Oak Ridge Reservation: Public Health Assessment Work Group

Public Health Assessment Work Group

September 2, 2003 - Meeting Minutes

Attendees:

ORRHES members attending:
Bob Craig, Chair
Kowetha Davidson
Bob Eklund
Susan Kaplan
James Lewis
Pete Malmquist
LC Manley

Public members attending:
Janine Voner Anderson (phone)
Gordon Blaylock
Walter Coin
David Fields
George Gartseff
Timothy Joseph
Mike Knapp (phone
)John Merkle
Janice Stokes (phone)
Sally Tinker (phone)

ATSDR staff: Jack Hanley (phone), Bill Murray

The meeting was called to order at 5:30 p.m., by Bob Craig, Chair. Members present and on the phone introduced themselves.

Bob Craig then reviewed the agenda.

1.) Minutes of PHAWG meeting on February 4, 2002, were not available for review.

2.) Letter to Henry Falk, MD, Assistant Administrator, ATSDR - In the meeting on February 11, 2002, the ORRHES had recommended that the PHAWG send a letter to Dr. Falk, ATSDR Assistant Administrator, requesting that he write to Dr. Allen Craig, Tennessee Department of Health. The letter would urge Dr. Craig to make available all of the references from the Oak Ridge Dose Reconstruction (ORDR), including the interviews conducted by ChemRisk, to the public in Oak Ridge.

Timothy Joseph, DOE-ORO, presented the Oak Ridge Health Agreement Steering Panel (ORHASP) data process used in the ORDR. The interviews are in the ChemRisk repository listing on the ORDR CD-ROM, along with information on the references cited in the ORDR. The complete text of all the references has been reproduced on 19 CD-ROMs. A copy has been provided to the Oak Ridge Field Office. He thinks that the need for such a recommendation has been superseded.

Bob Eklund made a motion regarding the initial ORRHES recommendation to Dr. Falk regarding the references and interviews from the ORDR that was seconded by Susan Kaplan.

MOTION - The Public Health Assessment Work Group recommends to the Oak Ridge Reservation Health Effects Subcommittee that the letter to Dr. Henry Falk, Assistant Administrator, Agency for Toxic Substances and Disease Registry, regarding the need for public availability of the references and interviews for the Oak Ridge Dose Reconstruction, not be sent in light of what we have learned about it.

Bob Craig was concerned that the public could still interpret that the information is not available.

The motion carried unanimously.

3.) DOE worker surveillance program - James Lewis introduced the topic with a video prepared by the Paper, Allied-Industrial, Chemical, and Energy (PACE) Union. He stated that he had accessed the DOE web site on the Former Workers Program and presented an overview of the information on the web site, including the history, the Pilot Projects (Phases I and II) and progress reports. In Oak Ridge, only construction workers and production workers at K-25 are included in the pilot projects.

Janine Voner Anderson asked if the medical tests depended on the worker’s exposure and if there are no records, how do you know what the exposures were.

Bob Craig said they can use job titles.

James Lewis went on to describe the exposure assessment done by University of Massachusetts (UM) at Lowell in the PACE study. He showed the flow diagram for the work in Phase I.

Janine Voner Anderson asked if the workers for the construction sub-contractors were included.

James Lewis talked about the risk mapping that UM had done based on interviews to supplement the exposure records.

Jack Hanley asked what the basis for the risk mapping was.

James Lewis replied that they used worker epidemiological studies and the Oak Ridge Dose Reconstruction, the same information ATSDR is using in the public health assessment, and that UM had high confidence in the data.

Bob Craig remarked that that’s not where they have found health effects. They are toxicological-based; the effects are known from the toxicology literature.

Susan Kaplan said the exposures are based on self evaluation.

Timothy Joseph said that they used the SENES data.

Janine Voner Anderson asked for information about how much is the toxic amount.

Bob Craig said that depends on the person.

Mike Knapp said that nobody knows what went on in the 1940s-1950s. The threshold for illness is a difficult issue for the Energy Employees Occupational Illness Compensation Act. They may know something about the toxic effects from single exposures but combined exposures (synergistic effects) are still a problem and science lags reality. Nobody is doing clinical evaluations.

LC Manley asked if they’re looking at uranium, why are only K-25 workers included?

Mike Knapp remarked that they are also looking at medical records of workers for individual diseases but this is not being done in the general public.

James Lewis continued that the needs assessment was reviewed by NIOSH but that Phase II is not included. He is getting a copy of the needs assessment report.

Mike Knapp asked where we were on the clinic issue.

James Lewis said the issues and concerns regarding Phase I need to be compiled. In the discussion, the following issues were raised:

• add contractors and sub-contractors
  
• funding and legislative issues - justification for program, history, funding, legislative process
  
• why not workers at other ORR sites than K-25
  
• beryllium sensitization
  
• contamination at non-production buildings
  
• take home contamination
  
• why only PACE workers

Susan Kaplan said the issues and responses should be posted on the web site.

4.) Issues concerning the presentation by Health Resources and Services Administration - Jack Hanley reported that Bill Carter (ATSDR) developed a list of issues and concerns from the videotape of the presentation and the meeting minutes. He read and distributed the list.

John Merkle asked about the number of clients needed (2500).

Pete Malmquist said that the Veterans Administration has the same criterion (2500). It is a large number of people and the driving distance is 30 miles. Regarding the medically underserved criterion, Oak Ridge will have an upward battle.

James Lewis said the trust in the physicians here is a major issue.

Susan Kaplan mentioned competence since many physicians here can’t handle occupational health issues.

James Lewis said PACE has a medical education program but asked again if the people trust the doctors.

Pete Malmquist said you have to educate the doctors on environmental illnesses.

Bob Eklund said you have to educate the doctors on whom to refer the patient to.

Janice Stokes said the number of clients and the driving distance are both problematic. We have to find out how to get around the regulations. There are no doctors here to treat nickel poisoning. The doctors don’t recognize synergistic effects.

Jack Hanley responded to Pete Malmquist that ATSDR has done physician training on polychlorinated biphenyls (BCPs) and cyanide.

Janice Stokes asked if it had any benefit.

Jack Hanley replied that it resulted in counseling patients about their exposures and referrals to specialists.

Janice Stokes asked if the referrals were helpful.

Sally Tinker remarked that high levels of cyanide can cause memory problems.

Jack Hanley stated that the closest clinics that belong to the Association of Occupational and Environmental Clinics are the University of Cincinnati and Emory University, both of which have specialists in Occupational and Environmental Medicine.

5.) Screening maps - These are maps that show the location around the ORR where environmental sampling has been done for various chemicals.

There was considerable discussion on this topic. The WG members want to know what type of sampling was done and where and when it was done for each contaminant of concern (COC).

Jack Hanley said that ATSDR has not yet done the screening process for current exposures and that the generation of these maps would slow that process down.

Motion: The Public Health Assessment Work Group recommends to the Oak Ridge Reservation Health Effects Subcommittee that they urge the Agency for Toxic Substances and Disease Registry to expedite the generation of maps (in color) showing where all soil, water, air sampling was done for each contaminant of concern as soon as possible because of the importance of this information to the credibility of the public health assessment.

There was additional discussion of the purpose of the maps and their effect on the public health assessment.

Motion carried with 10 yes votes and 2 no votes.

James Lewis said he would make a presentation about Scarborough to inform the W.G. about what happened there.

The next meeting will be on April 1, 2002, followed by a 2nd meeting two weeks later (April 15).

The meeting was adjourned at 8:00 p.m..