ORRHES Meeting Minutes
September 22, 2005

Work Group Reports

Dr. Davidson explained that Drs. Malinauskas and Malmquist had to leave early so they were moving up the Exposure Evaluation Work Group report.

Exposure Evaluation Work Group

Dr. Malinauskas said the work group met on September 12, primarily to discuss the comments collected and collated on the Evaluation of Potential Exposures to Contaminated Off-Site Groundwater from the Oak Ridge Reservation PHA. He expressed his belief that all ORRHES members have received these recommendations, and therefore he would not go through them as was done during the work group meeting. He asked if there were any comments associated with these recommendations. If there were not, he said, he wanted to formally transmit them to the chair and make a recommendation: ORRHES recommends that ATSDR address and respond to the ORRHES comments on the PHA for Evaluation of Potential Exposures to Contaminated Off-Site Groundwater from the Oak Ridge Reservation. Dr. Malmquist seconded the motion.

Dr. Davidson asked if anyone wished to discuss the recommendation. Mr. Gartseff said he did not have anything to raise in such a discussion, but that he had been unable to participate in the work group's discussion of these comments and recommendations; he had comments to add that may or may not have been discussed during the work group meeting, and he said he wanted to submit them to make sure they were part of what is considered by ATSDR. He also suggested a slight tweak to the recommendation to submit ORRHES recommendations as well as others that might come in from the public by the deadline (the day of the meeting). Dr. Davidson explained that other public comments are all addressed, so they did not have to deal with those. However, she asked if Mr. Gartseff had specific comments to submit on the document. Mr. Gartseff said he did. She asked him to tell them about his comments so they would know what they were adding, but said he did not need to provide a lot of detail.

Mr. Gartseff indicated that he had three pages of what he hopes are corrective criticisms. In general, he said he felt the hydrogeologic discussion is sketchy and the lay people are not likely to go to the source documents, much less understand them. In his opinion, he said, ATSDR would greatly enhance the document if it put forward several pieces of data so conclusions can be substantiated within the body of the PHA and be better understood. He suggested providing things such as vertical profiles or cross-sections of the site so people can see how stratigraphy and aquifers interact with each other at the different locations. The monitoring data come across to him as very selective; he said perspective needed to be given as to where the data came from, why those pieces were chosen for discussion, and so forth. He noted that he is familiar with some of these data and knows they are problematic in the sense of consistency, data quality, and other aspects, but suggested addressing this issue.

In Mr. Gartseff's opinion, there were issues that needed to be brought forth in the document; otherwise, it comes across to him as a very "summary-level" document. He indicated there was more to be said than "We think groundwater is going this way or not." According to Mr. Gartseff, the biggest issue is that of all the different concerns heard from the public, Ms. Adkins (though he did not want to single her out), and others near her, this appears to be the closest to environmental exposure that might have occurred. He said the document does not have to specifically address that, but monitoring data are very close to the reservation and the possibility of a data gap of further migration (in Ms. Adkins' case, to the west) needs to be explored a bit more. He noted that the report does cite several references describing uncertainties about groundwater flow and direction due to fractured bedrock.

Mr. Gartseff then said he had given the gist of his comments and asked who should receive them. Dr. Davidson asked to hear a motion to include Mr. Gartseff's comments with the ORRHES comments, and then deal with the main motion after receiving ORRHES approval. Dr. Malinauskas stated that he had a problem with this because none of them had an opportunity to review those comments. To make things easier, he suggested that Mr. Gartseff submit his comments as a member of the public. Mr. Gartseff said he had no problem doing this. Dr. Davidson indicated that they could handle his comments in this way.

Dr. Malinauskas said compared to the amount of comments on the TSCA Incinerator PHA, the number of comments on the groundwater PHA is very small. Thus, if someone were happy with the amount received on the incinerator document, they would be ecstatic with the groundwater PHA–although, he said, Mr. Gartseff might call this into question.

There was no further discussion on the recommendation that ATSDR address these comments. The motion passed with 11 in favor.

Dr. Malinauskas mentioned that he would like to receive the comments on the Evaluation of Current (1990 to 2003) and Future Chemical Exposures in the Vicinity of the Oak Ridge Reservation PHA by October 24. He said he would compile the comments, but was not sure where they would go from there. He stated he could iterate by e-mail or via a work group meeting (if they had one). Since Dr. Taylor will not be there and the office will be closed, Dr. Davidson recommended that each individual submit his or her comments to Dr. Malinauskas, who she asked to assimilate the comments. If they cannot have another work group meeting, she said, Dr. Malinauskas should be prepared to bring the comments to the next ORRHES meeting (hopefully they will have one) for discussion. Dr. Davidson asked if an e-mail could be sent out to remind everyone of the October 24 date. Dr. Malinauskas said he could once his computer was working. Dr. Davidson indicated that possibly Dr. Taylor or Ms. Horton could send out an e-mail so everyone would have this date in written form.

Mr. Lewis asked about a point made by Susan Kaplan at the last ORRHES meeting regarding core sampling at different levels in the area where there may be bands of mercury. He asked whether there had been a recommendation on the table or anything said after her presentation on how this issue would be dealt with. He asked if ATSDR was going to pick the issue up, and he requested that it be on the record. Mr. Hanley said that it will be addressed; Dr. Taylor is working on the issue.

Discussion of Priorities

Since he raised the issue of priorities, Mr. Lewis said, he had discussed it briefly with everyone he could find during the break. He indicated that he might not be the best person to present this information, adding that someone might have to help him. According to Mr. Lewis, there is a concern about health outcome issues and health outcome data in the registries within the state. He said they have been told that these registries are not the best; however, there might be some things in the registries, such as cancer incidence and possibly birth defects. He explained that they did not know what was in these registries, but the suggestion was to determine whether there was anything in a formal register (such as birth defects) that has undergone quality control (QC) and see if any of the contaminants could be looked at for a possible correlation. He said they needed to try to connect ATSDR's findings as associated with exposure evaluations and the contaminants there. He stated that they have been told that the state had started a birth defects register (which was dropped); he asked whether this register might have picked up mercury as maybe associated with birth defects and things of that nature.

According to Mr. Lewis, for existing things in registries, the suggestion was to prioritize those that possibly linked to the QC data in the cancer register and try to focus on them so you could have something to draw your conclusions from. He said this was the sense he got from the discussion with other ORRHES members. Brenda Vowell said that there is no birth defects register; there is only a cancer register that has been only about 80 percent cleaned.

Mr. Lewis indicated that this was something that they could work with and prioritize. He said that Dr. Cember had mentioned mercury, and suggested taking this into consideration as part of the effort to reach a general consensus. He expressed his belief that DOE had been concerned enough about birth defects to start a register at one time, but the ball had been dropped. If DOE felt it was important enough to put some money there, he said, then it was worthy to consider this as part of their efforts. Mr. Lewis asked Mr. Hanley if this was something he would consider in prioritizing the elements that they have to work with.

Dr. Davidson said that mercury was associated with birth problems and iodine 131 was associated with cancer, but she said these were not included in registers.

