ORRHES Meeting Minutes,
October 21, 2003
Table of Contents
October 21, 2003
Opening Session and Introductions
Agenda Review, Correspondence and Announcements
Review of August 2003 ORRHES Meeting Minutes
Review of Current ORRHES Action Items
Project Management Update
Proposed Plan for the Iodine-131 PHA
Community Assessments At Other Sites
Public Comment Period
Work Group Reports
Guidelines and Procedures
Work Group
COWG
Agenda Work Group
HENAWG
PHAWG
Cancer Incidence Assessment
Public Comment Period
Update on the Community Health Concerns
Database
Work Group Recommendations
Unfinished/New Business and Outstanding
Issues/Concerns
Closing Session
Glossary Key
Final Minutes of the Meeting
The Department of Health and Human Services (HHS), the Centers for Disease
Control and Prevention (CDC), and the Agency for Toxic Substances and
Disease Registry (ATSDR) convened a meeting of the Oak Ridge Reservation
Health Effects Subcommittee (ORRHES). The proceedings were held on October
21, 2003 at the U.S. Department of Energy (DOE) Information Center, 475
Oak Ridge Turnpike in Oak Ridge, Tennessee.
Opening Session and Introductions
Dr. Kowetha Davidson, the ORRHES Chair, called the meeting to order at
12:20 p.m. She welcomed the attendees to the proceedings and opened the
floor for introductions. The following individuals were present to contribute
to the discussion.
ORRHES Members
Dr. Kowetha Davidson, Chair
Ms. Peggy Adkins
Mr. Don Box
Dr. Herman Cember
Ms. Karen Galloway
Mr. George Gartseff
Mr. Jeffrey Hill
Mr. David Johnson
Ms. Susan Kaplan
Mr. James Lewis
Dr. Anthony Malinauskas
Dr. Peter Malmquist
Mr. L.C. Manley
Ms. Donna Mosby
Ms. Barbara Sonnenburg
Mr. Charles Washington
ORRHES Liaison Representatives
Mr. Chudi Nwangwa (TDEC)
Ms. Brenda Vowell (TDOH)
Designated Federal Official
Ms. Lorine Spencer,
Executive Secretary
ATSDR Representatives
Ms. Subha Chandar
Dr. Paul Charp
Mr. Burt Cooper
Ms. Melissa Fish (OR Field Office)
Mr. Jack Hanley
Mr. Michael Hatcher
Ms. Marilyn Horton
Dr. Elizabeth Howze
Ms. Sandra Isaacs
Ms. Theresa NeSmith
Mr. Jerry Pereira
Dr. Terrie Sterling
Dr. William Taylor (OR Field Office)
Ms. Dhelia Williamson
Point of Contact
Dr. Timothy Joseph (DOE)
Guests
Dr. Gordon Blaylock
Ms. Faye Martin
Agenda Review, Correspondence and Announcements
Agenda Review. In addition to the project management
update, work group reports and two public comment periods, Dr. Davidson
announced that the following topics would be presented and discussed during
the meeting:
- Proposed plan to address the iodine-131 public health assessment (PHA)
by Dr. Paul Charp.
- Examples of health education and promotion projects at other sites
by the Division of Health Education and Promotion (DHEP).
- Description of the ORR cancer incidence assessment by Ms. Dhelia
Williamson.
Correspondence. No correspondence was noted for the
record.
Announcements. Dr. Davidson distributed the current
roster for each ORRHES work group. She asked the members to indicate their
interest in continuing to participate, serving on another work group or
resigning. Ms. Marilyn Horton, the ORRHES Committee Management Specialist,
will update the roster for each work group and circulate a new list.
Review of August 2003 ORRHES Meeting Minutes
Dr. Davidson entertained a motion to approve the previous meeting minutes.
She pointed out that revisions to the first draft were in bold print on
pages 8, 12, 13, 17, 24 and 25. Mr. Lewis conveyed that several members
of the Communications and Outreach Work Group (COWG) stated the previous
meeting minutes did not contain sufficient detail, their voices were not
heard and key comments were omitted. Although the members did not submit
written changes, he emphasized the need to note and address these concerns.
