ORRHES Meeting Minutes,
June 11-12, 2001
June 12, 2001
On the following morning, the members reconvened at 8:30
a.m. Members present were:
Al Brooks
Bob Craig
Kowetha Davidson
Bob Eklund
Ed Frome
Karen Galloway
Jeff Hill
Susan Kaplan
Jerry Kuhaida
James Lewis
David Johnson
Peter Malmquist
L.C. Manley
Therese McNally
Donna Mosby
Bill Pardue
Barbara Sonnenburg
Charles Washington
Mr. Don Creasia was absent.
All the liaisons were present: Elmer Akin, Chudi Nwanga,
Brenda Vowell; as was LaFreta Dalton, Executive Secretary.
ATSDR staff present were: Sherri Berger, Bill Carter, Carl
Markevitz, Theresa NeSmith, Lucy Peipins
Members of the public or presenters attending included:
Ann Henry
Cathy Nye
Janice Stokes
Opening
Comments
Dr. Davidson again thanked DOE for arranging and summarized
the previous day's tour of the ORNL X-10 facility.
Presentation
of the ATSDR Epidemiology Workshop
Ms. Sherri Berger and Dr. Lucy Peipins, of ATSDR's Division
of Health Studies, provided an overview of the science of
epidemiology. They also provided a copy of the study by
Joseph Mangano of "Cancer Mortality Near Oak Ridge, TN."
They defined epidemiology as the study of the distribution
(who, what, when, where) and determinants (why, then) of
disease in populations. It involves groups of people, not
individuals; measurement; and comparison.
In groups of people, epidemiology can determine
the impact of disease and detect changes the occurrence
of disease; it can measure the relationship between exposure
and disease; and it can evaluate the efficacy of health
interventions and treatments. Epidemiology cannot
determine the cause of an individual's disease, with a few
exceptions; it cannot prove a particular exposure caused
an illness, and it should not be conducted without good
measurement of exposure and disease.
Epidemiology can draw some information on exposures and
outcomes from evidence already compiled in animal studies,
case reports, or toxicological models. The common steps
in establishing a relationship between exposure and disease
are: report of a series of cases (e.g., by a physician);
descriptive analyses to describe the problem, those affected,
and where the disease is occurring; analytic studies to
test the exposure-disease hypothesis in a study group; experimental
reproduction of the disease by exposure in animals; and
observations done to assess whether removing exposure lowers
disease.
Statistics/Measures of Disease Frequency. Disease
frequency can simply be measured by counting the affected
individuals, Ms. Berger began, but that is not enough. The
significance of three cases of a disease occurring in a
town of 1000 people is much greater than the same number
in a city of 100,000. Epidemiology, therefore, examines
at the size of the population from which affected individuals
come and the time period in which the information was collected.
A rate is a basic epidemiologic measure that is
used to compare the frequency at which disease occurs on
a group and to compare that occurrence to other groups.
It is calculated by dividing the number of events in a specific
time period by the average population over that period.
A mortality rate is the number of deaths in a defined
group during a specified time period; a birth rate
does the same for births. Incidence is another
type of rate. It is arrived at by dividing the number of
new cases that develop in a period of time by the number
of individuals at risk during that time period. For example,
150,000 new cases of lung cancer in the U.S. in 1997 would
be divided by the population present at that time (150,000
รท 260 million). The result, 0.000058, would then be multiplied
by 100,000 to determine the rate: 58 cases per 100,000 people
per year.
Association measures how much greater the frequency
of disease may be in one group than another. It is often
provided in a two-by-two table, demonstrated by Ms. Berger
as an example. Into the four squares, for example, all the
participants in a study of lung cancer and smokers/non-smokers
can be categorized/placed (smoking: yes/no; lung cancer:
yes/no):
|
lung
cancer: yes |
lung cancer: no |
smoking: yes |
a |
b |
smoking: no |
c |
d |
Relative risk (RR) can then be measured. It is
the likelihood that one group (e.g., the exposed group of
smokers) will develop a disease compared to the unexposed
group. Relative risk is calculated by dividing the incidence
in the exposed group (a/[a+b]) by the incidence in the unexposed
group (c/[c+d]). If the result of the calculation comes
out to 1.0, there is no association between exposure and
disease and the risk is even whether one is exposed or not.
If the result is above 1.0, there is a positive association
or an increased (excess) risk (e.g., a 2.0 RR indicates
twice the risk of someone unexposed); if it below 1.0, there
is a decreased risk among the exposed group.
Standardized Mortality Ratios (SMR) are the ratio
of an observed number of deaths to an expected number of
deaths. The expected number is drawn from a standard group
(e.g., U.S. the population or a county), which is similar
to the exposed group of interest. The standard group serves
as a comparison group. The number of deaths of the exposed
group are divided by the observed deaths of the comparison
group to arrive at an SMR. So, for example, if 58 deaths
are found in an exposed group, and the comparison group
has 42.9 deaths, the SMR (58/42.9) is 1.35: the exposed
group has a 35% higher risk of death.
Measuring Exposure and Outcomes in Environmental Epidemiology.
An outcome is any change in health status or body
function, which covers a broad range (e.g., from wheezing
to disease and death). Outcomes can be local or systemic,
acute or chronic, and reversible or irreversible.
Dr. Peipins commented that measurement of both exposure
and outcomes must be clear to produce a definitive study
result. The measurement, therefore, has to be precise. Exposure
by contaminants can produce an outcome at the point of entry
and/or one that is distributed throughout the body ("body
burden"). The exposures can be measured in a number of ways.
The best is from direct biological analysis of body tissue;
the poorest is measurement of such surrogate measures as
environmental samples of the general area in which a person
lives.
Biologically plausible outcomes are explored by ATSDR,
by contaminant route of exposure (to define the vulnerable
organ systems), toxicity or level (severity of outcome),
and potential alternative explanations for an outcome (confounding
factors). But importantly, health effects are not uniquely
caused by environmental exposures. For example, 1 in 2 men
will develop cancer, and 1 in 3 women will do so; 2% of
infants are born with developmental disabilities; 25% of
pregnancies result in spontaneous abortions; and 8-10% of
children have asthma.
Cancer is a particular problem as an outcome because of
its complexity. For example, smoking causes most of the
cancer in the U.S., and 25% of Americans smoke. Cancers
can take a long time to develop after an exposure, and many
other exposures may occur in the interim. In addition, cancer
is not one, but probably more than 100, different diseases
that affect 40 anatomic sites.
In measuring adverse health effects, the goal
is to count all the cases in an exposed group or population
and to compare that with cases in an unexposed group. The
sources of this information include death and birth certificates,
medical exams, hospital discharge data, questionnaires,
disease registries, and lab tests or biomarkers of exposure.
But all these sources are very variable in their ability
to report the severity of the disease; the accuracy of the
disease classification; information on such potentially
contributing confounders as smoking; and finally, they vary
in cost, complexity of access, and invasiveness.
Dr. Peipins outlined some of the shortcomings of these
sources:
-
Death certificates: do not list all conditions of interest,
only those that cause death; have considerable inaccuracy
in diagnosis; and have no data on other risk factors.
-
Registries: are relatively new. They exist for reportable
disease (TB, cancer, birth defects), but only cancer
incidence data are available for all states. They do
not collect data on other risk factors, and the completeness/timeliness
of their data may be an issue.
-
Medical exams/biologic tests: are the "gold standard,"
but diagnosis may vary for outcomes with no standard
case definition (e.g., asthma, multiple sclerosis).