Dr. Cember said he had been impressed that there was much more manganese than mercury when Mr. Lewis showed the emissions from the various places. He expressed his belief that manganese causes basically the same symptoms as mercury. For example, it can cause volitional tremors in welders, tremors, memory loss, and possibly an increased chance of developing Alzheimer's disease. According to Dr. Cember, three to four times more manganese was being discharged than mercury. Therefore, he said, they would have to look at other substances that would cause more or less similar symptoms.

Mr. Lewis indicated that he did not know what else to say. To him, he said, this is an outstanding issue. According to Mr. Lewis, people have seen and read about health data, such as the report provided to him by John Merkle from The Oak Ridger about cancer that was so broad. In his opinion, he said, these types of things needed to be addressed for the public, and it would be helpful to the public wherever they could make those types of correlations. Referring to articles like this that have been presented in the paper, he expressed his belief that it was time to evaluate available and updated data to determine whether any correlation exists between diseases and these contaminants. If so, those contaminants need to be prioritized.

Dr. Davidson said she would need to do a more detailed analysis, but the only chemical she saw that is really associated with cancer is iodine 131. She added that thyroid cancer is the only cancer, but expressed her belief that it is not in the registry. Ms. Vowell and Mr. Hanley both indicated that thyroid cancer is in the state's registry.

According to Dr. Davidson, mercury is associated with specific types of problems in women and their offspring who have been exposed. Mr. Hanley explained that kidney effects and toxicity might also result. In addition, he said, exposure to the organic form of mercury in fish is associated with neurological problems. Dr. Davidson added that organic mercury is a really "bad actor" for exposure of women during pregnancy. Mr. Hanley indicated that there is no registry for kidney problems and those types of things. Dr. Davidson said that she usually thinks of malformations when considering birth defects. She could not recall that mercury causes malformations, but said it caused more functional deficits.

Dr. Davidson referred to uranium as far as exposure to radiation is concerned. Mr. Hanley said that it would cause kidney effects; Dr. Davidson agreed. Dr. Cember asked if they were referring to the element uranium or any of the specific radioisotopes. Dr. Cember said that, relatively speaking, natural uranium is so non-radioactive that its chemical toxicity far outweighs its radiological toxicity. Dr. Davidson expressed her belief that they were looking at both. Mr. Hanley said this was correct. According to Dr. Cember, you would only start to theoretically expect radiological effects when uranium is enriched and if it is enriched to more than 5 percent.

Ms. Adkins said that they are only guessing at this point. However, she stated, they had a chance to get specific. According to Ms. Adkins, she has never worried about thorium or gallium and has no friends who ever worried about these before, but she said you get concerned about them when you find they are present at extremely high levels and working on your system. In her opinion, she said, there are things they have not even talked about that they should possibly be more concerned about. She expressed her belief that they could only know what their priorities should be if they determined the most frequent toxin in people around them. She stated that they now had a chance to do this. She stated that they had talked about the bureaucracy and how hard it would be to involve this new information, but she did not see how in good conscience they could not use documentation that might point them in the right direction. She added that, as she understood it, cadmium causes kidney cancer. She expressed her belief that this is something they did not talk about often, but a lot of people who have been tested have extremely high levels of cadmium.

Dr. Cember pointed out that cadmium is present in cigarette smoke. According to Dr. Cember, data from the Karolinska Institute in Finland found that the average smoker reaches about 50 percent of the acutely toxic level of cadmium in the kidneys–halfway up to places where the kidney will start to bleed and be noticeably damaged. Therefore, he said, they need to be concerned about smokers when they talk about cadmium.

If there was any way to work it out, Mr. Lewis requested that ATSDR use any leftover money for trips to bring Dr. Cember to help them, even if they have to leave some people in Atlanta. Dr. Cember thanked Mr. Lewis.

Dr. Davidson asked if there was a recommendation from the small group or just a discussion. Mr. Lewis suggested prioritizing any data that have undergone a quality assurance/quality control (QA/QC) review and from which they might be able to get a correlation. In addition, he said, there may be some other data that could be picked up. He recommended listening to Ms. Adkins and working with her to see if something could be used to help prioritize the list. Dr. Davidson said she was not sure how to summarize this recommendation for the subcommittee. Mr. Lewis said that they would request that ATSDR prioritize the COCs as associated with formal disease registries that exist in the state. In addition, ORRHES asks that ATSDR interact with Ms. Adkins and others who might provide links to other data that could be used to prioritize the list. Ms. Adkins seconded the motion.

Dr. Davidson said she would not try to repeat the motion, but that the gist was for ATSDR to prioritize the remaining chemicals based on disease registries. Dr. Cember noted that they heard there were no disease registries other than for cancer, so this was a moot point. Dr. Davidson said there is one COC–iodine–associated with cancer.

Ms. Adkins asked if they could use resources such as the March of Dimes, National Parent Teacher Association (PTA), and other foundations that might have rankings. Mr. Hanley explained that these types of data are not normally used because they do not undergo a QA/QC as a cancer registry does and have not captured all of the cases. In addition, they are usually missing data because they contain self-reported information or data obtained by reaching out to certain public members. He noted that these data are hard to apply to this type of work. They are good for helping organizations try to prioritize their allocation of resources into different areas and different issues, but they are not appropriate for this type of analysis, which is associated with chemical exposure.

Mr. Lewis noted that they are limited to the Tennessee Registry, which is viable, but questioned whether there might be some correlation between other state registries, such as those for Hanford and other sites. He suggested dealing with what they have here, but considering data available at these other sites as next in line. Dr. Davidson expressed her belief that Mr. Lewis was basically asking ATSDR to look at the literature to see what effects are related to these particular chemicals. She indicated that they did not need databases to do this because the information on effects associated with these particular chemicals is out in general toxicological and medical literature. Mr. Lewis said he did not know all of the cancers. Based on her experience in studying chemicals and associations of toxic effects with chemicals, Dr. Davidson said that you could not take a disease registry from another state and superimpose it on this community. She indicated that cancer registries do not relate chemicals to specific types of exposure; they only tell the incidences of cancer in the particular areas they cover. If they wanted to associate chemicals with particular types of exposure, then they would have to go to the epidemiological literature for humans and available laboratory animal data.

Mr. Hanley suggested saying whether no registry exists, and indicating why something could not be associated with a national registry if it could not be. Mr. Lewis stated that this would help, but did not know what else to say. Mr. Hanley said that this subject could be clarified.

Dr. Davidson asked if they were ready to vote on the recommendation. Basically, she said, they were prioritizing these chemicals based on disease registries. She pointed out, however, that they only had one registry in Tennessee and iodine is the one chemical on the list associated with a type of cancer in the registry. Ms. Adkins said that the recommendation also called for linking this with data collected by Advanced Wellness on metal poisoning around this area.

Mr. Lewis indicated that he did not know exactly how to say it, but said he believed ATSDR understood the spirit of what they were trying to do to identify wherever there are some correlations, while also picking up Ms. Adkins' suggestion.

As Dr. Malmquist had pointed out before, Dr. Cember said, the perception is the reality. According to Dr. Cember, some people have a perception of an enormously harmful effect from some of these contaminants. For example, he said, people think that skiing is pretty safe, but it is really an unsafe activity. Thus, the perception is the reality. In his opinion, he said, if they were concerned with what the community was worried about, they would not rank these concerns only by the physical effects in bodies because concerns might also have adverse mental effects. He expressed his belief that this would be handled differently if addressed from a public health point of view. In his opinion, he said, the concerns for PCBs are overrated based on what he has read. Nevertheless, if PCBs are a high-ranking concern in this community, then they have to be dealt with.