Dr. Davidson clarified that members must submit revisions to the minutes
to ATSDR in writing to be incorporated. A motion to approve the minutes
was properly made and seconded by Mr. Hill and Mr. Manley, respectively.
There being no abstentions, opposition or further discussion, the August
26, 2003 ORRHES Meeting Minutes were unanimously approved.
Review of Current ORRHES Action Items
Ms. Lorine Spencer, the Designated Federal Official (DFO), provided a
status report of pending and ongoing action items.
- Phase II of the ORR needs assessment will be changed from “pending”
to “ongoing” in the list of action items since these activities
will be conducted in conjunction with PHAs.
- Periodic updates will be given on the briefing books for the media
and key community groups. This activity will be noted as “ongoing”
in the list of action items since briefing papers, fact sheets and other
materials for PHAs will be distributed to community groups on a continuous
basis.
- An update on the cross-index for the ORRHES web site will be given
during the meeting.
- The Public Health Assessment Guidance Manual will be distributed
to ORRHES after approval is obtained to circulate the document.
Ms. Kaplan noted corrections to be made on the list of recommendations
and action items: change “pending” items color-coded as gray
to yellow; change the spelling of the name to Patrick “Lipford”
on page 3; and change the spelling of the name to Senator “Frist.”
Ms. Spencer asked the members to submit additional changes to the list
by e-mail.
Project Management Update
Mr. Jerry Pereira, the ORR Project Manager, reported that activities
planned over the next three to four months are on schedule. In November
and December 2003, the Public Health Assessment Work Group (PHAWG) will
review the draft White Oak Creek (WOC) PHA and make recommendations to
ORRHES. ATSDR will provide assistance to PHAWG since the review period
is relatively short. Because ATSDR is scheduled to present the public
comment version of the draft PHA to ORRHES during the February 2, 2004
meeting, efforts will be made to convene this meeting in Kingston. Staff
will scout the area to identify potential locations.
ATSDR made adjustments to its DOE funding to complete COWG meeting minutes
under the ERG contract. For meeting minutes of other work groups, the
DHEP Director, the Division of Health Assessment and Consultation (DHAC)
Director and other ATSDR staff will meet and eventually request more funding
from Dr. Henry Falk, Director of the National Center for Environmental
Health/ATSDR. ATSDR realizes that work group minutes are extremely important
in maintaining ORRHES’s history.
Proposed Plan for the Iodine-131 PHA
Dr. Paul Charp of ATSDR described a tentative plan for the iodine-131
PHA. ATSDR learned that some data may not have been included in the Task
1 Report of the Oak Ridge Dose Reconstruction Project (ORDRP). ATSDR outlined
the process to PHAWG on the previous evening and is now presenting the
plan to the full ORRHES for consideration. In step 1, ATSDR will continue
to review the current literature published after Chernobyl from 1986 to
the present. Efforts will be made to locate environmental, radio-epidemiological,
dose-response and thyroid cancer studies related to iodine-131. These
data encompass more than 100,000 persons who lived in the area during
the Chernobyl event. ATSDR estimates a one-month time-line will be needed
to complete this task.
In step 2, ATSDR will collect new ORR data related to biota, air and
soil concentrations of iodine-131 and iodine-129. The data collection
effort will include iodine-129 because this isotope is a solid indicator
of the presence of iodine-131 during the radioactive lanthanum runs (RaLa)
in the 1950s. During the RaLa process, lanthanum was pulled from the Oak
Ridge reactor and shipped to the Los Alamos site for weapons design. ATSDR
estimates a one-month time-line will be needed to complete this task.
In step 3, air data from the 1950s will be reviewed because these studies
were not specifically addressed in the ORDRP. In 1954, Oak Ridge officials
moved the HP-8 monitoring station from the confines of X-10 to Rogers
Quarry. The purpose of this activity will be to identify differences in
the air dispersion of iodine from the HP-8 monitoring station based on
its placement at the two locations. ATSDR hopes the data will assist in
validating the model. ATSDR estimates a two-month time-line will be needed
to complete this task.
