ATSDR - Oak Ridge Reservation - ORRHES Meeting Minutes

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ORRHES Meeting Minutes
September 22, 2005

Table of Contents

Call to Order/ Opening Remarks

The Oak Ridge Reservation Health Effects Subcommittee (ORRHES) convened on September 22, 2005, in the Alpine Room at Oak Ridge Mall at 333 East Main Street, Oak Ridge, Tennessee. Chairperson Kowetha Davidson called the meeting to order at 12:30 p.m.

Introduction of Subcommittee Members and Attendees

Kowetha Davidson asked all attendees to introduce themselves. The attendees present during the meeting were:

Kowetha Davidson, ORRHES Chair
Peggy Adkins, ORRHES member
Don Box, ORRHES member
Herman Cember, ORRHES member
Karen Galloway, ORRHES member
George Gartseff, ORRHES member
Jeff Hill, ORRHES member
David Johnson, ORRHES member
James Lewis, ORRHES member
Tony Malinauskas, ORRHES member
Pete Malmquist, ORRHES member
Charles Washington, ORRHES member
Chudi Nwangwa, Tennessee Department of Environment and Conservation liaison
Jon Richards, U.S. Environmental Protection Agency Region IV liaison
Brenda Vowell, Tennessee Department of Health liaison
Marilyn Horton, Designated Federal Official for ORRHES
Loretta Bush, ATSDR
Paul Charp, ATSDR
Burt Cooper, ATSDR
Jack Hanley, ATSDR
Sandy Isaacs, ATSDR
Karl Markiewicz, ATSDR
Rachel Powell, ATSDR
Ken Rose, ATSDR
Bill Taylor, ATSDR
Amanda Bird, TA Consulting, Inc.
John Merkle, member of public
Lynne Roberson, member of public
Scott Fraker, The Oak Ridger
Ellen Rogers, The Oak Ridger
Liz Bertelsen, ERG
John Wilhelmi, ERG

Agenda Review and Correspondence

Agenda Review
Dr. Davidson reviewed the main agenda items. (She explained that Sandy Isaacs was there in place of Bill Cibulas, who could not attend due to illness.)

Status of action items.

Project management update on the 2006 fiscal year budget.

Update on the pre-draft final Toxic Substances Control Act (TSCA) Incinerator public health assessment (PHA), presented by John Wilhelmi.

Presentation and discussion of the draft PHA for public comment titled Evaluation of Current (1990 to 2003) and Future Chemical Exposures in the Vicinity of the Oak Ridge Reservation, presented by Karl Markiewicz.

Public Outreach Plan for the Assessment of Cancer Incidence (ACI).

Overview of the National Academy of Sciences (NAS) Biological Effects of Ionizing Radiation (BEIR) VII Committee’s Report.

Work group reports and recommendations.

Update on collecting information on the community surrounding the Oak Ridge Reservation (ORR).

Two public comment periods.

Dr. Davidson noted that the work group reports might need to be moved around because two people had to leave early. She stated that they would complete their agenda, even if they had to stay beyond the scheduled completion time.

Correspondence
Since the May 3, 2005, ORRHES meeting, Dr. Davidson had only received a copy of the Local Oversight Committee's (LOC's) response to comments on the draft PHA titled Evaluation of Potential Exposures to Contaminated Off-Site Groundwater from the Oak Ridge Reservation.

Discussion: June 28, 2005, ORRHES Meeting Minutes

Dr. Davidson asked if there was a motion to approve the June 28, 2005, ORRHES meeting minutes. Pete Malmquist moved to accept the minutes and Don Box seconded the motion.

James Lewis asked whether a comment made by Mark Evans, which in his opinion had helped set the tone of the last meeting, had been added verbatim to the minutes as he had requested. He said he had not had a chance to review the minutes again, but indicated that he had made Marilyn Horton and others aware of Dr. Evans' comment and had asked for it to be included. If the comment had not been incorporated, he asked why not. Dr. Davidson asked whether Mr. Lewis had submitted it as a written comment. Mr. Lewis said that he had not, but that he had conveyed his request to Ms. Horton, Bill Taylor, and Trent LeCoultre. According to Mr. Lewis, Ms. Horton had said this would be addressed. Ms. Horton said she would have Liz Bertelsen listen to the tape recordings again, and that the comment would be added to the minutes if it was on the tape. She noted that they are listening to their comments.

Mr. Lewis stated that this change had not yet been made, so they would be approving minutes before this was covered. Ms. Horton pointed out that Mr. Lewis had made a comment on the minutes before they were distributed. Mr. Lewis replied that he had been given a copy and flagged this. He asked if this had been revised or if the words were the same. Ms. Horton said she believed the minutes were the samethat they did not include this additional comment. Mr. Lewis responded that he had been told that this issue was being taken to Dr. Cibulas or to someone else to determine whether or not Ms. Bertelsen would modify the minutes. He asked whether this had been done. Ms. Horton explained that she would have Ms. Bertelsen listen to the tapes to see if the comment is there; the comment was not initially heard, and therefore it was not included in the minutes. In his opinion, Mr. Lewis said, it was important for this to be taken care of as it relates to the tone of things because the comment establishes the ramifications of the information that follows. He said he was not sure how to handle this, questioning whether they should approve these minutes with the commitment that the tapes will be listened to. According to Mr. Lewis, the preparer of the report had listened to the recording and there was agreement that this was not reflected in the current set of minutes.

Dr. Davidson said that Mr. Lewis's comments were noted. In her opinion, however, this comment had been made near the end of the meeting and did not really set the tone. Although it may have caused some problems after that point, she said, the tone of the meeting was set before then. She suggested that they vote on whether or not to approve the minutes.

Charles Washington said that they needed to amend the motion before the vote; Dr. Davidson replied that no motion had been made to amend the minutes. Mr. Washington stated that he would make a motion to amend the minutes as enumerated by the said person. Dr. Davidson explained that they needed to be more specific in their motion to indicate exactly what they were amending. Mr. Washington indicated that he did not understand, but Mr. Lewis said he could clarify. Dr. Davidson stated that, since Mr. Lewis understood the situation, she would allow him to make the motion for Mr. Washington without going back through the discussion. Mr. Lewis made the motion to withhold formal approval of the minutes until this particular issue was addressed or they had something as part of this effort showing that the minutes needed to be modified or changed based on the review of the tape. Dr. Davidson confirmed that Mr. Lewis was making a motion to withhold formal approval of the minutes. He said that this was his motion, expressing his belief that there was timely awareness of this issue and it was understood. George Gartseff seconded the motion.

In his opinion, Mr. Washington said, this was not all necessary because they were requesting that the minutes be accurate. He said that it was required that accurate minutes be provided to this body. He expressed his belief that the motions were really inappropriate because the minutes should just present what took place at the meeting. Dr. Davidson explained that no one was questioning the accuracy of the minutes. Instead, they were asking for a statement to be included that had not previously been included. She said that this was a matter of adding something to the minutesnot a matter of questioning what was already in them. Mr. Washington said that this change would make them accurate. Dr. Davidson noted that ORRHES does not have transcripts for its meetings, so it can have accurate minutes without having every statement included.

Mr. Lewis stated that he did not want to spend much time on this issue. In his opinion, he said, the issue was relatively simple and Ms. Horton was familiar with the passage he was referring to. Mr. Lewis said that this statement made about another product had caused a lot of things to transpire in the meeting, especially after Dr. Cibulas talked about the tone. Mr. Lewis expressed his belief, if ATSDR establishes a tone, it is important that the agency stand up for what it is doing and live in accordance with that.

Dr. Davidson asked the subcommittee to vote on delaying approval of the minutes. There were seven votes for the motion and it passed.

Status of Action Items

Ms. Horton said there were no action items to report.

Project Management Update

Sandy Isaacs explained that Dr. Cibulas sent his regrets: he was very sick and unable to come to the meeting. He asked Ms. Isaacs to provide general information about the Centers for Disease Control and Prevention's (CDC's) and ATSDR's response to Hurricane Katrina. She said that this was the largest response the agency has had, and it might be of interest because some of the people who have attended these meetings were part of that response, including Tom Sinks, Henry Falk, Ms. Horton, and Lieutenant LeCoultre. They were on the ground in different places throughout Mississippi.

