ORRHES Meeting Minutes,
January 18-19, 2001
Table of Contents
JANUARY 18, 2001
Opening Comments
AOEC Presentation
Presentation of the ORR Health
Education Initiative
Public Comment
Work Group Reports
Agenda Work Group
Communications and Outreach
Work Group
Guidelines and Procedures Work
Group
Discussion of Subcommittee Voting
Protocol
Round Table Discussion With
Agency Management Staff
ATSDR Comments
NIOSH Comments
DOE, Oak Ridge Operations Comments
DOE, Headquarters Comments
Discussion
Public Comment
JANUARY 19, 2001
ATSDR Public Health Assessment
Process
Discussion
Public Comment
Subcommittee Discussion
Housekeeping Issues
Unfinished Business
New Business
Activity of the Communications/Outreach
Work Group
Public Comment.
Closing Discussion
ATTACHMENTS
Summary of the Meeting
The second meeting of the Oak Ridge Reservation Health
Effects Subcommittee (ORRHES) was held on January 18-19,
2001, under the auspices of the Agency for Toxic Substances
and Disease Registry (ATSDR) and the Centers for Disease
Control and Prevention (CDC). All but one member was present,
as well as all three state agency liaisons, representatives
of federal agencies, and several members of the public.
ATSDR's action items from the last meeting were all completed;
one item by CDC/NCEH was pending. The November meeting Minutes
will be approved at the next meeting. The agenda for the
next meeting was requested in advance for member comments.
Communications to the Subcommittee since the last
meeting were outlined.
A presentation was provided by Dr. Katherine Kirkland,
Executive Director of the Association of Occupational
and Environmental Clinics (AOEC), outlined the
AOEC's history, membership, and processes. They focus on
patient rights and use a public health model in their work.
They are primarily funded by two cooperative agreements
with ATSDR and NIOSH. They conduct research, health promotion,
and education to improve the infrastructure, in order to
address health concerns. They also consult, including clinical
evaluations and collaborations with community members and
medical practitioners.
Dr. Rebecca Parkin of George Washington University,
the AOEC's contractor to conduct the Oak Ridge Reservation
(ORR) Needs Assessment and Health Education Needs Assessment,
presented her own and her two co-Principal Investigators'
credentials, outlined the project work done to date, and
discussed future site work with the Subcommittee.
In a multi-phased process requiring the subcommittee's
input, GWU will conduct interviews with key informants to
explore community concerns about the ORR's effects. They
then will conduct seven (more if needed) focus groups on
topics specific to those community concerns, and one group
more general in scope. The resulting information will be
used to develop a questionnaire for a telephone survey of
a representative sample of the entire "community", however
that is defined. Data from existing records also will
be researched (vital statistics, reports, articles). Also
with the Subcommittee's input, GWU will then explore how
the answers obtained can best be interpreted for educational
planning, to help the community make sound decisions about
health questions. A summary of the documents already reviewed
for this project was distributed.
The Subcommittee provided specific input to GWU in planning
its work, which is detailed in the Minutes. This included
a resolution to use as the geographic health effects study
area the counties of Anderson, Knox, Roane, Loudon, Meigs,
Rhea, and Morgan; and the city of Oak Ridge. A Health Assessment
Work Group was formed to help define the descriptors to
be used in forming the focus groups.
Public comment was solicited at regular
intervals in the meeting. The responses included:
- A recommendation that the members read the 1999 Oak
Ridge Dose Reconstruction Study Report, which included
an additional county (Blount) thought to be at risk from
I-131 exposures. The report's listed chemical releases
from the ORR also should be compared to ATSDR's toxicological
profiles.
- Still another comment urged the inclusion of Blount
County in the study's geographic area; the use of the
Internet to deploy educational materials; and the use
of TV Access Channel 12 in Oak Ridge, as many elderly
people watch that.
- A request that the Subcommittee attend to the effects
of depleted uranium (DU), and hydrogen fluoride leaks
from the ORR.
- A welcome for the committee's work, and expressed hope
that something will be done to help the sick workers before
they all die.
- A recommendation to identify and separately seat the
non-voting liaisons.
- It was charged that the negative findings produced from
public health activities at the Oak Ridge Reservation
were based on faulty science, biased beliefs, and political
influence.
- A call was issued for research on the synergistic, multiplicative,
additive, and concurrent effects of exposures, and on
diagnosis and treatment to address the results of toxic
exposures in a scientifically credible and rapid response
mechanism. A multi-disciplinary team to develop recommendations
on such protocols was requested.
- DOE was asked about the likelihood of a health clinic
being opened in Oak Ridge. Dr. Seligman reported DOE's
consideration of convening an environmental workshop of
pertinent agencies and organizations to combine information
on offsite contamination. Congress must be convinced that
such clinical care is needed, and he would be happy to
do so. He also noted that Congressional mandate began
the current medical monitoring of DOE workers; they could
do the same with other agencies. Dr. Falk reiterated ATSDR's
intent to help other PHS agencies to think "out of the
box," to try to deliver such needed services within existing
programs.
- A statement of pride in some of the Subcommittee members,
but not others, was made. The resignation of these "Judases,"
who formerly doubted any ill effects from Oak Ridge, was
advised, or they would be exposed.
- Comment noted an expected common perception that CDC
has tracked environmental illnesses for a long time, and
the frequent difficulty of participating in CDC's studies
of such illnesses. Many physically disabled people cannot
do so; they are in wheelchairs and/or have lost everything.
- An e-mail sent to the EQAB was read. The writer threatened
to mount an Internet campaign to deter anyone from moving
to Oak Ridge unless the area's environmental problems
are addressed within one month.
Work Group reports and draft statements
of work were provided by the Agenda Work Group, the Communications/Outreach
Work Group, and the Guidelines and Procedures Work Group.
