ORRHES Meeting Minutes,
March 19-20, 2001
Table of Contents
MARCH 19, 2001
Opening Discussion
Presentation on Roberts Rules
of Order
Presentation of the Public
Health Assessment, Steps 1 and 3
Public Comment
Presentation/Discussion of
the Health Needs Assessment
Health Needs Assessment Work
Group Report
Public Comment
MARCH 20, 2001
Health Effects Subcommittee
Evaluation Report
Findings: Cross-Cutting Issues
Recommendations on Cross-Cutting
Issues
COSMOS Evaluation Findings
Public Comment
Presentation of the HHES Web
Page
Work Group Reports
Agenda Work Group
Procedures and Guidelines Work
Group
Communications/Outreach Work
Group
Health Needs Assessment Work
Group
Unfinished Business
Report on EPA Sampling
Geographic area of interest/phone
survey
Seating a DOE Liaison
New Business
Public Comment
Housekeeping/Closing Comments
Attachments:
Summary
of the Meeting
The Agency for Toxic Substances and Disease Registry (ATSDR)
and the Centers for Disease Control and Prevention (CDC)
convened the third meeting of the Oak Ridge Reservation
Health Effects Subcommittee (ORRHES) on March 19-20, 2001.
All but two members were present. All the Subcommittee state
and federal liaisons attended, as did agency staff were
present from ATSDR, CDC, DOE, and the EPA, and several members
of the public. Ms. La Freta Dalton, the Subcommittee's new
Executive Secretary, was introduced.
Motions to approve the agenda and the minutes of the last
meeting were approved. The Chair reported correspondence
to the Subcommittee since the last meeting, and announced
ATSDR's solicitation for a worker representative member.
The action items from the previous meeting had all been
completed.
A presentation was provided and the committee members participated
in a demonstrative skit on Roberts Rules of Order
to familiarize all with them. Use of these rules is a component
of the Subcommittee bylaws. The main concern expressed about
using Roberts Rules was that they be used appropriately,
and not to stifle the process.
A presentation was provided of Public Health Assessment
process, Steps 1 (evaluate site information) and
3 (determine the contaminants of concern - chemicals and
radionuclides - and any completed pathways to the public
offsite). ATSDR was beginning Steps 1 and 3 as of this meeting.
Step 2, identifying health concerns, has been ongoing and
will continue. Subsequent steps' work was outlined. ATSDR
will use the report of the 1993 Tennessee dose reconstruction
feasibility study, which: 1) described historical operations
and releases of the X-10, Y-12, and K-25 plant facilities.;
2) identified available environmental data collected and
analyzed over the years (by the state, EPA, TVA, and others);
3) identified complete exposure pathways; and 4) evaluated
environmental exposure pathways. The findings of these four
tasks were outlined .
The released contaminants identified included: 1) for X-10:
uranium, argon, plutonium, and various fission products.
Particular problems were the unfiltered stack and releases
of iodine and fission products of the Radioactive Lanthanum
(RaLa) process; 2) Y-12: uranium, mercury and magnesium
99; 3) the K-25 gas diffusion processes released uranium
and magnesium 99, and the mid-1940s liquid thermal process
had consistent mechanical problems.
The dose reconstruction dropped some contaminants from
consideration due to their use of small quantities or in
processes believed not to have been released offsite (radionuclides,
lithium, benzene, and chloroform), or those of little or
no toxicological impact, even in large quantities (Freon,
acids and bases like fluorine and fluorine-type compounds).
The Oak Ridge Health Assessment Steering Panel (ORHASP)
received a detailed dose reconstruction analysis of the
screening's identified four priority contaminants: I-131,
cesium, mercury, and PCBs. They also reviewed a screening
analyses for other contaminants screened out in Task 4 (uranium,
arsenic, beryllium copper, lithium, other radioactive products).
ORHASP recommended and reported on a more detailed analysis
of asbestos and plutonium. They recommended further evaluation
of I-131, mercury, cesium-137, PCBs, uranium, fluorine and
various fluorides. The next steps in the Public Health Assessment
process were outlined.
In discussion, the Subcommittee:
-
Requested ATSDR to: consider the cumulative effect
from coal burning; offsite releases of carbon tet from
Y-12 which blew east; that the gasoline facility was
originally on the ORR; check that the ORHASP comments
on the dose reconstruction work were addressed; ensure
the clear peer review status of anything given to the
Subcommittee; and supply a list of peer reviewed documents
about offsite effects from ORR exposures.