Ms. Isaacs said that they sadly had to report that Dr. Taylor is leaving to go to the Food and Drug Administration (FDA). She noted that this information had been sent out in an e-mail, but said she wanted to say a few words about Dr. Taylor and about his service to this community and to ATSDR. She explained that he had worked for ATSDR twice. The first time, he came to the agency in 1992 and stayed until 1998, when he also left to go to FDA. After Bill Murray left the field office, ATSDR persuaded Dr. Taylor to come back. Ms. Isaacs said she believed most people would agree that Dr. Taylor sets a tone whereby people can gain confidence and can talk to him very forthrightly. She said she very much regretted that FDA was gaining him again. She announced that ATSDR had a certificate of appreciation for the work Dr. Taylor has done in Oak Ridge, at ATSDR, and at the field office. She asked Dr. Davidson to present Dr. Taylor with the certificate. Dr. Davidson expressed that the subcommittee really appreciated the work he had done here in Oak Ridge, and that he made a presence of ATSDR in the community. As the Chair of ORRHES, she said, she would like to thank him for his service to the subcommittee. Dr. Taylor thanked everyone, stating that he had enjoyed getting to know all of them and the work here.

Mr. Lewis said that he had worked pretty closely with Dr. Taylor, Mr. Murray, and many other people within ATSDR. He expressed his belief that Dr. Taylor has been a breath of fresh air for him and for many people who were not at the meeting. He stated that Dr. Taylor can interact with all parties, including activists and technical people, which in his opinion was a missing element prior to his arrival. He expressed concern that losing Dr. Taylor will have a major impact on whether they have a good outreach program in place. In his opinion, they would be much further along if they had people like Dr. Taylor who can go and interact with these groups, and if they had this type of support and things got out in a timely manner. He expressed his belief that this was pretty close to devastating; he was not saying that people could not be replaced, but as of this point, he said, he had not seen this type of talent, commitment, heart, and drive to meet the needs and concerns here in a technical and professional fashion. According to Mr. Lewis, it was crucial to consider this. He asked that they give Dr. Taylor a special round of applause for his effort and the difference he has made in this area. Mr. Washington said he wanted to associate himself with the words of Mr. Lewis. Ms. Isaacs expressed her appreciation for the comments about Dr. Taylor, indicating that they will very much miss him as they have found him to be a critical part of their team in Oak Ridge and at other sites as well.

Ms. Isaacs said she needed to bring the subcommittee up to date regarding what the agency knows and does not know about the fiscal year 2006 budget, and how it will impact the work at Oak Ridge. The agency is anticipating a change in the U.S. Department of Energy (DOE) funding for fiscal year 2006. Because of the uncertainty, however, ATSDR must work under the most conservative budget assumptions. Its priority is to work on the PHAs to the extent possible. The next step of the process requires that the two bills (House of Representatives and Senate) go to conference for markup, but given the current priorities of Congress the time frame is unknown; it looks like it will happen after October 1.

Ms. Isaacs began to lay out how the agency has to proceed given the uncertainties of the budget. Frankly, she said, the agency was making very conservative assumptions, but it had to try to take the most responsible public health actions it can. Within the agency, she said, the highest priority is completing as many PHAs as possible. When the documents are completed, they will be made available to the public in ways that the agency has always used, such as repositories at libraries and in different places throughout the impacted communities; they will still be available on the Internet as well.

Ms. Isaacs noted that the ATSDR Oak Ridge Field Office will be closed at the end of September, and will remain closed until the agency is more certain about the budget. She indicated that ATSDR still plans to work with the community to the extent allowed by the budget. She pointed out that ATSDR is not going away, adding that Jack Hanley, Ms. Horton, and other staff members who they have worked with will still be there. In addition to ATSDR, she said, they could also contact CDC at 1-800-CDC-INFO about health issues that they might have.

With the limited resources, she reiterated, ATSDR finds it imperative to produce the health assessments that have been started to the extent allowed by the uncertainties. If the budget allows, ATSDR plans to haveat a minimumpublic meetings as the documents are released to allow input from the community, as well as public comment periods on the documents. The agency does not know, however, how much it can support ORRHES at this time. As more is learned about the budget for fiscal year 2006, ATSDR will have a better idea of the feasibility of supporting work group meetings and ORRHES next year. Now, however, they did not know where they were. Ms. Isaacs expressed that the wish of the agency is to continue having ORRHES and meetings, and to remain on schedule. She indicated that the people of Oak Ridge are very important to ATSDR, but that the uncertainty of the budget is driving these decisions. She expressed her commitment to inform the ORRHES members as soon as anything is known about the 2006 fiscal year budget.

Herman Cember asked when ATSDR would know about the budget. Ms. Isaacs said that this was uncertain. She explained that there are two versions of funding proposals that have not gone to conference or been scheduled (to the agency's knowledge). The bills have to go to conference, will require some sort of conference language, and then will be given for signature. In the past, she said, ATSDR might not have received the budget until the next calendar year, but had an indication of where the levels would be. Now, however, the agency did not know. As soon as ATSDR knows something, it can reassess its ability to support ORRHES meetings. Dr. Cember expressed his belief that they could meet until June 30, 2006, under the sunset parameters. Ms. Isaacs said that this was correct, but that they would not be able to schedule any ORRHES meetings at this time. She indicated that they were not closing the Federal Advisory Committee Act (FACA) per se, but that they were leaving it open until there was more certainty about the budget. She stated that there were disparities in the two bills, and ATSDR did not know whether it would receive almost what it got last time or if it would take a big hit.

Mr. Lewis stated that he had heard Ms. Isaacs say that she had high hopes that this work would have been completed. He expressed concern that they have been here for nearly 5 years. During that time, according to Mr. Lewis, they have almost begged and asked for a definitive project plan that provides an overview of where they are and where they are going. He explained that a project plan would have indicated the various steps that could be looked at, eliminated, or speeded up; however, he said, they had never received an adequate project plan to enable them to do this. He expressed concern that the intended course of action was to complete the work that been started. Instead, in his opinion, since they were running out of money and were in a critical stage, they should consider the remaining items and determine those that would have the most benefit. He expressed his belief that there was much "low-hanging fruit"things they were concentrating on that did not get the most bang for the buck. For example, he said, they evaluated the TSCA Incinerator, which was basically a current topic with one or two issues. Since money was running out, he recommended, ATSDR should look at the "heavy hitters" that would have the most impact on the community. He suggested evaluating what could be done to accelerate this and to focus the remaining time and money on the issues that will be most beneficial. Mr. Lewis said he had not heard this from any member of the project management team, but they have heard that ATSDR is running out of money. To this day, he said, it has seemed as though it was business as usual. He stated that he would like to see a proposal reviewed by ORRHES to determine what to focus their efforts on and to consider what needs to be done in those areas. In his opinion, he said, the low-hanging fruit was not of much benefit to them. He asked if there was a possibility that ORRHES could look at this, figure out what they were doing, and determine what would have the greatest impact on the community. Then, based on their suggestions, ATSDR could put most of its efforts into the identified areas and possibly combine some of the other issues so they could move on.

Ms. Isaacs indicated that ATSDR is open to input on this. She said that she could not, however, promise that there would be another ORRHES meeting. Mr. Lewis stated that he was asking that ORRHES and the community provide input though whatever methods are necessary; he was not implying that there had to be an ORRHES meeting. He expressed an interest in having an action or recovery plan laid out to them instead of only hearing that ATSDR is going to continue its work that has already been started. He said that perhaps he was wrong and should not think like this, but this did not sound right to him. He reiterated that they have been here for 5 years and it had taken the other group 9 years to conduct the original exposure evaluations. In his opinion, the community deserves something in the specific areas where they have health concerns. He recommended that ATSDR focus its limited resources on the areas that would do the most good.

Ms. Isaacs said that she certainly agreed that ATSDR would like to focus on things that would do the most good. She explained that because the agency does not know the level of funding, it cannot determine if any more ORRHES meetings can be supported. She said that, if appropriate, perhaps a discussion of priorities could take place under new business. She indicated that community member meetings are also an open way to provide suggestions; however, they could not give consensus advice because such meetings would not be under the auspices of ORRHES. She added that nothing precludes them from having their own group meetings and meeting as individuals to provide advice. In addition, she said, ORRHES could give ATSDR advice at this meeting that ATSDR would welcome and take forth. She emphasized that ATSDR is very uncertain about the budget. One issue is being able to fund salaries: the agency does not know about staff level in house as well as being able to support ORRHES. Ms. Isaacs explained that the Senate's language offers $2.7 million for the U.S. Department of Health and Human Services (HHS), giving emphasis to worker support for the National Institute for Occupational Safety and Health and mentioning a dose reconstruction for Los Alamos (being done by CDC's Radiation Studies Branch). There is no mention, however, of ATSDR. Thus, even when the money is passed from DOE to HHS, ATSDR will still not know about its budget. Internally, she said, ATSDR does not know how its staff will be impacted until there is more certainty about the budget.