- Questionnaires: may miss most severe outcomes. They
involved self-reports of illness or symptoms; the wording/type
of administration may influence responses; and they are
subject to recall and response bias. However, some outcomes
may be measured only through questionnaire, and they enable
collection of data on other risk factors.
Other considerations include the timing and latency of
reports (especially important in chronic disease), individual
variability (e.g., by age, gender, pre-existing illnesses,
and genetic predisposition); and confounding and bias (alternative
explanations for an exposure-disease association).
In summary, the basic criteria for considering a health
study are:
-
Necessary: measurable exposure, completed pathway to
an exposed population, and a measurable effect that
is plausibly related to the exposure.
-
Will the epidemiologic study advance knowledge about
the relationship between exposure and disease?
-
Judging a cause-effect relationship: strength of association
(relative risk: the larger the risk, the more likely
the relationship exists); consistency of this study's
findings with other studies, study designs, and groups
of people.
- Judging the dose-response relationship: whether disease
increases with exposure, based on the exposure which must
occur first, and biologic plausibility (there is a known
mechanism for the exposure to lead to disease).
Discussion with Dr. Peipins included:
-
Ms. Sonnenburg: Would you track people who may
have been exposed? If the basic criteria are fulfilled.
I keep hearing that epidemiology studies (e.g.,
Chernobyl and Hanford) could neither prove nor disprove
a relationship between I-31 exposure to the thyroid
and thyroid disease. If you have 1000 children with
thyroid disease in one area and only 6 in another, or,
if more tests show them to be ten times over the normal
rate, would that prove the association? How high does
the ratio have to be before you determine there is a
relationship? I have not read the Hanford study.
(Please do by September.) But I would say that
there is a relationship; such a large relative risk
(i.e., 1000:6 versus 50:48) certainly strengthens the
case, if not definitively proves it. There is no standard
level of an effect for a relative risk. It is dependent
on other factors such as confounders. What is your
opinion of the Mangano study distributed? I would
not say it was good or bad. It was just provided so
that at the next workshop in September these principles
of epidemiology study can be applied and to see how
it stands up to critical analysis. But one might note
that it is a study done at the county level.
-
Mr. Lewis: What is the impact on such studies of
people concerned about privacy issues (e.g., potentially
raised insurance rates)? Study Institutional Review
Boards (IRBs) try to ensure confidentiality, and information
leaks are rare, but those concerns do reduce the ability
to do these studies. What should we tell the public
about the validity of anecdotal, verbally reported,
data from the community? We cannot answer about
legalities; but such observations are not surprising,
given how many people naturally develop cancer.
-
Ms. Kaplan: How specific is the data on cancer
incidence collected by registries? Are interviews done?
It varies by state; some will analyze by county/zip
code, but no personal interviews are done.
-
Mr. Pardue: Why use mail questionnaires, with their
poor rate of return and potential bias? They can
help to discover what other factors may contribute,
but in-person interview is much better. Why not
do more clinical studies than epidemiology? That
can be the community's choice, but the epidemiology
study could add to the knowledge that would indicate/support
a clinical study.
-
Mr. Kuhaida: How do you factor in the frequency
and magnitude of exposure (e.g., three very high exposures
versus long low-dose exposures)? The importance
of such factors often depends on the contaminant. Categories
are assigned for analysis (e.g., low frequency and high
exposure, or vice versa), and the results are compared
to current knowledge that can be helpful (e.g., toxicology,
medicine).
-
Dr. Brooks: What are the effects of sample size
on study validity? This can be further explained
in another workshop, but "spikes" of disease that naturally
occur can be seen in small cohorts. These can be leveled
out with a large enough cohort to indicate the true
underlying incidence, and to determine how many cases
are required to satisfy statistical significance about
the exposure-disease relationship.
-
Dr. Frome: Standard error is another statistical
tool used to judge how far a relative risk is from a
standard point. It can factor in exposure and non-exposure
to indicate the significance of whatever relative risk
is calculated.
-
Mr. Johnson: How do you address roadblocks to research,
such as inaccessible data? Part of the considerations
of the study design is to ensure that all the necessary
data will be accessible.
- Dr. Davidson: How do confounders affect interpretation
of an epidemiological study? A stratified analysis
can be done to address confounders. For example, data
for those who were exposed to radon and developed lung
cancer can be delineated by those who smoked tobacco and
those who did not.
Public
Health Assessment Process
Mr. Jack Hanley reviewed the steps of the Oak Ridge public
health assessment process, and the independent review done
for ATSDR of the Tennessee Department of Health's screening
evaluation in the Oak Ridge health studies. The public health
process is to identify for the area residents any exposures
from the site, and to evaluate any risk from those exposures.
They will then report on any contaminant levels of concern
found to the public and to relevant local, state, and federal
agencies, and advise on potential follow-up public health
actions.
Mr. Hanley reviewed the steps in this process: 1) evaluation
of all the site information gathered over the years, 2)
identification of community health concerns, 3) identification
of any contaminants of concern, 4) determination/evaluation
of a pathway of exposure, 5) assessment of public health
implications of exposure, and 6) report on the conclusions
and recommendations, including 7) a site-specific action
plan.
Steps 1 and 3 were initiated at the March ORRHES meeting.
Step 1 involved review of the Tennessee Department of Health's
environmental dose reconstruction of past releases from
the ORNL and those contaminants of largest impact offsite.
This report recommended further evaluation of iodine 131,
mercury, cesium 137, polychlorinated biphenyls (PCBs), uranium,
and fluorine and various fluorides.
In its Task 7 Screening Evaluation, the Oak Ridge Health
Agreement Steering Panel (ORHASP) did an additional screening
of 18 other contaminants based on the quantities onsite
and on expressed public concern. Three different approaches
were used:
-
Qualitative evaluation: screening for contaminants
used in quantity, in certain forms and in manners of
use, that could have gone offsite. Those going offsite
below levels of concern were screened out (e.g., in
too-small quantities; the forms of carbon fiber and
glass; and those used in sealed cylinders).
-
Quantitative evaluation was done of the three materials
for which there had been insufficient information previously.
If found to be below threshold quality limits with the
conservative screening index used, these were screened
out. The quantitative analysis screening was done in
two levels:
* Level I: The conservative screening level indices used
by the ORHASP were similar to those used by EPA, regulatory,
and health agencies. Estimates of maximum exposure dose
from the ORNL materials (worst-case exposure) were done.
If these were below the decision guidelines, no further
study was done.
* Level II: If the levels were above the screening guidelines,
further evaluation was done using less conservative, more
realistic screening parameters for exposure levels and environmental
concentrations (e.g., soil ingestion such as through eaten
fish, or dirt eaten by children; air; time in spent in an
exposure location, etc.). However, these remained considerably
conservative because the same transfer factors and toxicity
values were used.
-
As before, a screening index below decision levels
were dropped; those above received high priority for
further study. That study ultimately resulted in designation
of arsenic at K-25 and arsenic and lead at Y-12 as high-priority
candidates for further study. The screening process
of Level II was outlined on a distributed chart (Attachment
#1, Table 2). Mr. Hanley noted that beryllium was screened
out for offsite risk of chronic beryllium disease and
for cancer endpoints, using the most conservative, worst-case
scenarios.
Discussion included the following:
-
Ms. Sonnenburg/Kaplan: Were any of these compounds
screened out because there wasn't enough data?
Yes. In the absence of data for some facilities (e.g.,
the three contaminants at Y-12), estimates had to be
made.
-
Mr. Manley: What are the toxic effects of rare
earth metals? I handled two of them. Mr. Hanley
agreed to check the toxicological information on the
cited compounds, which are considered rare earth materials
and are likely to have little information on them.