Based strictly on toxicology, her knowledge, and what she has heard from the group, Dr. Davidson said, she would rank the documents in the following order: iodine, mercury, uranium, and PCBs. She pointed out that this is not the only way of ranking as sometimes contaminants are ranked by production volume. If they were going to put these in order of what has been evaluated, Mr. Hanley asked about including fluoride, groundwater, and K-25 uranium, which have not been addressed and evaluated. Dr. Davidson replied that she had not included these because she would have thought they were so far in the pipeline.

Mr. Lewis asked if there was anything wrong with the list Dr. Davidson suggested, questioning if anyone challenged it or agreed with it. Dr. Davidson pointed out that her list was also contingent on the premise that the PHAs in the pipeline should be completed. In her opinion, there was no reason to stop working on those other PHAs; her list prioritized the remaining four.

Dr. Malinauskas said he would put iodine lower on the list, expressing his belief that it is no longer a public health concern. Dr. Davidson explained that it is a concern because people exposed as children would be getting thyroid cancer now and in the future if iodine were an issue. According to Dr. Malinauskas, there is nothing that you could do about that except to provide care to those who have thyroid cancer, which is an easily curable type of cancer. However, he said, something could be done about all of the others if they were of public health concern.

Ms. Adkins said she would like to see how many people grew up in this community and went to elementary school in Oak Ridge, Roane County, or the Morgan County area. She stated that she did not know if others had the same experiences as her. According to Ms. Adkins, she was taught early on that science is glorious and you should not disbelieve or doubt scientists who come to the classroom and say everything is safe and you have nothing to worry about. She stated that she believed this, and so did a lot of her classmates–many of whom are dead now. She expressed concern that people do not know to be afraid of thorium, gallium, and other bizarre elements because they are taught as children not to doubt or to be afraid. She indicated that they are all arguing about what is more important according to opinion, but they did not have to use opinions anymore because there are people who have gathered data on chemicals that are actually in people's bodies. In her opinion, she said, they were doing a great disservice if they close their books and say that everything is fine and these are the only things that need to be worried about. She said they needed to use the available information to determine what has poisoned people before they have to become statistics and some other committee forms in another 20 years to look at the health effects from the ORR. She stated that they would be dead statistics and that maybe they could be dug up for autopsies. In her opinion, she said, they were failing if they did not use the available information while they have it.

Mr. Lewis said he wanted to withdraw his recommendation because Dr. Davidson's statement has captured what he said and what Ms. Adkins is asking for. He asked Dr. Davidson to restate her suggestion as a motion within this context. Dr. Davidson moved that ATSDR prioritize the remaining chemicals in order of iodine, mercury, uranium from K-25, and PCBs, and also look at the data from Ms. Adkins to see if this information can be incorporated. Mr. Lewis seconded the motion. Ms. Adkins asked what was meant by the term "incorporated." Dr. Davidson explained that this was requesting that ATSDR look at and evaluate the information to see what data can be used. Also, she said, ATSDR would have to evaluate the data to determine what could be done as far as rolling the data into a PHA. The motion passed with 11 for.

Dr. Cember asked what action ATSDR will take once it has this priority list. Dr. Davidson and Ms. Adkins asked which information he was referring to. Dr. Cember said he was talking about all of the information, indicating that the motion was valid but he questioned what ATSDR would do with it. Depending on funding, Dr. Davidson said, she expected that ATSDR would finish the PHAs in the pipeline and then prepare the remaining PHAs in the specified order of priority.

Ms. Adkins suggested publishing a list of the toxins found in people's bodies through metal screening to alert people that these things exist and require further study. Mr. Hanley said that they have to look at the data she is referring to and determine how they could be applied. He explained that there are many issues they must consider before something can be published, such as what analysis was done, what kind of sampling was conducted, and whether sampling was conducted before or after chelation.

Dr. Cember referred to International Commission on Radiological Protection (ICRP) publication 23, in which Tipton at the University of Tennessee analyzed cadavers that had many of the elements listed there. He stated that it could be a good idea to see if what they find now is different from what was found 30 or 40 years ago. Ms. Adkins asked where she could find that information; Dr. Cember said it is published in ICRP 23.

Presentation/Discussion: Public Outreach Plan for the Assessment of Cancer Incidence

Before they heard the public outreach plan for the ACI, Dr. Malmquist asked Ms. Isaacs if ATSDR has enough money to implement the plan and go forward with it. He indicated that if they had to choose between this and the PHAs, he recommended that they do the PHAs and not be involved with getting the information out on the ACI. Ms. Isaacs explained that with the uncertainties in the budget, the implementation of the plan might impact PHAs. She stated that if the budget was sufficient, they would want to bring this issue to rest. However, she could not say at this time whether this would not impact the PHAs.

Dr. Davidson expressed her belief that it was initially said that ATSDR would conduct the ACI for the eight-county area. Ms. Isaacs replied that DHS has made that commitment; however, it might become a matter of priorities if a more in-depth analysis is required. Dr. Davidson indicated that the only other issue would be ORRHES involvement in the implementation of the plan, because ATSDR already said DHS is committed to completing this. Though ATSDR might not have the resources for ORRHES to be involved, she said, this did not mean that the plan could not be implemented. Ms. Isaacs explained that they certainly have a commitment from DHS to conduct some of the statistical analysis, barring any problems. The issue, however, is whether money will be available to do some of the communications around this. Ms. Isaacs continued that the plan includes many suggestions to reach out to the public, which involves travel. She indicated that this was different from what DHS has already committed to doing as far as the analysis; the communication of this work is somewhat uncertain. Dr. Davidson suggested that they hear the plan: they might be able to identify things that could be prioritized.

Loretta Bush said she knew this committee has been looking forward to seeing the public outreach plan for the ACI for some time now. In October 2004, she presented the concept based on communications with various work groups to see what should be incorporated into this plan. Last week, Mr. Hanley met with the Ad Hoc Work Group and the Community Concerns and Communications Work Group (CCCWG) to present this draft plan. She indicated that this is a draft document, and therefore it is subject to change based on additional comments received from ORRHES members and TDOH officials.

She explained that her discussion would be about the communications aspect related to the ACI. She referred to the overview of the plan, noting that citizens living in communities near the ORR had expressed concerns about a perceived increase of cancer in the area. The purpose of conducting the ACI is to give citizens within the eight counties information regarding the cancer rates within each of the eight counties compared to the State of Tennessee rates. The assessment will also be used to determine if any unusual patterns of higher incidence of cancers are occurring within those eight counties relative to the state rates as well.

Ms. Bush explained that the plan was broken into six different phases based on comments received in October 2004 and last week. She said she thought separate objectives and phases were needed to incorporate the majority of the comments that had been received. She noted that she wants their feedback and input, adding that the plan would hopefully be implemented as soon as more was learned about the findings of the assessment.

Ms. Bush explained that the objective of Phase 1 is to obtain feedback from ORRHES, work groups, and TDOH officials. She indicated that meeting with TDOH officials would be next, but she had wanted to share the plan with them first and get their input. Certain people were identified for ATSDR to share the plan with at TDOH, including Dr. Paul Erwin and Ms. Vowell. In addition, Ms. Bush said that today Ms. Vowell had provided her with names of additional people to consult with. In the next month, ATSDR will be meeting and speaking with these officials to present this plan.