Mr. Washington said he understood Ms. Isaacs' plight as a manager, but stated that someone at ATSDR had to understand their plight. He explained that many ORRHES members have been involved with this issue for longer than the 5 years the subcommittee has existed, as some have served on other boards and worked with this issue in other ways. Of the three or four major sites throughout the nation, in his opinion, Oak Ridge deserved the most attention to help people silence many of their fears. According to Mr. Washington, people in this community believe they became ill because of many of the things that took place in Oak Ridge. While Ms. Isaacs might be doing her best, he said, maybe the subcommittee or another board could do something or the ORRHES members could talk with their representatives and senators. He expressed his belief that Oak Ridge needed the attention of someone because this could not go on forever. In his opinion, he said, they wanted to finish this as soon as possible with an endpoint that satisfied the people in this community, which it seemed they were not getting. He said he was as disappointed as Mr. Lewis. He expressed his belief that they were not getting attention because they are not screaming at everybody and getting in the streets to do whatever it takes to get the work done as people might have done at other sites. Nonetheless, according to Mr. Washington, they needed the attention of all of the agencies, including the U.S. Environmental Protection Agency (EPA) and others. He said that they needed to understand that operating this site for the past 50 years has contaminated Tennessee from Oak Ridge to Chattanooga. They needed definite answers now, he said; many of them would not like to work on this for another 5 years without having any answers. He asked who they could write to in order to get the attention they needed.

Dr. Davidson explained that any ORRHES member could write to his or her congressman or senator as a citizen of the community, but not as an ORRHES member. She said that they could not use their positions as ORRHES members because they are special government employees, not allowed to lobby Congress. Mr. Washington stated that he understood this because he has served on other committees. He said, however, that subcommittee members could write to the Chairman of DOE and tell him about the plight of Oak Ridge, adding that he has done this before while serving on other committees.

Mr. Lewis pointed out that agencies were represented at the meeting, including the Tennessee Department of Health (TDOH), the Tennessee Department of Environment and Conservation (TDEC), and EPA. In his opinion, some of these reports were only going over documents produced by other people and rehashing a lot of the same things that have already been done. He expressed his belief that some of these things could probably be handed over to the state, adding that the state effort in Loudon County appeared to have worked well and been executed in a timely manner. He stated that he had been told this effort was crude, but said he felt that it met most of the needs of the people (with some refinements). He indicated that there were alternatives and suggestions they could make for ATSDR to bring back to whoever is in charge for consideration. For instance, he said, some people have gone directly to TDEC to address issues on groundwater. He asked what tasks could be taken away from ATSDR and given to these other agencies. In his opinion, they should utilize some of their talent that has been brought in to help with these issues, such as the senior scientists who have done a great job for them, but there was no need to repetitively evaluate things that have already been addressed. He expressed his belief that ORRHES had enough talent to help ATSDR identify what needs to be done.

Regardless, Dr. Davidson said, it would be much easier for them if ORRHES and ATSDR had no policies that they had to adhere to so they could do things in the way they wanted and when they wanted. She explained that they are somewhat hindered because of the certain bounds that they have to operate within.

Peggy Adkins said she wished she heard all of Mr. Lewis's comments, but that it sounded like he was on a good track.

Discussion of Oak Ridge Reservation PHAs: Status and Priorities

According to Mr. Hanley, ATSDR has made tremendous progress on the PHAs in the last 6 to 9 months, particularly this past summer. During the last few months, ATSDR has responded to public and peer review comments on the TSCA Incinerator PHA. In addition, ATSDR released its public comment version of the PHA on off-site groundwater, which had never had a public health evaluation. The public comment period has been extended to allow more time for comments. ATSDR would be receiving the ORRHES comments on this PHA at the meeting today; ATSDR has also received other public comments. Next week ATSDR will release, for public comment, the draft PHA titled Evaluation of Current (1990 to 2003) and Future Chemical Exposures in the Vicinity of the Oak Ridge Reservation, which Dr. Markiewicz has been working with the ORRHES on for a couple of years.

Mr. Hanley asked if the group would like to take a few minutes during the meeting to follow up on Mr. Lewis's recommendation. He expressed an interest in getting the subcommittee's input on quick priorities in case ATSDR has to make adjustments.

Mr. Hanley noted that ATSDR has completed two PHAs. ATSDR has already prepared the public comment versions of three PHAsWhite Oak Creek radionuclide releases, off-site groundwater, and the current and future chemical screening. The agency is currently responding to comments received on White Oak Creek; it will be responding to comments on off-site groundwater and will be releasing the current and future chemical screening soon. Regarding the iodine PHA, there are some outstanding issues pertaining to uncertainty with the previous analysis. ATSDR has an internal review draft of the PHA, which has already gone through data validation. The data validation issues have been addressed, and the agency now has an internal draft. This could be the next PHA released for public comment. For the K-25 uranium and fluoride releases PHA, there are also some outstanding issues from the state's previous analysis. Currently, ATSDR is addressing data validation issues on the K-25 uranium and fluoride PHA, as well as on the PHA on polychlorinated biphenyls (PCBs). According to Mr. Hanley, Dr. Taylor is making very good progress on the evaluation of past exposures to mercury, looking at the dose reconstruction conducted by the State of Tennessee. Mr. Hanley said that he will obtain Dr. Taylor's analysis before he leaves, and incorporate his section into the previous version of the PHA on current exposures that was completed a while ago. Once this document has been merged, it will have to go out for data validation and then through internal review before it can be released for public comment.

Mr. Hanley asked the ORRHES what PHAs would have the most impact regarding community concerns and outstanding issues that they think need to be addressed. According to Mr. Lewis, he has argued all along that current issues are not of major concern for the lay public. He expressed his belief that various agencies were handling current issues in an aggressive and professional manner, and therefore were not of major concern. In his opinion, the city and Chamber of Commerce might be interested in whether current conditions will have some impact, but they have EPA and the state here to handle these things. He expressed his belief that they needed to evaluate the pastwhich he said they have been arguing all along, as ATSDR knows. He suggested that they focus on the past and concentrate on key items, contaminants, and PHAs. According to Mr. Lewis, one of the saddest things was that they did not have a complete listing of the community's health issues and concerns at this stage in the process when they are shutting down. Mr. Lewis indicated that most of the issues concern the past, questioning that ATSDR's products do not address what the agency came here for. He suggested separating the past from the present, dealing with the past to focus on the key items here, and putting the issues into categories for ranking purposes.

According to Mr. Lewis, cancer incidence and health issues are very important to this community. He said he was not sure where this ranked. In his opinion, if current exposures could be addressed somewhere else, they should be separated and given to someone else. He suggested that ATSDR then go back and deal with the past issues, which would probably provide the most benefit for the community. For clarification regarding current exposures, Mr. Hanley said, the other agencies' primary focus and goal is to address Superfund on-site cleanup. Whereas ATSDR looks at things from a public health perspective and evaluates off-site exposures, these agencies look at sites from a cleanup or regulatory perspective. Mr. Hanley said he appreciated Mr. Lewis's concern and interest about the past, but the present needed to be looked at and considered to some extent: the state's previous efforts focused on the past, so the present has not been evaluated.

Mr. Hanley indicated that Mr. Lewis was rightthere are some outstanding issues. In less than 6 months, he explained, the followup on the needs assessment (which Mr. Lewis has been asking for) was completed. This included a review of all of the newspaper articles and documents and extracting community concerns from them. Where appropriate, Mr. Hanley said, these concerns will be placed into PHAs as they are prepared. According to Mr. Hanley, many of the concerns were similar and were repeated in different documents. He said that ATSDR will address these past concerns. Noting that the subcommittee members are in tune with the people's issues and concerns, he asked about their preferences regarding the PHAs. He asked if iodine or mercury would be a priority, or whether the priority should be off-site groundwater (since it has not been looked at extensively and they are receiving a number of concerns on the subject).

Mr. Lewis said that based on his limited knowledge, mercury, iodine, and Y-12 were the three "heavy hitters" that he had heard most of the challenges about. He added that he was not sure the Y-12 PHA had been done that well because there are some outstanding issues. He indicated that there was much more expertise around the table than he had, and suggested getting guidance from some of the technical people on how to prioritize the items that would be of most benefit to the community.