In step 4, ATSDR will validate existing data. Auxier & Associates
located additional data indicating that iodine-131 remained within the
confines of X-10 and did not travel offsite. ATSDR discussed these findings
with SENES Oak Ridge because this company completed the iodine dispersion
component of the Task 1 Report. ATSDR will continue to engage Auxier and
SENES in discussions since the companies may take different approaches
in interpreting the data. ATSDR estimates a one-month time-line will be
needed to complete this task. If Auxier and SENES cannot reach agreement,
ATSDR will convene an expert panel to address the usefulness of the 1950s
air data and document its opinions in a report. ATSDR estimates a two-month
time-line will be needed to complete this task if needed.
In step 5, ATSDR will develop an iodine-131 decision tree with potential
doses and public health actions based on the literature review and usefulness
of the existing iodine-131 data. ATSDR hopes to obtain input and approval
of this activity from a qualified and nationally or internationally recognized
radio-epidemiologist. Dr. Jerome Hershman will be asked
to provide feedback as well. In step 6, ATSDR will combine the information
in the PHA based on the conclusions of these tasks. Although the data
acquisition, literature review and data analysis are incomplete, ATSDR
has already drafted the introduction and background of the iodine-131
PHA. ATSDR may possibly have a draft of the iodine-131 PHA available for
ORRHES to review in four to six months.
Dr. Malinauskas questioned whether the ORDRP addressed physicochemical
forms of iodine, such as elemental versus particulate. He recalled that
the Chernobyl iodine releases were emitted as cesium and in several other
forms as well. Dr. Cember asked if ATSDR’s literature review will
include thyroid uptake studies of persons who had iodine administered
for medical diagnostic purposes. Because these data encompass a large
population of individuals who received high iodine doses, the information
would be relevant to ORR activities. Dr. Charp replied to the questions
as follows. Particulate, organic and elemental forms of iodine are all
addressed in the ORDRP. The report shows that materials released from
the stack were in elemental form, but were converted to a methyl or particulate
form after migrating to monitoring stations.
The iodine-131 PHA will also include a discussion of studies that have
been conducted on radio-therapeutic administration of iodine. In response
to Mr. Manley, Dr. Charp confirmed that the potential for Rogers Quarry
to be downwind from X-10 will be addressed in the PHA. ATSDR will obtain
wind rose data from the National Oceanic and Atmospheric Administration
and other sources. Dr. Charles Miller, Chief of the CDC Radiation Studies
Branch, is an expert in meteorology and will review the ORR air dispersion
data. Mr. Lewis recalled that concerns were previously raised about the
possibility of some ORR data being shredded. During the ORDRP, a massive
effort was undertaken to locate missing records and interview persons
with knowledge of site activities. He advised ATSDR to highlight these
attempts in the iodine-131 PHA.
Ms. Kaplan reiterated the need for ATSDR to act on Mr. Lewis’s
suggestion. For example, ATSDR found gum filter data in a box that had
previously been searched during the ORDRP. Dr. Charp and Mr. Jack Hanley
of ATSDR provided details about actions that will be taken to address
missing data in the iodine-131 PHA. ATSDR has collected weekly reports
from 1953, 1955 and 1956, but the 1954 quarterly reports are averaged
over a three-month period and contain less information. ATSDR
does not have the 1954 weekly reports. ATSDR also has over 20
searchable CD-ROMs of interviews; some of these records relate to iodine.
Efforts are currently being made to locate missing data on the HP-8 monitoring
station.
ATSDR will act on Mr. Lewis’s suggestion by describing efforts
that were made to locate data and explicitly stating if information was
not found. Document reference numbers for iodine data on the CD-ROMs will
be included in the PHA as well. Additionally, the gum filter data were
not newly discovered by ATSDR; the information was actually reported prior
to the initiation of the ORDRP. Overall, the missing data will undoubtedly
fill some gaps, but the absence of the information will not adversely
impact the iodine-131 PHA to a significant degree. Even if the data are
not located, ATSDR will still be able to draw conclusions in the PHA.
Most notably, the thyroid studies on deer can be used to quasi-validate
the model.
