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Public Health Assessment Work Group
Meeting Minutes
November 17, 2003
Attendance
ORRHES Members:
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.
- Approval of PHAWG meeting minutes from October 20, 2003
- Previous Action Items
- Update on PHAWG resolution regarding EPA comments to ATSDR
- Unscheduled Action Items
- Biota data screening-Karl Markiewicz
- New Business
- Letter for EPA-Kowetha Davidson
- Work group chairs report form for ORRHES-Kowetha Davidson
- 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.
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:
- 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.
- 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.
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