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Oak Ridge Reservation: Compendium of Public Health Activities at the US Department of Energy
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3.3 Issue 3: Reported Illnesses

3.3.1 Health Statistics Review to Address Oak Ridge Physician's Concerns

Purpose

A health statistics review was conducted to compare mortality rates and cancer incidence rates of counties surrounding the Oak Ridge Reservation to rates from the rest of the state.

Findings

Findings of the review are in a Tennessee Department of Health memorandum of October 19, 1992, from Mary Layne Van Cleave to Dr. Mary Yarbrough. The memorandum details an Oak Ridge physician's concerns about health status in the Oak Ridge area. Also available from the Tennessee Department of Health are the minutes and handouts from the presentation given by Ms. Van Cleave at the Oak Ridge Health Agreement Steering Panel on December 14, 1994.

Background and Agencies Involved

In June 1992, an Oak Ridge physician reported to the Tennessee Department of Health and the Oak Ridge Health Agreement Steering Panel that he believed approximately 60 of his patients had experienced occupational and environmental exposures to several heavy metals. The physician felt that these exposures had resulted in increased cancer, immunosuppression, chronic fatigue syndrome, neurologic diseases, autoimmune disease, bone marrow damage, and hypercoagulable state including early myocardial infarctions and stroke. Following is a summation of the concerns expressed by the physician.

  1. He expects an increased rate of cancer in Oak Ridge and stated that cancer cases are presenting early and with a more aggressive course.
  2. He had seen prostate cancer cases with very aggressive growth patterns in patients of unusually young ages (e.g., 42 years).
  3. He stated that the cancer best correlated with radiation is acute leukemia, and that over the last 6 months he has had 3 cases in Oak Ridge, and the normal rate was 5 per 100,000.
  4. He noted that there were more cases of lung cancer and colon cancer than all of the other cancer cases combined. In addition, he noted that the effect of confounders such as tobacco and diet were not considered, but if smoking were controlled, the lung cancer rate would be higher for those with exposure to radioactive elements.

Time Line

The health statistics review of cancer incidence rates was conducted in 1992, and the health statistics review of mortality rates was conducted in 1994.

3.3.2 Review of Clinical Information on Persons Living in or near Oak Ridge, Tennessee

Purpose

The purpose of this review was to evaluate clinical information on persons tested for heavy metals and to determine whether exposure to metals was involved in these patients' illnesses.

Findings

ATSDR concluded that this case series did not provide sufficient evidence to associate low levels of metals with these diseases. The Tennessee Department of Health came to the same conclusion.

Background and Agencies Involved

In 1992 an Oak Ridge physician reported that he believed approximately 60 of his patients had experienced occupational and environmental exposures to several heavy metals. He felt that these exposures had resulted in increased cancer, immunosuppression, and autoimmune disease.

At the request of the physician, ATSDR reviewed the clinical data and medical histories of 45 patients. The Tennessee Department of Health also conducted a review of the information.

Time Line

In August 1992, the Oak Ridge physician made a request to ATSDR to review the data.

ATSDR sent a copy of their review to the physician in September 1992.

3.3.3 Clinical Laboratory Analysis

Purpose

Clinical laboratory support was supplied to Howard Frumkin, MD, to provide individual clinical evaluations of patients referred by a physician in Oak Ridge.

Findings

Because of patient-to-physician and physician-to-physician confidentiality, results of the clinical analysis have not been released to public health agencies.

Background and Agencies Involved

In 1992 a physician in Oak Ridge reported that he believed approximately 60 of his patients had experienced occupational and environmental exposures to several heavy metals. He felt that these exposures had resulted in increased cancer, immunosuppression, and autoimmune disease. At the request of Howard Frumkin, MD, DrPH, of the Emory University School of Public Health, ATSDR and NCEH facilitated clinical laboratory support by the NCEH Environmental Health Laboratory for patients referred by the Oak Ridge physician.

Time Line

Clinical laboratory support was provided in 1992 and 1993.