Dr. Davidson pointed out that all of these have importance to some community members. Mr. Lewis said he did not deny that. Dr. Davidson noted that they had a community member attend work group meetings who was concerned about K-25, so those releases are on the list of importance. They also had presentations on mercury in their meetings. She noted that PCBs are ubiquitousthey have contaminated all of the country, not just Oak Ridge. Therefore, she said, something will be found about each contaminant that is of high priority to a subgroup in this community. As a toxicologist, she said, she could not prioritize one as more important than another: doing so would mean taking the stance that one issue is more important to one group of people than another issue is to a different group. Thus, they would not only be making a judgment about resources, but also making a value judgment.

In his opinion, Mr. Lewis said, oftentimes looking at the concerns will drive you in a certain direction, but ATSDR never put a list together to review. According to Mr. Lewis, the survey from the dose reconstruction provided some guidance on what the issues and problems were. He said that this survey was not done randomly, and that looking at it could provide a feel for the issues. Dr. Davidson explained that other things have become issues since that time, such as when they had a work group attendee talk about uranium and fluoride releases from K-25. Regardless of what the dose reconstruction says, she stated, each one of these chemicals is of interest to some subgroup of the community. (Mr. Lewis agreed.) But, she continued, none of the issues will be of interest to all members of the community. She again questioned how they could make a judgment that one is more important because it is more important to a particular group. She expressed her belief that this was a difficult decision to make.

Mr. Box indicated that mercury was of concern, particularly because such a large amount had been discharged from Y-12 and the Y-12 area. Mr. Box stated that barely a week passes when he does not read a newspaper or journal article discussing another study on a different disease possibly caused by mercury. For instance, there was an article relating Parkinson's disease to mercury, and now innumerable studies are being conducted to ascertain if there is a connection. Though Dr. Davidson might not agree, he added, it appears mercury is becoming a prime culprit in many diseases in the public.

Mr. Hanley said that concerns have been collected in the Community Concerns Database regarding mercury, and ATSDR has also looked at past concerns for issues that have come up. He indicated that Dr. Taylor has been addressing some of these, while some others are addressed in the current exposure portion of the document. He noted that mercury is often an issue in connection to fish. In the document, he said, ATSDR will clarify how the type of mercury released from Y-12 could have impacted people, adding that mercury is an important contaminant. Mr. Box mentioned that steam plants emit quite a bit of mercury and the Oak Ridge area is bracketed between two steam plants. Mr. Hanley indicated that this issue has been brought up at meetings; Dr. Taylor is looking into it and it will be addressed.

Dr. Cember said he concurred with Mr. Box. When talking about interest to various segments of the population, he questioned whether they were concerned about a perceived risk or a real risk. He expressed his belief that the PCB risk is greatly exaggerated, noting that human data on places where there have been exposures did not confirm fears. He said that the opposite is true for mercury. In his opinion, he said, the Occupational Safety and Health Administration's (OSHA's) Permissible Exposure Limits (PELs) are not enough to prevent mercurialism among workers. He said he thought this had been demonstrated. Although there might be a great perceived risk from PCBs, he expressed his belief that it is small compared to the actual risk scientists have demonstrated from mercury. Dr. Cember added that mercury not only comes out of coal, which contains reasonably large amounts of mercury, but it is also in newsprint. He indicated that one of the main reasons he supports recycling newsprint is to prevent mercury from being burned and released into the air. (He explained that mercury gets into the paper when it is made: phenylmercuric acetate is used to inhibit the growth of mold on the rolls used to make the paper.) Dr. Cember stated he had read somewhere that at least 90 percent of the nation's supply of mercury went through the labs at ORR. He said he did not know the transmission chain to get to people, so he was not sure how it was getting around or if it was isolated. He said he would rank mercury as number one.

Ms. Adkins said that probably a month ago she would have said that mercury was the highest priority, but she has since come to realize that they are not even touching the tip of the iceberg here. According to Ms. Adkins, she went to the emergency room in the last month and was alarmed to learn about the health effects of strange elements, such as thorium and gallium, which she has never worried about before. She expressed concern that there are many elements in people's bodies that they do not even discuss in their studies, stating that they either got these from the moon or the nuclear facilities around us. In her opinion, Ms. Adkins said, there are things they never discuss that are harmful and no one even knows to be tested for them. She said she did not know where to begin.

Mr. Hanley explained that he is planning to incorporate an evaluation of past exposures into an overall summary document. This past evaluation developed a list of contaminants, which included those mentioned by Ms. Adkins. They were evaluated by the state a couple of times, and ATSDR had experts look at them as well as other contaminants. Mr. Hanley indicated that they needed to document that these substances were evaluated, and based on Ms. Adkins' comments (as well as comments received before the meeting) they could explain the significance of these contaminants. Before Ms. Adkins was on ORRHES, Mr. Hanley explained, they went through the screening analysis of TDOH's efforts.

Dr. Malmquist agreed with what had been said, but noted that perception is also a fact of life in what happens. He explained that he is one of the few members of ORRHES who uses the lake a tremendous amount. In his opinion, PCBs are very important. He said that if they read over the reports, they would see that PCB levels are dropping in all lakes except the Clinch River. In addition, Watts Bar is one of the few lakes with warnings not to eat the fish. According to Dr. Malmquist, if you go back to the state, the PCB levels are one reason for this. He said he hoped that this would be dropped, but nonetheless, the perception is that this water is bad. He stated that when they start ranking things and they have high levels of PCBs that are not going down in the Clinch River, they had to ask why. He expressed concern that the perception is that this is dangerous for this area. He said he did not know how to rank these either. He expressed his belief that mercury is very important and causes all kinds of problems. He noted that he was in Florida last winter, and people were told not to eat fish on the high end of the food chain, such as swordfish, because they have high levels of mercury. He said that he did not know the perception there, but that the perception here is that the lake water is bad, it is contaminated with PCBs, and the Clinch River is the worst. He repeated that he did not know how to rank these, but that something needed to be pointed out.

Tony Malinauskas explained that they had discussed a summary document, mentioning that he strongly supports this. He asked whether it was off the table regardless of the funding situation. Mr. Hanley indicated he was looking forward to releasing a summary document, but that it would depend on funding. In his opinion, Mr. Hanley said, this document was important, but he could not say at this time whether it would be produced. They would have to wait to hear from senior management and know how much funding there would be to get this document out. Dr. Malinauskas suggested adding the summary document to the PHA status table.

Dr. Davidson pointed out that they would finish their agenda even if they had to stay until 9 p.m. Mr. Hanley indicated the importance of taking the time to discuss the priority issues Mr. Lewis had brought up. Mr. Hanley said that this might be taking time away from some of the presentations, but that maybe those could be made a little more quickly. Mr. Hanley explained that he appreciated this time because ATSDR would have to make these decisions and bring these issues to the forefront. Therefore, it was good to get their comments on the front end.

Ms. Adkins said she had a proposal for how to prioritize the use of limited resources. She said that a group called Advanced Wellness has a thorough testing method that it uses to test people for toxins. She said they test for about 20 different toxins, but do not cover the entire periodic table. She suggested devoting resources to studying toxins that this company most frequently finds in its patients. According to Ms. Adkins, Advanced Wellness documents everything it does, and is very thorough and extremely cautious. This is the only company she knows of, she said, that has studied people rather than fish. She expressed her belief that this would be an answer to their concerns.

Mr. Lewis said he heard Dr. Malmquist and believed he understood what he was sayingthe PCBs are up and down the entire river. Mr. Lewis asked who was responsible for the signs, and asked who was primarily responsible for the PCB releasesthe state, the Tennessee Valley Authority (TVA), or another entity. In his opinion, he said, their work should be about addressing this issue to meet the needs of the people. To get anything out of this, he stated, they had to pick based on what would benefit the community. He told a story about how the sign was sitting at the river when he and some others went to baptize someone. According to Mr. Lewis, the sign provided no information on where to go for details, such as a Web site. He indicated that they need to look at what is out there and decide what to do; he said that someone has to make a call. Mr. Lewis said Dr. Malmquist had a good point, but indicated that they could discuss PCBs around this table pretty quickly, know where most of them came from, and discuss what they could do to address the matter.

Dr. Davidson said she assumed they were discussing PHAs that are not almost finished or so far in the pipeline that it would infeasible not to complete them. She expressed her belief that it made no sense to not complete those that were almost done, noting that there were two or three in this category.

Mr. Lewis asked whether iodine had been a major issue in the beginning of the program. He stated that they had had enough of a fight on this topic to indicate that iodine was an outstanding issue. In her opinion, Dr. Davidson stated, they could say that there were outstanding issues involving all of these topics, which was the problem. Mr. Lewis recited a saying: "To treat everything or everybody the same is to treat everything or everybody unfairly." He expressed concern that they had to make a decision; if not, then people will get nothing and everyone would be treated unfairly. He expressed his belief that mercury, iodine, and uranium were high priorities. He asked what they could do to prioritize these, noting that key issues have been challenged, including PCBs as Dr. Malmquist has mentioned.

