDR's assessment are needed after the dose reconstruction and other studies; the likely need to address differing opinions about what "plausible" health outcomes are; a request that the Communications/Outreach Work Group suggest a strategy that ATSDR can use to communicate (and evaluate the communication) to the public the results of the assessments done; the source of ATSDR's numbers regarding the materials' effect; and the reliability of estimating synergistic effects.

Further discussion included inquiry of how the Subcommittee members may be affected by a recent class-action federal lawsuit filed on the impacts of the Oak Ridge Reservation on the public (it is unaffected). It was agreed to have future meetings on Mondays (noon to evening), and Tuesdays (8:00 a.m. to 4:30 p.m.). The tentative 2001 meeting schedule is: June 11-12; September 10-11; and December 3-4.

Unfinished business discussed included the Subcommittee's memberships composition; specifically, if representation of the community-selected criterion of a "self-identified sick worker" should still be solicited. One potential such nominee had declined. The CDC/ATSDR Committee Management Office will be asked if they would support an new solicitation announcement.

New business discussed included a request for a presentation on health effects that could be expected among children as well as adults; formation of the Health Needs Assessment Work Group; and further discussion of the focus groups' methodology. Concern was expressed that the Work Group be able to advise on the descriptors for the focus groups before the next meeting. The Work Group's recommendation will be sent to ATSDR, which will distribute it to the other members and liaisons for review/comment.

Final discussion noted that ATSDR will respond to each of the public comment and that the minutes will summarize the remarks. The Communications/Outreach Work Group was asked to discuss how the Subcommittee could be even more responsive, and to recommend to ATSDR as to how the Subcommittee could best use its Website. The action items developed at this meeting were summarized and are appended to the Minutes. It was agreed to discontinue the verbatim transcript of the meetings, and to retain the audio and videotaping.

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