3.3.4 Health Statistics Review of Amyotrophic Lateral Sclerosis and Multiple Sclerosis Mortality Rates

Purpose

Mortality rates were reviewed to find the incidence and mortality rates of amyotrophic lateral sclerosis (ALS) and multiple sclerosis (MS) in the counties around Oak Ridge and to compare those rates with the background rate in the United States.

Findings

Because these diseases are not reportable, it is impossible to find the incidence rate. The mortality rates were not significantly different from rates in the rest of the state.

Background and Agencies Involved

In 1994 local residents reported that there were many community members with ALS and MS. In consultation with Peru Thapa, MD, MPH, from the Vanderbilt University School of Medicine, the Tennessee Department of Health conducted a health statistics review of ALS and MS mortality rates for select counties in the state of Tennessee. ATSDR also provided technical assistance to the department.

Time Line

The health statistics review was conducted in 1994.

3.3.5 Public Presentation on Amyotrophic Lateral Sclerosis and Multiple Sclerosis

Purpose

A public presentation was conducted to provide the Oak Ridge Health Agreement Steering Panel and the public with an overview of amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS), and epidemiologic studies.

Findings

Neuroepidemiologist Dr. Leonard Kurland explained that there are three kinds of ALS: sporadic, genetic, and Western Pacific. He reported that in the United States 90% of ALS cases are sporadic and 10% genetic. He said that approximately 5,000 people each year are diagnosed with ALS in the United States. He stated that researchers have not yet been able to identify a cluster of ALS because (1) ALS is easy to misdiagnose and (2) the incidence rate is approximately 2 ALS cases per 100,000 people per year. He explained that if someone is genetically predisposed to having ALS they will develop the disease if they live long enough and that there is no indication to confirm a causal relationship between mercury exposure and ALS and MS.

Dr. Kurland showed a video about his research in Guam and indicated that the Western Pacific cases are probably attributable to a botanic toxin.

Background and Agencies Involved

In 1994 local residents reported that many community members had ALS or MS. The Tennessee Department of Health sponsored Leonard Kurland, MD, DrPH, a neuroepidemiologist and senior consultant with the Mayo Clinic in Rochester, Minnesota, to give the presentation to Oak Ridge Health Agreement Steering Panel and the public.

Time Line

The presentation by Dr. Kurland was given at the Oak Ridge Health Agreement Steering Panel public meeting on August 18, 1994.

3.3.6 Oak Ridge Health Agreement Steering Panel: Feasibility of Epidemiologic Studies

Purpose

A study was conducted to explore the feasibility of initiating meaningful and valid analytical epidemiologic studies to address potential health concerns in the off-site populations surrounding the Oak Ridge Reservation.

Findings

A copy of the final report containing the findings of the study may be obtained from the Tennessee Department of Health.

Background and Agencies Involved

The Oak Ridge Health Agreement Steering Panel recognized that there may be a need to supplement findings of the main dose reconstruction studies as they are limited to estimates of health risk in a given population. Panel members were considering adding epidemiologic studies in the future to directly evaluate health outcomes. The Tennessee Department of Health and the Oak Ridge Health Agreement Steering Panel commissioned Puru B. Thapa, MD, MPH, of the Department of Preventive Medicine at Vanderbilt University, to conduct the study.

Time Line

The study was released in July 1996.

3.3.7 Physician Health Education Program on Cyanide

Purpose

A physician education program was conducted to provide information regarding the health impacts of possible cyanide intoxication. In addition, the program was intended to assist community health care providers in responding to health concerns expressed by employees working at the East Tennessee Technology Park.

Findings

  1. ATSDR provided the employee and local physicians with copies of the ATSDR Case Studies in Environmental Medicine publication "Cyanide Toxicity," the NIOSH final health hazard evaluation, and ATSDR public health statement for cyanide.
  2. ATSDR instituted a system through which local physicians could make patient referrals to the Association of Occupational and Environmental Clinics (AOEC).
  3. ATSDR conducted an environmental health education session for physicians at the Methodist Medical Center in Oak Ridge, Tennessee. The medical staff grand rounds provided the venue for conducting this session. The workshop focused on providing local physicians and other health care providers information to help them diagnose chronic and acute cyanide intoxication and answer patients' questions .

