Oak Ridge Reservation: Public Health Assessment Work Group

Public Health Assessment Work Group

November 17, 2003 - Meeting Minutes

Attendance

ORRHES Members attending:
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Bob Craig (Chair), David Johnson, Tony Malinauskas, Susan Kaplan, Pete Malmquist, James Lewis, LC Manley, Kowetha Davidson

Public Members and Others:

Gordon Blaylock, Tim Joseph (DOE), Al Brooks

ATSDR Staff:

Bill Taylor, Karl Markiewicz (telephone), Melissa Fish, Jack Hanley (telephone)

Purpose

There were four items on the agenda for discussion.

1. Approval of PHAWG meeting minutes from October 20, 2003
2. Previous Action Items
   1. Update on PHAWG resolution regarding EPA comments to ATSDR
   2. Unscheduled Action Items
3. Biota data screening-Karl Markiewicz
4. New Business
   1. Letter for EPA-Kowetha Davidson
   2. Work group chairs report form for ORRHES-Kowetha Davidson
   3. Unscheduled new business

Meeting Minutes

The draft meeting minutes for October 20, 2003 were approved unanimously.

Previous Action Items
/> Update on PHAWG resolution regarding EPA comments to ATSDR

Bill Taylor told the group that by the December 2nd ORRHES meeting, the resolution reading as “ORRHES requests that ATSDR request that EPA come back with a definitive set of comments reconciling the original set of comments from EPA Radiation and Indoor Air to ATSDR on the Y-12 Uranium document, prior to December 1st” will be a moot point. Bill Taylor indicated that he spoke with Lorine Spencer about holding a conference ORRHES meeting in which the above resolution would be voted on prior to the December 2nd ORRHES meeting. Bill told the group that there are no plans for an interim telephone conference ORRHES meeting between this PHAWG meeting and the December 2nd ORRHES meeting.

Responding to Bob Craig’s question about activity between ATSDR and EPA, Bill Taylor told the group that it is his understanding that ATSDR staff in Atlanta have been in contact with both Region IV EPA and Headquarters EPA and have passed along ORRHES and community concerns to EPA. Bill told the group that it was his understanding that for the December 2nd ORRHES meeting, Jon Richards will arrive with a letter from EPA Headquarters. Ideally the letter will address the issues and concerns that have been addressed. However, ATSDR does not know if the letter will be adequate and will satisfy the concerns of ORRHES.

James Lewis asked if the EPA letter has been reviewed by ATSDR. Bill Taylor responded that he had not seen the letter and does not believe that ATSDR has seen the letter.

Susan Kaplan asked if ORRHES members would see the EPA letter before the December 2nd meeting. Bill Taylor said that he was not sure but did not think letting the ORRHES members view the letter prior to the December 2nd meeting was a part of the plan.

James Lewis asked if ATSDR will have the opportunity to review the letter to see if there are any disconnects and if there are disconnects will ATSDR be willing to share that information with ORRHES in advance of the December 2nd ORRHES meeting? James Lewis requested that if ATSDR does learn what differences exist between ATSDR and EPA—that ATSDR be willing to share that information prior to the December 2nd meeting.

Bill Taylor told the group that he does not know if ATSDR will receive the EPA letter prior to the December 2nd ORRHES meeting or not.

Al Brooks told the group that he is hearing a lot of “kind of” statements. Al said that he feels that the group is where they were before. EPA spoke with two voices and ATSDR is trying to reconcile the situation. Al Brooks said that if the Y-12 Uranium report is issued without reconciliation then the problem still exists. Reconciliation is the important thing and it would be nice to make sure that the Y-12 Uranium report is consistent with the reconciliation. Al Brooks said that if ORRHES hears the EPA discussion first and then decides the motion is a mute point, ORRHES could then vote down the motion.

James Lewis asked when ATSDR plans on issuing the final Y-12 Uranium PHA. James also asked if the final Y-12 Uranium PHA would include an evaluation of what EPA has to say.

Al Brooks asked if reconciliation would take place between ATSDR and EPA before the Y-12 Uranium PHA is released and if any reconciliation would influence the report.

Jack Hanley said that he does not know what EPA is going to do; all he knows is what ATSDR is going to do.

Bob Craig responded by asking if ATSDR plans to release the report.

Tony Malinauskas then asked what would happen if ATSDR and EPA agree to disagree. Jack Hanley said that it is his hope that ATSDR would be able to come to Oak Ridge and explain the differences that the two agencies did not agree on.

Tony Malinauskas then asked what ATSDR would expect of ORRHES. Jack Hanley responded that he would hope that ORRHES would have an understanding of the differences in approaches and methodologies of the two agencies.