Dr. Davidson said that ATSDR had heard their discussion. She indicated that ATSDR will have to make its final decisions regarding what can and cannot be done with available resources. She added that she would not want to be the one who made this decision. Mr. Lewis suggested that subcommittee members meet to talk about this issue before they put it to rest to see if they can come to a consensus before they leave. He noted that this could be their last meeting, and said he highly recommended getting together in a small group to discuss this issue and determine whether they could present something. Dr. Davidson asked the subcommittee members if they agreed. Mr. Lewis suggested having a 15- to 20-minute break for discussion; Karen Galloway said that was a good idea. Dr. Davidson stated that they would hopefully have this time available at 2:45 p.m. for such a discussion.

Status of Assessment of Cancer Incidence

Mr. Hanley noted that Mr. Lewis had mentioned the ACI for the eight-county area. The portion of the original ORRHES recommendation has been developed, has gone through data validation with the Tennessee Cancer Registry (TCR), and is currently undergoing ATSDR internal review. According to Mr. Hanley, this part of the report could be completed fairly shortly and would be submitted to TDOH's East Tennessee Regional Office. In addition, the report will be provided to the Ad Hoc Work Group for discussion on how to make sure the information is in an understandable form and to get feedback. Then the document will go out for public comment. This report is on standard incidence ratios (SIRs) for all cancers with the eight counties from 1991 to 2000.

At the last meeting, Mr. Hanley said, ORRHES recommended modifying its original geographic area because of problems with the census data. Since then, ATSDR has gone back to the state and was able to obtain census tract data for Knox, Blount (part of geographic area), and Loudon Counties. ATSDR has reviewed the data and discussed them over the phone with TCR staff; an ATSDR statistician was also involved in that communication. Recently, the division director from the Division of Health Studies (DHS), David Williamson, sent a letter to the director of TCR identifying some issues that ATSDR was having with the data regarding census tracts. DHS is looking to get a response to see if this can be done and if it is even advisable to move forward. If this analysis cannot be done, Dee Williamson and her division director will come and discuss this with community members, including the technical issues and difficulties regarding any census tract analysis.

Mr. Hanley confirmed that Mr. Lewis had said in the past that the state has committed to conducting a crude analysis by census tract in Loudon County; Mr. Lewis said this was correct. According to Mr. Hanley, Dr. David Williamson said if the state can conduct this crude analysis by census tracts in Loudon County, then ATSDR should be able to follow up with the geographic area ORRHES developed and discussed many times over the years using SIR analysis. Mr. Lewis said that ATSDR needed to talk to the state, but that the state had indicated that it could look at the data at a lower level and had talked about census-tract type of information or stratifying data. Mr. Lewis noted that he had not, however, said that the state had indicated it could do this exactly at the census tract level: rather, the state had said it could produce something other than the whole county and bring it down to the area of concern.

Mr. Hanley explained that the state had conducted a crude rate analysis last time using information at the county level. The state had used this analysis to rank Loudon County against all other counties in the state; the county was at the top for all cancers. Mr. Hanley explained that this analysis was different from ATSDR's, which is looking at each cancer within a large geographic area to see if any are elevated compared to the state. If any cancers are elevated, ATSDR will quantify how much they are elevated (and put confidence intervals around them to indicate its confidence in those quantifications). Mr. Hanley pointed out that this is a different type of analysis, but if the state could evaluate data at the census tract level, then ATSDR will try to work toward doing so as well.

According to Mr. Lewis, whether or not the analysis was crude, it failed to meet the community members' needs. The community members need something that validates their perceptions, he said: if he lives in this area and sees this all of the time, he wants to know if what he is seeing is true and how it relates to the big picture. He stated that the public understands the crude analysis and how things are elevated. He said that they could put something out that toxicologists might prefer, but asked what they have done if the public cannot understand their results. Mr. Hanley explained that crude rates are often used within agencies to help allocate resources and for public health policy purposes. But there are limitations to crude analyses, which is why ATSDR is using a SIR approach to address the issues that have been raised here. Unlike crude rates, the SIR approach enables you to adjust for age, gender, and race.

Dr. Davidson added that by definition, a crude analysis does not give you much information either. Mr. Hanley indicated that this was very appropriate for the state's purpose of developing relative rankings. He expressed his belief that this was a first cut, and now the community members are asking the state to do more. According to Mr. Hanley, it appears that the state will follow up on the community's request. He said that the bottom line was that ATSDR will work with the state to determine whether this area can be evaluated. If it cannot be done, regardless of the budget, DHS has made the commitment to coming to town and discussing this. Mr. Hanley noted that ATSDR will be contacting the ORRHES members via e-mail, letters, and other means. Dr. Davidson said, it sounded as though the ACI requested of Dr. Dee Williamson by ORRHES was a more refined assessment than the one done by the state for Loudon County. Mr. Hanley agreed, noting that these were different types of analyses.

Ms. Adkins expressed her belief that this plan would be fine if time and money were not limited. However, since they were, she said she felt it would be better to know if people had extremely high levels of cadmium rather that waiting until they become kidney cancer statistics in a decade or two. She reiterated her suggestion of using the remaining time and resources to look at populations with high levels of heavy metals and toxin poisoning. According to Ms. Adkins, there are ways to find people before they become a cancer or mortality statistica lot of this information is available through Advanced Wellness. She indicated that more information would be available if more people knew to get tested. Mr. Hanley thanked Ms. Adkins for her suggestion and indicated that they would consider it.

Presentation/Discussion: Update on the Pre-Draft Final TSCA Incinerator PHA

John Wilhelmi explained that he is a chemical engineer with ERG, a contractor to ATSDR. His role in this project has primarily been to help ATSDR evaluate the public health implications of the TSCA Incinerator. The goal of his presentation is to give a brief overview of ATSDR's responses to public comments and peer review comments on the TSCA Incinerator PHA. Per Mr. Hanley's request, Mr. Wilhelmi said, he had sent a copy of the responses to all of the ORRHES members. He had also tried to e-mail them to everyone, but some of the e-mail addresses bounced back. He had also sent them via FedEx to everyone on Tuesday. He said that most people should have received a copy of the responses, but apologized to anyone who did not receive them.

He showed an outline of the topics he would present, mentioning that he would focus most of the presentation on discussing the overview of comments and responses. An overview map was presented to show the location of the TSCA Incinerator, which was signified by a red dot. Mr. Wilhelmi explained that if they drove from the meeting location, down the turnpike, and turned right at Blair Road, they would see the incinerator. A photograph showed the incinerator, and Mr. Wilhelmi identified the main stack. He indicated that usually you see steam coming out of the stack, which mostly contains benign byproducts of combustion. Some trace contaminants come out as well, though. The objective of the PHA is to determine whether local residents have been exposed to unhealthy levels of contaminants released by the incinerator.

Mr. Wilhelmi presented a project timeline. He explained that he visited the former Public Health Assessment Work Group (PHAWG), now known as the Exposure Evaluation Work Group (EEWG), in March 2004. At this meeting, they discussed data sources that ATSDR had acquired and assessed whether anyone had additional data sources for ATSDR to consider. In addition, he said, this meeting gave him an idea of the community concerns, which he indicated were really important in driving the focus of the PHA. Mr. Wilhelmi returned to the PHAWG in November 2004 to provide a preview of the findings. In January 2005, though Mr. Wilhelmi did not attend the meeting in person, he spoke with the EEWG over the phone regarding a very specific topic (review of emissions sources). In May 2005, Mr. Wilhelmi presented and discussed his findings for the public comment release with ORRHES. Since this time, ATSDR has received public and peer review comments; Mr. Wilhelmi was at this meeting to provide an overview of the comments and responses.

Mr. Lewis stated that the community concerns section of this document was different from others he had seen. It included an extensive amount of concerns, which to the best of his knowledge had not been reviewed in any of their meetings. Mr. Wilhelmi said he could explain where the list of concerns came from. Mr. Lewis indicated that he saw many community health concerns in other documents that were technical, but this document contained many concerns that were health issues. According to Mr. Lewis, this was an area where they had not done anything. He asked where Mr. Wilhelmi obtained these concerns. Because Mr. Wilhelmi had said these concerns were his driver, Mr. Lewis said, he would like to see them addressed. Mr. Wilhelmi explained that section five or six of the PHA contained about 30 to 50 concerns and responses.

