ORRHES Meeting Minutes
June 11-12, 2001

On the following morning, the members reconvened at 8:30 a.m. Members present were:

Al Brooks
Bob Craig
Kowetha Davidson
Bob Eklund
Ed Frome
Karen Galloway
Jeff Hill
Susan Kaplan
Jerry Kuhaida
James Lewis
David Johnson
Peter Malmquist
L.C. Manley
Therese McNally
Donna Mosby
Bill Pardue
Barbara Sonnenburg
Charles Washington

Mr. Don Creasia was absent.

All the liaisons were present: Elmer Akin, Chudi Nwanga, Brenda Vowell; as was LaFreta Dalton, Executive Secretary.

ATSDR staff present were: Sherri Berger, Bill Carter, Carl Markevitz, Theresa NeSmith, Lucy Peipins

Members of the public or presenters attending included:

Ann Henry
Cathy Nye
Janice Stokes

Opening Comments

Dr. Davidson again thanked DOE for arranging and summarized the previous day's tour of the ORNL X-10 facility.

Presentation of the ATSDR Epidemiology Workshop

Ms. Sherri Berger and Dr. Lucy Peipins, of ATSDR's Division of Health Studies, provided an overview of the science of epidemiology. They also provided a copy of the study by Joseph Mangano of "Cancer Mortality Near Oak Ridge, TN." They defined epidemiology as the study of the distribution (who, what, when, where) and determinants (why, then) of disease in populations. It involves groups of people, not individuals; measurement; and comparison.

In groups of people, epidemiology can determine the impact of disease and detect changes the occurrence of disease; it can measure the relationship between exposure and disease; and it can evaluate the efficacy of health interventions and treatments. Epidemiology cannot determine the cause of an individual's disease, with a few exceptions; it cannot prove a particular exposure caused an illness, and it should not be conducted without good measurement of exposure and disease.

Epidemiology can draw some information on exposures and outcomes from evidence already compiled in animal studies, case reports, or toxicological models. The common steps in establishing a relationship between exposure and disease are: report of a series of cases (e.g., by a physician); descriptive analyses to describe the problem, those affected, and where the disease is occurring; analytic studies to test the exposure-disease hypothesis in a study group; experimental reproduction of the disease by exposure in animals; and observations done to assess whether removing exposure lowers disease.

Statistics/Measures of Disease Frequency. Disease frequency can simply be measured by counting the affected individuals, Ms. Berger began, but that is not enough. The significance of three cases of a disease occurring in a town of 1000 people is much greater than the same number in a city of 100,000. Epidemiology, therefore, examines at the size of the population from which affected individuals come and the time period in which the information was collected.

A rate is a basic epidemiologic measure that is used to compare the frequency at which disease occurs on a group and to compare that occurrence to other groups. It is calculated by dividing the number of events in a specific time period by the average population over that period. A mortality rate is the number of deaths in a defined group during a specified time period; a birth rate does the same for births. Incidence is another type of rate. It is arrived at by dividing the number of new cases that develop in a period of time by the number of individuals at risk during that time period. For example, 150,000 new cases of lung cancer in the U.S. in 1997 would be divided by the population present at that time (150,000 ÷ 260 million). The result, 0.000058, would then be multiplied by 100,000 to determine the rate: 58 cases per 100,000 people per year.

Association measures how much greater the frequency of disease may be in one group than another. It is often provided in a two-by-two table, demonstrated by Ms. Berger as an example. Into the four squares, for example, all the participants in a study of lung cancer and smokers/non-smokers can be categorized/placed (smoking: yes/no; lung cancer: yes/no):

	lung cancer: yes	lung cancer: no
smoking: yes	a	b
smoking: no	c	d

Relative risk (RR) can then be measured. It is the likelihood that one group (e.g., the exposed group of smokers) will develop a disease compared to the unexposed group. Relative risk is calculated by dividing the incidence in the exposed group (a/[a+b]) by the incidence in the unexposed group (c/[c+d]). If the result of the calculation comes out to 1.0, there is no association between exposure and disease and the risk is even whether one is exposed or not. If the result is above 1.0, there is a positive association or an increased (excess) risk (e.g., a 2.0 RR indicates twice the risk of someone unexposed); if it below 1.0, there is a decreased risk among the exposed group.

Standardized Mortality Ratios (SMR) are the ratio of an observed number of deaths to an expected number of deaths. The expected number is drawn from a standard group (e.g., U.S. the population or a county), which is similar to the exposed group of interest. The standard group serves as a comparison group. The number of deaths of the exposed group are divided by the observed deaths of the comparison group to arrive at an SMR. So, for example, if 58 deaths are found in an exposed group, and the comparison group has 42.9 deaths, the SMR (58/42.9) is 1.35: the exposed group has a 35% higher risk of death.

Measuring Exposure and Outcomes in Environmental Epidemiology. An outcome is any change in health status or body function, which covers a broad range (e.g., from wheezing to disease and death). Outcomes can be local or systemic, acute or chronic, and reversible or irreversible.

Dr. Peipins commented that measurement of both exposure and outcomes must be clear to produce a definitive study result. The measurement, therefore, has to be precise. Exposure by contaminants can produce an outcome at the point of entry and/or one that is distributed throughout the body ("body burden"). The exposures can be measured in a number of ways. The best is from direct biological analysis of body tissue; the poorest is measurement of such surrogate measures as environmental samples of the general area in which a person lives.

Biologically plausible outcomes are explored by ATSDR, by contaminant route of exposure (to define the vulnerable organ systems), toxicity or level (severity of outcome), and potential alternative explanations for an outcome (confounding factors). But importantly, health effects are not uniquely caused by environmental exposures. For example, 1 in 2 men will develop cancer, and 1 in 3 women will do so; 2% of infants are born with developmental disabilities; 25% of pregnancies result in spontaneous abortions; and 8-10% of children have asthma.

Cancer is a particular problem as an outcome because of its complexity. For example, smoking causes most of the cancer in the U.S., and 25% of Americans smoke. Cancers can take a long time to develop after an exposure, and many other exposures may occur in the interim. In addition, cancer is not one, but probably more than 100, different diseases that affect 40 anatomic sites.

In measuring adverse health effects, the goal is to count all the cases in an exposed group or population and to compare that with cases in an unexposed group. The sources of this information include death and birth certificates, medical exams, hospital discharge data, questionnaires, disease registries, and lab tests or biomarkers of exposure. But all these sources are very variable in their ability to report the severity of the disease; the accuracy of the disease classification; information on such potentially contributing confounders as smoking; and finally, they vary in cost, complexity of access, and invasiveness.

Dr. Peipins outlined some of the shortcomings of these sources:

• Death certificates: do not list all conditions of interest, only those that cause death; have considerable inaccuracy in diagnosis; and have no data on other risk factors.

• Registries: are relatively new. They exist for reportable disease (TB, cancer, birth defects), but only cancer incidence data are available for all states. They do not collect data on other risk factors, and the completeness/timeliness of their data may be an issue.

• Medical exams/biologic tests: are the "gold standard," but diagnosis may vary for outcomes with no standard case definition (e.g., asthma, multiple sclerosis).