Once again Bob Craig asked if ATSDR plans to release the report. Jack Hanley responded yes, most likely a few weeks after the December 2nd ORRHES meeting.

Al Brooks asked if the Y-12 Uranium PHA would be influenced by what EPA says during the ORRHES meeting. Jack Hanley responded that currently his management had not commented on the issue.

Al Brooks asked Jack Hanley if he feels that what ATSDR will have done regarding interactions with EPA prior to the December 2nd ORRHES meeting will satisfy the motion of “ORRHES requests that ATSDR request that EPA come back with a definitive set of comments reconciling the original set of comments from EPA Radiation and Indoor Air to ATSDR on the Y-12 Uranium document, prior to December 1st”.

Jack Hanley responded to Al Brooks saying that he hopes so and is trying to work with Region IV and Headquarters so that the motion/resolution is not necessary. During the ORRHES meeting Jon Richards can explain where the differences of opinion exist.

Al Brooks asked if there is anything wrong with leaving the motion/action in existence because ORRHES can vote down the motion or vote to approve it with amendments as needed during the ORRHES meeting.

It was decided that no action needed to be taken regarding the motion/action from the November 6th PHAWG meeting.

Kowetha Davidson asked about the process involved in the release of the final Y-12 Uranium PHA.

Jack Hanley said that normally there are initial press releases, fact sheets, and discussions with the media. Following that, when it is appropriate, presentations to various audiences are given and CIB and DHEP develop a plan to inform the public of the findings.

Tony Malinauskas asked if ATSDR and EPA agree on the category of “No Apparent Public Health Hazard”.

Jack Hanley said that Region IV has clearly stated in a letter that they agree with ATSDR’s conclusion. Jack is unsure about what Headquarters agrees with or disagrees with.

Gordon Blaylock said that EPA Indoor Air agreed with Region IV about the category used for the current health effects but question the conclusion category for the past health effects.

Tony Malinauskas said that it is important that the group keeps the final outcome in mind and does not worry about different methodologies of the two agencies.

Previous Action Items
/> Unscheduled Action Items

As it related to a previous disagreement with Al Brooks about the clean up level of the Civic Center, Susan Kaplan distributed an article from the Knoxville News Sentinel dated September 12, 1984 that showed that the Civic Center had been cleaned up to the level of 10 ppm (Handout One).

Biota data screening-Karl Markiewicz

All handouts used in this presentation are available in the Field Office with the meeting minutes.

Karl Markiewicz told the group that he would only be speaking about Biota and that a presentation regarding Air would be at a later date. Karl Markiewicz also pointed out that the PHAWG had previously suggested that he limit the map portion of his presentation to only a few chemicals. Thus, Karl limited the map portion of his presentation to mercury and PCBs since many people are familiar with those.

Fish First Screen Summary Statistics Handout

Karl Markiewicz explained how many chemicals were sampled in fish species in East Fork Poplar Creek, Clinch River, Watts Bar Reservoir, and on-site. Karl added that some areas might have had boat access so when it was possible those areas were considered as more of an off-site sample.

Karl Markiewicz explained the chemicals in fish with subsistence-level exposure doses that exceeded the first screen—screening guidelines. Karl explained that the subsistence level means that the person ate a lot of fish—fish were used as their main protein source. Because this is a screening process, a conservative screen is used. It is assumed that if a level is OK at the subsistence level then it will be OK for other people who do not consume as many fish.

Responding to the list of chemicals that exceeded the first screen, Tim Joseph asked what is gained by breaking down the PCBs instead of grouping them all together?

Karl Markiewicz said that the PCBs can be grouped all together but in the first screen he likes to break down the PCBs in order to see if only certain congeners are a problem and others are not. However, it could have been done both ways. Karl pointed out that by breaking down the PCBs they learned that for East Fork Poplar Creek, 1254 and 1260 are the ones that ATSDR needs to focus a little further on.

Tim Joseph said that he is concerned that by breaking the PCBs out, that the PCB concentration would be underestimated.

Gordon Blaylock asked why the dose lists contain “PCB congeners” as well as four Aroclors? Gordon added that the four Aroclors listed are probably the most important ones but Gordon wondered how many PCB congeners were looked at.

Karl Markiewicz said that they are limited by data and that not all of the data has the PCB congeners broken out.

Al Brooks wanted clarification regarding mercury and how it was listed in the dose lists. Al said that he assumed the term mercury means all of the inorganic forms and then “mercury organic” is listed separately. Karl Markiewicz told Al that he was correct. Al went on to say that in the list under Clinch River and under Watts Bar Reservoir only mercury is listed-which means inorganic. No organic is listed. Al asked if he is correct. Karl responded that Al was correct and that this is what fell out of the first screening, which means that it exceeded the guidelines.