-
Mr. Lewis: What will be done about contaminants
of high priority such as arsenic that were screened
out for low levels but may have had higher cumulative
levels (e.g., including TVA and other plants)?
ATSDR's mandate is only to address ORNL; it has no authority
to address others. But if other obvious public health
issues seem to arise, they will be referred to the appropriate
agencies. But you are factoring in contaminants
from the NTS tests, and comparatively, these are right
next door. Mr. Akin: that is a question of total
risk, not the risk specific to ORNL that is being pursued
here. Mr. Hanley: we can investigate what data are available
to indicate total risk, but our authority does not extend
to doing detailed analyses of sites other than the ORR.
-
Mr. Hill: Why was X-10 not shown as an arsenic
source; it burned coal for a very long period? ATSDR
agreed to investigate this.
-
Dr. Eklund: What is the value of doing this work
if all sources are not considered to indicate the true
risk? Reporting only on ORNL could mislead people. Our
final report should include a strong recommendation
to look for all the sources of contaminants. There are
residents of Roane or Anderson counties who never worked
at ORNL and have toxic levels of arsenic in their body.
ATSDR will reanalyze some of the older analyses
using the more updated EPA maximum concentration transfer
factors (as opposed to the NCRP transfer factors previously
used), and they will do a separate analysis of current
exposures. These screening analyses can help to further
establish the ORNL emission levels, which would be of
interest if a comprehensive, additive analysis of risk
is done. ATSDR also can extrapolate potential contaminant
spread, for example, from levels found in soil data
combined with wind direction/pattern data, to determine
whether some of the contaminants found could have come
from another source. Doing detailed modeling from TVA
or other sources is not within ATSDR's purview; but
regardless of the source, if a public health hazard
is determined (e.g., high levels of arsenic or in the
water source or PCBs in fish), ATSDR will recommend
a responsive public health action. In one case, a community
was advised to use alternate water sources until more
detailed analysis could be done of the local sources.
But implementing such an action is the domain of the
local or state agencies.
-
Several members of the committee expressed frustration
at the division of agency responsibilities that seems
to prevent the kind of overall health evaluation desired.
But aside from that important goal, this also involves
a national debate about litigation and the culpable
party. If DOE is not the sole source of the contamination,
it should not take all the blame.
- Dr. Frome: Could the homes' coal burning also have
been a significant source of contaminants? That
is possible, but ATSDR does not know.
The Tennessee Department of Health reports were released
publicly in January 2000, and a panel of independent experts
conducted a technical review of them at ATSDR's request.
They evaluated the quality and completeness of the report
to indicate if it could provide a foundation for public
health decisions. They found that some of the report's screening
level methodologies were internally inconsistent (e.g.,
using maximum numbers for arsenic under surface water of
Poplar Creek, but mean values for the Y-12's McCoy Branch;
or were inconsistent in the conservatism of their concentration
factors).
Every study has strengths, weaknesses, and limitations
which must be considered to properly interpret its findings.
While the reviewers found the reports' interpretations to
be reasonable, appropriate, and well supported, they disagreed
that this type of screening index should be used to only
identify the contaminants posing a low health risk. It is
good for identifying pathways of exposure. It should not
be used to determine relative risk or to identify the important
exposure pathways.
One thing noted by the reviewers was the ingestion of contaminated
vegetables and fish as primary pathways of concern (80-90%
of dose). However, that may have been due to the conservative
screening, transfer, and bioconcentration factors. Overall,
the reviewers found the report's conclusions to be reasonable,
and the approaches to be well supported and appropriate
for making public health decisions. ATSDR is following up
on the study's weaknesses in its own screening analysis
for the contaminants of concern.
Presentation
of ATSDR Screening Process
Dr. Karl Markiewicz provided an overview of the
three steps of the screening process, which are to determine
if:
- The chemical concentrations are above acceptable screening
levels: Determine the important compounds and chemicals,
using maximum concentrations in air, soil, water, and
biota, particularly in cases of incomplete or missing
data.
- The chemical concentrations are above screening levels
in areas of exposure. In the case of missing or incomplete
data, ATSDR will assume the maximum bioconcentration of
any adjacent areas known to risk exposures.
- The calculated exposure doses exceed health values for
each chemical in each area.
Dr. Markiewicz described the screening calculation, which
is EMEG = MRL x BW / IR, where EMEG is Environmental
Media Evaluation Guide (for water and soil); MRL is Minimal
Risk Level (measured by mg/kg/day; ATSDR's standard established
levels are similar to the EPA's reference doses, with safety
factors added on); BW is Body Weight (kg); and IR is Ingestion
Rate (units/day). This process is very health-protective;
it is simply the MRL times the body weight, without considering
bioavailability, cooking loss, chemical form of the process,
etc. Those factors are considered later in the process that
considers the public health implications.
Discussion included:
-
Ms. Kaplan: Worker studies are often not based
on actual health impact, but rather on the limits of
measurement. What are ATSDR's? You need to be very clear
for the public that some of these conclusions are based
not on research, but on equipment limitations. ATSDR
uses all available data, animal (e.g., the PCB MRL is
derived from rat studies) or human, and for some compounds
will use a biokinetic uptake model. The report will
be clear, for example, if doses are greater or lower
than the literature's values, and try to interpret the
meaning of that, to provide some perspective.
-
Ms. Sonnenburg: Where/how do your equations consider
cumulative lifetime dose? That is included in the
more refined analytic process. How can you distinguish
present dose from those in the past? E.g., the TVA emissions
data are available for the last few years; but not for
the past when the air cleaning equipment was absent
or inferior. Some of these elements linger in the
environment and can be sampled; or, if the process'
material usage is known, the emission can be extrapolated
by dispersion models.
-
Mr. Akin: From where does the ingestion rate data
come? The data for the first screening analysis
is historical (e.g., site, state, and dose reconstruction
data such as on fish ingestion to calculate PCB exposure).
That for the second screening analysis of more recent
exposures will use data of offsite sampling around the
reservation. The offsite actual value used for the calculation
are ATSDR's or EPA's. Whether past or recent data, they
will be presented with their limitations. And if, for
example, as has commented occurred with mercury levels,
if past data seems to have been under- or overestimated,
ATSDR will try to determine that and any effect on the
reported outcomes.
-
Ms. Kaplan: Data indicate that mercury-contaminated
soil from the East Fork of Poplar Creek grew huge quantities
of vegetables, but the mercury risk levels (measured
for dehydrated foods) indicate that a lot can be eaten
without harm. But are there any other contaminants of
concern in soil-grown food? Arsenic was identified
as another such element, but the more recent EPA biotransfer
factors were reduced, so those levels of concern may
also be lowered. The biota analysis will break down
all the foodstuffs addressed in the analysis.
-
Mr. Lewis: Was any analysis done of the game living
on the reservation? Yes, some was screened in the
annual DOE monitoring reports; and some ecological studies
done for the Superfund cleanup work will include such
data. At some sites, both turtle and racoon data were
analyzed.
-
Dr. Davidson: Are the EMEG parameters for children
or only adults? Adults; but if there is a particular
concern for children, we have carried that through in
the analysis. This is generally done for lead, for example,
to which children are particularly sensitive.