Ms. Sonnenburg recalled that at a previous ORRHES meeting, an individual
made a public comment about his knowledge of unrecorded discharges at
ORR. She raised the possibility of ATSDR contacting this individual to
clarify his comments. Ms. Adkins mentioned that this individual may be
Mr. Harry Williams who was directed to place a large canister of toxic
materials into the creek and shoot a hole in the canister for it to sink.
Mr. Hanley clarified that Mr. Williams has made public comments about
uranium in K-25 and fluoride in nighttime releases. ATSDR noted the concerns
and will address these issues in the K-25 PHA. Dr. Malinauskas asked if
the iodine releases will also include emissions from K-25 and Y-12. Dr.
Charp responded that the primary focus will be on RaLa releases from X-10.
The current data do not mention releases from K-25 or Y-12, but the monitoring
data will capture all sources.
Community Assessments At Other Sites
Dr. Elizabeth Howze, the DHEP Director, described several health education
and promotion projects ATSDR has completed at other sites. The Isle de
Vieques in Puerto Rico was used as a bombing range by the U.S. Navy. The
site has been a source of controversy for quite some time due to the close
proximity of a residential community, weapons storage facility and bombing
range. ATSDR completed a focused PHA to identify public health hazards
of persons on the bombing range and an informal community needs assessment
to document specific concerns of residents about chemicals in the air
and water. ATSDR identified health education needs for children, health
care providers and the general community. Asthma, cancer and vibroacoustics
were the primary community concerns in Vieques.
Residents adjacent to the bombing range were experiencing a thickening
of coronary arteries or heart muscles. ATSDR reviewed the literature on
potential health effects from bombing vibrations, but found no causal
relationship. ATSDR also found no association between the bombing range
and concerns about elevated levels of asthma and heart disease. Due to
the controversy, strong activism, public protests and threats at the site,
ATSDR could not convene public meetings. Information was informally gathered
by speaking to residents in their homes and engaging day care center workers
in dialogue.
ATSDR also used its environmental medicine case studies to convene training
sessions for physicians and nurses and provide continuing medical education
credits on Vieques. ATSDR’s other activities on Vieques included
assistance with a summer environmental camp for children; implementation
of a Spanish environmental curriculum in schools; development of a monthly
community newsletter; and participation in establishing an environmental
health resource center with books and other relevant materials targeted
to children.
At the Vasquez Boulevard/Interstate 70 (VBI-70) site in Denver Colorado,
ATSDR identified arsenic and lead in soil. The site is adjacent to three
lead smelters and arsenic was previously used in residential yards to
control pests. However, the actual source of contamination could not be
determined. Interstates that cut through the community and industrial
activities also impact the community. Most of the ~4,000 residents are
persons of color and low-income. In the VBI-70 PHA, ATSDR found an urgent
public health threat for children with soil pica behavior. ATSDR convened
a site team of health officials and community representatives; conducted
a community assessment in close collaboration with residents; held public
availability sessions; and trained community representatives in the PHA
process.
ATSDR also developed three activities to address more specific issues.
The Community Education Program focused on community concerns, community
assessment data and children's health. The Gardening Education Program
was created in collaboration with the Cooperative Extension Service and
implemented door-to-door in neighborhoods to answer gardening questions.
Program materials were developed and distributed and small community meetings
were held. The Health Care Provider Education Program was designed as
grand rounds in local hospitals. Physician toxicologists and other providers
facilitated the courses and also held small meetings in the homes of community
residents.
In Fallon, Nevada, ATSDR responded to childhood leukemia cases by conducting
a community health education assessment. The site is a small agricultural
community located near Reno and a naval air station; the population is
primarily Native American and Hispanic. The source of the 20 childhood
leukemia cases has not been determined to date, but jet fuel, tungsten
mining, excess arsenic levels in drinking water, and agricultural spraying
of herbicides and pesticides have been considered as possible exposure
sources.
The community also suffers from a great deal of stigma because many Reno
grocery stores place “not from Fallon” stickers on produce.
In an effort to cohesively, systematically and effectively address the
high level of concern among parents and respond to the childhood leukemia
cancer cases, community leaders were identified, trained and formed an
organizational infrastructure. The Community United Response Team (CURT)
attended ATSDR's community stress workshops; participated in training
sessions to lead focus groups and communicate risk; and collaborated with
ATSDR, the U.S. Environmental Protection Agency (EPA) and agencies at
state and regional levels.