Tim Joseph and Al Brooks suggested that to avoid confusion, Karl should identify mercury as organic or inorganic.

Al Brooks said that generally the mechanism in Watts Bar and the Clinch River has been organic mercury—Karl’s screening results imply something different.

Karl Markiewicz responded that the information included in the lists is what was found in the fish tissues.

Bob Craig clarified that Al Brooks is saying that elevated levels of organic mercury have been found in fish tissues in Watts Bar and Clinch River.

Gordon Blaylock said that in the muscle tissue of fish, 95% of the mercury would be methylmercury. Karl Markiewicz agreed. Gordon added that in the edible portion of the muscle tissue in fish—most of it is organic mercury. Gordon also pointed out that it is very difficult to measure methylmercury in sediment and the concentration factor is extremely high.

Responding to questions about the difference in various data sets regarding methylmercury, Karl Markiewicz said that he would take a second look at his data since it seems that Karl’s information is contradicting what has been found before in other studies.

Gordon Blaylock said that methylmercury is more difficult to measure than just mercury. Thus, sometimes-just mercury will be measured and they will say that in fish, 95% of it is methylmercury. Gordon thought that this explanation could be the reason that methylmercury is not in the screening list.

Al Brooks pointed out that regarding Watts Bar, ATSDR sampled 154 fishermen-the most frequent fish eaters that could be found and still found nothing.

Karl Markiewicz reminded the group that this portion is just the screening portion and once [at this point Karl was interrupted and the rest of his statement could not be heard].

Al Brooks asked if ATSDR is using a conservative screen. Karl Markiewicz responded, yes.

After further discussion Karl Markiewicz said that he needs to explain in writing, the PCBs and mercury and how it is being looked at and what that means. Karl told the group that he viewed the description as something that would be done in the next step but he is willing to write a description in this first step of the process.

Bob Craig said that he is not sure that this is a conservative screening.

Kowetha Davidson said that “organic mercury” would most likely be included in “total mercury”.

Al Brooks asked if there were any comparison samples available. Karl Markiewicz responded that there are some comparison samples available.

Al Brooks said that it would be interesting to see what the profiles of the comparison samples are compared to the profiles that Karl has listed for East Fork Poplar Creek, Clinch River, Watts Bar Reservoir, and On-Site.
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/> Karl Markiewicz said that some backgrounds might not have a complete list but Karl will try to pull that information together. Bob Craig agreed that it would be helpful if Karl would look into finding profiles of the comparison samples.

Sample Locations of All Fish Species Handout (map)

The group reviewed the map with the understanding that it was distorted because it had been enlarged for easier viewing.

Mercury Sample Locations of All Fish Species Handout (map)

Karl Markiewicz told the group that there were more than 2,700 samples that were looked at and that over 2,000 of the samples had concentrations that were greater than the comparison value.

Sample Locations of All Fish Species Mercury Concentrations>0.14 ppm Handout (map)

Tony Malinauskas asked if it is possible that the concentrations below the confluence between the Clinch and the Tennessee River were higher than those above. Karl Markiewicz agreed that it is possible but reminded the group that this map is only for mercury.

Karl Markiewicz told the group that Sun Fish are territorial and will not move around very much. Karl emphasized that when he takes a closer look at the data he will consider certain fish species in particular areas having higher concentrations where as there might be a declining concentration trend in other areas.

Tony Malinauskas said that it is unfortunate that there were no samples taken upstream on the Tennessee-above the confluence.

Karl Markiewicz said that it is possible that there are data for upstream samples that were not included in the database in which these data were pulled from.

The group felt it would be important to get any fish data that Tennessee Valley Authority (TVA) might have available, especially concerning upstream fish samples.

Karl Markiewicz told the group that ATSDR has been asking TVA for data (TVA only has some of it electronically) and ATSDR is still trying to get what it can. The data might be in the form of a written report.

Concerning this issue, Al Brooks said that he has a type written page as well as a contact person-he will look for it. Karl Markiewicz asked Al to give the page to either Bill Taylor or Melissa Fish.

When looking at the sample locations on the Clinch River, Al Brooks said that he thinks all but one sample are above the significant entry point of mercury in the Clinch River. Al Brooks said that the problem that ATSDR and ORRHES are examining is releases from the Oak Ridge Reservation site. Al said that people should not assume that everything in the streams has been released from the site.

Karl Markiewicz said that he agrees with Al’s statement but the purpose is to look at places where people fish and not where the contaminant actually came from. The focus of this portion is to screen what was found in the fish tissue and see if that chemical screens in or out.