Public
Comment
Ms. Janice Stokes reported her own contamination
with multiple heavy metals, and pleaded for a clinic to
study and treat the effects of such contamination. Her body
burden includes nickel, now at toxic levels in her body,
for which she has received chelation therapy. It may have
come from the K-25 barrier pipes. Although she did not work
at the plant, she has measurable and elevated levels of
copper, barium, arsenic, chromium, lead, mercury, cesium,
nickel and uranium body burdens. She called for someone
to be seated on the ORRHES who is, like her, a local resident
familiar with the data and who has these contaminants in
their body, to provide a balanced input to those who disbelieve
there have been any effects. Secondly, she opposed spending
several million dollars on an epidemiologic study, when
it could fund a multidisciplinary clinic for the residents
to detect and treat heavy metal contamination. Oak Ridge
offers the scientific facilities and intellectual power
to be a model pilot project. She implored the Subcommittee
to support a health clinic to address those who are feel
that they have been most affected.
She noted that since the contamination from fish ingestion
will not necessarily be measurable in the blood stream at
high levels at all times, a challenge test is needed to
detect it. This was not used by ATSDR and is not normally
used in a standard physician's office visit test. She noted
that the ATSDR study results are countered by other studies,
and charged that communities in the southeast whose problems
were addressed by ATSDR were not helped. She stated that
ATSDR was chartered to, and is mandated by FACA-chartered
boards to, set up health intervention clinics. However,
this was changed by Congress 7-8 years earlier, and can
be changed back. She believed that ATSDR can locate a clinic
in Oak Ridge if the Subcommittee recommends it, which she
urged them to do. She hoped that nickel would be studied
as a contaminant of concern, and she called for an end to
"paralysis by analysis."
Mr. Dwight Napp asked if the additive or synergistic
effects of contamination could be addressed for levels of
health concern. There is some information on synergistic
effects, such as the combination of cigarette smoking and
asbestos exposure, but in general the literature has little
evidence to offer on synergistic effects. ATSDR examines
what is known. There are multiple chemical effects studies
from the Netherlands indicating no synergistic effects at
lower levels than are typically present in the environment.
Mr. Napp commented that a clinic could help to compile that
knowledge. He asked the Tennessee Department of Health if
there is a mechanism to track such sub-clinical effects
of noncancerous conditions as hypo- and hyperthyroid disease,
which Dr. Hoffman had indicated on the previous day could
be an impact of exposure. Ms. Vowell knew of no such mechanism.
Dr. Frome read an e-mail letter to the Environmental
Quality Advisory Board from a person identified as Michael
Stevens, which was distributed to the Subcommittee members.
Mr. Stevens expressed concerns about the environmental safety
of Oak Ridge, as he is planning to move there. Ms. Ellen
Smith, of EQAB, an Oak Ridge resident and an environmental
scientist at ORNL, referred him to Websites which could
provide other information, and expressed her own opinion
as a 20-year resident that the environment is a safe place
for her and her family. She thought there to be no immediate
threats to public health from the ORR, "unless surveillance
and maintenance lapses occur and cleanup fails to occur."
Dr. Frome invited ATSDR and members of the board so inclined
to also respond to Mr. Stevens.
Ms. Stokes responded that there is the potential of mercury
vapor, which occurs at 72. It rises from East Fork of Poplar
Creek when it is low in the summer, and which is recontaminated
by the incinerator every time it floods. She was concerned
that houses are being built nearby whose buyers are unaware
that they risk contamination.
With no further comment, the Subcommittee adjourned for
lunch, after which Mr. Hanley completed his presentation.
Presentation
of the ATSDR Program of Work
Mr. Hanley presented ATSDR's draft program of work (Attachment
#2), showing the Subcommittee's opportunity to comment on
a) the information available, b) ATSDR's assessment, and
c) ATSDR's report. This process began with iodine, and will
continue for mercury, PCBs, and all the past contaminants
identified in the screening process. All the reports will
be compiled into a public health assessment document for
public comment, which will be addressed in the final PHA
report.
Discussion included:
-
Mr. Lewis: Is there a point in the process to evaluate
the conflicting studies referenced earlier? ATSDR
will examine what is brought to it; if appropriate,
it will be brought to the Subcommittee as well. This
was done by Dr. Hoffman on the previous day, or comments
on fluoride that were provided, leading to it being
added to ATSDR's list of contaminants of concern that
will be addressed and presented later in this process.
ATSDR much prefers to gather this input early, rather
than waiting until after the analyses are done, but
the process is deliberately long to allow as much of
that input as possible.
-
Mr. Pardue: Can we advertise a solicitation for
such information to make sure it is not brought up at
the last minute? ATSDR developed a compendium
of all the activities that have been conducted relative
to the ORR, and had received little to add to it. Perhaps
the Communication Work Group could suggest other methods
to solicit such input. Mr. Lewis suggested letters to
other organizations in the area.
-
Mr. Akin suggested developing a cross-referential document
about the role of epidemiology and the public health
assessment, relative to drawing conclusions about health
hazards in a community as pertain to specific chemicals
and their sources. Perhaps Ms. Berger and Dr. Peipins
can explain those differences at the next meeting. The
Communication Work Group also is working with Ms. Dalton
to develop the health assessment and needs assessment
processes.
-
Ms. Kaplan: What do you do with additional information
once you receive it? For example, CDC responded to the
document "Inconclusive By Design", but no discussion
ensued. That is up to the Communications Work Group
and the Subcommittee; outstanding issues can be discussed,
but these were not raised.
-
Dr. Frome: How far along, for iodine, is ATSDR
to do Step 4, evaluating public health effects? That
first-cut report could one place where people could
identify work not reviewed or discussed by ATSDR.
Agreed; if such issues are raised by the Work Groups,
ATSDR can return to the Subcommittee to discuss that.
If there are none, work will begin on mercury. Dr. Brooks
reported that the Step 4 discussion of iodine is scheduled
for the September meeting.
-
Dr. Eklund agreed with Ms. Kaplan that a formal mechanism
is needed for information, such as "Inconsistent By
Design," that is not applicable to the source term or
contaminant information but might offer good critical
input. He suggested a Work Group evaluation of such
matters and then a report to the Subcommittee on it,
perhaps under "New Business." Dr. Davidson asked the
Work Group advise how they would like to handle this.
-
Dr. Brooks thought that a special meeting would be
required to be able to forward that in September, since
the formal process has the Work Group reporting to the
Subcommittee, which then reports to ATSDR. However,
Ms. Kaplan noted that this was the discussion
through which the Subcommittee would refer this to ATSDR,
so a precedent had been set in doing that. Dr. Davidson
asked the Procedures Work Group to review these steps
at their next meeting to go see if any adjustments are
needed.
Work
Group Reports
Agenda Work Group
(Attachment #3)
Dr. Brooks reported two meetings of the Agenda Work Group
and their adoption of this meeting's agenda. They prepared
and soon will finalize with Ms. Dalton a preparation schedule
for the September meeting. Another two meeting dates will
be held to plan that agenda. The Work Group also considered
the Program of Work (dated 5/5/01) which was presented at
the last meeting. A corresponding milestone chart was created
and will be updated with work progress. Dr. Brooks moved
that the ATSDR Program of Work for the public health assessment
be adopted as a living document expressing the future tentative
plans and schedule of the task. The motion was
seconded.
Mr. Lewis had no objection as long as it was clear that
this is a living document for which review and comment had
just been requested. Ms. Kaplan stated that the program
of work was never discussed by the full Subcommittee, only
by the Work Group. Dr. Davidson distinguished this document
from another developed by Dr. Brooks which had a time line
incorporated to it. Since this document simply reflects
the steps in the process with no specific time line, a formal
adoption may not be necessary.
Dr. Brooks rejoined that the Work Group would just proceed
to work with ATSDR to accomplish agendas and schedules.