The Subcommittee provided specific edits for refinement.
Outstanding issues remaining to be addressed include the
equivalence of the process document and the by-laws; the
need (and -permissibility under FACA) of a Vice Chair position;
designation of a Parliamentarian (and how much to adhere
to Roberts' Rules of Order to run the meetings); and final
Subcommittee agreement on a voting protocol.
A round table discussion was help with
the management staff of ATSDR (Dr. Henry Falk, Assistant
Administrator), NIOSH (Mr. Larry Elliott, Branch Chief)
and DOE (Dr. Paul Seligman, Headquarters, and Ms. Leah Dever,
Oak Ridge Operations).
ATSDR reported the imminent opening of a permanent office
at Oak Ridge, to be staffed by Mr. Bill Murray. NIOSH's
Acting Director will be informed of the ORRHES' desire to
have a representative at each meeting; even if not, they
expected to be attend to make presentations, or otherwise
to respond to the Subcommittee's needs. DOE/Oak Ridge acknowledged
that past mistakes, mismanagement, lack of good information
to the community, etc., had contributed to the decline of
trust in DOE. This independent study and Subcommittee were
welcomed to further inform DOE of the communities' perspectives.
DOE's response to the Subcommittee's communications was
pledged. DOE/Headquarters' health-related work was described,
as was the Energy Employees Occupational Illness Comprehensive
Program Act of 2000. The Act addresses beryllium disease,
radiation-induced cancer, and silicosis, among DOE workers
and contractors. It provides for 1) compensation of $100,000
for confirmed beryllium disease (and medical care payment
if sensitization is determined); 2) $150,000 and medical
monitoring for silicosis; and 3) a compensation process
for radiation-attributed cancer, which is now being developed.
The DOE Office of Advocacy will help workers answer DOE
contractor disputes of claims and to procure state compensation
benefits for diseases not addressed by this Act. An amendment
to the Act also allows an option for workers to choose a
more a traditional compensation package (i.e., lost wages
and medical benefits, training, and rehabilitation), rather
than the lump sum payment. Congressional scrutiny and decision
is pending.
In discussion, the Subcommittee asked when claims filing
could begin; about workers' families who were exposed, the
likelihood that recommended activities that ATSDR cannot
do, will be done (Dr. Falk hoped the Subcommittee could
advance previous ATSDR efforts to involve other federal
health agencies whose programs may be able to respond; e.g.,
HRSA, HCFA); examples of DOE's new proactivity for workers;
how DOE can ensure that safety and health is secure at all
facilities; the need to validate the Scarboro soil study
samples (progress toward an interagency meeting will be
reported at the next ORRHES meeting); the need for better
timing of study result releases and for evaluation of the
success of that information dissemination; a request for
the definition of a "medically under-served" population;
the committee's ability to recommend medical evaluations;
the need for DOE, to rebuild its credibility regarding worker
safety, DOE should consult OSHA as well as the NRC; and
request that NIOSH provide information on what its research
has accomplished for workers. The agencies were invited
to return for further dialogue.
The steps of the ATSDR public health assessment
process were described. The public health assessment
analyzes and states the public health implications to off-site
populations from releases of hazardous substances, after
which a triage process determines the need for follow-up
public health actions or studies. The assessment's seven
steps, ranging from evaluation of site information to development
of a public health action plan, were described. Also distributed
were time lines outlining the various Oak Ridge facilities'
major processes, the public health activities relating to
them, and the studies ATSDR will examine to develop the
public health assessment.
The Subcommittee's members discussed: the need to address
the chemicals' synergistic effects; the need for periodic
worker screening; the relationship between assessing health
education needs and the public health assessment; the likelihood
of ATSDR's independent testing or exposure investigation;
what could be done if exposures cannot be linked to health
outcomes data; how to get a baseline of the community's
health; the public health assessment process' schedule;
how existing environmental data fit in with the study; why
ATSDR's assessment are needed after the dose reconstruction
and other studies; the likely need to address differing
opinions about what "plausible" health outcomes are; a request
that the Communications/Outreach Work Group suggest a strategy
that ATSDR can use to communicate (and evaluate the communication)
to the public the results of the assessments done; the source
of ATSDR's numbers regarding the materials' effect; and
the reliability of estimating synergistic effects.
Further discussion included inquiry of how the Subcommittee
members may be affected by a recent class-action federal
lawsuit filed on the impacts of the Oak Ridge Reservation
on the public (it is unaffected). It was agreed to have
future meetings on Mondays (noon to evening), and Tuesdays
(8:00 a.m. to 4:30 p.m.). The tentative 2001 meeting schedule
is: June 11-12; September 10-11; and December 3-4.
Unfinished business discussed included the Subcommittee's
memberships composition; specifically, if representation
of the community-selected criterion of a "self-identified
sick worker" should still be solicited. One potential such
nominee had declined. The CDC/ATSDR Committee Management
Office will be asked if they would support an new solicitation
announcement.
New business discussed included a request for a presentation
on health effects that could be expected among children
as well as adults; formation of the Health Needs Assessment
Work Group; and further discussion of the focus groups'
methodology. Concern was expressed that the Work Group be
able to advise on the descriptors for the focus groups before
the next meeting. The Work Group's recommendation will be
sent to ATSDR, which will distribute it to the other members
and liaisons for review/comment.
Final discussion noted that ATSDR will respond to each
of the public comment and that the minutes will summarize
the remarks. The Communications/Outreach Work Group was
asked to discuss how the Subcommittee could be even more
responsive, and to recommend to ATSDR as to how the Subcommittee
could best use its Website. The action items developed at
this meeting were summarized and are appended to the Minutes.
It was agreed to discontinue the verbatim transcript of
the meetings, and to retain the audio and videotaping.
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