ATSDR partnered with CURT to conduct a community assessment that included
a series of focus groups. This activity was designed to address large
Hispanic and Native American populations that were not receiving information;
parents who requested additional information about leukemia; other health
concerns of the community; and information about children. ATSDR introduced
an environmental curriculum into the Fallon school system and ensured
that Hispanic and Native American schools were included.
At the Herculaneum, Missouri site, ATSDR detected lead contamination
throughout the community in soil, air and street dust. ATSDR learned about
concerns at the site from the Community Assistance Group (CAG) and data
from the census outreach and education initiative. The small community
has contained an active lead smelter since 1892; the site has been continuously
contaminated and cleaned since that time. The smelter was conclusively
identified as the source of exposure at the site. ATSDR used materials
from effective local lead programs to develop community education activities.
ATSDR also provided technical assistance to the state health department
by reviewing fact sheets and the health education plan; participating
in weekly conference calls; and implementing onsite health education activities.
Health education activities by the state include door-to-door delivery
of educational packets and monthly presentations to CAG members, K-12
schoolteachers and a local church group. The presentations are given by
physicians with expertise in lead poisoning. One-on-one conversations
are also held with the community and politicians at local, state and federal
levels. The Herculaneum site has received a great deal of attention and
interest from federal politicians. Articles are written for a multi-governmental
agency newsletter, while health consultations are implemented through
the state health department web site and direct mailings to CAG leaders
and other community members.
At the Orote Landfill in Guam, the community was concerned about PCB
contamination in water and fish. ATSDR conducted health care provider
education courses for nurses, environmental public health staff, physicians
and other providers. ATSDR also developed a “Safe Cooking”
brochure and plans to implement an environmental curriculum in schools
and throughout the community.
At the Anniston, Alabama site, the community was concerned about lead
exposure and health effects from PCB contamination. However, ATSDR has
not determined adverse impacts from PCBs to date. A Gardening Education
Program was designed with community meetings, a calendar and other specific
materials. ATSDR also developed documents on PCBs, screened children for
lead, and convened public availability sessions on lead. ATSDR's Pediatric
Environmental Health Specialty Unit and a community-based work group jointly
address lead concerns and developmental disabilities at health fairs.
The West Anniston Foundation was established as a non-profit organization
to evaluate access to health services and ensure children in the community
have the best education, health care and remedial services. Overall, ATSDR
conducts both site- and non-site-specific community assessments. Strong
efforts are always made to closely collaborate with communities and other
partners as well as to tailor activities to specific community concerns
and needs.
Ms. Sandra Isaacs and Ms. Theresa NeSmith of ATSDR provided additional
details about some of the sites in response to ORRHES’s questions.
Because the infrastructure of the Vieques cancer registry was extremely
weak, ATSDR and CDC signed a cooperative agreement with government officials
to gather data for the cancer registry. Information is still being entered
into the system, but a preliminary report from the local health clinic
showed a 25% higher rate of cancer on Vieques compared to Puerto Rico.
The community is ~7 miles from the bombing range, but ATSDR found no completed
exposure pathways through groundwater or air. The environmental curriculum
developed for Vieques school children can be replicated for ORR and other
sites.
ATSDR did not consider coal-burning stoves in VBI-70 homes as a source
of arsenic in the community. The lead smelters were analyzed as the source
for low arsenic levels, but neither ATSDR nor EPA could identify the source
for high arsenic levels. Mr. Hill noted a similarity between the ORR and
VBI-70 sites. On the one hand, ORR residents have been informed that coal-burning
furnaces and steam plants in the community are not sources of arsenic.
VBI-70 residents used coal-burning stoves and arsenic was also found to
be a problem in this community. On the other hand, ATSDR did not relate
coal usage in either site to arsenic levels.
Mr. Lewis pointed out a difference in ATSDR’s site activities.
On the one hand, members of the clergy, nurses and other community residents
in Fallon were convened to describe specific issues and concerns. On the
other hand, generic comments were captured during the ORR needs assessment.