He explained that this was simply an update on a few minor
changes to the Program of Work that was developed with the
Work Group. It was adopted by the Subcommittee as a living
document at the last meeting. Since Mr. Hanley had elaborated
on the original sketchy plan, he now felt that the plans
should be merged and finalized. The information at this
meeting now allows a similar brief work program with a milestone
chart to be developed for the health needs assessment. Pending
ATSDR's and GWU/Hahnemanns agreement that it is representative
of their intended work, the Work Group can produce a final
document.
Dr. Davidson suggested referring this back to the Public
Health Assessment Work Group to decide if the flow chart
includes all the steps necessary, as previously requested.
Dr. Brooks withdrew the motion. Dr. Davidson
clarified that the presentation on this day by Mr. Hanley
was more of a logistical procedure than the 6-step program
of work which was presented to the Subcommittee and incorporated
into the ORRHES press release describing the March meeting.
Dr. Brooks agreed; the other document supplied a lot more
detail about these steps, including references to data.
The milestone chart simply compiled the time indications
of Mr. Hanley's other document onto one sheet of paper,
to help prevent the scheduling of too many topics for one
meeting (as has occurred already). Ms. Dalton assured the
Subcommittee that the document provided merely process information,
and was a shorter complement updating the more detailed
previous program of work document. They are complementary
rather than stand-alone pieces.
Dr. Brooks moved that the Subcommittee request
from ATSDR and GWU/Hahneman the brief information necessary
to form a program of work and a milestone chart for the
public health needs project, similar in content to those
of the public health assessment project, a brief
description of the tasks, and when they hope to complete
them (including presentation dates). Dr. Davidson noted
that this was already an action item for ATSDR to present
that program of work based on Mr. Christenson's presentation
of the previous day. Upon a vote, 14 were
in favor, and none opposed. The motion carried.
Public
Health Assessment Work Group (PHAWG)
Mr. Pardue reported two meetings held by this, the Subcommittee's
newest work group. On May 7, 2001, the items discussed were:
-
General discussion of scope and function.
-
Start development of the PHAWG scope and mission statement.
-
Discuss draft outline for "Epidemiology 101" presentation
by telephone with Lucy Peipins.
-
Receive dry run briefing from Jack Hanley on development
of the public health assessment.
-
Review tentative agenda for addressing the entire iodine-131
issue.
One May 31, 2001, the Work Group:
-
Reviewed, discussed, and commented on the presentation
on epidemiology by Lucy Peipins to be given at the June
12 meeting.
-
Received an updated presentation by Jack Hanley on
the PHA process.
In addition, Mr. Pardue commented that the agendas for
the Work Group meetings have been too crowded with presentations,
precluding the ability to address anything in detail. He
requested ideas for the next Work Group meeting, which he
also suggested be scheduled for 3-4 hours rather than two.
Discussion included Ms. Sonnenburg's question
of whether the members of the public can just provide
a phone number, address or e-mail to be advised of the Work
Group\ meetings? The anwer was yes; they can be provided
to Mr. Pardue (or to Dr. Davidson, for any work group).
The e-mail addresses are also on the committee roster. Ms.
Stokes requested to be on this Work Group.
Guidelines and
Procedures Work Group
Dr. Davidson reported that the Guidelines and Procedures
Work Group had one meeting since March. They were asked
to address the following:
I. Define the vote to recommend on what constitutes a major
recommendation to ATSDR, for which the bylaws require a
two-thirds vote. The Work Group included:
A. Advice or recommendations to ATSDR regarding the public
health assessment, the Health Needs Assessment, or public
health follow-up activities.
B. Advice or recommendations that affect the makeup or
structure of the Subcommittee, including recommendations
concerning the liaison members on the Subcommittee.
C. Other recommendations as determined by a majority vote
of the Subcommittee. That is, if there is a difference in
opinion of what the major recommendation is, a majority
vote decides if this is a major recommendation (which in
turn requires a two-thirds vote).
Ms. Sonnenburg moved to accept the Guidelines and
Procedures Work Group's report on major recommendations.
The motion was seconded and carried with 15 in
favor and none opposed.
II. Procedure for individual Subcommittee members submitting
material to ATSDR for distribution to the Subcommittee.
A. Material submitted to ATSDR for distribution to the
Subcommittee members must be received by ATSDR 4 weeks before
the next meeting. The material must include a cover letter
describing: (1) what is being submitted, including a brief
abstract or summary of the material, (2) why the individual
wants the material distributed to the members, and (3) how
the material is related to the activities of the ORRHES.
A motion was made and seconded to accept the Work
Group's recommendation. Dr. Davidson explained
the multitude of tasks that ATSDR staff must accomplish
to convene a meeting. Members of the public who wish to
bring something to the Subcommittee's attention at the meeting
are welcome to do so, as long as they bring their own copies.
Dr. Davidson called the question. With 14 in favor and one
opposed, the motion carried.
Health Needs Assessment
Work Group
Mr. Lewis reported on a brief meeting held on the previous
day with Greg Christenson, Teresa NeSmith and Bill Carter.
They discussed some of the issues of the health needs assessment
and opened up links of communication to help the work proceed
better.
Communications
and Outreach Subcommittee Work Group
Ms. Kaplan noted that quite a bit of material from her
had been distributed at various times, including a June
11 report about two Work Group meetings which addressed
three major categories:
1. Tools to improve the Subcommittee/public communications
are on the Web page: a community input form, an Oak Ridge
fact sheet, and discussion of putting the Subcommittee and
work group meetings on the Oak Ridge community calendar.
2. Refining the communications and outreach strategy: a
procedure was added for a pre-meeting press release, which
was submitted to Ms. Dalton.
3. A list of general recommendations to ATSDR was compiled
(Attachment #4a), some of which they have already implemented.
Further suggestions will be welcome.
4. A training recommendation to ATSDR was developed.
5. The minutes from the May 21 meeting was sent to the
members. She requested a motion at the next Work Group meeting
to approve those, having received no comments on them.
6. A communication and outreach strategy was voted on by
the Work Group and provided to the Subcommittee on the previous
day (Attachment #4b). She suggested that the word "Draft"
be removed from that if the Subcommittee votes to accept
it at this meeting. The only changes from the March meeting
were under item #3, is now "Procedure," and still to be
changed under #7 was "MP" to "Ms. Dalton."
A motion was made and seconded to accept the proposed
Communications and Outreach Strategy. The vote
was 14 in favor and none opposed. The motion passed.
A motion to accept the proposed list of recommendations
to ATSDR was seconded. With 13 in favor and none
opposed, the recommendations passed.
Ms. Kaplan referred the members to their meeting book's
Tab 6, which contained a Work Group resolution on the Subcommittee
Web page which the Work Group endorsed. Dr. Frome noted
that page one was the resolution; the second and third pages
were informational about the Website contents (e.g., regarding
HTML links and PDF files).
Discussion included the following:
-
Mr. Hill: Who will maintain the Web site?
That will be determined by the ATSDR Web Administrator;
it could be maintained in-house or by a contractor.
-
Dr. Frome: How do we decide which information should
be put onto the Web site? Documents such as the
program of work that ATSDR has already approved internally
would automatically be placed there. There is an ATSDR
Website committee that reviews all potential documents
to go on the site. If there are any portions of the
Website resolution with which ATSDR cannot comply, the
Subcommittee will be advised. Will all the information
on the Website be publicly available? The Hanford site
requires a password. The Hanford site is not yet
a public document on the ATSDR server. Once that is
done, no password is needed.
Presentation
of the ORRHES Website.