• Questionnaires: may miss most severe outcomes. They involved self-reports of illness or symptoms; the wording/type of administration may influence responses; and they are subject to recall and response bias. However, some outcomes may be measured only through questionnaire, and they enable collection of data on other risk factors.

Other considerations include the timing and latency of reports (especially important in chronic disease), individual variability (e.g., by age, gender, pre-existing illnesses, and genetic predisposition); and confounding and bias (alternative explanations for an exposure-disease association).

In summary, the basic criteria for considering a health study are:

• Necessary: measurable exposure, completed pathway to an exposed population, and a measurable effect that is plausibly related to the exposure.

• Will the epidemiologic study advance knowledge about the relationship between exposure and disease?

• Judging a cause-effect relationship: strength of association (relative risk: the larger the risk, the more likely the relationship exists); consistency of this study's findings with other studies, study designs, and groups of people.

• Judging the dose-response relationship: whether disease increases with exposure, based on the exposure which must occur first, and biologic plausibility (there is a known mechanism for the exposure to lead to disease).

Discussion with Dr. Peipins included:

• Ms. Sonnenburg: Would you track people who may have been exposed? If the basic criteria are fulfilled. I keep hearing that epidemiology studies (e.g., Chernobyl and Hanford) could neither prove nor disprove a relationship between I-31 exposure to the thyroid and thyroid disease. If you have 1000 children with thyroid disease in one area and only 6 in another, or, if more tests show them to be ten times over the normal rate, would that prove the association? How high does the ratio have to be before you determine there is a relationship? I have not read the Hanford study. (Please do by September.) But I would say that there is a relationship; such a large relative risk (i.e., 1000:6 versus 50:48) certainly strengthens the case, if not definitively proves it. There is no standard level of an effect for a relative risk. It is dependent on other factors such as confounders. What is your opinion of the Mangano study distributed? I would not say it was good or bad. It was just provided so that at the next workshop in September these principles of epidemiology study can be applied and to see how it stands up to critical analysis. But one might note that it is a study done at the county level.

• Mr. Lewis: What is the impact on such studies of people concerned about privacy issues (e.g., potentially raised insurance rates)? Study Institutional Review Boards (IRBs) try to ensure confidentiality, and information leaks are rare, but those concerns do reduce the ability to do these studies. What should we tell the public about the validity of anecdotal, verbally reported, data from the community? We cannot answer about legalities; but such observations are not surprising, given how many people naturally develop cancer.

• Ms. Kaplan: How specific is the data on cancer incidence collected by registries? Are interviews done? It varies by state; some will analyze by county/zip code, but no personal interviews are done.

• Mr. Pardue: Why use mail questionnaires, with their poor rate of return and potential bias? They can help to discover what other factors may contribute, but in-person interview is much better. Why not do more clinical studies than epidemiology? That can be the community's choice, but the epidemiology study could add to the knowledge that would indicate/support a clinical study.

• Mr. Kuhaida: How do you factor in the frequency and magnitude of exposure (e.g., three very high exposures versus long low-dose exposures)? The importance of such factors often depends on the contaminant. Categories are assigned for analysis (e.g., low frequency and high exposure, or vice versa), and the results are compared to current knowledge that can be helpful (e.g., toxicology, medicine).

• Dr. Brooks: What are the effects of sample size on study validity? This can be further explained in another workshop, but "spikes" of disease that naturally occur can be seen in small cohorts. These can be leveled out with a large enough cohort to indicate the true underlying incidence, and to determine how many cases are required to satisfy statistical significance about the exposure-disease relationship.

• Dr. Frome: Standard error is another statistical tool used to judge how far a relative risk is from a standard point. It can factor in exposure and non-exposure to indicate the significance of whatever relative risk is calculated.

• Mr. Johnson: How do you address roadblocks to research, such as inaccessible data? Part of the considerations of the study design is to ensure that all the necessary data will be accessible.

• Dr. Davidson: How do confounders affect interpretation of an epidemiological study? A stratified analysis can be done to address confounders. For example, data for those who were exposed to radon and developed lung cancer can be delineated by those who smoked tobacco and those who did not.

Public Health Assessment Process

Mr. Jack Hanley reviewed the steps of the Oak Ridge public health assessment process, and the independent review done for ATSDR of the Tennessee Department of Health's screening evaluation in the Oak Ridge health studies. The public health process is to identify for the area residents any exposures from the site, and to evaluate any risk from those exposures. They will then report on any contaminant levels of concern found to the public and to relevant local, state, and federal agencies, and advise on potential follow-up public health actions.

Mr. Hanley reviewed the steps in this process: 1) evaluation of all the site information gathered over the years, 2) identification of community health concerns, 3) identification of any contaminants of concern, 4) determination/evaluation of a pathway of exposure, 5) assessment of public health implications of exposure, and 6) report on the conclusions and recommendations, including 7) a site-specific action plan.

Steps 1 and 3 were initiated at the March ORRHES meeting. Step 1 involved review of the Tennessee Department of Health's environmental dose reconstruction of past releases from the ORNL and those contaminants of largest impact offsite. This report recommended further evaluation of iodine 131, mercury, cesium 137, polychlorinated biphenyls (PCBs), uranium, and fluorine and various fluorides.

In its Task 7 Screening Evaluation, the Oak Ridge Health Agreement Steering Panel (ORHASP) did an additional screening of 18 other contaminants based on the quantities onsite and on expressed public concern. Three different approaches were used:

• Qualitative evaluation: screening for contaminants used in quantity, in certain forms and in manners of use, that could have gone offsite. Those going offsite below levels of concern were screened out (e.g., in too-small quantities; the forms of carbon fiber and glass; and those used in sealed cylinders).

• Quantitative evaluation was done of the three materials for which there had been insufficient information previously. If found to be below threshold quality limits with the conservative screening index used, these were screened out. The quantitative analysis screening was done in two levels:

* Level I: The conservative screening level indices used by the ORHASP were similar to those used by EPA, regulatory, and health agencies. Estimates of maximum exposure dose from the ORNL materials (worst-case exposure) were done. If these were below the decision guidelines, no further study was done.

* Level II: If the levels were above the screening guidelines, further evaluation was done using less conservative, more realistic screening parameters for exposure levels and environmental concentrations (e.g., soil ingestion such as through eaten fish, or dirt eaten by children; air; time in spent in an exposure location, etc.). However, these remained considerably conservative because the same transfer factors and toxicity values were used.

• As before, a screening index below decision levels were dropped; those above received high priority for further study. That study ultimately resulted in designation of arsenic at K-25 and arsenic and lead at Y-12 as high-priority candidates for further study. The screening process of Level II was outlined on a distributed chart (Attachment #1, Table 2). Mr. Hanley noted that beryllium was screened out for offsite risk of chronic beryllium disease and for cancer endpoints, using the most conservative, worst-case scenarios.

Discussion included the following:

• Ms. Sonnenburg/Kaplan: Were any of these compounds screened out because there wasn't enough data? Yes. In the absence of data for some facilities (e.g., the three contaminants at Y-12), estimates had to be made.

• Mr. Manley: What are the toxic effects of rare earth metals? I handled two of them. Mr. Hanley agreed to check the toxicological information on the cited compounds, which are considered rare earth materials and are likely to have little information on them.