-
ATSDR agreed to provide: an overview of the NTS I-131
and I-133 exposures inclusion in the analysis, and their
effects, and to present the potential calculated impact
of altering the initial assumptions about scrubber efficiencies.
-
Comments were that: the report's comparison of PCBs
to beryllium may be inappropriate; peer review of the
ORHASP studies is needed; concern was raised about the
porosity of the limestone bedrock below the ORR and
the sparse documentation of buried waste; the relative
importance was raised of the "significance" of early
releases was raised, based on poor early disposal methods
and the still-unknown effects of multiple combinations'
synergism, which will skew the data.
-
The roles of the Subcommittee and the Public Health
Assessment in evaluating the health effects of the ORR
were delineated (the latter will be one of the products
of the former's advice given to ATSDR). A Public Health
Assessment Work Group was formed to provide that advice.
The presentation of the Health Needs Assessment
Work Group was altered by the Subcommittee's selection
of a new course of action subsequent to the Work Group's
meeting with the project contractor, George Washington University.
Two of the Principal Investigators (Drs. Parkin and Paranzino)
reviewed the project's status. They particularly defined
the work of: 1) the key informant interviews of groups and
individuals (with open-ended questions about their experience
of health problems); 2) the focus group interviews (to learn
about sub-groups with health issues, identifying the information
needed and how they want to receive it); and 3) the telephone
survey of a representative sample of the general population.
It was the latter that caused the alteration. Concern was
expressed that the random digit dial method described would
place most calls in Knox County, the least impacted but
with most of the phone numbers. The Work Group re-examined
the ORR area map, consulted with experts and proposed that
the geographic area of the survey be altered. The new area,
including Blount county, will be redrawn and described in
text.
The work group also suggested changing the term "key informant"
to "key resource", and modifying the original plan of work
to conduct the focus groups before the telephone survey.
The Subcommittee approved all these changes. A subgroup
of volunteers was formed to help pilot-test the questions
to be asked by GWU to ensure that the terminology is correct
and that the questionnaire captures the information needed.
In discussion, the Subcommittee warned GWU that those interviewed
might expect GWU to do something about those health issues,
expectations that were dashed in the past. GWU will identify
available health information resources for people to access,
and ATSDR has funded the AOEC clinics to do some follow-up.
Dr. Parkin in particular is committed to do science that
is useful, and pledged to do all she can to provide ATSDR
with information it can use to move forward on the community's
behalf. The Subcommittee also noted that many of the agencies
on the GWU resource/advocacy list are underfunded and cutting
services. That will be determined in the data gathering
phase, but the focus groups can use this opportunity to
advise what services are desired. GWU will avoid telling
people specifically where to go until Phase II, the implementation
of the health plan. Phase I is only to research information
and combine it in such a way as to guide services to the
community.
ATSDR stated that the focus on community health education
need not be primary; the health needs assessment is more
to the community's interest and will be done first. And,
while ATSDR cannot provide health care, they can recommend
to other agencies. A suggestion was broached to invite HRSA
to describe their criteria for placing a clinic in underserved
areas. However, ATSDR warned that its past efforts to place
HRSA clinics at Superfund site areas have yet to be successful
in meeting their very strict criteria.
A report on the CDC/ATSDR evaluation of the Health
Effects Subcommittees was provided by the contractor,
COSMOS Corporation. An Evaluation Work Group was formed
of two representatives from each of the four Subcommittees
and agency representatives. They developed four evaluation
questions, for each of which COSMOS presented its findings.
The questions and COSMOS recommendations were as follows:
1. Are the Subcommittees effective in providing relevant
and timely advice? Recommendations: Agency development
of activity-specific plans identifying the issues on which
they need consensus advice; the Subcommittees' establishment
of procedures to help them determine when and on what issues
they need to provide consensus advice; and both groups'
collaboration to set goals and time lines and to develop
procedures to promote accountability. Keeping a log to track
Subcommittee advice was advised.
-
How effective are CDC and ATSDR in using the advice?
Recommendations: Agencies should provide complete
and detailed explanation of why a consensus recommendation
is not implemented; agency need to determine whether
priority is given to consensus advice (and if so, communicate
such priorities to the Subcommittees); and 3) both Subcommittees
and agencies should hold to a zero tolerance policy
for personal attacks.
-
What is the effect of the advisory process on the
credibility of public health activities and research,
and the public's trust in the federal government?