Ms. Dalton reported the content approved for placement
on the Web site:
1. The Community Health Concerns Comment Sheet: was drafted
in response to the members' wish to collect information
from community members about their health concerns about
the ORR site. The front of the sheet has prompts about the
type of information the Subcommittee is looking for, the
purpose of this, and contact information. An additional
sheet can be attached. She requested comments on this draft.
When final, it will be placed in the ATSDR Oak Ridge field
office. The community concerns will be used in the public
health assessment process. They generally are rewritten
into specific questions and then answered in the final report.
2. The Oak Ridge Reservation Health Effects Fact Sheet:
provides an overview of ATSDR's activities, CDC's two activities
in Oak Ridge, and the Subcommittee's work, as well as contact
information. It discusses the public health assessment and
the Health Needs Assessment, and provides some background
information about both. She requested feedback on this draft,
which she developed with the Outreach Work Group. When final
it also will be placed in the ATSDR Oak Ridge field office.
3. A summary of the March meeting (the same document as
the press release).
Discussion included:
-
Dr. Frome: What will you do with all the health
concerns? Will they be compiled in a database?
Ms. Dalton stated that they are retained as part of
the record, but the format and contents of the database
have not yet been determined.
-
Mr. Akin: Can this be broadened to include a request
for information that may relate to additional contaminants,
pathways, or reports not addressed by ATSDR to date?
All that information could be included; it all
is considered part of the public health assessment process.
Mr. Lewis noted that this could be captured under item
#2.
-
Mr. Hill: How do you get back to the question's
originator? ATSDR does not typically do that unless
they specifically ask to be contacted. Normally there
is a statement, which will be incorporated into this
form, that this information will be used as part of
the public health and information that becomes part
of the public record.
-
Mr. Lewis: Can these comments be anonymous?
Yes.
- Mr. Johnson suggested including a few paragraphs of
the many uses of this information and a short caption
to invite the persons' anonymous or attributed comment.
Team Building Training Needs Assessment. Ms. Dalton
reported that a training was provided to the Communications
and Outreach Work Group meeting on May 8 about several issues:
trust building, communication, Subcommittee mission, goals,
etc. The Work Group compiled specific recommendations about
the workshop such that it must be at least a day long. It
will be provided at a full subcommittee meeting, on the
proposed date of July 31. It is a team-building, conflict
resolution, consensus-building workshop to be at the Children's
Defense Fund lodge in Clinton, from 9:00 a.m. to 6:00 p.m.
Information will be provided about the facilitator, who
will return on September for a one-hour follow-up session.
This workshop is meant to be an opportunity for all the
members to discuss not only their specific role, but that
of the subcommittee as a whole The estimated cost is $20/person,
which Bill Murray will collect and provide to the Children's
Defense Fund.
Discussion included:
- Two members could not attend on July 31. Ms. Dalton
will check to see what other dates the lodge may have
open and send out an e-mail. Currently, 8-10 people can
attend.
Ms. McNally moved to proceed with the proposed
training session. The motion was seconded. With
ten in favor and two opposed, the motion carried.
Unfinished
Business
ORRHES Vice Chair. Ms. Dalton stated that, if
the ORRHES wishes to proceed with a request for a Vice-Chair,
the same process used for the members' selection would have
to be used. That person would need specific roles and duties.
CDC does not encourage Vice Chairs. it can be requested,
but none of the other Subcommittees have one. If Dr. Davidson
is unable to attend, she would contact Ms. Dalton as the
Designated Federal Official to advise her of that, and she
could ask a member of the Subcommittee to act in that capacity.
Discussion included:
-
Dr. Davidson expressed her interest in having someone
assume part of the Chair's workload. The Vice Chair
would have specific duties well beyond substituting
as Chair.
-
Mr. Johnson: What would be the process to select
a Vice Chair, what criteria would apply, etc.?
Ms. Dalton responded that, in view of the time this
would require, the best choice probably would be to
nominate a Subcommittee member. With 19 members and
two vacancies, it is uncertain if the Agency would support
adding an additional member beyond those.
- Dr. Eklund suggested delegating some of the Chair's
workload to a person or a work group rather than pursuing
a Vice Chair.
Dr. Brooks moved to table the topic indefinitely
and the motion was seconded. The purpose of such a motion
is to kill the topic without committing an opinion on it.
He felt that in the unlikely event that Dr. Davidson cannot
make a meeting, someone could be appointed to take her place,
and time would be wasted discussing the issue. Dr. Davidson
called the question. With 15 in favor of tabling the motion
and none opposed, the motion passed.
Nominations for the Ill Worker ORRHES representative.
Ms. Dalton reported that the nominations for the ill worker
closed on April 30, and produced applications that are now
being considered. However, the hiring freeze on special
government employees prevents taking on any other members,
leaving that vacancy and that from Dr. Lands' resignation.
Another solicitation can be issued for another physician
or another individual, or the applications previously received
can be re-reviewed, which may include a self-identified
ill resident. However, whatever the Subcommittee decides
cannot be effected until the freeze is lifted.
Discussion included:
-
Mr. Pardue: Is there an application from another
oncologist? (No.) So we could not replace his expertise.
The DOE FACA committee is adding 3-4 new members;
are they not covered under the freeze? ATSDR's
White House liaison confirmed that the freeze is still
in effect. Although sometimes waivers are granted, there
is no waiver for ATSDR for this.
-
Mr. Hanley stated that, considering the time required
to nominate and seat a member, it would be worthwhile
to begin the process.
-
Ms. Mosby commented on the record that at almost every
meeting there is public comment that this group does
not seem to want a sick person or a sick-identifying
person as a member. She did not share that opinion;
and in fact understood that some members are sick. She
suggested that a collective biography of the Subcommittee
be developed to challenge those comments without needing
to force anyone to self-identify. She felt the level
of expectation for anyone so identifying to be completely
unrealistic, since no one could be a universal representative,
just as she could not represent the views of all the
Oak Ridge area African-Americans.
-
Ms. McNally supported the idea of opening up the solicitation
process, having heard much more public awareness of
and interest in of the ORRHES' existence.
- Mr. Akin asked how the Chair wished the members to
respond to public comments. Dr. Davidson responded that
she will appreciate being informed if the members feel
there is a strong need to respond; that can be done at
the meeting's next session. However, she wished to avoid
any back-and-forth heated debate during the public comment
period, as has occurred in other Subcommittee meetings.
Mr. Akin recalled that Ms. Scopes had asked about the
possibility of waivers to allow the participation of an
ill worker without hazarding their compensation, and had
the sense it was not addressed. However, Ms. Dalton recalled
that the resolution was that the person needed to address
those questions with their own legal counsel. However,
Ms. Mosby felt that some response should be provided as
able at the time of the public comment, either a reference
to past minutes if it has already been answered or a commitment
to respond in future. In fact, the Website would be a
good place to post repeated inquiries. There was a general
feeling, voiced by Ms. Galloway, that the Subcommittee
needs to exercise every effort to make the public feel
as welcome and included in the meeting as possible.
Dr. Eklund moved to establish a position for a
self-identified sick resident and to solicit nominations.
Ms. Kaplan seconded the motion. Mr. Washington apologized
for missing much of the meeting, and agreed with Dr. Eklund.
He felt that this is critical to establish the credibility
of the Subcommittee's work. Dr. Davidson noted that this
motion was for a sick resident, to replace Dr. Lands. Ms.
Dalton asked if a specific type of person was desired to
replace Dr. Lands, noting that the ill resident had been
raised several times.
Public
Comment
Dr. Bob Peelle recalled that the state Health
Department advertised for public input, whose comments are
recorded in the study database along with many other public
comments over the years. He suggested that these be reviewed,
as they may well be applicable to the ORRHES as well. If
they are not in the database, Pat Turrey of the Health Department
can help gain access to those comments, following Tom Widner's
directions (on the table at this meeting) of how to gain
access to ORHASP materials.