• Mr. Lewis: What will be done about contaminants of high priority such as arsenic that were screened out for low levels but may have had higher cumulative levels (e.g., including TVA and other plants)? ATSDR's mandate is only to address ORNL; it has no authority to address others. But if other obvious public health issues seem to arise, they will be referred to the appropriate agencies. But you are factoring in contaminants from the NTS tests, and comparatively, these are right next door. Mr. Akin: that is a question of total risk, not the risk specific to ORNL that is being pursued here. Mr. Hanley: we can investigate what data are available to indicate total risk, but our authority does not extend to doing detailed analyses of sites other than the ORR.

• Mr. Hill: Why was X-10 not shown as an arsenic source; it burned coal for a very long period? ATSDR agreed to investigate this.

• Dr. Eklund: What is the value of doing this work if all sources are not considered to indicate the true risk? Reporting only on ORNL could mislead people. Our final report should include a strong recommendation to look for all the sources of contaminants. There are residents of Roane or Anderson counties who never worked at ORNL and have toxic levels of arsenic in their body. ATSDR will reanalyze some of the older analyses using the more updated EPA maximum concentration transfer factors (as opposed to the NCRP transfer factors previously used), and they will do a separate analysis of current exposures. These screening analyses can help to further establish the ORNL emission levels, which would be of interest if a comprehensive, additive analysis of risk is done. ATSDR also can extrapolate potential contaminant spread, for example, from levels found in soil data combined with wind direction/pattern data, to determine whether some of the contaminants found could have come from another source. Doing detailed modeling from TVA or other sources is not within ATSDR's purview; but regardless of the source, if a public health hazard is determined (e.g., high levels of arsenic or in the water source or PCBs in fish), ATSDR will recommend a responsive public health action. In one case, a community was advised to use alternate water sources until more detailed analysis could be done of the local sources. But implementing such an action is the domain of the local or state agencies.

• Several members of the committee expressed frustration at the division of agency responsibilities that seems to prevent the kind of overall health evaluation desired. But aside from that important goal, this also involves a national debate about litigation and the culpable party. If DOE is not the sole source of the contamination, it should not take all the blame.

• Dr. Frome: Could the homes' coal burning also have been a significant source of contaminants? That is possible, but ATSDR does not know.

The Tennessee Department of Health reports were released publicly in January 2000, and a panel of independent experts conducted a technical review of them at ATSDR's request. They evaluated the quality and completeness of the report to indicate if it could provide a foundation for public health decisions. They found that some of the report's screening level methodologies were internally inconsistent (e.g., using maximum numbers for arsenic under surface water of Poplar Creek, but mean values for the Y-12's McCoy Branch; or were inconsistent in the conservatism of their concentration factors).

Every study has strengths, weaknesses, and limitations which must be considered to properly interpret its findings. While the reviewers found the reports' interpretations to be reasonable, appropriate, and well supported, they disagreed that this type of screening index should be used to only identify the contaminants posing a low health risk. It is good for identifying pathways of exposure. It should not be used to determine relative risk or to identify the important exposure pathways.

One thing noted by the reviewers was the ingestion of contaminated vegetables and fish as primary pathways of concern (80-90% of dose). However, that may have been due to the conservative screening, transfer, and bioconcentration factors. Overall, the reviewers found the report's conclusions to be reasonable, and the approaches to be well supported and appropriate for making public health decisions. ATSDR is following up on the study's weaknesses in its own screening analysis for the contaminants of concern.

Presentation of ATSDR Screening Process

Dr. Karl Markiewicz provided an overview of the three steps of the screening process, which are to determine if:

1. The chemical concentrations are above acceptable screening levels: Determine the important compounds and chemicals, using maximum concentrations in air, soil, water, and biota, particularly in cases of incomplete or missing data.
2. The chemical concentrations are above screening levels in areas of exposure. In the case of missing or incomplete data, ATSDR will assume the maximum bioconcentration of any adjacent areas known to risk exposures.
3. The calculated exposure doses exceed health values for each chemical in each area.

Dr. Markiewicz described the screening calculation, which is EMEG = MRL x BW / IR, where EMEG is Environmental Media Evaluation Guide (for water and soil); MRL is Minimal Risk Level (measured by mg/kg/day; ATSDR's standard established levels are similar to the EPA's reference doses, with safety factors added on); BW is Body Weight (kg); and IR is Ingestion Rate (units/day). This process is very health-protective; it is simply the MRL times the body weight, without considering bioavailability, cooking loss, chemical form of the process, etc. Those factors are considered later in the process that considers the public health implications.

Discussion included:

• Ms. Kaplan: Worker studies are often not based on actual health impact, but rather on the limits of measurement. What are ATSDR's? You need to be very clear for the public that some of these conclusions are based not on research, but on equipment limitations. ATSDR uses all available data, animal (e.g., the PCB MRL is derived from rat studies) or human, and for some compounds will use a biokinetic uptake model. The report will be clear, for example, if doses are greater or lower than the literature's values, and try to interpret the meaning of that, to provide some perspective.

• Ms. Sonnenburg: Where/how do your equations consider cumulative lifetime dose? That is included in the more refined analytic process. How can you distinguish present dose from those in the past? E.g., the TVA emissions data are available for the last few years; but not for the past when the air cleaning equipment was absent or inferior. Some of these elements linger in the environment and can be sampled; or, if the process' material usage is known, the emission can be extrapolated by dispersion models.

• Mr. Akin: From where does the ingestion rate data come? The data for the first screening analysis is historical (e.g., site, state, and dose reconstruction data such as on fish ingestion to calculate PCB exposure). That for the second screening analysis of more recent exposures will use data of offsite sampling around the reservation. The offsite actual value used for the calculation are ATSDR's or EPA's. Whether past or recent data, they will be presented with their limitations. And if, for example, as has commented occurred with mercury levels, if past data seems to have been under- or overestimated, ATSDR will try to determine that and any effect on the reported outcomes.

• Ms. Kaplan: Data indicate that mercury-contaminated soil from the East Fork of Poplar Creek grew huge quantities of vegetables, but the mercury risk levels (measured for dehydrated foods) indicate that a lot can be eaten without harm. But are there any other contaminants of concern in soil-grown food? Arsenic was identified as another such element, but the more recent EPA biotransfer factors were reduced, so those levels of concern may also be lowered. The biota analysis will break down all the foodstuffs addressed in the analysis.

• Mr. Lewis: Was any analysis done of the game living on the reservation? Yes, some was screened in the annual DOE monitoring reports; and some ecological studies done for the Superfund cleanup work will include such data. At some sites, both turtle and racoon data were analyzed.

• Dr. Davidson: Are the EMEG parameters for children or only adults? Adults; but if there is a particular concern for children, we have carried that through in the analysis. This is generally done for lead, for example, to which children are particularly sensitive.