Phase 2, continued Ms. Bush, is when ATSDR will inform the public about this plan. She noted that they had assisted ATSDR in the October 2004 meeting with identifying interested organizations and environmental groups. Fourteen groups were identified, and government entities within the eight counties were also suggested. The government entities include a congressional delegation, state legislators, city councils, county commissioners, and boards of health. In addition, ATSDR has an extensive list of churches, containing well over 500 in the eight-county area. Ms. Bush noted that Ms. Adkins had mentioned that TDOH has a coalition of churches, and Ms. Bush has made arrangements to meet with the coalition, which would bring and share this information with area churches. She asked that ORRHES help ATSDR streamline the churches within these respective areas where they would suggest conducting outreach, adding that she definitely needed their input. According to Ms. Bush, some work members indicated that ATSDR needed to be communicating this information out the field before the report is released to the community at large.

Ms. Bush noted that during Phase 3, ATSDR wants to inform the public regarding dates, times, and locations of various different meetings that the agency would like to hold. The plan is to mail flyers announcing these upcoming meetings and also post information on ATSDR's and ORRHES's Web sites. In addition, e-mail flyers will be sent to people on the LOC and ORRHES distribution lists.

Ms. Bush explained that Phase 4 is part of the media outreach portion of the plan. ATSDR wants to conduct media interviews with local media outlets. At the October 2004 meeting, ATSDR received a list of media outlets within the area, and has since added the Dr. Bob [Overholt] television show to the list as well as some of the local cable networks that cover city council meetings. Dr. Malinauskas asked about the Hallerin Hill show, which he stated was a very popular radio talk show. Ms. Bush said that this would be added. In addition, Ms. Bush explained that she had contacted officials at the Dr. Bob show. She indicated that this is a delayed program (not aired live), which is now actually taping for January or February. She said she did not know if they could really make a time frame until they have a release date for the report. ATSDR could still go on and present the information, but it would not appear the same day that the information was actually presented there–it would be delayed 3 or 4 months down the road.

During Phase 5, Ms. Bush said, ATSDR will send the press release to the media via the Newswire announcing the (hopefully) upcoming ORRHES meeting and community education sessions. She said that during discussions some people indicated they should hold a public meeting to present the findings, while others felt community education sessions should take place.

Ms. Bush said that the agency would bring in ATSDR individuals, but also invite other representatives as shown in Phase 6, such as the American Cancer Society, American Lung Association, Tennessee Cancer Registry, and the National Cancer Institute. These agencies will be invited to the meetings to provide community members with additional resources, such as fact sheets and flyers, and also assist with addressing specific questions that relate to particular types of cancer. In addition, ATSDR plans to conduct media briefings in all of the eight counties and will meet with government entities listed in Phase 1 to discuss the findings. Press kits that discuss the plan will be sent to previously identified media outlets. The objectives of Phase 6 are to provide information on who ATSDR is, why the agency is conducting the ACI, what the ACI will and will not tell you, what study area was included, the ACI's limitations, and the findings and conclusions of the report.

In addition, Ms. Bush stated, there were several people who provided comments on the plan at the meeting last week. She thanked Mr. Gartseff for providing extensive comments, not only on the flyer but also on the fact sheet. She recognized that additional work was needed on the flyer. However, she noted it was in draft form, and said she would appreciate any additional questions, concerns, or comments that could be provided.

Ms. Bush referred to the draft flyer, noting that the objectives in Phase 6 of the communications plan were the same as the questions listed in the fact sheet. Though, the flyer also contained responses to these questions. Ms. Bush quickly summarized the questions presented:

• What will it tell you?



• Why was it conducted?



• What was the study area?



• How were the data analyzed?



• What will the report tell you and not tell you?



• Can the ACI tell me the cause of cancer?

Ms. Bush asked the group to tell her if there were additional questions that could be added.

Mr. Lewis said that he had reviewed this and looked at it, but asked what it would take to get it done. He expressed his belief that some consideration needed to be given to how it would be presented, who the presenter would be, whether the presenter would be believable, and if the presenter would be acceptable to the public. In his opinion, he said, it only takes one well-written press release to get the attention of most people in this area. According to Mr. Lewis, they would not have to worry about getting people to come as a general rule if the press release said there would be an open town meeting and it were put out right. Mr. Lewis indicated that it is a question of whether or not ATSDR is ready to answer the questions from the audience. He said that they have discussed having an oncologist and some people are very comfortable with doing that.

According to Mr. Lewis, Dr. Sinks indicated that CDC does this all of the time and has expertise in handling these types of issues in communities. Mr. Lewis stated that Dr. Sinks explained that they have a track record for dealing with these things, know what they are dealing with, and know how to handle these situations. Mr. Lewis expressed concern that they only had one shot, and suggested speaking to the experienced people Dr. Sinks was referring to and having them review the plan and program. He suggested coming back with a sound approach that has been proven because they did not have the time, money, or inclination to go through another failure. In his opinion, this was the most important thing they could do. Mr. Lewis recommended having Dr. Erwin, an oncologist, and people like Dr. Cember sitting on a panel instead of having a dry speaker. He said they needed someone who could handle and field issues so people can leave with some confidence. He indicated he did not doubt them, but based on what he has heard and seen, he recommended incorporating someone with expertise in this area into the program.

During the community education sessions, Ms. Bush confirmed, Mr. Lewis was suggesting having individuals on a panel to deal with questions coming from the audience instead of only having ATSDR present the information as it relates to the findings of the report. Mr. Lewis said this was correct. He suggested finding someone at CDC who has experience in dealing with these types of things and knows how to field questions, and bring them to present the information. He expressed his belief that they did not need to be how they have been in the past when they have lost it. Ms. Bush expressed her personal feelings that DHS should present the findings of the report. She said she had no objection to having different experts there to field questions, but indicated she was not sure about having different people presenting information that relates to DHS's report. Mr. Lewis indicated that they had one shot. He said he had seen people who did not do the work present to make sure the information was conveyed to the audience. In his opinion, they need someone who can capture the information, present it, and fend off questions so the public can leave with what it needs. Mr. Lewis said he had shared this with Dr. Falk and would call him back if this does not work. Mr. Lewis recommended that they work this out internally, but asked them to bring a good professional program.

According to Dr. Davidson, the person who did the report knows the most about it. Thus, no one in ATSDR or CDC would know the report as well as Dr. Dee Williamson. She indicated that someone else could talk about it, but the audience would be able to tell the difference. Dr. Davidson noted that she has been to many meetings where a person is presenting someone else's work; in such situations, she said she felt the information is not as well or thoroughly presented, or as well organized–the preparer knows more about it than anyone else. Mr. Lewis replied that he had seen some nervous speakers who might be the most knowledgeable, but they lose the entire audience because a heckler or someone else knows how to rattle them. In his opinion, a balance is needed; they will lose if they did not have a person who is seasoned.