Gordon Blaylock pointed out that some of TVA’s processes also release mercury.

Karl Markiewicz told the group that it is known that mercury is everywhere in America and he feels that using background data will be beneficial to this process.

Al Brooks said that many discussions were held about whether the Iodine-131 doses from other areas would be added in with the releases from Oak Ridge. Al felt that the group reached a conclusion (it might not be final) that other doses would not be added. Now it seems that we are not looking at the releases from the plants but are looking at the surrounding area and not treating it as background but as part of the problem.

Susan Kaplan said that one point from those Iodine-131 discussions is that the problem should be looked at from a public health standpoint. The public cares about total exposure and not where the contaminant comes from. If the Oak Ridge Reservation in combination with other sources caused a certain contaminant level to be brought to a level of health concern then the public has the right to understand that.

Kowetha Davidson pointed out to Al Brooks that ATSDR is looking at measured concentrations and the source of the contaminant cannot be differentiated when looking at measured concentrations of mercury in fish.

Bill Taylor pointed out that the agency does not have a clear policy regarding this issue; it is usually left up to the individual health assessor. ATSDR frequently finds contaminants above screening levels that for various reasons are not suspected to be entirely a result of site activities. The information is usually handled as a public health data point that is evaluated.

Karl Markiewicz said that if there is information to suggest that the contamination is not a result of the site, ATSDR could indicate that a particular contaminant is present but does not appear to be a result of site facilities.

Bob Craig said that he feels Susan Kaplan’s point is well taken. It is important to know if the ORR site kicks a contaminant level up and over a screening level. ATSDR is doing a screening level right now. If some contaminants are over the screening level then ATSDR could take a look and when possible explain if a contaminant is also from an outside source. But right now, this discussion is about screening.

Al Brooks asked if the 0.14-ppm comparison value for mercury was comparable to the World Health Organization (WHO) and said that the WHO always sticks in his mind. Karl Markiewicz said that WHO’s value of 1.0 ppm is currently being reviewed and that ATSDR tends to follow EPA more than other organizations. Karl added that the children in the study with the highest blood concentrations of mercury showed no adverse health effects.

PCB Sample Locations of All Fish Species Handout (map)

Karl Markiewicz pointed out that there were 84 unique sample locations for mercury and 89 unique sample locations for PCBs. There were nearly 11,000 fish samples looking at PCB concentrations, about 5,300 of those were above the comparison value.

Sample Locations of All Fish Species PCB Concentrations>Comparison Value Handout (map)

Karl Markiewicz told the group that this map represents about 5,000 fish samples and also pointed out that the different fish species were broken out, such as bass, sunfish, and crawfish.

Gordon Blaylock asked which PCBs were being referred to. Karl Markiewicz said that the map corresponds to the first page/first section of the presentation. At this point in the screening, the group could be looking at Aroclors and/or total PCB congeners-everything is being looked at and ATSDR was driven by what the data offered.

Vegetation First Screen Summary Statistics Handout

Karl Markiewicz pointed out that vegetation was grouped together and that they tried to capture what they knew people ate. Ninety-four different chemicals were sampled, five off-site chemicals (all metals) had doses above the screening guidelines, and ten on-site chemicals had doses above the screening guidelines.

Al Brooks asked what Karl meant about five off-site chemicals with doses above the screening guidelines.

Karl Markiewicz said that when they calculated doses, there were five chemicals that were above the screening guidelines. Karl explained that this is the average of the maximum concentrations (for a specific contaminant) across data sets and that the maximum in a data set could be established by one sample. Karl emphasized that this is a conservative screening and that as the process continues; the process will become more refined.

Karl Markiewicz also pointed out that if a chemical was detected in less than 10% of the samples then that chemical was screened out. Karl added that for off-site, none of the chemicals were detected in less than 10% of the off-site samples.

Sample Locations of All Vegetation Species Handout (map)

Karl Markiewicz explained that the map shows the distribution of the samples that were taken. Karl also pointed out that the fish sampling was much more extensive than vegetation and game sampling.

Susan Kaplan asked how many samples were taken. Karl Markiewicz apologized for not having that information and said that he would find that information and pass it along.

Game First Screen Summary Statistics Handout

Karl Markiewicz told the group that he plans to explain that ATSDR took the average of the maximum concentration across the different animal species.

Karl Markiewicz told the group that 23 chemicals were detected in less than 10% of the off-site samples so those 23 chemicals would not continue throughout the screening process.

Sample Locations of All Game Species Handout (map)

Karl Markiewicz explained that the map shows a distribution of sample locations in the area.

Questions are comments regarding the entire presentation

James Lewis asked why the sampling was not consistent among fish, vegetables, and game.