As a scientist, Mr. Wilhelmi said, he has helped prepare many of these documents. He stated that it is easy to get into the scientific mode and come up with something fairly technical, but this might not serve the audience. He explained how he met with them early in the process to develop a list of concerns, and also looked at newspaper articles to see what people were asking about. He added that a list had been distributed at one of the PHAWG meetings, and that list continued to be added tothe list in the PHA is what emerged from these efforts. Mr. Lewis recalled that someone else had collected some of the concerns. Mr. Wilhelmi replied that he ran a query on a database to obtain some of the concerns. In his opinion, Mr. Lewis said, Mr. Wilhelmi had also run across some others and had a good compilation of issues. Mr. Wilhelmi added that he had gone through these to see what the community was interested in, and then backtracked to see the responses. Mr. Lewis repeated that he had never seen a set like these until this PHA, and wanted to know where they came from and how they got into the PHA. He expressed his belief that Mr. Wilhelmi had done a good job of addressing these issues.

Mr. Wilhelmi explained that the document review process comprised multiple rounds of review. Initially, the document was reviewed carefully within ATSDR for scientific and editorial comments. Next, the document went through data validation review, as is usual for these PHAs. ATSDR also coordinated an independent peer review panel containing four experts in the field. There was also a public comment period for the PHA, during which ORRHES contributed the majority of the comments received. Mr. Wilhelmi said he had developed one summary statement indicating that through all of the rounds of review, no comments suggested a conclusion other than "no apparent public health hazard," which he noted was a very important point. He said that all of the comments really strengthened the document, noting that when you work on a document so closely, you sometimes lose sight of things that might be important or might not be apparent to people who have not studied the document's subject in depth.

Mr. Wilhelmi divided the public and peer review comments into four different categories. He said there were probably about a dozen editorial comments, such as using "of" instead of "or." All of these comments were incorporated. There were five general comments, which Mr. Wilhelmi said were mostly favorable and reflected the fact that so many people contributed throughout the process. There were 41 specific comments and minor clarifications, 10 comments on methodology, and 11 comments on the conclusions and recommendations.

Mr. Wilhelmi provided some more information on the specific comments. Some requested more detailed discussion of inputs, uncertainties, and interpretations of modeling studies that has been incorporated into Appendix B. Some people asked about the public availability of certain referenced documents, and the Web sites were included. One peer reviewer suggested having more discussion on periodic thermal relief vent events or certain conditions that make it necessary to shut off the feed and let out puffs of gas (not treated by air pollution controls). Mr. Wilhelmi pointed out that the reviewer did not question the conclusion associated with this, but just recommended dealing with the topic more thoroughly. One or two comments asked if all of TDEC's data sources had been considered, which they had. Mr. Wilhelmi noted that he saw a few statements in the text that could lead someone to think a few things had been overlooked, and this language was clarified. There were questions regarding comparison values (CVs) that were addressed.

One commenter did not like the use of "contaminant" and suggested using a softer, less threatening term such as "substance." In his opinion, Mr. Wilhelmi stated, this would be masking what really is out there. Mr. Washington asked if this comment was from one of the agencies. Mr. Wilhelmi explained that it had come from one of four independent expert peer reviewers. The reviewer expressed concern that using the word "contaminant" could lead to fear. However, Mr. Wilhelmi said, using a softer word like "substance" to refer to toxic chemicals such as dioxins is not fair either. Mr. Washington expressed his belief that this would be denying what exists; Mr. Wilhelmi agreed.

Mr. Wilhelmi noted that the PHA focuses very much on inhalation exposures. While peer reviewers said that this was entirely appropriate, they suggested making it more clear in the PHA that this was the case. These changes were incorporated. There were also a few comments that nearly implied that ATSDR was being too thorough and too protective. In his opinion, Mr. Wilhelmi said, this is fineit is the approach that ATSDR uses. He elaborated that the PHA provides a detailed analysis of arsenic, cadmium, and chromium, which the reviewer indicated might raise concerns where there were not any issues. He explained that the detailed evaluation was mainly done because of the way that contaminants of concern (COCs) are selected. He expressed his belief that this is stemming from the fact that the CVs are set so low that these might have been COCs no matter where you were in the United States, which is true to a certain extent. The comment was not, however, questioning the overall conclusion, but asking why the PHA was going into so much detail for contaminants not originating from the incinerator. Mr. Wilhelmi stated that he was fine with being too protective or too thorough in the analysis. He would not, however, want someone to say he was cavalier in looking at the data.

Mr. Lewis applauded Mr. Wilhelmi for his work. In reviewing the PHA and looking at what was done for the Kingston Steam Plant, he said that the concerns involving those three items jump out at him.

Mr. Washington stated that it might mean something to the rest of the group if "no apparent public health hazard" was explained. (Mr. Wilhelmi noted that the PHA's glossary defines this term.) Mr. Wilhelmi explained that ATSDR has different categories for its conclusions. "No public health hazard" means no one is exposed to any contaminants, and therefore no hazard could exist if there is no exposure. "No apparent public health hazard" is the conclusion category ATSDR uses when there is potential for exposure, but not at a level that would be expected to be associated with adverse health effects. Mr. Wilhelmi explained that they have said all along that the incinerator does release some contaminants. Most of the releases consist of benign byproducts of combustion (steam and carbon dioxide), but there are some untreated chemicals that pass through and are not collected by air pollution control devices. According to Mr. Wilhelmi, the sampling and modeling data all point the same directionamounts released from the incinerator do not really rise to a level of public health concern.

Mr. Wilhelmi summarized the comments received on the conclusions and recommendations. There was support for the main conclusion of "no apparent public health hazard." One comment suggested that ATSDR reconsider its specific recommendation to TDEC to use more sophisticated lab equipment for analyzing some of its samples. This recommendation was revised based on the comment to say that ATSDR encourages TDEC to verify DOE's metals sampling data through achieving lower detection limits or other means, some of which are listed in the recommendation.

Mr. Wilhelmi summarized that they have been addressing the TSCA Incinerator for 1½ years. Over 50 references were considered, tens of thousands of sampling results were evaluated, many different studies were reviewed, and all of the subcommittee members' input was received. He indicated that there were three take-home messages. First, the guiding principle from the beginning of the work here has come from an ATSDR Guidance Document on incinerators: "Thermal treatment technologies [including incinerators] are inherently neither safe or unsafe; whether they are safe depends on how they are designed and operated." The second take-home message referred to the main findings. Different independent lines of evidence were reviewed, all of which pointed in the same direction. Mr. Wilhelmi presented a figure containing pillars, and explained that this was a metaphor for the conclusion resting on these pillars. It was not a case of one line of evidencethey were on firm ground. The third take-home message was that there were three key points to consider. The incinerator has only been around from 1991 to the present, and therefore it is close to being a state-of-the-art facility. It has a very sophisticated process design and highly efficient air pollution controls. Mr. Wilhelmi said it was important to remember that it was constructed at the time when strict environmental regulations were in place. It has been studied extensively and regulatory agencies have said that the incinerator can operate safely at a certain level of waste throughput. He noticed that throughout history, DOE has operated the incinerator at a much lower throughput than that considered safe, even by regulators. In Mr. Wilhelmi's opinion, this was another reassuring point. Mr. Wilhelmi said that even though they are at the end of the road for the PHA, DOE is still required to do a lot of emissions monitoring and TDEC provides very extensive oversight. He did not want people to leave thinking that ATSDR is responsible for all of this; DOE, EPA, and TDEC have put many mechanisms in place to make sure these actions are safe. In addition, the public health action plan in the document includes some recommendations that he would classify as being fairly minor, including what should be done to continue to ensure that things are safe and what to do about general air quality issues (not associated with the TSCA Incinerator's emissions). Mr. Wilhelmi said that their input has helped him make this a good health assessment and that he had appreciated their input throughout. He wished everyone luck in what happens here in the future. Dr. Davidson thanked Mr. Wilhelmi for doing a good job.

Mr. Box told a story about when he was doing work with the environmental division at X-10. As they were going to the site and passing by pine trees that were turning brown, a representative from the environmental division said, "There's another result of the TSCA Incinerator." Mr. Box said that they were downstream of the incinerator, and asked if Mr. Wilhelmi had any comment on whether there was destruction by the TSCA Incinerator or the pine beetle. Mr. Wilhelmi said that this was addressed in the PHA: a study to evaluate this issue concluded that it was a result of the pine beetle. He explained that the conclusion had to deal with how the harm to trees would be expected to occur in a far more widespread area if it was truly the incinerator causing the harm. Mr. Box said that he noticed extensive damage on the TSCA side of the road, but healthy trees on the other sidedirectly across the road. He said he had mentioned this to the representative who said it just had not gotten there yet. Mr. Wilhelmi replied that this could be possible, noting that he had written one to two paragraphs explaining this in the section Mr. Lewis referred to earlier.