Mr. Walter Coin stated that the last iodine report
was watered down. In 1954, ~4,000 curies were released to
the air and went all way to Oliver Springs. Boron and other
elements also went in the air; the water supply was never
discussed; and many accidents at Oak Ridge have never been
told. A 1954 nuclear blast in the Pacific was 2.5 times
bigger than expected. Many Marshall Island residents were
contaminated and many military people were contaminated,
and not one ever got any help.
Mr. Dwight Napp appreciated the committee's thoughts
about ensuring that there is some interaction with the public.
Regarding the Social Security question, he stated that their
rules indicate that anyone who has the ability to waive
their rules for any period of time demonstrates the ability
to work, and hazards their benefits. That is one reason
that people may be hesitant to participate. And it is difficult
for someone who is ill to sit in a meeting for two days.
Allowing an alternate would be helpful for those people.
He felt that it should be obvious that the public should
have the right to ask the committee questions. Regarding
a self-identified ill person on the committee, he understood
the issues of medical privacy, and he agreed that there
may be unrealistic expectations of that person. But there
should be a person on the committee with intimate personal
knowledge of the effects of exposure, perhaps who had had
such related therapies as chelation therapy. In addition,
this contamination must be viewed in context, of a time
when there was allegedly no mercury released; then that
it did not go into the environment; and now people are trying
to understand that they have mercury in their bodies. He
charged that people were not only contaminated but also
researched for health effects, and bodies were exhumed for
research without notifying their families. These are all
public record and were written about in People
magazine a couple of months previously. He wished the committee
well in its work in addressing such issues.
Ms. Linda Gas stated that the issues of the workers
are very different from those of the residents. The the
perspectives of both ill workers and residents should be
represented on the Subcommittee, by people who are not only
self-identified but with some history of work with an organization
of health-affected persons. The board needs to be more public-friendly;
note should be taken of the persons who are conspicuously
absent month after month.
Dr. Davidson noted that a motion was on the table
to nominated an ill residents to the Subcommittee.
She asked if anyone had anything new to add to that discussion.
Mr. Washington reported that a FACA committee on which
he has served had granted waivers to persons to continue
to receive SSI benefits while they continued to serve. Mr.
Hanley noted that ATSDR had contacted the Social Security
Administration office as promised when this issue was first
raised, which invited all those interested to come in to
discuss it. The person who originally raised the question
was advised by her own counsel not to participate. However,
ATSDR welcomed all who wished to participate in the work
groups, which is where much of the Subcommittee's work is
done. He also noted that under its charter, this committee
charged to advise CDC and ATSDR, but not the SSA directly.
Mr. Johnson called for vigorous outreach to the SSA to ensure
that applicants will not be harmed by participation. However,
while the intent behind this was appreciated, the Subcommittee
was warned that doing so could open themselves to potential
legal liability. The people themselves must ensure their
own rights and responsibilities.
The motion was re-raised and clarified to pertain only
to nominate a sick resident. The solicitation for a sick
worker representative has been issued and nomination packages
have already been prepared. Dr. Eklund urged the committee
to support his motion regardless of the disability issues.
A vote on this will indicate to the public the committee's
cognizance of this deficit in representation, and there
is a good chance that someone appropriate could be found.
Dr. Davidson called the question; as a major decision that
impacts the structure of the subcommittee. The vote was
ten in favor, six opposed. The two-thirds majority required
was not met, and the motion failed.
Ms. Mosby moved to open the nomination process
and that preference (not exclusionary priority) be given
to a sick resident. The motion was seconded. Mr.
Pardue hoped the board would encourage a medical professional
to apply. The vote was taken, with 12 in favor, two opposed,
and one abstention. The motion carried.
Mr. Kuhaida asked Ms. Gas for her suggestions as to how
the meetings could be made more public-friendly. She stated
that the audience should not be so dominated by agency members
from Atlanta, and less domination of the board by Dr. Brooks
and Dr. Davidson. The latter pointed out that the agency
staff attend to respond to the Subcommittee's concerns.
She added that no member of the Subcommittee can speak for
her, as anyone who knows her would testify.
Closing
Comments
Dr. Davidson deferred the members' discussion of their
expectations of this Subcommittee to the workshop. Final
statements included Ms. Sonnenburg's request that if the
ATSDR staff returned to provide their critique of "Cancer
Mortality Near Oak Ridge", that the author also be invited
to explain and defend his report. Dr. Davidson referred
that to the Agenda Work Group. Dr. Brooks noted that `gano
had presented his paper in Oak Ridge several years ago,
so Oak Ridge had heard his viewpoint. He also assured the
committee that he would post any agenda information desired
on the ORRHES Web page.
Ms. Sonnenburg also asked to follow up on Ms. Stokes' idea
of a health clinic. The Local Oversight Committee, on which
she also serves, had passed such a recommendation a year
earlier. She moved that a Work Group be established
to investigate the feasibility of opening such a clinic
in Oak Ridge. Ms. Dalton pointed out that the clinic
is under HRSA's purview's domain, not ATSDR's. Ms. Sonnenburg
noted earlier comments that ATSDR can advise other agencies,
and assumed that this also pertained to HRSA. Ms. Dalton
responded that of course ATSDR would consider any recommendation
from the Subcommittee and inform the members of their response,
but she could not promise any particular outcome. Ms. Sonnenburg
persisted that nothing could be done without examining the
idea for its merit. Dr. Davidson recalled the suggestion
at the last meeting that HRSA be invited. Ms. Dalton reported
ATSDR's contact with HRSA, but no response yet as to when
they could attend. A follow-up was requested. Ms. Dalton
reiterated that this is beyond ATSDR's domain, but also
noted that ATSDR conversations with HRSA are not unusual.
Ms. Sonnenburg asked if a motion would help. Ms. Dalton
could not say that it could. Dr. Davidson defined this as
an action item for ATSDR to pursue the Subcommittee's request
to ask HRSA to attend to speak to the Subcommittee.
Mr. Lewis commented that "communication is what the receiver
understands, not what the sender says." He called for clarification
to the community that the focus of the ORRHES' activity
will be in the Work Groups, if that is how it will work.
Using the Oak Ridge calendar would help in that area. Ms.
Dalton noted that Mr. Murray had put this meeting on that
calendar; the same could be done for the work group meetings.
Dr. Davidson will also forward to the Work Group Chairs
her list of people interested in participating, so that
announcements of the meetings can be sent directly to them.
Mr. Johnson asked if ATSDR could write to UNOS (phonetic)
to ask how they obtained the exception to the disability
rule that he had referenced earlier. Ms. Dalton agreed to
take this up with ATSDR's management. He then stated that,
if convincing evidence of the need for a clinic is taken
forward, particularly to public officials, then a clinic
will be opened. Otherwise, he feared the funding would be
taken out of ATSDR's budget.
Ms. Kaplan suggested arranging standing meeting times for
the Work Groups. She asked if another work group should
be set up to review "Inconclusive by Design." Dr. Eklund
clarified that his intent was not to set up a work group,
but to refer it to whatever work group is appropriate.
Mr. Johnson called for a different meeting time to be set
so that the public can attend, not during working hours.