Karl Markiewicz said that the difference is in the data itself. For PCBs there were nearly 11,000 data points, for game and vegetation there are not as many data sets available. Using the average of the maximum screening for fish is not appropriate, but using the average of the maximum for the vegetation and game was appropriate because it is a conservative method due to the fact that there was not as robust of a database.

Al Brooks said that he felt that ATSDR’s degree of conservatism is unpredictable. Al Brooks provided an example of getting a sample from the tomatoes on his property or going down and sampling the ones in the floodplain, he said that the results would distort the entire picture and could vary by a factor of 1000.

Karl Markiewicz said that he agrees. But for the screening process of vegetation and game and with the limited data sets, based on his experience Karl felt that this was the better way of doing it. Karl said that many variables come in and a lot is left up to the discretion of the health assessor and what they feel is most appropriate for each individual site. Karl added that he could go through and make everything consistent but there would still be some people who would disagree with that as well.

Tony Malinauskas had three questions. What were the sources of the data? If there were different sources of data at the same sampling point were the data consistent? Have you exhausted all data sources?

Karl Markiewicz said that all electronic data available in the system were used. There are other data sets that are either in paper form or ATSDR has not been able to receive them electronically. As of this meeting regarding trend analysis, Karl has not performed a trend analysis comparison. Karl told Tony that the trend analysis would be performed in the next phase.

Responding to Bob Craig and Tony Malinauskas, Karl Markiewicz said that he was using Oak Ridge Reservation Environmental Information System (ORREIS) data and state data.

Related to the average of the maximum concentrations over data sets, Al Brooks said that he would like to see a very detailed description of how data samples were selected because that could result in an order of magnitude or several orders of magnitude range depending on how many data points were kept and how many were rejected.

Susan Kaplan thanked Karl for the colored maps and said that it would be helpful if the number of samples taken could be included on each map as well as information regarding which samples were taken on-site and which were taken off-site. Karl said that he understood what Susan was saying.

Al Brooks said that PCBs have been variously estimated at 8-15% as coming from the site. If that is true and the 8% kicks the level over a screening level or a comparison value, it will do very little good to recommend that DOE sites reduce their outflow.

Karl Markiewicz said that ATSDR would not make a recommendation that is a regulatory decision. Instead, ATSDR’s recommendation would be related to public health-for example, an advisory to pregnant females to not eat a certain food. And if ATSDR did make such a recommendation it would not matter where the PCBs came from because the concentration is already in the fish in the river.

Al Brooks said that he believes ATSDR’s guidelines include making recommendations for limiting releases. Karl Markiewicz responded that in a simple case where there is only one industry in the area producing a certain contaminant, ATSDR could make a recommendation. However, with a situation like PCBs in fish, Karl cannot see the agency saying that DOE needs to limit its outflow. At this point in the process, ATSDR does not have enough data to say that output is coming from a particular source.

Kowetha Davidson pointed out to Al Brooks that in just a screening of chemicals the source could not be distinguished.

Susan Kaplan said that from a public health standpoint it is critical to look at total exposure and the impact of the total exposure.

Gordon Blaylock asked if deer were included in the game species. Karl Markiewicz responded that in the data set he used deer were not specifically identified.

Bob Craig asked if Karl would be presenting this information at the December 2nd ORRHES meeting. Karl said that some form of this presentation would be made at the December ORRHES meeting but he did not know if he would be physically present at the meeting.

New Business
/> Letter for EPA

Kowetha Davidson read aloud and distributed a draft letter that she planned to send to EPA on her behalf as Chair of ORRHES (Handout Two).

In general, the group thought that the letter was good and suggested that it should be sent to the appropriate people, whoever they might be. The group did not make a definitive decision regarding who should receive the letter.

Pete Malmquist moved that the draft letter that Kowetha Davidson presented be sent to the appropriate people at EPA. The motion received a second.

Motion voted on:
/> The draft letter that Kowetha Davidson presented to the PHAWG should be sent to the appropriate people at EPA.

The motion passed.

New Business
/> Work group chairs report form for ORRHES-Kowetha Davidson

Kowetha Davidson presented a template that she feels will address the issues of work group reports (Handout Three). Kowetha explained that the template is simple and it is meant to be simple, uncomplicated, and short. The purpose of the template is to record key points and indicate recommendations that occurred during the work group meetings. Kowetha suggested that the chair of each work group fill out the template after each meeting. Kowetha said that this template would allow the subcommittee members to have a short outline of what went on in the various work group meetings so that ORRHES is kept current on the key issues.

Kowetha Davidson clarified that the recommendations that should be included are the recommendations that will be going to ORRHES. Kowetha added that the recommendation could also be attached to the template if need be.