Recommendation: Joint exploration by agencies and Subcommittees
of the Subcommittees' current lack of trust in the federal
agencies, and proposal of ways that trust can be enhanced.
This stood out to both COSMOS and the Work Group as
a big issue.
-
Is the advisory system helping to deliver appropriate
prevention services? Recommendation: NCEH and ATSDR
should jointly assess the value of Subcommittee outreach
activities. If supported, identify outreach as an expected
activity in the next FACA charter and allocate resources
to support it.
-
Is the FACA-chartered Subcommittee process the best
mechanism for obtaining public involvement? Recommendation:
Both agencies and Subcommittees should acknowledge from
the beginning that the Subcommittees will eventually
end, and plan early on for their discontinuance and
for sustaining public involvement afterward.
Four cross-cutting issues were also explored: 1) adequacy
of resources, 2) role of the Subcommittees in conducting
community outreach; 3) composition of the Subcommittees
and rotation of members; and 4) continuation of the Subcommittees.
The findings were reported, which supported the following
recommendations: joint review of the FACA charter by agency
staff and Subcommittee members to reach agreement on their
appropriate purpose and functions; provision of periodic
training on the FACA charter; and consistent agency application
of its provisions' implementation.
COSMOS' final finding was that this evaluation is a first
step. The evaluation's findings suggest ways to improve
effectiveness and accountability. Their final recommendation
was that CDC and ATSDR, in collaboration with the Subcommittees,
continue to evaluate and assess the effectiveness of the
Health Effects Subcommittee advisory process. ATSDR is planning
a meeting of the Subcommittee DFOs on May 17-18 to review
these recommendations and the next steps.
The Subcommittee discussion with the COSMOS representatives
included the following: agreement that time lines and implementation
procedures are needed to gauge progress and success; that
the most important things to discuss are why the members
are involved and what they want out of this process, to
find common goals; then to agree what the Subcommittee
wants to accomplish and track it along a time line to assess
progress (advice given, agencies' response). If the advice
is not implemented, the members should ask why, to avoid
a vague feeling of dissatisfaction about advice not taken.
A Subcommittee discussion of its mission statement was advocated,
and it was felt that communication between the Subcommittees
would be helpful.
The Agenda Work Group was asked to arrange a facilitated
discussion of why the members participate individually,
and the individual and collective goals and expectations
of the Subcommittee; how those fit with ATSDR/CDC's missions;
how to envision and track the ORRHES' progress and accomplishments,
and what benchmarks to use to track progress.
A presentation of the HHES Web page was
provided for the consideration of the ORRHES home page suggested
by some members. Two members volunteered to help built the
site, which is being coordinated through the Communications/Outreach
Work Group.
Work Group reports were provided. The
Agenda Work Group provided a broad overview of its Program
of Work for the next 2-3 years. The Subcommittee accepted
this. The Procedures and Guidelines Work Group reported
on changes made to the bylaws document since the January
meeting. The Work Group made the Procedures and Guidelines
an appendix of the bylaws, noted with an asterisk all the
bylaws that cannot be changed (by law, agency rule or Subcommittee
charter); consolidated all the work group information into
one Article; provided for Subcommittee meeting by conference
call if this is published in the Federal Register and open
to the public; modified the general order of business according
to Subcommittee recommendations (including the public comment
period); and added a Section to specify a two-thirds affirmative
vote on all major recommendations.
Committee discussion included the need to defined what
constitutes a "major recommendation" (this was remanded
back to the Work Group), and clarification about when a
member can and cannot discuss Subcommittee matters with
the media. The bylaws were accepted with two changes, 1)
to allow mon-members full participation (except voting)
in discussion germane to the topic, by a simple majority
vote of the Subcommittee, and 2) deleting "only" from Article
10, Section 13.
The Communications/Outreach Work Group reported changes
to its purpose and statement of work, which were accepted.
A formal Work Group response will be sent to a letter suggesting
better ways to communicate with the public. The Work Group
will further consider an ORAU-proposed workshop for the
Subcommittee on conflict resolution skills, understanding
personality types, etc. One suggestion was to involve the
community in this as well. A proposed ORRHES mission statement
was distributed for the members' consideration before the
next meeting's discussion. The Health Needs Assessment Work
Group requested other suggestions for the key informant
or focus group lists. The key resources list was referred
back to the Work Group for further refinements. A conference
call will be held on April 24th to review that list.