Background and Agencies Involved

In January 1996 a Lockheed Martin Energy Systems employee requested assistance from ATSDR concerning occupational exposure to cyanide. On January 29, 1996, NIOSH received the request for a health hazard evaluation. Between February and June of 1996, NIOSH representatives made four site visits to conduct a medical and environmental assessment. NIOSH released the health hazard evaluation in July 1996.

In a cooperative effort with AOEC, ATSDR, NIOSH, and the Tennessee Department of Health followed up on the recommendations in the NIOSH health hazard evaluation by conducting a physician health education session at the Methodist Medical Center in Oak Ridge. Lorne Garrettson, MD, ABMT, Medical Director of the Georgia Poison Control Center, made a presentation at the grand round entitled "Cyanide Intoxication: Acute and Chronic."

Time Line

The physician education program was held in August 1996.

3.3.8 Governor of Tennessee's Independent Panel on the DOE Toxic Substances Control Act (TSCA) Incinerator at the East Tennessee Technology Park

Purpose

An independent panel was appointed to review the operations of the DOE Toxic Substances Control Act (TSCA) incinerator at the East Tennessee Technology Park to ensure that the TSCA incinerator is properly and legally operated and monitored and protective of human health and the environment. The panel was also charged with addressing the concerns and issues raised by the public about the TSCA incinerator.

Findings

  1. The TSCA incinerator facility and operating conditions were in harmony with its permit and had experienced few operating violations. The amount of waste actually burned is a small fraction of the volume that the incinerator is designed and permitted to process. The highest measured concentrations at the site monitors were a small fraction of the permissible levels, and most pollutants measured were not primarily from the TSCA incinerator. Because the incinerator is regulated and monitored and the permissible levels of pollutants in the environment are deemed adequate to protect public health, then the TSCA incinerator is not a major contributor to the illnesses seen in the Oak Ridge area.
  2. Transportation of hazardous substances to and from the DOE Oak Ridge facilities is regulated and monitored by the US Department of Transportation and the state of Tennessee. The record of safety for such shipments has been exemplary. There have been no highway accidents involving wastes being shipped to the TSCA incinerator. The transportation of hazardous substances to the incinerator and from the Oak Ridge site involves risks well within those accepted on a daily basis in the transportation of other hazardous materials, such as gasoline.
  3. The panel found that there are sick workers at the East Tennessee Technology Park and sick residents in the vicinity of the facility. The panel also found that the areal distribution of affected workers and members of the public conforms to no pattern and that the reported diseases are not unique to specific chemicals. The panel reported that it is not known whether the incidence and types of illnesses reported are above normal or a statistical aberration. The panel found no specific causes for the illnesses suffered by workers and members of the public or whether they are more numerous than the norm.
  4. Many of the workers and members of the public were not stratified with the availability, quality, and extent of medical care. Complaints received by the panel include reports of doctors refusing to accept patients, lack of availability of a specialist, lack of coverage of "preexisting illnesses" for employees continuing to work with changing contractors, lack of medical care for nonworkers, and lack of responsiveness.

Background and Agencies Involved

In response to a series of articles in the Tennessean concerning the impact of the incinerator upon the health of workers at K-25 and hearings held at the Tennessee State General Assembly on the illnesses in Oak Ridge and the transportation of hazardous waste through the state to the TSCA incinerator, the governor appointed an independent panel of environmental scientists, engineers, and occupational health professionals to investigate the operations of the TSCA incinerator, currently operated under contact for DOE by Lockheed Martin Energy Systems. The panel inspected the TSCA incinerator, investigated allegations at the East Tennessee Technology Park, visited the SEG incinerator, and held four meeting in Oak Ridge, Tennessee.

Time Line

The panel was appointed in May 1997. The panel's final report was submitted in January 1998.

3.3.9 Presentation of the Utah Leukemia and Thyroid Disease Studies Related to Fallout From the Nevada Test Site

Purpose

This presentation was conducted to inform the Oak Ridge Health Agreement Steering Panel and the public of the multiple studies related to the fallout from the Nevada test site, including the study of leukemia and thyroid disease.