Dr. Davidson repeated her statement that only the person who prepared the report can present that information and answer questions about the report: other people could be present to field questions, but they would be setting themselves up for problems by bringing in someone who had not been involved in creating the report. In her opinion, it does not matter how good the speaker is if he or she does not know the information; knowing the information is most important. Mr. Lewis said he had seen experts give dry runs of presentations and then be replaced with people with general backgrounds because of their presentation skills. Mr. Lewis suggested having the person there with someone else behind him or her in case someone gets cornered. According to Mr. Lewis, the idea is to meet the needs of the audience no matter what it takes. He said that Dr. Davidson might be right where she comes from, but he has seen it and knows it can happen. In his opinion, this is crucial to this community. He said he had seen a good example of this when watching Drs. Cember and Brent field questions and handle things. He expressed his belief that they make people leave with an aura of confidence, even though they had not prepared the report they were discussing. He indicated that this does not change what the person has done, but he was asking that his point be taken into consideration.

Dr. Malmquist said he agreed with both viewpoints. In his opinion, he said, Dr. Dee Williamson had to explain how she did the study, what the results are, and how she obtained the results. However, he said, she is not an oncologist or a physician, and so they need one present to answer the public's questions at the public meeting. He said that a question could come up about whether something particular caused a high incidence; she would not be able to answer that, but an oncologist would be able to explain why we cannot say what caused cancer. He indicated that this was not Dr. Dee Williamson's job, but she could explain what the results were and how she got there. He recommended having someone there to field questions that are going to come up. Dr. Davidson agreed that other people should be there, but again expressed her belief that the person presenting the report should be the person who prepared it. Dr. Malmquist agreed, saying that Dr. Dee Williamson is very knowledgeable and can answer all of the questions about how she came to those results, what the statistics were, and other questions. He suggested that they have someone like Dr. Erwin on the panel saying he looked at the results and agrees with them. Then this would not only be ATSDR presenting its results, but also an indication that TDOH looked at the findings, agrees with them, and cannot find fault with them.

Dr. Davidson suggested having the people who conducted the Loudon County study present so they can discuss the differences in interpretations and results between the two. She cautioned that when they are looking at oncologists, clinicians are not necessarily always the best to discuss cause and effect because their primary focus is treatment. Though what they do is important, she said, they needed someone who is knowledgeable about causes of cancer.

Mr. Lewis recalled hearing a radio presentation by Paul Charp in which Dr. Charp said how far something would go if it hit Topside Road. According to Mr. Lewis, sometimes familiarity with a community and what is going on there can make a difference in how you get something across. In his opinion, Mr. Lewis said, Dr. Malmquist's comments were right on the money. He indicated that how you pick up and handle a question, even if it is irrelevant and unrelated, makes a difference as to whether you get a buy-in or not. He said that they needed to make sure this was in place.

Dr. Davidson asked what items on the plan would cost the most and the least in case this came down to money. She questioned how they could look at this from that point of view. She indicated that DHS had made a commitment to completing the ACI, and they might also be able to implement some of these things even if not all of them because of limited funds. Ms. Isaacs said she liked the suggestion about using someone with a background in causation because this would not use up ATSDR resources if the agency can get CDC to make this commitment. She said she had made a note of this and hoped they could identify someone who has a background on causation of cancer within his or her normal work at CDC. If so, she said, this would be a win for them; she indicated that they would definitely look into this. Ms. Isaacs identified staff-related expenses as the most costly, including traveling to make presentations. She noted that it would be great if they could find ways to make presentations without traveling, such as making a DVD as a resource to distribute without the person actually appearing at the meeting. She said this was something they could certainly consider if the final information on funding is negative. She indicated that suggestions along these lines and advice on prioritizing the PHAs are very beneficial. It would also be very valuable for the agency to still meet as many of these outreach objectives in a more economical way.

Dr. Davidson asked whether one well-done, televised public presentation could be used instead of other personal presentations. Ms. Isaacs indicated that this would help, particularly with the uncertainty of funding. According to Ms. Isaacs, the part of the plan that lists the presentations ATSDR will make causes the most concern. Dr. Davidson said they could look at this from the standpoint that they could probably do at least one presentation. Ms. Isaacs replied that they would do their best.

Mr. Lewis said he had asked the state how it drew 100 people to a meeting; the state replied that it had put the draft report on the Web site, the press had gotten a hold of it, and the way it was written up had gotten everyone's attention. In his opinion, Mr. Lewis said, they sometimes customize things to the point where you pick something up and cannot figure out what it is talking about. He said they might be technically right, but they have to say things so that people can understand them. In his opinion, he said, if they draw people in, even if they come in with the wrong perceptions, you can clarify and go from there. He indicated that they needed to do whatever it takes to reach the people. He expressed concern that the press releases have been really weak and shaky and have not met the needs of the people. Thus, he said, ATSDR ought to do this one to the best of its ability.

Referring to Phase 1, Ms. Vowell said that TDOH has videoconferencing so they could get everyone together while saving on travel. Ms. Isaacs said this was a good idea, noting that ATSDR also has this capability. Ms. Vowell replied that TDOH does a lot of CDC videoconferencing.

Dr. Davidson asked if the CCCWG had a recommendation on this. Mr. Gartseff replied that the work group had a recommendation, but it was not about this specifically. He said this recommendation had first been proposed on August 29, which was the meeting before Mr. Hanley came to present the draft communication plan. At the time, according to Mr. Gartseff, Mr. Lewis seemed to feel strongly that they needed to have a better picture of the product before discussing and approving a communications plan about that product. Mr. Gartseff said he saw the recommendation printed here, which appeared to come verbatim from the draft minutes, though he had wordsmithed it for today's meeting. The gist, he said, was that the work group wanted to recommend to ORRHES that ATSDR bring Dr. Dee Williamson to discuss the product before they could intelligently discuss the communications plan. The motion passed two to one. In view of today's discussions, however, this may or may not be germane at this point. Dr. Davidson asked if Mr. Gartseff wanted to put this recommendation on the table or withdraw it since they have already discussed the plan. Mr. Gartseff stated he would hand this over to Mr. Lewis since it was his recommendation.

Mr. Lewis stated that he was not sure what to say since they might not be having another meeting. He expressed his belief that they needed something in writing from Dr. Dee Williamson. According to Mr. Lewis, they have been arguing about the definition of plumes and census tracts, but never received anything officially to assure them of what this product would look like. In his opinion, he said, something like this could be helpful since they might not meet again; he was not sure if it mattered, though. Dr. Davidson pointed out that Dr. Dee Williamson might be ready to present this document if they meet again. Even if they get funding, she said, they did not know when the next meeting would be because it would depend on scheduling.

Mr. Gartseff explained that when they first discussed this motion at the CCCWG meeting, he could see Mr. Lewis's point and interest. At the same time, however, he could see how this recommendation would simply delay the process. Though this is speculative, he would rather get the product than have more discussion and wait longer for it. He said he would prefer to withdraw the recommendation, provided that Mr. Lewis was comfortable with that suggestion. Dr. Davidson mentioned that David Johnson had also been at that meeting.

Mr. Lewis indicated that his only fear about withdrawing this recommendation was that they do not know what the community wants. According to Mr. Lewis, the presentation in Loudon County did not meet the needs of that community and the people challenged the state to go look at a lower level. He expressed his belief that they have been debating this and ATSDR said it was capable of doing this. In his opinion, he said, something should be e-mailed or sent to let them know what they will be getting so they do not get to a meeting expecting something different. He suggested providing them with this information, not in a formal presentation, but by some means so they know what to expect and why things were not done (if they were not). He repeated that it would be helpful to know what they will be facing when they show up.

