ORRHES Meeting Minutes
November 16-17,
2000
Table of Contents
NOVEMBER
16, 2000
Opening Comments
NOVEMBER 16, 2000 Opening Comments
Subcommittee Introductions
Presentation on the FACA
Discussion
Overview of the Subcommittee
Charter
Ethics Video and Discussion
Letter from NIOSH to the ORRHES
Overview Presentation of ATSDR
Discussion
Public Comment
Scope of the Subcommittee
Discussion
Presentation of the Public Health Assessment Process
Discussion
Public Comment
NOVEMBER 17, 2000
Presentation of ATSDR Needs
Assessment
Discussion
ORRHES Guidance Document
Presentation/Discussion
Discussion
Public Comment
Continuation of Process Guideline Discussion
Discussion of Work Groups
Public Comment
Committee Planning Discussion
Closing Comments
Attachments
Summary of the Meeting
The first meeting of the Oak Ridge Reservation Health
Effects Subcommittee (ORRHES) was held on November 16-17,
2000 under the auspices of the Agency for Toxic Substances
and Disease Registry (ATSDR) and the Centers for Disease
Control and Prevention (CDC). All but two members were
present, plus all three state agency liaisons and several
members of the public.
The members were thanked for their willingness to serve
on this Subcommittee, which is a key component of ATSDR's
outreach to the Oak Ridge community. It will provide advice
and recommendations to ATSDR and CDC, particularly in prioritizing
and determining how to evaluate health issues and community
concerns, and to determine the public health responsibilities
suggested. That advice will be taken seriously and responded
to.
After the members and liaisons introduced themselves,
committee education began. Presentations were heard and
a video was presented on the Federal Advisory Committee
Act (FACA), under which the ORRHES was chartered. The FACA
was created to prevent advisory committees from being dominated
by any one viewpoint or special interest. It is the only
way that consensus advice can be provided to an agency,
which must respond to the advice and recommendations. The
basic FACA procedural guidelines were explained pertaining
to the committee function, meetings, membership, Designated
Federal Official (DFO), Chair, quorum (50% + 1), Member
compensation, conflict of interest regulations and standards
of ethical conduct. An overview of the Subcommittee's charter
was also provided. It can have up to 30 members; 20 of
whom are currently seated. They have overlapping 4-year
terms and serve until replaced.
Agency presentations began with a letter read from National
Institute for Occupational Safety and Health (NIOSH). It
requested time on the second meeting's agenda to outline
NIOSH's mission and research agenda at Oak Ridge, and its
role in the Energy Employees' Occupational Illness Compensation
Program. An overview of ATSDR's general mission was provided
(to conduct public health assessments, establish and maintain
toxicological databases, disseminate information on exposures,
and provide medical education to health care providers
on the health effects of environmental contamination).
The Subcommittee's discussion questioned what interactions
among chemicals ATSDR is exploring; why Oak Ridge was not
yet assessed as a Superfund site, the area selection method
for siting an environmental health clinic; whether ATSDR
an use classified information; the relative danger of exposures
to community versus workers; ATSDR's ability to examine
cumulative impacts from low background originating from
other than the ORNL; how a public health assessment is
conducted; and how chemicals not listed or profiled are
addressed.
Public comment was solicited several times in the meeting.
Responders included a member of the former committee, the
Oak Ridge Health Agreement Steering Panel (ORHASP), who
described that work, and several former and present ORNL
workers. The latter described their work and its then-unknown
hazards. They: 1) asked how to find out what and how much
they might have been exposed to; 2) hoped the ORRHES would
help facilitate closure of the debate about health effects
in Scarboro to reduce the community's anxiety, and to try
to ensure that future studies do as little harm as possible.
The members noted that these speakers were both residents
and workers, involving double exposures; and that beyond
an understandable, well-done report, closure also involves
the community's belief and confidence in the work done.