Al Brooks suggested that the recommendations included on the template should be complete recommendations that are not vague; any recommendation included should be ready for action by ORRHES.

Kowetha Davidson said that she would like to see the templates included in the pre-mailing packets.

James Lewis complimented Kowetha on the template concept. James went on to say that it is important that the work groups and ORRHES have good agendas with clear objectives identified. James complained about meetings with such vague agendas that people do not know the reason that they should attend a meeting.

Bob Craig asked James Lewis to provide an example of a meeting with an agenda that he did not think was adequate. Bob Craig said that he is satisfied with the agendas.

James Lewis reiterated that some agendas are not adequate. He also added that there are other work groups whose agendas are frequently inadequate. James went on to say that if the items up for discussion are not clearly defined, people could not properly prepare for the meeting. James said that the November 6th PHAWG meeting did not have a clear agenda.

Bill Taylor said that the November 6th PHAWG agenda had only one major item, which was the EPA issue. What Bill knew about that meeting was that Al Brooks and Susan Kaplan had resolutions and motions that they wanted to present to the PHAWG. However, Bill did not know the details so he did not include any details regarding the resolutions on the agenda. Bill added that there is a lot of variance in regard to what is going on prior to each work group meeting and that often ATSDR does not always know what will be discussed until late in the process.

Al Brooks said that he feels that James Lewis is alluding to the fact that at the November 6th meeting Al came in loaded with new motions. Al said that it is true that he did come in loaded with new motions. Al went on to say that he did not present three of the five motions because he heard through the grapevine that those motions would be taken care of—and they did get taken care of. Al said that he feels it would be advantageous if people who know they are going to submit a motion would get the motion to Bill so that he can distribute a copy prior to the meeting when possible. Al thought that it would also be helpful if any reference documents that should be reviewed prior to the discussion of the motion were numbered and available so that people can better prepare for the work group meetings.

New Business
/> Unscheduled new business

Susan Kaplan proposed that during ORRHES meetings, ORRHES members vote on the recommendations as they are introduced during the work group reports. Susan said that she realizes that at one point ORRHES changed the voting order to allow members of the public to come. However, as the voting process is being drug out, the ORRHES is losing voting members.

Kowetha Davidson said that the reason that the group decided to hold off the voting was because there was some concern from some subcommittee members that [at this point Kowetha was interrupted and the rest of her statement could not be heard].

Al Brooks said that he agrees with Susan Kaplan because if a motion is brought to the ORRHES and the background is reviewed and then the vote is put off, then the same information needs to be presented again.

Kowetha Davidson suggested that Susan Kaplan bring up the issue at the next ORRHES meeting as well as in an Agenda meeting since it would change the way the agenda is organized.

Pete Malmquist said that he also agrees with Susan because what ends up happening is the same thing is discussed twice. The group ends up going back through the original discussion. If a person is truly unhappy with a motion they should bring it up when the motion is brought to the floor and not later.

Al Brooks would like to see copies of the resolution/motions that will be discussed during the ORRHES meetings included in the pre-mailing packet and available prior to the ORRHES meeting.

In response to previous concerns about public comments on important issues, Kowetha Davidson said that the Chair could ask for comments from the public before a vote takes place.

Susan Kaplan will prepare a resolution regarding this issue if she chooses to do so.

New Business
/> Unscheduled new business

Regarding the cancer incidence review, Pete Malmquist told the group that there is still no resolution regarding whether the State of Tennessee will provide ORRHES and ATSDR with combined data from 49 census tracts. Pete told the group that ORRHES and ATSDR are guinea pigs for the State’s new process of releasing data. Pete made the suggestion that if the State refuses to release the census tract data, that the group use political pressure to get the census tract data from the State of Tennessee.

Bill Taylor added that after the original agreement that the State would supply census tract data, the State said that the rules had changed. ATSDR is still pursuing this issue.

Pete Malmquist said that Dee Williams would still like to have the final cancer incidence review report finalized by February. However, the timeline would be impacted by the length of time that it takes the State to respond to ATSDR’s request.

New Business
/> Unscheduled new business

James Lewis passed out a handout to the group that included a four-paragraph write-up about the importance of health outcome data and provided six statements regarding ATSDR’s Y-12 Uranium Releases PHA and Health Outcome data. Also included in the handout were Figure 8-5 Health Outcome Data Evaluation Decision Tree, Figure 1-1 Basic Components of the Public Health Assessment Process, and Figure 2-3 Information Needed to Evaluate Exposures and Health Effects (Handout Four). The three figures were from the Public Comment version of ATSDR’s Guidance Manual (2002).