Findings

Dr. Joseph Lyon explained that nuclear testing began at the Nevada test site in January 1951. Public safety concerns began in the mid 1950s with all atmospheric testing discontinued by 1961. In late 1961, the US Public Health Service worked with the Utah Department of Health to conduct a leukemia mortality study. An excess in leukemia was found using death certificate records. This study was reported to the Utah Department of Health and the Atomic Energy Commission, but was not published.

In 1979 Dr. Lyon began studying childhood leukemia associated with fallout from nuclear testing. His study involved a review of all deaths from childhood (under 15 years of age) cancers occurring in Utah between 1944 and 1975. The high exposure cohort was defined as Utah residents under the age of 15 residing in rural counties receiving the most fallout from the 26 nuclear tests that occurred between 1951 and 1958. Leukemia mortality increased by 2.44 times in the high exposure cohort residing in the high exposure counties. No consistent pattern was found for other childhood cancers in relation to fallout exposure.

In 1965, the Bureau of Radiological Health examined 4,818 school children for thyroid disease. These children lived in two Nevada and Utah counties thought to have had large exposure to radioiodine. This cohort was re-examined annually between 1966 to 1970. No excess thyroid disease was found in these children.

In 1985, Dr. Lyon was involved in a follow-up cohort study of the original 1960s group. This study included 2,473 of the original 4,818 children. The study has two major parts, dosimetry and epidemiology. Using the dosimetry data (the primary pathway was milk consumption), the study found an association between exposure to radioiodine and thyroid neoplasia.

Background and Agencies Involved

The Tennessee Department of Health sponsored Joseph L. Lyon, MD, MPH, professor of Family and Preventive Medicine at the University of Utah, to give the presentation in Oak Ridge to the Oak Ridge Health Agreement Steering Panel and the public.
Time Line

The presentation was given at the Oak Ridge Health Agreement Steering Panel public meeting on February 16, 1995.

3.3.10 Health Assessment of the East Tennessee Region, Second Edition

Purpose

The health assessment of the East Tennessee region was conducted to evaluate the health status of the population, assess the availability and utilization of health services, and develop priorities in planning to use resources.

Findings

A copy of the document is available from the Tennessee Department of Health, East Tennessee Region.

Background and Agencies Involved

In response to the Institute of Medicine's 1988 report on the "Future of Public Health," in 1991, the Tennessee Public Health Association encouraged each region of the Tennessee Department of Health to look at the health status of the population, evaluate the availability and utilization of health services, and develop priorities in planning to make the best use of resources. In December 1991, the East Tennessee Region released the first edition of "A Health Assessment of the East Tennessee Region," which included data generally from 1986 to 1990. The second edition included data generally from 1990 through 1995.

Time Line

The second edition of the health assessment for the East Tennessee region was released in 1996.

3.3.11 Medical Evaluation of K-25 Workers

Purpose

The purpose of the individual medical evaluations of K-25 workers was to assess occupational health complaints and symptoms of 53 current and former Lockheed Martin Energy Systems, Inc. workers at the East Tennessee Technology Park (formerly called the Oak Ridge K-25 site). These medical evaluations included reviews of prior health studies, visits to workers' workplaces, work history interviews, reviews of worker medical records, physical examinations, medical evaluations by specialists, and diagnostic testing.

Findings

The physicians determined that several workers have one or more conditions/illnesses likely to have been exacerbated, aggravated, or directly caused by historical exposures in the work environment at K-25.

Some of these medical conditions are the result of exposures to hazardous substances common to other industrial settings, such as organic and inorganic dust-including heavy metals. Health problems found in K-25 workers associated with these types of exposures include the following: allergic and non-allergic rhinitis and sinusitis, acute and chronic bronchitis, occupational asthma, contributing factors to the pathophysiology of emphysema, irritant induced vocal cord dysfunction, allergic and non-allergic dermatitis, noise induced hearing loss, and carpal tunnel syndrome.

Other medical conditions identified that are more unique to the K-25 site include possible beryllium sensitization (2 workers), definite peripheral beryllium sensitization (5 workers), chronic beryllium disease (1 worker), peripheral neuropathies, toxic encephalopathy, and autonomic neuropathy.