Ms. Adkins said that they might laugh when they hear about the beetles, but expressed her belief that disease is going to affect people with compromised immune systems. Regarding trees and plants, according to Ms. Adkins, insects will go to weaker vegetation. Thus if a tree is already damaged, it would be more prone to damage from pine beetles and other problems. She expressed concern that they should not rule out danger from contamination in trees because pine beetles attacked it. In her opinion, she said, they could blame this on the pine beetles, but there was a reason why the beetles went to those trees instead of the ones across the street. Mr. Wilhelmi said that she had a good point. He explained that he is not an ecologist and would not go into much detail, but noted that he had reviewed a report prepared by an ecologist who had studied this issue. He deferred to the experts in the field, he said, when responding to this concern. Dr. Davidson added that pine beetles had also affected trees located nowhere near the TSCA Incinerator. Mr. Wilhelmi said this was correct.

Ms. Galloway asked about a statement in the foreword to the PHA: "Any health threats that have been determined for high-risk groups (such as children, the elderly, chronically ill people, and people engaging in high-risk practices) are summarized in the conclusions section of this report." Ms. Galloway explained that she had looked in the conclusions section, but only saw children, elderly, and people with respiratory illness or conditions; she questioned the part about "people engaging in high-risk practices." Mr. Wilhelmi explained that this is a standard foreword used in all of the PHAs. Personally, he considers the category in question to include someone who could be trespassing on a site and doing something that could bring him or her into closer contact with a hazard than might be expected. He stated that he was not sure, however, what else the category would include. Ms. Isaacs explained that it is sometimes more applicable to food-related issues, such as when ATSDR is evaluating a subsistence fisherman who is eating something really contaminated and the contaminants might be focused in the fat; in such a circumstance ATSDR might recommend to clean the fish in a certain way. Another example would be a Native American population that has certain practices that may make them more susceptible to exposure. She too indicated that this was a generic foreword that does not sound really applicable to this PHA. Ms. Galloway suggested removing this part since she did not see anything related to it in the conclusions. Mr. Wilhelmi said this was a good point.

Mr. Lewis recalled reading one concern regarding Blair Road that said that most people are not out in their yard all of the time. According to Mr. Lewis, no requirements prohibit people from being in their yards, so one could conclude that it was high-risk behavior to play in your yard all of the time. He said this statement bothered himit was trying to identify worst-case conditions around Blair Road. In his opinion, Mr. Wilhelmi said, high-risk behaviors are things a person willingly chooses to do but should not be doing, such as trespassing. He explained that he has worked at sites where people try to play with unexploded ordnance; to him that is an example of an unadvised high-risk behavior.

Dr. Cember referred to the statement mentioning chronically ill persons. He said that a very large portion of the population is suffering from diabetes and has suppressed immune systems. In addition, he stated, a reasonably large portion of people have had organ transplants and take immunosuppressant drugs. It seemed, he said, that they should have enough data on these people to list them separately. Mr. Wilhelmi replied that this was a good point, but noted that the screening process used for chemicals does have layers of conservatism and protectiveness that hopefully account for some of the unique susceptibilities that people might have. Dr. Davidson pointed out that they needed to have evidence that what you are doing would affect that specific group in order to include itfor example, for air contaminants you might pull out asthmatics as a particular group. Mr. Wilhelmi noted that this had been done in this PHA. Dr. Davidson said that if you do not have this connection to show that population can be affected, then it is better to be general. According to Ms. Adkins, some toxins affect glucose levels. Again, she recommended looking at the contaminants that are inside people instead of looking at symptoms.

Mr. Lewis referred to the response on page 68 of the PHA regarding question B-2: "To what extent do air emissions from other sources other than the TSCA Incinerator, particularly the nearby power plants, contribute to local air pollution?" He complimented Mr. Wilhelmi on doing a good job. Mr. Lewis said he defines this as "low-hanging fruit" because this is a sophisticated process at a state-of-the-art facility. He had asked that the report put special emphasis on this, he said; it was also recommended that they include comments about TDEC, EPA, and DOE to indicate that they did a thorough job (similar to the comments ATSDR received on its report), but he did not see this in the report. He expressed his belief that compliments should have been given to these agencies that designed it and monitored it, and more emphasis should be put on the controls in place. He expressed that he is still frustrated when he reads this because if they went back to the minutes, he had wanted special emphasis on giving credit to the appropriate parties and off ATSDR. Though he expressed his belief that Mr. Wilhelmi did an excellent job, the report needed to put the emphasis on what is in place now.

Mr. Lewis referred to B.2, which showed the total number of pounds of air emissions from TVA. In his opinion, it was these questions that gave him confidence about what the issues were in the community. He expressed his belief that the way these concerns were addressed is how you "sales and market" to concerned citizens. If he looked at this, he asked, what would he be more concerned about? Regarding the recommendations, Mr. Wilhelmi agreed that they were "low-hanging fruit"minor things in the grand scheme. He explained that the recommendations were made more in the spirit of assuring that the PHA did not overlook anything. According to Mr. Wilhelmi, the fact that they had only minor recommendations was a testament to the work DOE, TDEC, and EPA have done on the incinerator.

Mr. Lewis referred to a table that had come up many times during PHAWG meetings regarding how the incinerator compares to other sources in the area. According to Mr. Lewis, TVA's Kingston Steam Plant came up repeatedly. Mr. Wilhelmi said that he is always a little nervous in responding because they are comparing apples to oranges to a certain extent, but nonetheless he wanted to respond to the question that had been asked. He explained that this table compared emissions that facilities reported to EPA's Toxics Release Inventory (TRI), assuming that facilities reported the correct amount of toxic chemicals that were released for those they are required to report. He said that "all of ETTP [East Tennessee Technology Park]" includes the TSCA Incinerator, which was reported as 83 pounds.

According to Mr. Wilhelmi, when those releases are compared to releases from fossil fuel plants in the area, the plants' releases are dramatically higherupwards of 5 million pounds per year. Mr. Wilhelmi explained that he is nervous about making these comparisons and mentioning them in the text because most of the power plant releases are hydrochloric acid, which is relatively benign in the grand scheme of things, while there could be 83 pounds of releases of very toxic chemicals that could be of concern from the incinerator. He pointed out that these are dramatically different sources, and various caveats are presented below the table in the document. Another difference is that the power plant emissions are coming out of 500-foot-tall stacks, which do not have lower emissions, but spread them over a larger area so they are a little less concentrated when they hit the ground. The incinerator, on the other hand, has a much smaller stack. Mr. Wilhelmi said that the genesis of this evaluation was a result of many questions on this topic at PHAWG meetings. Mr. Lewis expressed his appreciation for Mr. Wilhelmi doing this.

Mr. Lewis asked Mr. Wilhelmi to put up another table (Table 4), expressing his belief that people were concerned about this. He asked what was happening back when the plants had low stacks and were burning things in that area, noting that people have questions about this. He indicated that this might not be directly linked to this site, but said that there is a direct connection between what goes on down there and what went on during those years. In his opinion, having these types of quantities laid out in this manner helps the public understand and may be where ATSDR should focus its issues. He expressed his belief that the entire PHA was "low-hanging fruit." He said if Mr. Wilhelmi had shown this table in the beginning of this process, he would have suggested focusing on something else. He expressed concern that they had spent a lot of time and agreed there were some questions, but he said it was beneficial to him to know that you still did not see a problem when combining this with monitoring data. To him, he said, this was the way to close something out. However, he stated, as soon as they go to the past they do not have all of this monitoring data. He questioned the fact that they had to use models for the past, but still came back using the same words: "no apparent." He expressed concern that the conclusion does not have the same weight because health outcome data and other things were not reviewed and combined.

In his opinion, Mr. Lewis said, Mr. Wilhelmi did an excellent job. He expressed his belief that the weight of this conclusion is superior to that of the same health call made for the past. He expressed concern that this is a problem that someone needs to look into so that the community's questions can be answered. Mr. Lewis said he assumed that a lot of stuff had been dumped out around here and in certain communities near the plants when the stacks were low and the coals was being dumped out. He suggested going back and looking at the data. He expressed concern that they were saying things were perfect, but this was not true. Mr. Lewis stated that the current information looked good, but that the emphasis should be on the past. Ms. Adkins agreed. Dr. Davidson expressed her belief that they were putting effort into addressing past issues as well as the present. In her opinion, she said, you cannot compare the ability to look at past exposures with the ability to investigate current exposures because you can only work with whatever data you have for the pastyou cannot go back and get more. However, the current analysis will always be better because you have better data to work with.