James Lewis said that his review of the Public Health Assessment (PHA) titled “Y-12 Uranium Releases” revealed that the Y-12 PHA does not include a formal discussion and review of the medical, toxicologic and epidemiologic studies and data collected in disease registries in accordance with Section 1.2 of the ATSDR 2002 public comment version of the Public Health Assessment Guidance Manual (PHAGM).

Referring to Figure 2-3, James Lewis said that there are two major components in the PHA. One component is the exposure evaluation and the other is the health effects evaluation. Components of the health effects evaluation are the medical data, health outcome data, and toxicologic data. James went on to say that everything he read in the Y-12 Uranium PHA appeared to be associated with exposure evaluation and not health effects evaluation. The PHA as defined in ATSDR’s literature includes environmental data, exposure data, health effects data, and community concerns. The health effects data is equivalent to the health outcome data. James said that he is concerned by the absence of having the health outcome data component included in the Final Y-12 Uranium PHA. James said that it is ATSDR’s right to do as they see fit. However, James questioned whether or not ORRHES as a group would endorse a document that had a missing component as defined by ATSDR’s own program.

James Lewis reminded the group that ATSDR had not provided logic or reason for the health outcome data component not being a part of the Y-12 Uranium PHA effort. Jamessaid that a programmatic weakness exists within ATSDR and that issuing a document of great significance without a health outcome section is very bad judgment. James made several suggestions, which included:

1. ATSDR should include in its Y-12 Uranium PHA, a complete listing and summary of health outcome data sources for the area around the Oak Ridge Reservation, and formally evaluate those data where appropriate.
2. If ATSDR chooses to not include a summary and analysis of health outcome data, it should re-title its PHA as an Exposure Evaluation.

James Lewis felt that the health outcome portion of the Y-12 Uranium PHA should have started early in the PHA process so that time would permit disease registries to be evaluated as well as the evaluation of other health outcome data.

Pete Malmquist said that at the October ORRHES meeting, Jeff Hill brought up countywide problems with heart disease. Heart disease is not a reportable disease, only infectious diseases are reportable. Neither heart disease, prostate disease, nor kidney disease are reportable diseases. Most information reported in disease registries will not be related to contaminants. Pete said that there is not a good basis for health in the State of Tennessee. Pete added that for cancer there is cancer incidence data available because by law, cancer incidence must be reported.

Regarding mortality data, Pete Malmquist said that he could have ten different diseases and die in a traffic accident and the traffic accident is what would be reported as Pete’s cause of death.

Pete Malmquist said that the Y-12 Uranium PHA showed no public health effect from uranium releases. Pete then asked why ATSDR should dig up health outcome data when there was no cause for it in the first place. Kidney disease is the largest effect from uranium. However, kidney disease is not reportable: What will ATSDR and ORRHES do?—go door-to-door collecting urine samples? If the group did go door-to-door and found that people had protein in their urine what would that prove? Pete Malmquist does not want to see the ORRHES go down a street that does not have an end to it.

James Lewis projected Figure 8-25 from the PHAGM onto the wall. James said that what he read in the PHAGM is that if there are enough concerns in one particular area that area should be looked at closely. James said that he did not see a discussion related to health outcome data in the body of the Y-12 Uranium PHA. What the Y-12 Uranium PHA did say is that cancer will be evaluated at a later date. James Lewis said that it is his understanding that the Joint Centers looked at cancer data. Thus, an evaluation of the existing data (such as the previous cancer data) should be included in the PHA so that the general public has some idea as to what is going on with health outcome data.

Concerning health outcome data, Kowetha Davidson asked what the added value would be to the Y-12 Uranium PHA. Kowetha felt that the issue of health outcome data should be addressed when the entire PHA effort comes together. Kowetha felt that it would not add any value to try to have health outcome data for each individual PHA, especially when the level of a contaminant is not of health concern. Kowetha said that there is a disconnect between the exposure evaluation and the health outcome data if there are not levels of a contaminant that prove to be of concern. There needs to be a level of concern, if the amount of a contaminant has not reached a level of concern, then that contaminant cannot be related to a particular health outcome.

James Lewis said that he is not trying to relate exposure to health outcome; he is just trying to get information into the public. The public has concern and a perception about health issues; those key issues and perceptions must be addressed. How are ATSDR and ORRHES going to address the issue of perception? What will be said to the community as it relates to a particular contaminant of concern?

Kowetha Davidson said that it is important to communicate to the public that health outcome data will not be addressed in each individual PHA; it will be addressed at a later date in one document. Kowetha said that she was not saying that health outcome data should not be explained overall, she just does not see the added value of repeating the same information in each individual PHA.