Dr. Davidson said they could probably ask ATSDR to send an e-mail to all ORRHES members letting them know what parts of the ACI will be done, which could serve as a formal response to different aspects of the recommendation. According to Mr. Hanley, if Dr. Dee Williamson and the rest of the DHS staff decide this cannot be done, they will come to explain exactly why they cannot do the census tracts. Dr. Davidson pointed out that they might not be meeting again, and that if they were meeting they did not know when. Mr. Hanley said that they were nonetheless willing to come up–it would not necessarily be at an ORRHES meeting, but DHS will come and discuss this with anyone who is interested.

Mr. Lewis noted that if they invited people from Loudon County, they needed to make sure they did not conflict with what was being done for that area. He expressed his belief that if they conflicted, ATSDR would look silly because even if what they are doing in Loudon County is crude, it might meet the needs. Mr. Lewis cautioned ATSDR to make sure what it is doing comes close to what they have been asking for. He said they needed to look at this and see how it might be beneficial even if it is crude.

Mr. Hanley said he believed Mr. Lewis was saying that what was received in Loudon County was not to the level the people wanted, and that they were requesting additional details. According to Mr. Lewis, they had indicated that going down to a lower level would help them better deal with the issues. Mr. Lewis suspected that they will have the same question here about “What happened in my backyard?”

Dr. Davidson clarified that they would not be discussing the report per se, but discussing parts of the report and why they were not doing certain things (if they were not). Mr. Hanley said this was correct: if they cannot get down to the census travel level, then DHS will explain this.

Dr. Davidson pointed out that there was no motion on the table, as Mr. Gartseff had withdrawn the CCCWG recommendation. Mr. Gartseff said he had expressed a preference to withdraw it. Dr. Davidson noted that there were no objections heard; Mr. Gartseff withdrew the motion.

Dr. Davidson referred to the communications plan, indicating her perception that the first priority is to implement the plan with at least one meeting. A DVD will be made of this meeting and distributed throughout the eight-county area. Mr. Lewis expressed his belief that the priority should be to get as much public participation in that meeting as possible.

Mr. Hanley explained that the point of this plan is to reach more people. They are trying to do this by finding out which organizations are interested in these topics in advance, then going to them at their regularly scheduled meetings. According to Mr. Hanley, they would deal with people in smaller groups and could get answers to their questions in an environment they are comfortable with. He indicated this was a way to reach out to more people, but they might not have the funds to do this because it could be over 2 weeks of meetings. Thus, they might have to go to one meeting with a DVD. Mr. Hanley said they could bring in someone to help facilitate and present the material, while also having other people such as Dr. Erwin (as Dr. Malmquist mentioned) and the support of other agencies (such as TCR, TDOH, and others). Mr. Lewis indicated that this was basically what they had said.

Dr. Cember expressed his belief that it was a good idea to have a local physician's group because this all deals with health, but he did not see any listed here. Ms. Bush noted that the Boards of Health was listed. Dr. Cember said he was thinking of the American Medical Association (AMA) or an equivalent organization, because ordinary people do not come in contact with the Boards of Health; they come in contact with doctors.

Additional Comments

Mr. Lewis asked if there was any way for Dr. Taylor to come back and make a presentation on mercury. Ms. Isaacs said she did not know. Mr. Lewis requested that she look into this because there is a lot of confidence in him. According to Dr. Davidson’s comments, he said, Dr. Taylor would be the best person to present since he did the report. Dr. Davidson replied that her graduate professor always said that no one knows more about what you have done than you do.

Presentation/Discussion: Evaluation of Current (1990 to 2003) and Future Chemical Exposures in the Vicinity of the Oak Ridge Reservation

Dr. Markiewicz said that all ORRHES members should have received a copy of this document n the mail. The current time period for this PHA was defined as 1990 to 2003. A figure detailing ATSDR's chemical screening process was presented. Dr. Markiewicz noted that there were three similar figures in the document, but this was a generic diagram showing how the agency screens chemicals down to the public health implications portion of the document. Early in the process, ATSDR walked through each of these steps when evaluating soil, sediment, surface water, and biota. The figures were used to illustrate the generic screening process as well as what was done in this specific case, showing the chemicals that went through the screening process and those that screened in and out.

In the first phase of the chemical screening process, ATSDR screens against media-specific CVs known as environmental media evaluation guides (EMEGs). There are different types of EMEGs for soil, surface water, groundwater, and air. He indicated that commenters have asked about ATSDR's use of the term "conservative." In the first phase, he pointed out, ATSDR compares the maximum detected concentration to screening values. He identified this as one step of a conservative or health protective measure because any maximum detection that falls below the screening value could be screened out. Therefore, because you are looking at the maximum detected concentration, it could be said with reasonable certainty that this is not going to be at a health effect level.

According to Dr. Markiewicz, this covered a wide area and there were a high number of samples for much of the media. Exposure pathways are considered next in the screening process to identify those that are valid. Then, exposure doses are calculated and certain refinements are carried out. Then, exposure dose concentrations are estimated, and anything that comes through this process is included in the public health implications portion of the document. In this section, ATSDR looks at the existing data, the particular media, and the exposure scenario to determine the likelihood that adverse health effects could occur.

Dr. Markiewicz presented a map of the area of interest from the PHA titled ORRHES Area of Interest. He also noted that a map in the PHA shows all of the sample areas and identifies the different media where samples were collected throughout.

TDOH stopped its evaluation in 1990, so ATSDR went from 1990 to 2003 for its evaluation. Dr. Markiewicz said it is important to note that this PHA only deals with chemical exposures and certain chemicals. It does not include exposure to mercury, PCBs, uranium, iodine 131, the TSCA Incinerator, off-site groundwater, and White Oak Creek radionuclide releases; these are all covered in separate PHAs.

For each medium, ATSDR had the following approximate number of records:

• Soil: 10,000



• Sediment: 56,000



• Surface water: 93,000



• Biota:



• 16,000 (fish)
• 2,200 (game)
• 236 (vegetables)

ATSDR typically evaluates all media, but groundwater is included in a separate PHA. Dr. Markiewicz explained that the PHA includes a discussion of the limitations of some of the specific data, whether for a specific type of biota or a specific compound (such as dioxins).

He said he wanted to point out that the Director of Science had questioned the second-tier screening value approach used in this document. When calculating exposure doses, one often considers the average (arithmetic or geometric mean). In this PHA, however, ATSDR took one standard deviation above the mean instead of using average concentrations. Thus, the calculated exposure doses for this part of the screening include numbers that are higher than the average, which is a health-protective measure. By using this approach, he said, they would capture anything that may not have screened in or out when using the average.

Regarding how screening values are derived, Dr. Markiewicz reminded the group of a thermometer graph he had previously shown. He explained that the graph detailed where health effects have occurred based on animal and human data and showed where the screening values are. The graph had typical exposure doses that were calculated for different sites used to provide examples of the margin of safety, demonstrating that screening levels have built-in safety factors. He explained that the screening values used are not health effect values, but values used to bring whatever chemicals do not pass into further evaluation. However, he said, because of the large margin of safety, a chemical above a value will not necessarily cause health effects. Typically, the margin of safety is between 100 and 1,000, but it could be 300, 10,000, or something else. According to Dr. Markiewicz, how much of a safety factor depends on how much confidence there is in the data set.