Various types of neuropsychological changes were identified in some workers. These neuropsychological changes are consistent with toxic encephalopathy from heavy metal and solvent exposures, cerebrovascular problems, and with significant anxiety and depression. In some cases it was not possible to determine whether the neuropsychological changes resulted from workplace exposures or non-work related physical conditions, such as cerebrovascular abnormalities

Factors that had a significant impact in creating anxiety and depression in workers include: being informed that urine thiocyanate levels were elevated indicating possible cyanide exposure; being tested for heavy metal exposure and chelation therapy; developing medical symptoms and conditions during work activities; having concerns about potential hazards and exposures in the workplace and about emissions from the TSCA incinerator; feeling stressed by downsizing at the K-25 facility; and being distrustful of exposure information provided by contractors and the Department of Energy. Anxiety and depression in some of these workers manifested as work-related depression and anxiety that subsequently resulted in a physical abnormality.

No trends with regards to workplace exposure and health impacts were determined for the following: hypersensitivity pneumonitis, IgG and IgE antibody testing against diisocyanates, lyme disease, heavy metal screening, lead and serum ZPP/FEP, postural sway balance testing, peripheral vision symptoms and abnormalities in peripheral visual field testing, serum PCBs, dioxin and furan levels, and asbestos. Further study was recommended, however, for postural sway balance and peripheral vision symptoms and abnormalities in visual field testing. Increases in postural sway and visions problems were detected, but clinical epidemiological studies are necessary to determine possible causes.

Serum PCB levels were higher in workers with prolonged occupational exposures at the K-25 facility; however, the elevations were not marked and were not a level that would clearly cause health impacts.

Background and Agencies Involved

In the fall of 1995, workers for Lockheed Martin Energy Systems and residents living near East Tennessee Technology Park reported illnesses they believed to be associated with possible exposure to hazardous substances from the East Tennessee Technology Park site. In the fall of 1996, Lockheed Martin Energy Systems arranged for James Lockey, MD, MS, and Andrew Freeman, MD, MS, from the University of Cincinnati, Occupational and Environmental Medicine Clinic and Richard Bird, MD, MPH, from the JSI Center for Environmental Health Studies and the Beth Israel Deaconess Medical Center at the Bowdoin Street Health Center in Boston, Massachusetts to conduct a medical evaluation to determine whether work related factors could be playing a role in the symptoms and conditions of these K-25 workers.

Time Line

The Summary Report of Findings of K-25 Worker Evaluations was released on July 31, 2000.

Individual final medical reports were sent to each of the 53 workers. These reports provided summaries regarding medical conditions which the physicians determined were most likely work related or which the physicians could not state within a reasonable degree of medical probability and certainly were work related, based on the currently available clinical information and what is available in the scientific literature. For individuals that the physicians believed had a condition that was either directly caused by workplace exposure or significantly exacerbated or aggravated by workplace exposures, the physicians prepared a separate "Work Related Abnormalities as Determined to Date" summary. This summary includes all pertinent medical information, occupational history, symptomatology over time, and previous medical records and laboratory test as applicable to the work related condition.

3.3.12 Scarboro Community Health Investigation

Purpose

The Scarboro community health survey, which included a medical evaluation of children under age 18 years, was conducted to investigate a reported excess of respiratory illness among children in the Scarboro community.

Findings

The participation/response rate of the health investigation was 83% (220/264 households), and included 119 children. The asthma rate was 13% among children in Scarboro, compared to national estimates of 7% among all children aged 0-18 years and 9% among African American children aged 0-18 years. The Scarboro rate was, however, within the range of rates reported in similar studies throughout the U.S. and internationally. The wheezing rate among children in Scarboro was 35%, compared to international estimates which range from 1.6% to 36.8%. No statistically significant association was found between exposure to common environmental triggers of asthma (i.e., pests, unvented gas stoves, environmental tobacco smoke, and the presence of dogs or cats in the home) or potential occupational exposures (i.e., living with an adult who works at the Oak Ridge Reservation, living with an adult who works with dust and fumes and brings exposed clothes home for laundering) and asthma or wheezing illness.