The scope of the Subcommittee was presented by the agency
and discussed. In the ensuing discussion, the members asked
the ORRHES' relationship to the other agencies formerly
on the Public Health Work Group; requested a listing of
the recommendations made over time by the other Subcommittees,
and the response to them; that recommendations pertaining
to another agency be forwarded and that NIOSH have a liaison
member; that a comprehensive survey of the ORNL community
(asking if people are concerned about their health) useful
for multiple research purposes should have been done; noted
great community distrust of DoE and its contractors' data;
suggested review of a 1994 survey of the 8-county area,
the report of which cited about 3400 concerns; recommended
that the ORRHES member appointment process be clearly conveyed
to the community (which may hear that the "wrong people" were
appointed); how to reach consensus; that emotions as well
as numbers have to be dealt with, among the community and
directed to both the scientists and perhaps the Subcommittee
members as well. Expectations should not be raised and
science's lack of all the answers must be acknowledged.
A presentation of the Public Health Assessment (PHA) process
was provided. It will analyze and evaluate the information,
data, and findings from previous studies and investigations
on the radiological and chemical contaminants released
from the Oak Ridge Reservation. With the Subcommittee,
it will be decided what can be used in the public health
assessment. The primary sources of information for the
PHA were described (environmental and health data and expressed
community concerns). The subsequent discussion noted that
1) how the Tennessee Cancer Registry data could be used;
asked for examples of follow-up actions to PHAs done; how
the ORRHES will relate to the PHA's development. Other
significant questions asked were what to tell those members
of the community who don't want any more surveys/research,
but practical help, if ATSDR offers no medical treatment;
whether the viewpoint of community members who do not want
any more studies, but just care, was represented on the
Subcommittee (yes); what the Subcommittee can conclude
when disease causation is probably not provable, but only
an association. It was concluded that the Subcommittee's
must be made very clear, and caution exercised to avoid
raising expectations, while at the same time doing everything
possible to refer people with needs that the ORRHES cannot
meet to appropriate sources. The degree to which this Subcommittee
can clarify the causes of risk and perhaps health outcomes
also will help the community, or it will be seen as just
another committee that said it would help and didn't.
A presentation of ATSDR's needs assessment was provided,
which gauges the concerns, strengths, and resources in
a community. Its steps were described. Knowledge (about
subjects related to the site, such as about science or
disease), 2) attitudes (that influence message delivery:
trusting, suspicious, or overwhelmed by the situation),
and 3) behaviors (that contribute to healthy or unhealthy
lifestyles, such as children eating dirt) are explored,
as are the community, social, and local political structures,
accessibility and adequacy to health care, opinions of
the local media, local social services available, and identification
of key community leaders. ATSDR's specific plans for the
Oak Ridge needs assessment were outlined. It will be done
under a cooperative agreement with the Association of Occupational
and Environmental Clinics. They have engaged George Washington
University (GWU) to conduct the needs assessment. Their
researchers will come to Oak Ridge to discuss their assessment
plans with this Subcommittee. GWU's capabilities were praised
by one committee member.
The Subcommittee's discussion addressed how ATSDR would
reach everyone on this diverse community; what the agency/Subcommittee's
response would be if a non-ORNL (i.e., industrial) entity
was found to be a polluter; how long the assessment would
take; ATSDR was requested to provide a completed needs
assessment as an example; why ORISE would not be doing
the Oak Ridge work; whether the needs assessment would
address of the community's perceptions and fears; a suggestion
was offered to use the same community as the SSAB; and
an expectation expressed that the public would continue
to be divided in opinion.
The ORRHES guidance document was presented in detail and
discussed. A living document of five sections, Sections
1-3 provide the purpose and history of the Subcommittee,
its organizational structure and roles, and provides process
guidelines. ORRHES members provided input in writing prior
to the meeting, and during the review, on 1) the described
Subcommittee organization (specifically, the components
of the organizational flow chart); 2) work groups (the
manner of community members participation – the importance
of recognizing the people who work on a work group was
stressed); 3) process guidelines (requiring a simple or
super majority for a vote to pass);
In public comment, it was asked when the local people
get the benefit of this committee, or would it produce
more papers for the Reading Room? The destination of all
this work must be defined, to indicate why the public should
contribute; otherwise, the unions, at least, would not
help. One disabled person related her decision not to participate
on this committee because she would lose her disability
benefits. She stressed that the citizens must be able to
provide input and impact to the work group meetings. While
she had little hope for gains from this board, she challenged
it to get something positive done to give the community
a product useful to help the public's health. Another speaker
stated that the assessments and studies had already been
done, and the community can say by whom, of what, and where.