Dr. Markiewicz provided summary statistics for soil, sediment, surface water, biota, and air, which are provided below.

Soil: The maximum concentrations of 22 chemicals exceeded CVs (soil EMEGs). Four of these chemicals–arsenic, benzidine, iron, and lead–had exposure doses above screening guidelines (i.e., the minimal risk level, or MRL). These four chemicals were carried through to the public health implications section.

Sediment: The maximum concentrations of 33 chemicals exceeded CVs in sediment. None of these chemicals, however, had exposure doses that exceeded screening guidelines (MRLs).

Surface water: The maximum concentrations of 75 chemicals exceeded CVs. However, using one standard deviation above the mean, zero chemicals had exposure doses that were above screening guidelines.

Biota (fish): According to the average of the maximum by species, there were 12 chemicals above CVs. Primarily, these fish species included sunfish, catfish, and bass. ATSDR took the average of the maximum and grouped the data by species to see if any were above screening values. ATSDR used this approach instead of only looking at one maximum because some people only eat certain species and fish have different behaviors in the environment. Six chemicals had exposure doses above screening guidelines for both East Fork Poplar Creek and the Clinch River. Eight chemicals had exposure doses above screening guidelines for Watts Bar and also for "on-site fish." These on-site fish were included because some people may be able to get in and fish in the areas considered on site, and also because fish can move to different areas.

Mr. Washington asked if ATSDR had specified species relative to the area. Dr. Markiewicz said it had. Mr. Washington asked if bottom feeders and PCBs had been considered. Dr. Markiewicz explained that the PCB PHA contains a diagram and a picture on that subject. He said that he was writing two PHAs at the same time, noting that the PCB PHA talks about the different species. He indicated, however, that it would be a good idea to pull that into this document as well: it is germane for the PCB PHA because fish are a critical pathway for PCBs, but it would also help to have that information in this PHA since it also deals with fish.

Biota (game): Off-site game were below CVs. However, according to the average of the maximum, eight chemicals were above CVs for on-site game. There were seven chemicals with exposure doses above the screening guidelines. There are certain game species on site, including turkey, deer, and waterfowl.

Biota (vegetables): According to the average of the maximum, three chemicals were above CVs and three exposure doses were above screening guidelines.

Air: Three chemicals had maximum concentrations above CVs. These include arsenic, cadmium, and chromium. A total of six chemicals were looked at, as ATSDR had more limitations on the air data.

Dr. Markiewicz explained the public health implications regarding children's health considerations. When ATSDR goes through the screening process, the public health implications section is broken into two areas: a section on children's health considerations (to take the more susceptible population into account) and then more of a health evaluation. Under children's health considerations, ATSDR looks at a pica scenario. Soil-pica behavior is when a child exhibits an abnormal appetite for nonfood items, such as soil. Arsenic, iron, and lead were three chemicals that did not pass the screening criteria, so ATSDR had to look at them in greater detail. ATSDR used the maximum concentration with conservative assumptions for pica, considering 52 exposures with one exposure per week for 3 years. According to Dr. Markiewicz, most pica children are within a certain age range and typically are not outside 52 weeks a year–particularly in this part of the country, given the inclement weather. However, ATSDR finds these default assumptions to be health-protective because they consider the maximum default assumptions and keep a child at 10 kilograms over 3 years. When doing calculations and looking at pica doses, they are evaluating a milligram of a chemical per kilogram body weight per day. If the body weight remains the same, this will overestimate this type of exposure.

For arsenic, pica behavior at the maximum detected level could cause effects. No effects were expected based on pica behavior for iron, but pica behavior at the maximum lead detection could elevate the blood lead level (BLL) above 10 micrograms per deciliter (µg/dL). In addition, ATSDR made sure that the highest level was in an area where pica behavior could occur. For instance, many of the detections were at the Atomic City Parts Superfund Site where soil has been removed and it is an industrial area; therefore, pica behavior would not be likely here.

Arsenic was detected at 77.3 parts per million (ppm) in a yard on a residential property. This concentration was used in the calculation for pica behavior. Based on this and assuming 100 percent absorption (i.e., that 100 percent of what a child ingested will get into the child's body), acute health effects from arsenic could be seen if pica behavior occurred at the maximum detected level. These acute effects typically include gastrointestinal distress, such as vomiting, diarrhea, and possibly facial edema. The effects are painful, but do go away–there are no long-term effects. Once again, he said, a child would have to be exposed to the maximum level and have 100 percent absorption.

Mr. Washington asked if the level in question had been found in a yard in Oak Ridge. Dr. Markiewicz said it had. He explained that there were many past uses of arsenic, and bioavailability could be higher depending on what the use was. For instance, pesticides, herbicides, and defoliants have a higher bioavailability than something from a smelter-type activity. ATSDR assumed 100 percent bioavailability, but the range of arsenic is between 10 and 80 percent depending on the actual source of arsenic.

Mr. Washington pointed out that arsenic is also present in rat poison. Dr. Markiewicz said this was correct.

Dr. Markiewicz said he had found a contradiction in the PHA regarding iron that will need to be changed: the document refers to iron as the "second most abundant element" and also the "fourth most abundant element." Despite this, he said, there is still iron deficiency anemia in our society. The body can handle iron–it has a certain regulatory mechanism that excretes more if you get too much and absorbs more if you do not have enough. Given this and other parameters, ATSDR expects no adverse health effects from exposure (through pica or otherwise) to iron in soil.

Lead was detected in residential soil at a maximum level of 625 ppm. In children with pica behavior, this could produce an elevated BLL above 10 µg/dL, which is the current standard by which ATSDR determines if someone has an elevated blood level that could lead to adverse health effects. This is assuming 100 percent bioavailability and other parameters.

Dr. Cember asked how much soil a child would have to ingest; 5,000 milligrams (or 5 grams) for 52 times a year over 3 years, answered Dr. Markiewicz.

Mr. Washington expressed his belief that the lead in that backyard sample had probably come from paint. Dr. Markiewicz explained that they did not know if there was a paint chip there–they did not know the source of the lead. He said that someone could have used leaded gasoline and spilled the gas while cleaning engine parts. Mr. Hanley indicated that this was not widespread. Dr. Markiewicz stated that this was correct: based on all of the lead data, there was a high hit of lead in only one residential area.

Dr. Markiewicz explained that one recommendation made in the PHA is in support of BLL screening for any child aged 6 months to 6 years. He indicated that some physicians will not do this–you have to persuade them. Lead is a unique chemical. ATSDR looks at it using a multiple-source scenario to consider contributions from water, air, and food; adding contributions from soil lead or paint chips can really elevate a child's BLL. Thus, he said, this was speculative, but acute health effects could be caused if pica behavior occurred at the maximum detection.