Public Comment

Ms. Janice Stokes reported her own contamination with multiple heavy metals, and pleaded for a clinic to study and treat the effects of such contamination. Her body burden includes nickel, now at toxic levels in her body, for which she has received chelation therapy. It may have come from the K-25 barrier pipes. Although she did not work at the plant, she has measurable and elevated levels of copper, barium, arsenic, chromium, lead, mercury, cesium, nickel and uranium body burdens. She called for someone to be seated on the ORRHES who is, like her, a local resident familiar with the data and who has these contaminants in their body, to provide a balanced input to those who disbelieve there have been any effects. Secondly, she opposed spending several million dollars on an epidemiologic study, when it could fund a multidisciplinary clinic for the residents to detect and treat heavy metal contamination. Oak Ridge offers the scientific facilities and intellectual power to be a model pilot project. She implored the Subcommittee to support a health clinic to address those who are feel that they have been most affected.

She noted that since the contamination from fish ingestion will not necessarily be measurable in the blood stream at high levels at all times, a challenge test is needed to detect it. This was not used by ATSDR and is not normally used in a standard physician's office visit test. She noted that the ATSDR study results are countered by other studies, and charged that communities in the southeast whose problems were addressed by ATSDR were not helped. She stated that ATSDR was chartered to, and is mandated by FACA-chartered boards to, set up health intervention clinics. However, this was changed by Congress 7-8 years earlier, and can be changed back. She believed that ATSDR can locate a clinic in Oak Ridge if the Subcommittee recommends it, which she urged them to do. She hoped that nickel would be studied as a contaminant of concern, and she called for an end to "paralysis by analysis."

Mr. Dwight Napp asked if the additive or synergistic effects of contamination could be addressed for levels of health concern. There is some information on synergistic effects, such as the combination of cigarette smoking and asbestos exposure, but in general the literature has little evidence to offer on synergistic effects. ATSDR examines what is known. There are multiple chemical effects studies from the Netherlands indicating no synergistic effects at lower levels than are typically present in the environment. Mr. Napp commented that a clinic could help to compile that knowledge. He asked the Tennessee Department of Health if there is a mechanism to track such sub-clinical effects of noncancerous conditions as hypo- and hyperthyroid disease, which Dr. Hoffman had indicated on the previous day could be an impact of exposure. Ms. Vowell knew of no such mechanism.

Dr. Frome read an e-mail letter to the Environmental Quality Advisory Board from a person identified as Michael Stevens, which was distributed to the Subcommittee members. Mr. Stevens expressed concerns about the environmental safety of Oak Ridge, as he is planning to move there. Ms. Ellen Smith, of EQAB, an Oak Ridge resident and an environmental scientist at ORNL, referred him to Websites which could provide other information, and expressed her own opinion as a 20-year resident that the environment is a safe place for her and her family. She thought there to be no immediate threats to public health from the ORR, "unless surveillance and maintenance lapses occur and cleanup fails to occur." Dr. Frome invited ATSDR and members of the board so inclined to also respond to Mr. Stevens.

Ms. Stokes responded that there is the potential of mercury vapor, which occurs at 72. It rises from East Fork of Poplar Creek when it is low in the summer, and which is recontaminated by the incinerator every time it floods. She was concerned that houses are being built nearby whose buyers are unaware that they risk contamination.

With no further comment, the Subcommittee adjourned for lunch, after which Mr. Hanley completed his presentation.

Presentation of the ATSDR Program of Work

Mr. Hanley presented ATSDR's draft program of work (Attachment #2), showing the Subcommittee's opportunity to comment on a) the information available, b) ATSDR's assessment, and c) ATSDR's report. This process began with iodine, and will continue for mercury, PCBs, and all the past contaminants identified in the screening process. All the reports will be compiled into a public health assessment document for public comment, which will be addressed in the final PHA report.

Discussion included:

• Mr. Lewis: Is there a point in the process to evaluate the conflicting studies referenced earlier? ATSDR will examine what is brought to it; if appropriate, it will be brought to the Subcommittee as well. This was done by Dr. Hoffman on the previous day, or comments on fluoride that were provided, leading to it being added to ATSDR's list of contaminants of concern that will be addressed and presented later in this process. ATSDR much prefers to gather this input early, rather than waiting until after the analyses are done, but the process is deliberately long to allow as much of that input as possible.

• Mr. Pardue: Can we advertise a solicitation for such information to make sure it is not brought up at the last minute? ATSDR developed a compendium of all the activities that have been conducted relative to the ORR, and had received little to add to it. Perhaps the Communication Work Group could suggest other methods to solicit such input. Mr. Lewis suggested letters to other organizations in the area.

• Mr. Akin suggested developing a cross-referential document about the role of epidemiology and the public health assessment, relative to drawing conclusions about health hazards in a community as pertain to specific chemicals and their sources. Perhaps Ms. Berger and Dr. Peipins can explain those differences at the next meeting. The Communication Work Group also is working with Ms. Dalton to develop the health assessment and needs assessment processes.

• Ms. Kaplan: What do you do with additional information once you receive it? For example, CDC responded to the document "Inconclusive By Design", but no discussion ensued. That is up to the Communications Work Group and the Subcommittee; outstanding issues can be discussed, but these were not raised.

• Dr. Frome: How far along, for iodine, is ATSDR to do Step 4, evaluating public health effects? That first-cut report could one place where people could identify work not reviewed or discussed by ATSDR. Agreed; if such issues are raised by the Work Groups, ATSDR can return to the Subcommittee to discuss that. If there are none, work will begin on mercury. Dr. Brooks reported that the Step 4 discussion of iodine is scheduled for the September meeting.

• Dr. Eklund agreed with Ms. Kaplan that a formal mechanism is needed for information, such as "Inconsistent By Design," that is not applicable to the source term or contaminant information but might offer good critical input. He suggested a Work Group evaluation of such matters and then a report to the Subcommittee on it, perhaps under "New Business." Dr. Davidson asked the Work Group advise how they would like to handle this.

• Dr. Brooks thought that a special meeting would be required to be able to forward that in September, since the formal process has the Work Group reporting to the Subcommittee, which then reports to ATSDR. However, Ms. Kaplan noted that this was the discussion through which the Subcommittee would refer this to ATSDR, so a precedent had been set in doing that. Dr. Davidson asked the Procedures Work Group to review these steps at their next meeting to go see if any adjustments are needed.

Work Group Reports

Agenda Work Group (Attachment #3)

Dr. Brooks reported two meetings of the Agenda Work Group and their adoption of this meeting's agenda. They prepared and soon will finalize with Ms. Dalton a preparation schedule for the September meeting. Another two meeting dates will be held to plan that agenda. The Work Group also considered the Program of Work (dated 5/5/01) which was presented at the last meeting. A corresponding milestone chart was created and will be updated with work progress. Dr. Brooks moved that the ATSDR Program of Work for the public health assessment be adopted as a living document expressing the future tentative plans and schedule of the task. The motion was seconded.

Mr. Lewis had no objection as long as it was clear that this is a living document for which review and comment had just been requested. Ms. Kaplan stated that the program of work was never discussed by the full Subcommittee, only by the Work Group. Dr. Davidson distinguished this document from another developed by Dr. Brooks which had a time line incorporated to it. Since this document simply reflects the steps in the process with no specific time line, a formal adoption may not be necessary.