He wished this committee would move to validate what is
already known, because the community does not need 9 more
years of being told what they already know. But another
speaker testified to the independence of at least a few
members of this committee and thought that a big step forward
in Oak Ridge's process.
The process guideline discussion continued. There was
much discussion of enlisting the participation of an sick
worker (and concern expressed that this would not be seen
as a derogatory term). The wish was expressed to get whatever
waivers are necessary, to allow such a person to be paid
to participate without the risk of losing their benefits.
However, this is outside of ATSDR's control and the Subcommittee's
mandate. Since there is an outstanding invitation to participate
to someone who self identified as a "sick worker," and
since some members were selected because the ORHASP findings
indicated them to be at high risk, the Subcommittee's patience
until the next meeting to address this membership gap was
requested. First, an interested person must be identified,
and time is needed until the pending invitation is answered.
A Subcommittee letter to request that person's participation
was suggested by one member, to be forwarded through ATSDR
since that agency cannot reveal his/her name. Another member
wondered if the disabilities-benefits problem could be
resolved by enlisting community members who were adversely
affected just by living here.
After a brief presentation on the work groups formed by
the other subcommittees, it was agreed to form three ORRHES
work groups to address Guidelines and Procedures, the Program
of Work and Agenda, and Communications and Outreach. The
activity of the first was expected to be sporadic after
an initial intense focus, and the second and third to be
ongoing.
Committee planning included an ATSDR announcement that
a permanent ATSDR storefront office would be open by January,
to operate during normal business hours, five days a week.
Alternate meeting sites than the YMCA were suggested. Eight
action items were summarized, as were the next meeting's
potential agenda items. The Chair agreed to appoint the
Work Group Chairs shortly, to allow them to begin work.
The members tentatively agreed to meet on January 18-19,
2001.
The closing comments of the members to summarize their
perception of the meeting were generally very positive,
although the challenges were often acknowledged and some
ambivalence was expressed. The critical importance of how
to address the issues raised in the public comment periods
was discussed, and the need for a process to ensure that
feedback occurs.
Motions passed during the November 2000 meeting:
- The Procedures Work Group, when appointed by the Chair,
consider the Draft Operational Guidelines and the comments
received, and recommend on them to the full Subcommittee.
- Standing work groups will be appointed by the Chair:
1) a Guidelines and Procedures Work Group; 2) a Program
of Work and Agenda work group; and 3) a Communications
and Outreach Work Group; and that 4) other ad hoc work
groups be appointed as needed.
Action Items Created at the November, 2000 Meeting:
- ATSDR will provide a copy of the summary of the Oak
Ridge Health Assessment Study Panel.
- CDC and ATSDR will provide a listing of the recommendations
made over time by the other Subcommittees, and what happened
in response.
- ATSDR will provide a completed needs assessment to
the committee as an example.
- Committee Management and CDC's Office of General Counsel
will explore the regulations and procedures of what Subcommittee
work groups can and cannot do. Mr. Pereira will advise
the Subcommittee within 30 days of the formal procedures
found, if any.
- ATSDR will try to provide copies of the independent
investigation of the East Tennessee Technology Park study
report provided by Norman Mulbennet (two bound volumes).
- A PCB toxicological profile will be provided for Dr.
Eklund and Mr. Akin.
- Dr. Brooks will meeting with Ms. Bush on a compendium
of Oak Ridge-related data.
Department of Health and Human Services
Agency for Toxic Substances and Disease Registry
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