Thirty-six children were invited to receive a physical examination. These 36 included the children identified in the November 1997 media report. The other children were those identified in the questionnaire as having physician-diagnosed asthma that was incompletely controlled or those who had not been diagnosed with asthma but had experienced more than three exacerbations of wheezing episodes. Of the 36 children invited, 23 participated; all were generally healthy and no urgent health problems were identified. Only one child had any presence of lower respiratory illness, and none were wheezing at the time of the physical examination.

Background and Agencies Involved

In November 1997, the Tennessee Department of Health received notification of an unusual number of children affected by chronic respiratory illnesses in the Scarboro community, a predominantly African American neighborhood in Oak Ridge, Tennessee. The CDC was invited to participate in an investigation of these health complaints in early December 1997.

The Scarboro community lies in close proximity to the Y-12 plant, part of the Oak Ridge Reservation. This plant has been in existence for more than 50 years. Although requested to provide assistance in the investigation of respiratory illnesses among children, CDC also investigated a variety of other health complaints.

In December 1997, a team of investigators from CDC and ATSDR responded to the request. With the assistance of the Scarboro Community Environmental Justice Oversight Committee, a study protocol was developed, and a questionnaire was administered to the members of each household in the community. The questionnaire was used primarily to assess household environmental exposures and the prevalence of respiratory diseases and associated symptoms among children. In addition, information regarding occupation, occupational exposures, and general health concerns was collected for adults. A number of children were selected to receive a physical examination to document the presence of respiratory disease.

Time Line

On May 16, 1998, questionnaires were administered to community members. In September 1998, CDC released the preliminary results of the survey. On November 14, 1998, medical examinations were given to 18 children from the Scarboro community. On January 5, 1999, a team of physicians representing CDC, the Tennessee Department of Health, the Oak Ridge medical community, and the Morehouse School of Medicine thoroughly reviewed the findings of the physical examinations and the community survey. The results of this review were presented January 7, 1999, at a community meeting in Scarboro.

Status

The final report was released during July, 2000.

3.4 Issue 4: Community Involvement

3.4.1 Oak Ridge Health Studies Bulletin

Purpose

The Oak Ridge Health Studies Bulletin was published to provide information to the public on the Oak Ridge Health Studies.

Background and Agencies Involved

The bulletin was published by the Tennessee Department of Health.

Time Line

The bulletin was published from the fall of 1992 to the winter of 1997.

3.4.2 Technical Workshop for Phase I of Oak Ridge Health Studies

Purpose

A technical workshop was held in Oak Ridge to receive comments and suggestions from current and former workers of DOE facilities on the draft Phase I Oak Ridge Health Studies report (dose reconstruction feasibility study).

Findings

Comments were received and used to help refine the final Phase I Oak Ridge Health Studies report.

Background and Agencies Involved

The Tennessee Department of Health, Oak Ridge Health Agreement Steering Panel, and the TDEC sponsored the workshop.

Time Line

The workshop was held on June 23, 1993.

3.4.3 Community Feedback Sessions for Phase I of Oak Ridge Health Studies

Purpose

Community feedback sessions were held to receive comments from the public on the draft Phase I Oak Ridge Health Studies report.

Findings

Comments were received and incorporated into the final Phase I Oak Ridge Health Studies report.

Background and Agencies Involved

The Tennessee Department of Health and the Oak Ridge Health Agreement Steering Panel sponsored the community sessions.

Time Line

Sessions were held in Kingston and Oak Ridge on May 19, 1993, and June 24, 1993.

3.4.4 Public Meetings in Scarboro

Purpose

Public meetings were held in the Scarboro community to update the residents on Phase II of the Oak Ridge Health Studies and the ATSDR exposure investigation.

Findings

Many residents from the Scarboro community and other Oak Ridge areas attended these meetings.