Dr. Brooks rejoined that the Work Group would just proceed to work with ATSDR to accomplish agendas and schedules. He explained that this was simply an update on a few minor changes to the Program of Work that was developed with the Work Group. It was adopted by the Subcommittee as a living document at the last meeting. Since Mr. Hanley had elaborated on the original sketchy plan, he now felt that the plans should be merged and finalized. The information at this meeting now allows a similar brief work program with a milestone chart to be developed for the health needs assessment. Pending ATSDR's and GWU/Hahnemanns agreement that it is representative of their intended work, the Work Group can produce a final document.

Dr. Davidson suggested referring this back to the Public Health Assessment Work Group to decide if the flow chart includes all the steps necessary, as previously requested. Dr. Brooks withdrew the motion. Dr. Davidson clarified that the presentation on this day by Mr. Hanley was more of a logistical procedure than the 6-step program of work which was presented to the Subcommittee and incorporated into the ORRHES press release describing the March meeting. Dr. Brooks agreed; the other document supplied a lot more detail about these steps, including references to data. The milestone chart simply compiled the time indications of Mr. Hanley's other document onto one sheet of paper, to help prevent the scheduling of too many topics for one meeting (as has occurred already). Ms. Dalton assured the Subcommittee that the document provided merely process information, and was a shorter complement updating the more detailed previous program of work document. They are complementary rather than stand-alone pieces.

Dr. Brooks moved that the Subcommittee request from ATSDR and GWU/Hahneman the brief information necessary to form a program of work and a milestone chart for the public health needs project, similar in content to those of the public health assessment project, a brief description of the tasks, and when they hope to complete them (including presentation dates). Dr. Davidson noted that this was already an action item for ATSDR to present that program of work based on Mr. Christenson's presentation of the previous day. Upon a vote, 14 were in favor, and none opposed. The motion carried.

Public Health Assessment Work Group (PHAWG)

Mr. Pardue reported two meetings held by this, the Subcommittee's newest work group. On May 7, 2001, the items discussed were:

• General discussion of scope and function.

• Start development of the PHAWG scope and mission statement.

• Discuss draft outline for "Epidemiology 101" presentation by telephone with Lucy Peipins.

• Receive dry run briefing from Jack Hanley on development of the public health assessment.

• Review tentative agenda for addressing the entire iodine-131 issue.

One May 31, 2001, the Work Group:

• Reviewed, discussed, and commented on the presentation on epidemiology by Lucy Peipins to be given at the June 12 meeting.

• Received an updated presentation by Jack Hanley on the PHA process.

In addition, Mr. Pardue commented that the agendas for the Work Group meetings have been too crowded with presentations, precluding the ability to address anything in detail. He requested ideas for the next Work Group meeting, which he also suggested be scheduled for 3-4 hours rather than two.

Discussion included Ms. Sonnenburg's question of whether the members of the public can just provide a phone number, address or e-mail to be advised of the Work Group\ meetings? The anwer was yes; they can be provided to Mr. Pardue (or to Dr. Davidson, for any work group). The e-mail addresses are also on the committee roster. Ms. Stokes requested to be on this Work Group.

Guidelines and Procedures Work Group

Dr. Davidson reported that the Guidelines and Procedures Work Group had one meeting since March. They were asked to address the following:

I. Define the vote to recommend on what constitutes a major recommendation to ATSDR, for which the bylaws require a two-thirds vote. The Work Group included:

A. Advice or recommendations to ATSDR regarding the public health assessment, the Health Needs Assessment, or public health follow-up activities.

B. Advice or recommendations that affect the makeup or structure of the Subcommittee, including recommendations concerning the liaison members on the Subcommittee.

C. Other recommendations as determined by a majority vote of the Subcommittee. That is, if there is a difference in opinion of what the major recommendation is, a majority vote decides if this is a major recommendation (which in turn requires a two-thirds vote).

Ms. Sonnenburg moved to accept the Guidelines and Procedures Work Group's report on major recommendations. The motion was seconded and carried with 15 in favor and none opposed.

II. Procedure for individual Subcommittee members submitting material to ATSDR for distribution to the Subcommittee.

A. Material submitted to ATSDR for distribution to the Subcommittee members must be received by ATSDR 4 weeks before the next meeting. The material must include a cover letter describing: (1) what is being submitted, including a brief abstract or summary of the material, (2) why the individual wants the material distributed to the members, and (3) how the material is related to the activities of the ORRHES.

A motion was made and seconded to accept the Work Group's recommendation. Dr. Davidson explained the multitude of tasks that ATSDR staff must accomplish to convene a meeting. Members of the public who wish to bring something to the Subcommittee's attention at the meeting are welcome to do so, as long as they bring their own copies. Dr. Davidson called the question. With 14 in favor and one opposed, the motion carried.

Health Needs Assessment Work Group

Mr. Lewis reported on a brief meeting held on the previous day with Greg Christenson, Teresa NeSmith and Bill Carter. They discussed some of the issues of the health needs assessment and opened up links of communication to help the work proceed better.

Communications and Outreach Subcommittee Work Group

Ms. Kaplan noted that quite a bit of material from her had been distributed at various times, including a June 11 report about two Work Group meetings which addressed three major categories:

1. Tools to improve the Subcommittee/public communications are on the Web page: a community input form, an Oak Ridge fact sheet, and discussion of putting the Subcommittee and work group meetings on the Oak Ridge community calendar.

2. Refining the communications and outreach strategy: a procedure was added for a pre-meeting press release, which was submitted to Ms. Dalton.

3. A list of general recommendations to ATSDR was compiled (Attachment #4a), some of which they have already implemented. Further suggestions will be welcome.

4. A training recommendation to ATSDR was developed.

5. The minutes from the May 21 meeting was sent to the members. She requested a motion at the next Work Group meeting to approve those, having received no comments on them.

6. A communication and outreach strategy was voted on by the Work Group and provided to the Subcommittee on the previous day (Attachment #4b). She suggested that the word "Draft" be removed from that if the Subcommittee votes to accept it at this meeting. The only changes from the March meeting were under item #3, is now "Procedure," and still to be changed under #7 was "MP" to "Ms. Dalton."

A motion was made and seconded to accept the proposed Communications and Outreach Strategy. The vote was 14 in favor and none opposed. The motion passed.

A motion to accept the proposed list of recommendations to ATSDR was seconded. With 13 in favor and none opposed, the recommendations passed.

Ms. Kaplan referred the members to their meeting book's Tab 6, which contained a Work Group resolution on the Subcommittee Web page which the Work Group endorsed. Dr. Frome noted that page one was the resolution; the second and third pages were informational about the Website contents (e.g., regarding HTML links and PDF files).

Discussion included the following:

• Mr. Hill: Who will maintain the Web site? That will be determined by the ATSDR Web Administrator; it could be maintained in-house or by a contractor.

• Dr. Frome: How do we decide which information should be put onto the Web site? Documents such as the program of work that ATSDR has already approved internally would automatically be placed there. There is an ATSDR Website committee that reviews all potential documents to go on the site. If there are any portions of the Website resolution with which ATSDR cannot comply, the Subcommittee will be advised. Will all the information on the Website be publicly available? The Hanford site requires a password. The Hanford site is not yet a public document on the ATSDR server. Once that is done, no password is needed.

Presentation of the ORRHES Website.