Ms. Adkins said that children might only eat dirt three times a year, but a lot of people around here eat a lot of garden-grown root vegetables daily. She stated that this was a consideration for her, but expressed her belief that they were going to say that this is a consideration for the past and not the present. According to Ms. Adkins, a former practice of farmers and people who grew flowers and vegetables was to take dumped sludge from the ORR and carry it to fertilize their flowerbeds and gardens. She expressed concern that there are probably people all over this community who have nice flowerbeds and gardens, but do not understand why. She expressed her belief that this would mess up the average because there are places (she did not know where) that will be really high across the whole periodic table. She said this really concerns her because people are growing vegetables in these spots right now, and so it is really hard to say that things are as good as they wish they were.

According to Ms. Adkins, the county and state extension office was one of the most trusted government agencies. She indicated that they conduct soil testing and asked whether they would do this type of testing to cover these problems. She asked if there was any way, since they are an existing agency that already tests soil, to connect with them and encourage them to add some things to what they test for so people can see if some of these things from the past are in their gardens. She added that she used to work for the extension office, but did not know the extent of the chemicals they tests for. Dr. Markiewicz replied that they typically do not look at heavy metals but test for more basic soil science things, such as nitrogen, potassium, organic matter, and phosphorous. It costs more money any time more analytes are added.

Dr. Markiewicz explained that recommendations are made in the vegetable section about ways people can reduce their exposure if they are concerned. For instance, people can create raised-bed gardens for which they bring in clean soil or add amendments to existing soil, such as using a lot of organic matter that is clean–not sewage sludge because this also has heavy metals. Based on studies, lead on root vegetables is typically on the outside. Some people do not wash their vegetables as well as they could and do not use brushes to scrub them. According to the studies Dr. Markiewicz has seen, a good cleaning process can eliminate the vast majority of lead, since it mostly attaches to the outside of the root. Thus, there are ways to reduce exposures.

Ms. Adkins expressed her belief that wording has to be very important here. In her opinion, she said, people will not be conscious about this if they do not think there is really a problem. She expressed concern that this was a very real thing because people might have raised-bed gardens that have dirt that is rich because it contains sludge brought over from the ORR. Dr. Markiewicz agreed with Ms. Adkins, noting that there are certain vegetables that take up particular metals better than others. In the document, there is a caveat saying to bring in clean soil. However, he said, you could get soil from someone's backyard or from somewhere you think has good soil, but not know what is in it. Even if you buy soil at Home Depot, he stated, it does not mean that you know what is in the soil either. He added that companies often amend soil with certain things, and thus there could be some heavy metals in it. He explained that there are standards for certain states; he was not sure of the standards in Tennessee. He noted that people use all sorts of things in their gardens, such as sewage sludge and Dillo Dirt, that contain metals.

Ms. Adkins asked if there was any way to request or beg for instance the University of Tennessee soil test laboratory to expand the list of contaminants it will test for. She suggested that they let the public know that there are dangerous things out there and recommend having tests conducted for these things because of bad practices in the past. Dr. Markiewicz said he did not know how widespread that was, but only three were found based on the data ATSDR reviewed. However, he stated, they did not go into everyone's yard and sample in everyone's garden. He explained that he had worked for the state before he worked for the federal government, and state budgets are tighter. According to Dr. Markiewicz, you will not see the state routinely adding analytes such as cadmium, arsenic, and lead. However, he said, the state could always be asked. In his opinion, the state would probably tell someone who is concerned to take the soil sample to and pay a laboratory to run the analysis. He said that such testing is fairly inexpensive, but a lot of people do not do it. One action you can take is to add organic matter, such as a compost pile, that tightly binds metals and other chemicals in soil. Because organic matter has one of the highest binding capacities for those metals, they will not get into the plants, vegetables, or fruits.

Mr. Hanley asked Ms. Adkins which facility she was referring to. She replied that she had the information at home, but she could get the information regarding where farmers and workers came and got truckloads of this stuff, and also shared it with their neighbors. Dr. Markiewicz asked if she was referring to sewage sludge. She said she was, expressing her belief that it was nasty and highly dangerous. Dr. Markiewicz stated that this was interesting, indicating his knowledge that a lot of this happened in the past. He referred to a site in Pennsylvania where a battery recycler gave casings away as till material and now there are 300,000 ppm of lead in people's backyards. Dr. Markiewicz noted that this can happen, stating that back then people thought this was good because it was fill.

Mr. Box asked if this was sludge from the plants or from the Oak Ridge sewage treatment plants. According to Ms. Adkins, it was radioactive sludge from the ORR processes, which was cleaned out of the equipment at the plants; it was then carried by pickup trucks to communities all over this area. Mr. Box expressed his knowledge that many people took sludge from the city. Ms. Adkins said it came not from the city but from the ORR processes.

Dr. Markiewicz indicated that the health evaluation portion of the public health implications section provides a summary table (Table 5) of chemicals of concern. The table lists the chemicals and goes into detail. The section discusses non-pica-behavior children (those playing outside) and adults. Whereas pica assumes acute types of exposure, this evaluation considers more chronic or subchronic exposures–exposures occurring more than once a week or once every couple of days. The last column of the table says whether there are public health implications; if there are, these chemicals are carried through because they need more discussion.

Cadmium in vegetables was carried through, though ATSDR had limited vegetable data. From a public health perspective, Dr. Markiewicz said, they do not feel this is a problem: only 40 percent of the samples had detectable levels of cadmium. If a person consumed vegetables on a routine basis (1.2 pounds per year) at the reported levels, that person might suffer kidney effects after years of exposure. Dr. Markiewicz said that he does not have a large garden, but has already consumed more than this amount out of his own garden. If someone ate more, then cadmium at these levels over many years of exposure over a lifetime could result in kidney effects. He indicated that this brought up their conversation about what soil is out there, what the vegetables are grown in, and what people are eating. He noted that there was not a robust data set, but this was the one pulled through that needed this discussion and conclusion.

Dioxins in an unidentified fish species were also carried through. Dr. Markiewicz said when they looked at the data, it was easy to say if people ate bass, catfish, and sunfish. However, he stated, if they did not know what the species was, then they kept it in instead of throwing it out because it might be something a person would eat. Dioxins were identified as indeterminate because they did not have enough data; however, if people follow the fish advisories currently in place, which will limit and mitigate exposures, health effects are not expected.

Dr. Markiewicz explained that mercury and PCBs were the two chemicals really driving fish-type exposures for this pathway. He added that these were fish from a pond near K-25 that has limited access. He said he did not expect that people were going to be eating fish at subsistence-type levels out of this pond because they probably fish in other areas. For all other chemicals, Dr. Markiewicz stated, no public health effects are expected. He noted that the document provides detailed descriptions of how these conclusions were developed.

For the conclusions and recommendations, current and future exposure to dioxins pose an indeterminate public health hazard; however, following current fish advisories will mitigate and reduce that exposure. In addition, current and future exposure to remaining site-related chemicals pose no apparent public health hazard. Nonetheless, Dr. Markiewicz said, people should refer to the text for cadmium in vegetables and arsenic and lead for children exhibiting pica behavior.

Dr. Davidson pointed out that the comment period is from September 18 to November 18, and Dr. Malinauskas requested the comments on the document by October 24. Dr. Markiewicz asked for any comments to be e-mailed to him or Mr. Hanley, and they would respond back. He indicated that the document contained a lot of information, and asked the ORRHES members to point out anything that does not make sense or needs further clarification because now is when changes can be made.

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