Background and Agencies Involved

The Tennessee Department of Health and the Oak Ridge Health Agreement Steering Panel held two meeting in the Scarboro area. The first meeting was held at the Oak Valley Baptist Church at the request of Reverend Thomas. After Oak Ridge Health Agreement Steering Panel members consulted with Scarboro community leaders, the Oak Ridge Health Agreement Steering Panel held the second meeting at the Scarboro Community Center. At this second meeting, ATSDR staff members discussed the ongoing exposure investigation on serum PCB and blood mercury levels in consumers of fish and turtles from the Watts Bar Reservoir.

Time Line

Meetings were held on in Scarboro on November 17, 1995, and September 24, 1997.

3.4.5 Knowledge, Attitude, and Beliefs Study

Purpose

A knowledge, attitude, and beliefs study surveyed the eight-county area surrounding Oak Ridge, Tennessee. The purpose of the survey was (1) to investigate public perceptions and attitudes about environmental contamination and public health problems related to the DOE Oak Ridge Reservation; (2) to ascertain the public's level of awareness and assessment of the Oak Ridge Health Agreement Steering Panel; and (3) to make recommendations for improving public outreach programs.

Findings

A complete list of findings is in the report on the study, which is available from the Tennessee Department of Health.

Background and Agencies Involved

The Social Science Research Institute at the University of Tennessee in Knoxville, Tennessee, conducted the study from October through November 1993 for the Tennessee Department of Health, the Oak Ridge Health Agreement Steering Panel, and the Oak Ridge Reservation Local Oversight Committee.

Time Line

The report was released on August 12, 1994.

3.4.6 Community Diagnosis Status Reports-Anderson County and Roane County

Purpose

The community diagnosis process was conducted to analyze the health status of the community; evaluate the health resources, services, and systems of care within the community; assess attitudes toward community health services and issues; identify priorities, establish goals, and determine the course of action to improve community health status; and establish a baseline for measuring improvements over time.

Findings

These reports, with a complete list of findings, are available from the Tennessee Department of Health, East Tennessee Region.

Background and Agencies Involved

The Anderson County Health Council, established in 1968, in cooperation with the East Tennessee Regional Office of the Tennessee Department of Health, identified Anderson County as a pilot county for the community diagnosis process. This process included conducting a community survey, reviewing various data sets, and evaluating resources in the community to identify areas of concern that could affect the health of Anderson County citizens.

The Roane County Health Council, established in 1990, began implementing the community diagnosis process in 1996.

Time Line

The reports were completed in 1997.

3.4.7 Oak Ridge Health Agreement Steering Panel

Purpose

The Oak Ridge Health Agreement Steering Panel was appointed to direct and oversee the Oak Ridge Health Studies and provide liaison with the community.

Findings

Based on what is generally known about the health risks posed by exposures to various toxic chemicals and radioactive substances, the Panel concluded that past releases from the Oak Ridge Reservation were likely to have impacted the health of some people. Two groups most likely to have been harmed were local children drinking milk from a "backyard" cow or goat in the early 1950s, and fetuses carried in the 1950s and early 1960s by women who routinely ate fish taken from contaminated creeks and rivers downstream of the ORR.

The Panel made eight recommendations in their project summary report:

# Three specific initiatives directed to public health intervention should be undertaken:

  1. In partnership with a local college or university, a series of workshops should be periodically conducted for local physicians and other health professionals who need to be educated on ORR environmental and occupational health issues arising from the Oak Ridge Health Agreement studies and other related health studies, as results become available.
  2. In partnership with a local community college or community outreach program, a public information colloquium should be conducted to provide continuing dialogue and education on environmental and occupational health issues relevant to past, current, and future ORR operations.
  3. A partnership working group of local, state, and federal public health officials, health care professionals and representatives of the greater Oak Ridge community should be established to evaluate the need for a formal clinical evaluation process. If such a process is determined to be feasible, the group should formulate recommendations for the development of: (1) a goal for a formal community clinical evaluation process; (2) the types of and qualifications for health care professionals who would be involved in the clinical evaluations of concerned members of the community; and (3) protocol guidelines for individual clinical evaluations and referral for follow-up examinations. The Panel suggested that the results contained within this report and the other reports published as part of the Oak Ridge Health Agreement studies serve as a basis for the development of such protocol guidelines.