Ms. Dalton reported the content approved for placement on the Web site:

1. The Community Health Concerns Comment Sheet: was drafted in response to the members' wish to collect information from community members about their health concerns about the ORR site. The front of the sheet has prompts about the type of information the Subcommittee is looking for, the purpose of this, and contact information. An additional sheet can be attached. She requested comments on this draft. When final, it will be placed in the ATSDR Oak Ridge field office. The community concerns will be used in the public health assessment process. They generally are rewritten into specific questions and then answered in the final report.

2. The Oak Ridge Reservation Health Effects Fact Sheet: provides an overview of ATSDR's activities, CDC's two activities in Oak Ridge, and the Subcommittee's work, as well as contact information. It discusses the public health assessment and the Health Needs Assessment, and provides some background information about both. She requested feedback on this draft, which she developed with the Outreach Work Group. When final it also will be placed in the ATSDR Oak Ridge field office.

3. A summary of the March meeting (the same document as the press release).

Discussion included:

• Dr. Frome: What will you do with all the health concerns? Will they be compiled in a database? Ms. Dalton stated that they are retained as part of the record, but the format and contents of the database have not yet been determined.

• Mr. Akin: Can this be broadened to include a request for information that may relate to additional contaminants, pathways, or reports not addressed by ATSDR to date? All that information could be included; it all is considered part of the public health assessment process. Mr. Lewis noted that this could be captured under item #2.

• Mr. Hill: How do you get back to the question's originator? ATSDR does not typically do that unless they specifically ask to be contacted. Normally there is a statement, which will be incorporated into this form, that this information will be used as part of the public health and information that becomes part of the public record.

• Mr. Lewis: Can these comments be anonymous? Yes.

• Mr. Johnson suggested including a few paragraphs of the many uses of this information and a short caption to invite the persons' anonymous or attributed comment.

Team Building Training Needs Assessment. Ms. Dalton reported that a training was provided to the Communications and Outreach Work Group meeting on May 8 about several issues: trust building, communication, Subcommittee mission, goals, etc. The Work Group compiled specific recommendations about the workshop such that it must be at least a day long. It will be provided at a full subcommittee meeting, on the proposed date of July 31. It is a team-building, conflict resolution, consensus-building workshop to be at the Children's Defense Fund lodge in Clinton, from 9:00 a.m. to 6:00 p.m. Information will be provided about the facilitator, who will return on September for a one-hour follow-up session. This workshop is meant to be an opportunity for all the members to discuss not only their specific role, but that of the subcommittee as a whole The estimated cost is $20/person, which Bill Murray will collect and provide to the Children's Defense Fund.

Discussion included:

• Two members could not attend on July 31. Ms. Dalton will check to see what other dates the lodge may have open and send out an e-mail. Currently, 8-10 people can attend.

Ms. McNally moved to proceed with the proposed training session. The motion was seconded. With ten in favor and two opposed, the motion carried.

Unfinished Business

ORRHES Vice Chair. Ms. Dalton stated that, if the ORRHES wishes to proceed with a request for a Vice-Chair, the same process used for the members' selection would have to be used. That person would need specific roles and duties. CDC does not encourage Vice Chairs. it can be requested, but none of the other Subcommittees have one. If Dr. Davidson is unable to attend, she would contact Ms. Dalton as the Designated Federal Official to advise her of that, and she could ask a member of the Subcommittee to act in that capacity.

Discussion included:

• Dr. Davidson expressed her interest in having someone assume part of the Chair's workload. The Vice Chair would have specific duties well beyond substituting as Chair.

• Mr. Johnson: What would be the process to select a Vice Chair, what criteria would apply, etc.? Ms. Dalton responded that, in view of the time this would require, the best choice probably would be to nominate a Subcommittee member. With 19 members and two vacancies, it is uncertain if the Agency would support adding an additional member beyond those.

• Dr. Eklund suggested delegating some of the Chair's workload to a person or a work group rather than pursuing a Vice Chair.

Dr. Brooks moved to table the topic indefinitely and the motion was seconded. The purpose of such a motion is to kill the topic without committing an opinion on it. He felt that in the unlikely event that Dr. Davidson cannot make a meeting, someone could be appointed to take her place, and time would be wasted discussing the issue. Dr. Davidson called the question. With 15 in favor of tabling the motion and none opposed, the motion passed.

Nominations for the Ill Worker ORRHES representative. Ms. Dalton reported that the nominations for the ill worker closed on April 30, and produced applications that are now being considered. However, the hiring freeze on special government employees prevents taking on any other members, leaving that vacancy and that from Dr. Lands' resignation. Another solicitation can be issued for another physician or another individual, or the applications previously received can be re-reviewed, which may include a self-identified ill resident. However, whatever the Subcommittee decides cannot be effected until the freeze is lifted.

Discussion included:

• Mr. Pardue: Is there an application from another oncologist? (No.) So we could not replace his expertise. The DOE FACA committee is adding 3-4 new members; are they not covered under the freeze? ATSDR's White House liaison confirmed that the freeze is still in effect. Although sometimes waivers are granted, there is no waiver for ATSDR for this.

• Mr. Hanley stated that, considering the time required to nominate and seat a member, it would be worthwhile to begin the process.

• Ms. Mosby commented on the record that at almost every meeting there is public comment that this group does not seem to want a sick person or a sick-identifying person as a member. She did not share that opinion; and in fact understood that some members are sick. She suggested that a collective biography of the Subcommittee be developed to challenge those comments without needing to force anyone to self-identify. She felt the level of expectation for anyone so identifying to be completely unrealistic, since no one could be a universal representative, just as she could not represent the views of all the Oak Ridge area African-Americans.

• Ms. McNally supported the idea of opening up the solicitation process, having heard much more public awareness of and interest in of the ORRHES' existence.

• Mr. Akin asked how the Chair wished the members to respond to public comments. Dr. Davidson responded that she will appreciate being informed if the members feel there is a strong need to respond; that can be done at the meeting's next session. However, she wished to avoid any back-and-forth heated debate during the public comment period, as has occurred in other Subcommittee meetings. Mr. Akin recalled that Ms. Scopes had asked about the possibility of waivers to allow the participation of an ill worker without hazarding their compensation, and had the sense it was not addressed. However, Ms. Dalton recalled that the resolution was that the person needed to address those questions with their own legal counsel. However, Ms. Mosby felt that some response should be provided as able at the time of the public comment, either a reference to past minutes if it has already been answered or a commitment to respond in future. In fact, the Website would be a good place to post repeated inquiries. There was a general feeling, voiced by Ms. Galloway, that the Subcommittee needs to exercise every effort to make the public feel as welcome and included in the meeting as possible.

Dr. Eklund moved to establish a position for a self-identified sick resident and to solicit nominations. Ms. Kaplan seconded the motion. Mr. Washington apologized for missing much of the meeting, and agreed with Dr. Eklund. He felt that this is critical to establish the credibility of the Subcommittee's work. Dr. Davidson noted that this motion was for a sick resident, to replace Dr. Lands. Ms. Dalton asked if a specific type of person was desired to replace Dr. Lands, noting that the ill resident had been raised several times.

Public Comment

Dr. Bob Peelle recalled that the state Health Department advertised for public input, whose comments are recorded in the study database along with many other public comments over the years. He suggested that these be reviewed, as they may well be applicable to the ORRHES as well. If they are not in the database, Pat Turrey of the Health Department can help gain access to those comments, following Tom Widner's directions (on the table at this meeting) of how to gain access to ORHASP materials.