Dr. Davidson noted that the meeitng's first day begins later
in order to extend into the evenings. She also encouraged
the work groups to meet in the evenings, particularly those
that pertain to the public health assessment. In response
to Mr. Hill's report that many of the skilled craft workers
get off at 3:30 p.m. and the best time for them to attend
the meetings would be from 4:00 to 6 or 7 p.m., the Agenda
Work Group had scheduled the I-131 discussions for those
times. The attendance was good. Mr. Johnson persisted that
those who get off at 5-6 p.m. should also have an opportunity
to hear the full discussion of the Subcommittee, which would
require meeting from 7:30-8:00 p.m. Mr. Lewis stated that
the Subcommittees and Work Groups had bent over backwards
to set up meetings at times convenient to most people.
Ms. Kaplan asked for the tour guide's data, and Dr. Widner's
overheads from the previous day.
Action Items
Dr. Davidson reviewed the action items from this meeting:
-
Provide a brief program of work for the health needs
assessment; Dr. Brooks will send a copy to be edited.
-
Ms. NeSmith and Dr. Paranzino will develop a fact sheet
about the health needs assessment process.
-
An additional "Epidemiology 101" course was offered
to the committee
-
Why arsenic was not screened for the ORNL
-
ATSDR will follow up with HRSA about providing a presentation
at a future meeting.
-
ATSDR will advertise work group meeting on the Oak
Ridge Community Calendar.
-
The members will provide comments on the community
input form and the fact sheet; and the communications
committee will work on a procedure for capturing public
questions.
- Mr. Washington requested the emissions data on the
plutonium fire at ORNL; Dr. Davidson suggested that be
brought up to the Public Health Assessment Work Group.
She also noted that its agenda is growing, so patience
may be necessary.
Housekeeping Issues
Ms. Dalton provided ATSDR's new telephone numbers; her
direct line is 404-498-1743. Mr. Hill requested an e-mail
with everyone's names and numbers, and a new roster. Dr.
Eklund announced his new e-mail address at rheklund@earthlink.net.
The start time for the September meeting is at noon on September
10-11 and then December 3-4. Ms. Dalton asked that any information
to be circulated be sent to ATSDR in the time requested.
A press release was developed to announce the products of
this meeting, which will be provided to the media outlets
in Oak Ridge for distribution. She acknowledged Ms. Mosby's
contributions in arranging for the Subcommittee's snacks
and refreshments and asked the member to be sure reimburse
her before leaving.
Dr. Davidson asked all Subcommittee members who signed
up for work groups to attend either in person or by conference
call, so that the work group can attain a quorum. Ms. Kaplan
asked the members to RSVP and to respond to their e-mails.
Ms. Palmer will get the information to those without e-mail
by some other means.
Dr. Davidson asked again that a quorum to be maintained
during Subcommittee meetings. With no further comment and
her thanks, she then declared the meeting adjourned. The
motions, recommendations and action items of this meeting
are attached to this document as Attachment #5.
I hereby certify that, to the best of my knowledge, the
foregoing Minutes are accurate and complete.
Kowetha A. Davidson, Ph.D., Chair
Date
Attachments
1. Categorization of Materials Based on Screening Results
(Table 2)
2. Program of Work, Oak Ridge Reservation
Public Health Assessment Process
3. Report of the Agenda Work Group
4a. Communications and Outreach Work Group
Proposed Recommendations
4b. Communications and Outreach Work Group
Proposed Strategy
5. Motions, Recommendations, and Action Items,
June 2001 Meeting
Subcommittee Motions and
Recommendations, June 2001 Meeting
Recommendations
1. A collective biography of the Subcommittee should be
developed to challenge the comments about the need for the
representation of an ill worker on the Subcommittee, without
requiring anyone to self-identify.
Motions
1. Ms. Sonnenburg moved that the Subcommittee
members and the public be allowed a limited amount of time
after each speaker to ask questions and that each speaker
be encouraged to limit their remarks to 30 to 40 minutes.
Vote: 10 in favor, 5 opposed; the motion
passed.
2. Dr. Brooks moved that the ATSDR
Program of Work for the public health assessment be adopted
as a living document expressing the future tentative plans
and schedule of the task. He withdrew the motion
and this was referred tothe Public Health Assessment Work
Group to decide if the flow chart includes all the steps
necessary.
3. Dr. Brooks moved that the Subcommittee
request from ATSDR and GWU/Hahneman the brief information
necessary to form a program of work and a milestone chart
for the public health needs project, similar in content
to those of the public health assessment project.
Vote: 14 were in favor, none opposed; the motion
carried.
4. Ms. Sonnenburg moved to accept the Guidelines
and Procedures Work Group's report on major recommendations.
The motion was seconded. Vote: 15 in favor, none
opposed. The motion carried
5. A motion was made and seconded to accept the
Guidelines and Procedures Work Group's recommendation
on procedures for individual Subcommittee members submitting
material to ATSDR for distribution to the Subcommittee.
Vote: 14 in favor, one opposed. The motion carried.
6. A motion was made and seconded to accept the
proposed Communications and Outreach Strategy.
Vote: 14 in favor, none opposed. The motion passed.
7. A motion to accept the Communication and Outreach
Work Group's proposed list of recommendations to ATSDR was
seconded. Vote: 13 in favor, none opposed, the motion
passed.
8. Ms. McNally moved to proceed with
the proposed team-building training session at
the Children's Defense Fund Lodge. The motion was seconded.
Vote: 10 in favor, 2 opposed. The motion carried.
9. Dr. Brooks moved to table the topic
of an ORRHES Vice Chair indefinitely. Vote:15 in
favor, none opposed. The motion passed.
10. Ms. Mosby moved to open the nomination
process and that preference (not exclusionary priority)
be given to a sick resident. The motion was seconded.
Vote: 12 in favor, 2 opposed, 1 abstention. The
motion carried.
Action Items, July 2001 ORRHES Meeting
Reviewed by the Chair at the end of this meeting:
-
Provide a brief program of work for the health needs
assessment; Dr. Brooks will send a copy to be edited.
-
Ms. NeSmith and Dr. Paranzino will develop a fact sheet
about the health needs assessment process.
-
An additional "Epidemiology 101" course was offered
to the committee
-
Why arsenic was not screened for the ORNL
-
ATSDR will follow up with HRSA about presenting at
a future meeting, relative to their ability to establish
a clinic at Oak Ridge.
-
ATSDR will advertise work group meeting on the Oak
Ridge Community Calendar.
-
The members will provide comments on the community
input form and the fact sheet; and the communications
committee will work on a procedure for capturing public
questions.
-
Mr. Washington requested the emissions data on the
plutonium fire at ORNL; Dr. Davidson suggested that
be brought up to the Public Health Assessment Work Group.
She also noted that its agenda is growing, so patience
may be necessary.
Compiled during development of the minutes:
-
ATSDR will explore another date for the team buidling
exercise at the Children's Defense Fund Lodge.
-
The Outreach andCommunication Work Group will discuss:
1) ways other than advertising to solicit concerns and
information on contaminants, which also can be solicited
at the beginning of the public comment periods; 2) development
of a cross-referential document about the role of epidemiology
and the public health assessment, relative to drawing
conclusions about health hazards in a community as pertain
to specific chemicals and their sources. (Perhaps Ms.
Berger and Dr. Peipins can explain those differences
at the next meeting.)
-
The Public Health Assessment Work Group will evaluate
the need for a formal mechanism to track needed for
information, such as "Inconsistent By Design," that
is not applicable to the source term or contaminant
information but might offer good critical input.
-
The Agenda Work Group will discuss inviting Dr. Mongano
to the next meeting if his study is discussed.
-
Ms. Dalton agreed to consult with ATSDR's management
about following up with UNOS (phonetic), per
Mr. Johnson's suggestion, to ask how they obtained the
exception to the disability rule that he had referenced
earlier.
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