1. — Formal epidemiologic studies of populations exposed to iodine-131, mercury, PCBs, and radionuclides from White Oak Creek are unlikely to be successful and should not be performed at this time.

2. — The Department of Energy, the Environmental Protection Agency, the state (and perhaps other agencies) should undertake a coordinated program to obtain needed information and satisfy stakeholder concerns. A soil sampling program is vital to gain information relevant to the historic contamination levels in residential areas closest to the ORR plants. Detailed sampling is recommended in all of the most closely situated neighborhoods and also in a few residential areas at greater distances. Any decision about additional dose reconstruction studies should be deferred until the results of the recommended soil sampling program have been obtained and carefully interpreted.

3. — DOE should undertake a program to measure the atmospheric dispersion of controlled tracer releases from representative stacks and vents at Y-12. The primary goal of these measurements would be to define the transport of a non-depositing tracer such as SF6 from Y-12 to populated areas of Oak Ridge, including the Scarboro and Woodland communities, which are both relatively close to the plant.

4. — More definitive information is needed to better understand the potential toxic effects of exposures to mixtures of contaminants - mercury and PCBs, for example - on the same organ systems. Studies relating to this topic should be undertaken by one or more appropriate government-sponsored public health research agencies.

5. — DOE should take action to assure that copies of the important documents used in the health effects studies are properly indexed and retained at a secure location, irrespective of future shifts of contractor responsibility at the ORR facilities.

6. — DOE should assure the long-term continuation of the ORR environmental monitoring program. The program should include routine measurements in critical media for those materials found to be most important in the health agreement studies, if the material in question could still be present in the local environment. Specifically, the ORR program should: (a) continue to monitor the remaining environmental burden of mercury in East Fork Poplar Creek within the Y-12 plant, in the lower East Fork Poplar Creek floodplain, and in sediment in the downstream watercourses, tracking the resulting methyl mercury risk to consumers of fish taken from downstream fisheries; and (b) assure that the program continues to monitor uranium contamination originating from Y-12, with due consideration of isotopic form.

7. — In the area of statewide health effects registries, (a) the State should continue efforts to improve the accuracy and completeness of the cancer incidence registry, and (b) the State should continue to seek funding for a statewide birth defects registry.

Background and Agencies Involved

As part of the health studies agreement between the state of Tennessee and DOE, the Tennessee Department of Health established the Oak Ridge Health Agreement Steering Panel. The panel is composed of scientific and community representatives appointed by the commissioner of the Tennessee Department of Health. In addition to the nationally recognized scientists and local community representatives, the panel has one representative each from the state of Tennessee, the Environmental Quality Advisory Board of the city of Oak Ridge, the Oak Ridge Reservation workers, CDC, and DOE.

Time Line

The panel was formed in 1992 and oversaw the Oak Ridge Health Studies until its completion in December 1999.

Status

Between January 1992 and December 1999, the Tennessee Department of Health and the Oak Ridge Health Agreement Steering Panel held open meetings in Oak Ridge (over 40 meetings), Nashville (5 meetings), Harriman (2 meetings), and Knoxville (3 meetings).

4.0 POINTS OF CONTACTS FOR THE AGENCIES

4.1 Agency for Toxic Substances and Disease Registry

Jack Hanley 404-639-6024

4.2 Health Resources and Services Administration

Wade Kirstein 404-562-4146

4.3 National Center for Environmental Health

Jim Smith, PhD 770-488-7040

4.4 National Institute of Environmental Health Sciences

Freja Kamel 919-541-1581

4.5 National Institute for Occupational Safety and Health

Larry Elliott 513-841-4400

4.6 Tennessee Department of Health

William Moore, MD 615-741-7247

4.7 Tennessee Department of Conservation, DOE Oversight Division

Earl Leming 423-481-0995

4.8 US Environmental Protection Agency

Camilla Warren 404-526-8519

4.9 US Department of Energy, Health and Epidemiologic Studies

Barbara Brooks 301-903-4674

4.10 US Department of Energy, Oak Ridge Operations

Timothy Joseph, PhD 423-576-1582

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This page last updated on February 16, 2005
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