Mr. Walter Coin stated that the last iodine report was watered down. In 1954, ~4,000 curies were released to the air and went all way to Oliver Springs. Boron and other elements also went in the air; the water supply was never discussed; and many accidents at Oak Ridge have never been told. A 1954 nuclear blast in the Pacific was 2.5 times bigger than expected. Many Marshall Island residents were contaminated and many military people were contaminated, and not one ever got any help.

Mr. Dwight Napp appreciated the committee's thoughts about ensuring that there is some interaction with the public. Regarding the Social Security question, he stated that their rules indicate that anyone who has the ability to waive their rules for any period of time demonstrates the ability to work, and hazards their benefits. That is one reason that people may be hesitant to participate. And it is difficult for someone who is ill to sit in a meeting for two days. Allowing an alternate would be helpful for those people. He felt that it should be obvious that the public should have the right to ask the committee questions. Regarding a self-identified ill person on the committee, he understood the issues of medical privacy, and he agreed that there may be unrealistic expectations of that person. But there should be a person on the committee with intimate personal knowledge of the effects of exposure, perhaps who had had such related therapies as chelation therapy. In addition, this contamination must be viewed in context, of a time when there was allegedly no mercury released; then that it did not go into the environment; and now people are trying to understand that they have mercury in their bodies. He charged that people were not only contaminated but also researched for health effects, and bodies were exhumed for research without notifying their families. These are all public record and were written about in People magazine a couple of months previously. He wished the committee well in its work in addressing such issues.

Ms. Linda Gas stated that the issues of the workers are very different from those of the residents. The the perspectives of both ill workers and residents should be represented on the Subcommittee, by people who are not only self-identified but with some history of work with an organization of health-affected persons. The board needs to be more public-friendly; note should be taken of the persons who are conspicuously absent month after month.

Dr. Davidson noted that a motion was on the table to nominated an ill residents to the Subcommittee. She asked if anyone had anything new to add to that discussion.

Mr. Washington reported that a FACA committee on which he has served had granted waivers to persons to continue to receive SSI benefits while they continued to serve. Mr. Hanley noted that ATSDR had contacted the Social Security Administration office as promised when this issue was first raised, which invited all those interested to come in to discuss it. The person who originally raised the question was advised by her own counsel not to participate. However, ATSDR welcomed all who wished to participate in the work groups, which is where much of the Subcommittee's work is done. He also noted that under its charter, this committee charged to advise CDC and ATSDR, but not the SSA directly. Mr. Johnson called for vigorous outreach to the SSA to ensure that applicants will not be harmed by participation. However, while the intent behind this was appreciated, the Subcommittee was warned that doing so could open themselves to potential legal liability. The people themselves must ensure their own rights and responsibilities.

The motion was re-raised and clarified to pertain only to nominate a sick resident. The solicitation for a sick worker representative has been issued and nomination packages have already been prepared. Dr. Eklund urged the committee to support his motion regardless of the disability issues. A vote on this will indicate to the public the committee's cognizance of this deficit in representation, and there is a good chance that someone appropriate could be found. Dr. Davidson called the question; as a major decision that impacts the structure of the subcommittee. The vote was ten in favor, six opposed. The two-thirds majority required was not met, and the motion failed.

Ms. Mosby moved to open the nomination process and that preference (not exclusionary priority) be given to a sick resident. The motion was seconded. Mr. Pardue hoped the board would encourage a medical professional to apply. The vote was taken, with 12 in favor, two opposed, and one abstention. The motion carried.

Mr. Kuhaida asked Ms. Gas for her suggestions as to how the meetings could be made more public-friendly. She stated that the audience should not be so dominated by agency members from Atlanta, and less domination of the board by Dr. Brooks and Dr. Davidson. The latter pointed out that the agency staff attend to respond to the Subcommittee's concerns. She added that no member of the Subcommittee can speak for her, as anyone who knows her would testify.

Closing Comments

Dr. Davidson deferred the members' discussion of their expectations of this Subcommittee to the workshop. Final statements included Ms. Sonnenburg's request that if the ATSDR staff returned to provide their critique of "Cancer Mortality Near Oak Ridge", that the author also be invited to explain and defend his report. Dr. Davidson referred that to the Agenda Work Group. Dr. Brooks noted that `gano had presented his paper in Oak Ridge several years ago, so Oak Ridge had heard his viewpoint. He also assured the committee that he would post any agenda information desired on the ORRHES Web page.

Ms. Sonnenburg also asked to follow up on Ms. Stokes' idea of a health clinic. The Local Oversight Committee, on which she also serves, had passed such a recommendation a year earlier. She moved that a Work Group be established to investigate the feasibility of opening such a clinic in Oak Ridge. Ms. Dalton pointed out that the clinic is under HRSA's purview's domain, not ATSDR's. Ms. Sonnenburg noted earlier comments that ATSDR can advise other agencies, and assumed that this also pertained to HRSA. Ms. Dalton responded that of course ATSDR would consider any recommendation from the Subcommittee and inform the members of their response, but she could not promise any particular outcome. Ms. Sonnenburg persisted that nothing could be done without examining the idea for its merit. Dr. Davidson recalled the suggestion at the last meeting that HRSA be invited. Ms. Dalton reported ATSDR's contact with HRSA, but no response yet as to when they could attend. A follow-up was requested. Ms. Dalton reiterated that this is beyond ATSDR's domain, but also noted that ATSDR conversations with HRSA are not unusual. Ms. Sonnenburg asked if a motion would help. Ms. Dalton could not say that it could. Dr. Davidson defined this as an action item for ATSDR to pursue the Subcommittee's request to ask HRSA to attend to speak to the Subcommittee.

Mr. Lewis commented that "communication is what the receiver understands, not what the sender says." He called for clarification to the community that the focus of the ORRHES' activity will be in the Work Groups, if that is how it will work. Using the Oak Ridge calendar would help in that area. Ms. Dalton noted that Mr. Murray had put this meeting on that calendar; the same could be done for the work group meetings. Dr. Davidson will also forward to the Work Group Chairs her list of people interested in participating, so that announcements of the meetings can be sent directly to them.

Mr. Johnson asked if ATSDR could write to UNOS (phonetic) to ask how they obtained the exception to the disability rule that he had referenced earlier. Ms. Dalton agreed to take this up with ATSDR's management. He then stated that, if convincing evidence of the need for a clinic is taken forward, particularly to public officials, then a clinic will be opened. Otherwise, he feared the funding would be taken out of ATSDR's budget.

Ms. Kaplan suggested arranging standing meeting times for the Work Groups. She asked if another work group should be set up to review "Inconclusive by Design." Dr. Eklund clarified that his intent was not to set up a work group, but to refer it to whatever work group is appropriate.