Jack Hanley said that early last year, a PHAWG Ad Hoc group discussed the issue of health outcome data, which led to the cancer incidence review that is currently being performed. Cancer is a main concern of people and that is why ATSDR is going forward with the cancer incidence review. The other main issue in Scarboro was the respiratory problems in the children. The Y-12 Uranium PHA contains a detailed discussion about the respiratory issues in Scarboro children. With regards to uranium, the estimated exposure doses were very low and adverse health outcome is not expected from the low doses.

Jack Hanley said that kidney disease has a variety of other causes besides uranium. In fact, other contaminants have more of an impact on the kidneys than uranium does. Also, kidney disease is not a reportable disease. Jack said that he has not heard concerns voiced about kidney effects. In addition to that, because of the low exposures to uranium, ATSDR does not expect kidney effects to have occurred. Jack understands James Lewis’s frustration in trying to communicate exposure. In Jack’s opinion, the problem is developing a communication tool to explain to the lay public what the results of the PHA were.

James Lewis said that he agreed with Jack Hanley as related to the current exposures. However, people in the community are interested in the past exposures. James Lewis’s point is that if there are existing data related to the past those data should be shared.

Jack Hanley asked James Lewis to identify which data he is referring to.

James Lewis said that he is talking about cancer data that could be associated with uranium.

Jack Hanley said that ATSDR would be looking at cancer in the cancer incidence review. Jack Hanley added that in the PHAGM, Figures 8-23, 8-24, 8-25, and 8-26 explain the health outcome data process. Included in these figures is a decision tree that was reviewed with the Ad Hoc group and that is how the decision to perform a cancer incidence review was made by the PHAWG.

Jack Hanley said that he understands that ATSDR needs to get out and work with the community to get its message and findings delivered in a way that the lay public would understand and believe.

Al Brooks said that ATSDR’s guidelines seem to imply that when it is appropriate (when there is exposure), health outcome data would be examined. Al Brooks felt that at some point in the PHA process, ATSDR should plan to look at the subjective concerns as well as the objective concerns.

Bill Taylor said that there are a finite number of studies and databases available for the populations in this area, those studies and databases should be identified, summarized and analyzed when appropriate. CDC has mortality data from all of the states. The National Cancer Institute performed a study involving all DOE sites. As Kowetha Davidson pointed out, logistically there is a problem as to where to put the health outcome data because most of the health outcome data will not be useful or specific to one contaminant of concern.

Jack Hanley added that there are a number of evaluation investigations that could be considered. He added that all previous work relating to health outcome data could be compiled and put together in one single document.

Tim Joseph felt that the Iodine-131 PHA would be incomplete without a valid health outcome data section included.

Pete Malmquist pointed out that thyroid disease is not a reportable disease and that there are not databases available for thyroid disease.

Kowetha Davidson said that she saw merit in summarizing health outcome data in one document. She added that there are 18 months left before ATSDR and ORRHES should be finished with the PHA work. Kowetha does not want to see more work added if the value that it will add is minimal.

James Lewis said that a number of people have said that all ATSDR and ORRHES do is reiterate the Dose Reconstruction. James added that ATSDR and ORRHES lose site of the fact that there is a section of the community who is focused on a perception of what diseases exist due to contaminants. A documented approach concerning health outcome data should be laid out at the beginning of the PHA process so that the public understands the process and knows what they can expect.

Kowetha Davidson said that she does not want to give the community the false impression that certain diseases are a result of exposure when that is not the case.

Votes/Specific Actions Taken in the Meeting

The draft meeting minutes for the October 20th PHAWG meeting were approved.

The following motion passed: The draft letter that Kowetha Davidson presented to the PHAWG should be sent to the appropriate people at EPA.

Action Items

Karl Markiewicz will specify mercury as either organic or inorganic in the list of chemicals in fish with subsistence-level exposure doses that exceeded screening guidelines.

Regarding methylmercury in fish, Karl Markiewicz will take another look at his mercury data to see why his results seem to be contradicting results that have been found in other studies.

Karl Markiewicz will explain in writing how PCBs and mercury data are being looked at and the meaning of the results.

Karl Markiewicz will get the information that he can regarding the profiles of comparison (background) samples so that the samples from East Fork Poplar Creek, Clinch River, Watts Bar Reservoir, and on-site can be compared to them.

Karl Markiewicz will find out how many samples were taken for vegetation and for game.

Karl Markiewicz will consider indicating on the maps how many samples were taken and if the samples were on-site or off-site.

Susan Kaplan will prepare a resolution that during ORRHES meetings, ORRHES members vote on the recommendations as they are introduced during the work group reports instead of waiting until later in the meeting.

The meeting was adjourned at 8:15 PM.