He remarked that the ORR community would benefit more from ATSDR’s
strategy used at the Fallon site. Dr. Malmquist advised ATSDR to appropriately
design educational activities and dissemination strategies for the specific
needs of ORR. Most notably, ORR covers a large geographic area and multiple
school systems.
Ms. NeSmith clarified that ATSDR’s Tox Rap environmental curriculum
is designed for large geographic areas. For example, ORRHES could recruit
a small group of teachers to attend train-the-trainer sessions. ATSDR
would train the teachers in implementing the curriculum in classrooms;
the teachers would then train other community residents in conducting
the course on a broader scale. Ms. Adkins mentioned that environmental
education is a priority for extensions of the University of Tennessee
as well as those in each county. This initiative is targeted to nearly
all fifth and sixth grade students in the state. She raised the possibility
of ATSDR integrating its Tox Rap environmental curriculum into existing
activities being conducted by the academic extensions.
Dr. Howze confirmed that ATSDR will explore the academic extensions in
Tennessee as potential sources to implement the Tox Rap environmental
curriculum. Feedback from students in areas where ATSDR has introduced
the curriculum has been overwhelmingly positive to date. Dr. Cember explained
that low blood lead levels (BLLs) have been associated with learning deficiencies.
He questioned whether this health effect was measured in Herculaneum children.
Dr. Davidson added that 10 µg/dL is the level of concern among
children, but no “safe” threshold for lead has been detected.
To date, no beneficial effects from lead in the human body have been found.
She pointed out that health effects from low BLLs are extremely subtle;
high BLLs will cause illness and indicate to EPA the need to clean a site;
and acute lead exposures result in death. Although children and adults
can have the same BLLs, effects between the two groups will be different
since children are a much more sensitive population. Mr. Washington mentioned
that rates of mental retardation, kidney problems and other adverse health
effects should be high in the Herculaneum community since the lead smelter
has been active since 1892.
Dr. Howze provided additional details about the Herculaneum site. Test
results show that BLLs have declined in the community because children
in the area are periodically screened for lead. A community group is undertaking
a major effort to ensure that the polluter complies with regulations on
air emissions from the stacks. Dr. Howze committed to locating and distributing
to ORRHES results of BLL studies conducted at the site. At the national
level, a movement is underway to decrease the level of concern from 10
µg/dL because lower BLLs have been shown to adversely impact learning,
behavior and neurological development.
Ms. Sonnenburg noted that ATSDR was unable to make an association between
adverse health effects and sources at most of the sites. She asked if
ATSDR has ever made a causal relationship. Dr. Howze replied that in the
Anniston community, Solutia was releasing PCBs during the electro-generation
process and contaminating the site. ATSDR and EPA definitively concluded
that the plant was the source of health effects in the community. A lawsuit
was recently settled with local property owners. ATSDR also found a causal
relationship at the Libby, Montana site. The W.R. Grace Company mined
and processed vermiculite ore and also gave the material to residents
to use as insulation and for other purposes. ATSDR found that asbestos
in vermiculite ore was a direct cause of deaths and illnesses from asbestosis,
mesothelioma and other lung diseases in the Libby community. W.R. Grace
has declared bankruptcy and no longer produces vermiculite ore.
Mr. Lewis recalled that a group of Anniston residents was invited to
visit ORR residents. The community described steps that are needed for
a site to obtain an evaluation, compensation or other type of remedial
action. He urged ATSDR to educate communities about situations that will
trigger a PHA category, such as “no public health hazard,”
“apparent public health hazard” or “public health hazard.”
He also asked ATSDR to present its conclusions from the Anniston PHA to
determine if these findings can be applied to the ORR PHAs. Dr. Howze
confirmed that ATSDR looks forward to exploring this issue with ORRHES
in the future. Dr. Davidson questioned whether a disease registry has
been initiated at the Anniston site. If efforts are now taken to monitor
PCB levels of residents, a causal relationship could be identified in
the future. Dr. Howze replied that a health study will be implemented
in Anniston, but no plans have been made to develop a disease registry
at this time.
Public Comment Period
The Chair called for public comments; no attendees responded.
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