Mr. Johnson called for a different meeting time to be set so that the public can attend, not during working hours. Dr. Davidson noted that the meeitng's first day begins later in order to extend into the evenings. She also encouraged the work groups to meet in the evenings, particularly those that pertain to the public health assessment. In response to Mr. Hill's report that many of the skilled craft workers get off at 3:30 p.m. and the best time for them to attend the meetings would be from 4:00 to 6 or 7 p.m., the Agenda Work Group had scheduled the I-131 discussions for those times. The attendance was good. Mr. Johnson persisted that those who get off at 5-6 p.m. should also have an opportunity to hear the full discussion of the Subcommittee, which would require meeting from 7:30-8:00 p.m. Mr. Lewis stated that the Subcommittees and Work Groups had bent over backwards to set up meetings at times convenient to most people.

Ms. Kaplan asked for the tour guide's data, and Dr. Widner's overheads from the previous day.

Action Items

Dr. Davidson reviewed the action items from this meeting:

• Provide a brief program of work for the health needs assessment; Dr. Brooks will send a copy to be edited.

• Ms. NeSmith and Dr. Paranzino will develop a fact sheet about the health needs assessment process.

• An additional "Epidemiology 101" course was offered to the committee

• Why arsenic was not screened for the ORNL

• ATSDR will follow up with HRSA about providing a presentation at a future meeting.

• ATSDR will advertise work group meeting on the Oak Ridge Community Calendar.

• The members will provide comments on the community input form and the fact sheet; and the communications committee will work on a procedure for capturing public questions.

• Mr. Washington requested the emissions data on the plutonium fire at ORNL; Dr. Davidson suggested that be brought up to the Public Health Assessment Work Group. She also noted that its agenda is growing, so patience may be necessary.

Housekeeping Issues

Ms. Dalton provided ATSDR's new telephone numbers; her direct line is 404-498-1743. Mr. Hill requested an e-mail with everyone's names and numbers, and a new roster. Dr. Eklund announced his new e-mail address at rheklund@earthlink.net. The start time for the September meeting is at noon on September 10-11 and then December 3-4. Ms. Dalton asked that any information to be circulated be sent to ATSDR in the time requested. A press release was developed to announce the products of this meeting, which will be provided to the media outlets in Oak Ridge for distribution. She acknowledged Ms. Mosby's contributions in arranging for the Subcommittee's snacks and refreshments and asked the member to be sure reimburse her before leaving.

Dr. Davidson asked all Subcommittee members who signed up for work groups to attend either in person or by conference call, so that the work group can attain a quorum. Ms. Kaplan asked the members to RSVP and to respond to their e-mails. Ms. Palmer will get the information to those without e-mail by some other means.

Dr. Davidson asked again that a quorum to be maintained during Subcommittee meetings. With no further comment and her thanks, she then declared the meeting adjourned. The motions, recommendations and action items of this meeting are attached to this document as Attachment #5.

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

Kowetha A. Davidson, Ph.D., Chair
Date

Attachments

1. Categorization of Materials Based on Screening Results (Table 2)

2. Program of Work, Oak Ridge Reservation Public Health Assessment Process

3. Report of the Agenda Work Group

4a. Communications and Outreach Work Group Proposed Recommendations

4b. Communications and Outreach Work Group Proposed Strategy

5. Motions, Recommendations, and Action Items, June 2001 Meeting

Subcommittee Motions and Recommendations, June 2001 Meeting

Recommendations

1. A collective biography of the Subcommittee should be developed to challenge the comments about the need for the representation of an ill worker on the Subcommittee, without requiring anyone to self-identify.

Motions

1. Ms. Sonnenburg moved that the Subcommittee members and the public be allowed a limited amount of time after each speaker to ask questions and that each speaker be encouraged to limit their remarks to 30 to 40 minutes. Vote: 10 in favor, 5 opposed; the motion passed.

2. Dr. Brooks moved that the ATSDR Program of Work for the public health assessment be adopted as a living document expressing the future tentative plans and schedule of the task. He withdrew the motion and this was referred tothe Public Health Assessment Work Group to decide if the flow chart includes all the steps necessary.

3. Dr. Brooks moved that the Subcommittee request from ATSDR and GWU/Hahneman the brief information necessary to form a program of work and a milestone chart for the public health needs project, similar in content to those of the public health assessment project. Vote: 14 were in favor, none opposed; the motion carried.

4. Ms. Sonnenburg moved to accept the Guidelines and Procedures Work Group's report on major recommendations. The motion was seconded. Vote: 15 in favor, none opposed. The motion carried

5. A motion was made and seconded to accept the Guidelines and Procedures Work Group's recommendation on procedures for individual Subcommittee members submitting material to ATSDR for distribution to the Subcommittee. Vote: 14 in favor, one opposed. The motion carried.

6. A motion was made and seconded to accept the proposed Communications and Outreach Strategy. Vote: 14 in favor, none opposed. The motion passed.

7. A motion to accept the Communication and Outreach Work Group's proposed list of recommendations to ATSDR was seconded. Vote: 13 in favor, none opposed, the motion passed.

8. Ms. McNally moved to proceed with the proposed team-building training session at the Children's Defense Fund Lodge. The motion was seconded. Vote: 10 in favor, 2 opposed. The motion carried.

9. Dr. Brooks moved to table the topic of an ORRHES Vice Chair indefinitely. Vote:15 in favor, none opposed. The motion passed.

10. Ms. Mosby moved to open the nomination process and that preference (not exclusionary priority) be given to a sick resident. The motion was seconded. Vote: 12 in favor, 2 opposed, 1 abstention. The motion carried.

Action Items, July 2001 ORRHES Meeting

Reviewed by the Chair at the end of this meeting:

• Provide a brief program of work for the health needs assessment; Dr. Brooks will send a copy to be edited.

• Ms. NeSmith and Dr. Paranzino will develop a fact sheet about the health needs assessment process.

• An additional "Epidemiology 101" course was offered to the committee

• Why arsenic was not screened for the ORNL

• ATSDR will follow up with HRSA about presenting at a future meeting, relative to their ability to establish a clinic at Oak Ridge.

• ATSDR will advertise work group meeting on the Oak Ridge Community Calendar.

• The members will provide comments on the community input form and the fact sheet; and the communications committee will work on a procedure for capturing public questions.

• Mr. Washington requested the emissions data on the plutonium fire at ORNL; Dr. Davidson suggested that be brought up to the Public Health Assessment Work Group. She also noted that its agenda is growing, so patience may be necessary.

Compiled during development of the minutes:

• ATSDR will explore another date for the team buidling exercise at the Children's Defense Fund Lodge.

• The Outreach andCommunication Work Group will discuss: 1) ways other than advertising to solicit concerns and information on contaminants, which also can be solicited at the beginning of the public comment periods; 2) development of a cross-referential document about the role of epidemiology and the public health assessment, relative to drawing conclusions about health hazards in a community as pertain to specific chemicals and their sources. (Perhaps Ms. Berger and Dr. Peipins can explain those differences at the next meeting.)

• The Public Health Assessment Work Group will evaluate the need for a formal mechanism to track needed for information, such as "Inconsistent By Design," that is not applicable to the source term or contaminant information but might offer good critical input.

• The Agenda Work Group will discuss inviting Dr. Mongano to the next meeting if his study is discussed.

• Ms. Dalton agreed to consult with ATSDR's management about following up with UNOS (phonetic), per Mr. Johnson's suggestion, to ask how they obtained the exception to the disability rule that he had referenced earlier.

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