Mr. Box noted that practically everyone heated with coal from low stacks in the 1910s, 1920s, and 1930s; he questioned whether anyone has investigated correlations with some of the diseases in that era. Mr. Wilhelmi explained that he had not personally studied this because the focus of this PHA is on the incinerator that came into play in 1991. He explained that there are a lot of historical data on "horrendous" air pollution episodes in London and other places (not Oak Ridge) that have been associated with times when people were burning a lot of coal residentially. There is a lot of this information in the literature, but it does not pertain to this PHA except in that it shows these other sources do exist. As Mr. Lewis had said, all these sources are everywhere, but having measurements of what is in the air reflects the contribution from everything.

Mr. Lewis indicated that the PHA talked about what is carcinogenic and non-carcinogenic. He said that they have all of this data to support why this is a non-issuebut people wonder about 20 to 30 years ago, when they had low stacks and things were being dumped out. He expressed an interest in having this type of thing addressed in detail to assist the public in its understanding of what they have been doing.

Dr. Cember explained that in 1900, when they had low stacks and dispersion of all of these things, the infant mortality rate in New York City was 50 percent: one out of every two babies died before the age of 1. The life expectancy was about 47 years, compared to about 77 years today. He noted that there are many factors in this change, but air pollution controls are certainly one of the factors. According to Dr. Cember, after air pollution controls went into effect in Allegheny County in western Pennsylvania, there were measurable decreases in heart disease and other health problems. (Mr. Washington noted that modern medicine also did a lot for this.)

Mr. Washington referred to some of the "bad actors" in the table Mr. Lewis had referred to. He said that while Mr. Lewis might be right by saying he was pleased with the result, he stated that he was not so pleased because he is very familiar with this subject. He noted that the incinerator began operating in 1991, but DOE had tried to get a permit for much longer than that. He indicated that something that kind of disturbed him was thatas Mr. Lewis had mentioned you could kind of derive your own result depending on the stack height. You get many more of these things dropping around you when the stacks are low, he said. When the stacks are higher, however, you do not know what it is doing to the adjacent communities. He said this was why they had increased the height, adding that he was grateful that there is now a limit on stack height to prevent this sort of thing. In his opinion, Mr. Washington said, they should tell people here what was put into the incinerator. According to Mr. Washington, one thing the Oak Ridge Site-Specific Advisory Board did was make sure (at that time) that they accepted no waste from any other sites beside the Oak Ridge community because some of the waste was rather nasty. He expressed concern that you notice some really "nasty actors" when you look at the dispersion modeling for some of these contaminants, such as xylene and methylene. He indicated that the ORRHES members might get a much better appreciation if Mr. Wilhelmi described what the input materials were for the incinerator and where they came from.

Mr. Wilhelmi explained that certain sections of the PHA discuss this. He explained that this is a hazardous waste incinerator that also treats radioactive waste. It is designed specifically for this type of waste; it has appropriate air pollution controls, residence times, and other things to ensure that it achieves necessary destruction of waste that can be destroyed or collects materials that cannot be destroyed. Mr. Washington said he wanted Mr. Wilhelmi to say that nothing happens to the radioactive wasteit does not burn or disappear. Mr. Wilhelmi said that the radioactive waste is captured in the air pollution controls, noting that it is critical to know the types of waste before designing the incinerator. He said that Mr. Washington was correct; there was a 4- to 5-year period in which the incinerator did not operate. Primarily, the reason was that it had to be demonstrated to regulators that waste could be treated without unacceptable levels of emissions and with ample margins of safety. According to Mr. Wilhelmi, this was the reason it took so long to get on board because these things had to be demonstrated with a level of confidence. There was no doubt, however, that this was a hazardous waste incinerator, and it is monitored as such.

Mr. Lewis said he was not sure where the PHA was in the cycle, but asked when it was going out or if ATSDR was waiting for comments. Mr. Hanley replied that it would be going final. Mr. Lewis asked about the fact sheet that summarizes the PHA. He indicated that comments made during a work group meeting had recommended noting that this is a state-of-the-art facility and emphasizing what was seen as a good job by the other agencies. He stated that he was very concerned about this because he did not like outstanding issues that imply that the agencies might stop doing something that the law requires. In his opinion, he said, they need to indicate that they were doing a good job in a summary statement or on the fact sheet. He stated that he had not seen the final fact sheet yet, but said if they read those minutes they would know that the group had argued enough about this. Mr. Wilhelmi explained that he still needed to provide Mr. Hanley with the updated fact sheet. Mr. Lewis expressed his belief that it needs to be reviewed to make sure the comments are reflected before it goes out. Mr. Wilhelmi indicated that he has a copy of those minutes.

In response to Mr. Hanley asking if ATSDR ever compliments other agencies, Ms. Isaacs explained that it would be appropriate to state when an evaluation shows that other agencies are doing their job well, that things are being monitored in an appropriate manner, and that if these things continue then ATSDR is confident in this. She said they could look at wording to use. Mr. Lewis suggested referring to the comments they received from technical people about the great job they had done. He clarified that they did not have to say something exactly like that, but they should say something to reflect that ATSDR has no problem with what they are doing. Ms. Isaacs replied that she has nuanced comments on other agencies when they have done a very good job. She said they can express confidence that ATSDR does not foresee a problem if these practices are maintained.

Ms. Adkins expressed her belief that this was a wonderful report from 1991 to the present. She said she had the utmost confidence that everything is great and everyone is doing an excellent job. However, she indicated that she did not want to leave anyone with the false impression that everything is fine and has been fine. She expressed concern that all of the information prior to 1991 was probably from the Atomic Energy Commission (AEC) and DOE, which told people where they could and could not test. According to Ms. Adkins, there are mysteriously disappearing records that cannot be retrieved for unknown reasons. She said there are so many holes in the past, but the few living people who have these toxins in their bodies are the only source of information and therefore need to be looked at. She suggested somehow including a comment that information from the past is highly impaired. She said maybe they will get people to get tested to see if they have chemicals in their bodies rather than just thinking the government says everything is alright. Mr. Wilhelmi said he wanted to be very clear about the incinerator: it began routine operations in 1991, and was not routinely operating before then. He explained that there are other sources in the area, which he assumed would be covered in other PHAs. He noted that he has heard the point many times that what is in the body is of great concern and he expressed his belief that other health assessments would look at this.

According to Dr. Cember, transuranic registries are a major and good source of these data. He said these data are being held at Washington State University in the Hanford region, where they do autopsies and analyses for all of these chemicals. He has received reports in great detail of all the various chemicals found in the bodies of Hanford workers, residents, and so on. Therefore, he stated, a lot of those data are available. Ms. Adkins expressed concern that it was a shame to wait until someone is in autopsy or a cancer statistic; in her opinion, it would be good to know ahead of time what your chances are instead of becoming a statistic or dying from cancer.

In reading the health outcome data portion of this report, Mr. Lewis said, he had seen that ATSDR had done some work in this area to look at incinerators. He indicated that he was not privy to this information and did not see a copy of the document being referenced. He asked what kind of information was associated with this, what was going on, and what was found. In his opinion, he said, having this information discussed and laid out in advance could have helped Ms. Adkins and other ORRHES members with these questions. He did not recall any discussions about this in their meetings, but now that they had a section and reference point for something that had been done. He asked Mr. Wilhelmi to elaborate on this. Mr. Wilhelmi explained that ATSDR has a guidance document on incinerators. As part of this effort, ATSDR looked through literature on all past work at incinerator facilities to review health studies that had been done; none were done in Oak Ridge. The PHA acknowledges upfront that its information is not specific to this facility, but reflects what the literature says about some of the past studies. Something from the National Research Council was also reviewed, he noted. Dr. Malinauskas said that the reference is provided in the document. Mr. Wilhelmi indicated that it was a guidance document for thermal treatment technologies.

Dr. Davidson asked if the four-page and ten-page summary fact sheets would be released in final form along with the final release of this PHA. Mr. Hanley indicated that there was only a four-page fact sheet. Dr. Davidson recalled discussing this fact sheet in a work group meeting, and asked if ATSDR would let them know when it was ready to release it. Mr. Hanley said that they would inform them before its release.

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