Unfinished business discussed included
a report on EPA sampling in the Scarboro
community, which was postponed when EPA staff were reassigned
to address the Paducah issue. An Interagency Work Group
will prepare a work plan for sampling in Scarboro and offsite
the entire Oak Ridge Reservation. A February meeting on
this was held. The Subcommittee will be updated on the progress
of this work. The seating of a DOE liaison
with the Subcommittee was discussed. The perspectives offered
included that while a bureaucracy may not be trustworthy,
individuals can be trusted. There was general agreement
that resolution of trust issues with DOE is needed. The
main issue was whether such a formal liaison relationship
would damage the ORRHES' credibility.
Points cited in favor of seating a DOE liaison were that:
1) the public is unlikely to learn to trust DOE if the ORRHES
will not even have them at the table; 2) DOE is a major
player in all the issues of importance to the Subcommittee
and will be here long after DHHS leaves; 3) the current
staff are felt to be trustworthy and the best way to solve
a problem is to talk about it, particularly since some mistrust
may be based on simple misunderstanding; and 4) having DOE
at the table will allow direct communication in both directions.
The negative views were that: 1) a DOE presence would prevent
people from speaking about things they know occurred; 2)
that some community perception will be that DOE's presence
would fatally bias the Subcommittee's work; and 3) that
seating DOE will not gain the ORRHES anything, but cost
it the community's confidence. The discussion was tabled
to the next meeting.
New business included announcement of
the new ATSDR Oak Ridge office (at 197 South Tulane Avenue;
hours are 12-7, Monday-Thursday; 7-3 on Friday; telephone
is [865] 220-0295; or -0457 for fax). The office will be
open on another evening, perhaps Tuesday. ATSDR was urged
to adequately support this field office, which is still
under-supplied. There was discussion of ORR tours (e.g.,
the ETTP, K-25, and X-10) by the members to provide a better
understanding of the site and its environs. A plan to tour
1-2 sites (no preference) at the next meeting will be will
be arranged with DOE. Finally, an impending ORISE presentation
was reported.
Public comment was requested at regular
intervals of the meeting. The responses included:
Dr. Bob Peele, an ORHASP member, commented on their work.
He welcomed its review and agreed that the Subcommittee
may want to address further contaminants of concern; addressed
the differentiation and overlap of worker/resident contamination;
commented that at certain times different isotopes were
more important than others; and that mercury was both an
air- and waterborne hazard, particularly in the contamination
of the fish in Poplar Creek.
Mr. John Stewart reported that the PACE union is doing
a medical surveillance survey which would help to identify
the problems needing assessment. He stated clearly that
Oak Ridge physicians are loath to define any problem as
occupationally related. The workers need financial and medical
help. The DOE worker compensation legislation will benefit
only the few current and former workers who have one of
the eleven specified types of cancer. It is of concern that
this may now be the sole source of redress; this program
may eliminate the previous option of litigation or compensation
by other state or federal programs. The DOE-funded worker
medical survey has been one positive step to date, providing
a Catscan (able to detect lung cancer ~2 years before it
appears) at the union hall, but only about 300 of the already-1000
persons requesting it can be scanned in the two weeks it
is available.
Mr. Mike Napp asked several questions about the area included
in the telephone survey, whether the members self-identified
as having health effects from the ORR (they declined to
do so), and what site contaminants would be addressed. The
Chair explained the survey area selection and said the contaminant
list would be provided to him.
Ms. Linda Lewis urged the Subcommittee members, rather
than asking an organization for what it cannot provide,
to proactively explore the areas of potential help (e.g.,
disseminating information about the R.W. Johnson Foundation
funding to help cancer patients). She offered her help to
the Subcommittee. She also suggested that something be facilitated
on how the Subcommittee interacts and relates with DOE and
others, as related to the concept of trust.
Mr. Bert Cooper, of ATSDR's Division of Health Assessment
and Consultation, reported that the COSMOS recommendations
are now before with the senior CDC/ATSDR managers, and anticipated
that the recommendations will be well received. The DFO/Chair
meeting also may lead to another national meeting such as
was held in Salt Lake City. Mr. Jerry Pereira of ATSDR stated
that Ms. Dalton and Dr. Davidson will maintain a tracking
log for the ORRHES.
After attention to a few administrative details including
the need to maintain a quorum in both the full Subcommittee
and Work Group meetings, the meeting adjourned.
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