Oak Ridge Reservation: Guidelines and Procedures Assessment Work Group

Guidelines and Procedures Assessment Work Group

July 29, 2004 - Meeting Minutes

Attendance

Members attending: Karen Galloway (Chair), David Johnson, and James Lewis

ATSDR Staff attending: Marilyn Palmer, Bill Taylor, and Maria Teran-MacIver (phone)

ERG Contractor: Liz Bertelsen (phone)

Purpose

Karen Galloway called the meeting to order. Ms. Galloway noted one change for the minutes from the July 12, 2004, GPWG meeting. She referred to the following excerpt from the first page of the minutes that described a letter sent from George Gartseff to Ms. Galloway: The GPWG had addressed some of his comments at its last meeting, but Ms. Galloway had told Mr. Gartseff that the work group would discuss his comments further during tonight's meeting. Ms. Galloway wanted the second half of the sentence to be changed to: "...but Ms. Galloway wanted to discuss his comments further during tonight's meeting because her only contact with Mr. Gartseff was immediately after she had received the letter." The meeting minutes were approved with this one change.

The purpose of the meeting was to 1) review the work group changeover, 2) discuss the work group chair selection process, 3) prepare additional text for the new work group descriptions, 4) examine the changes made to the bylaws, and 5) present a primer used for health promotion planning.

Discussion on Work Group Changeover and Work Group Chair Selection

Facilitator: Karen Galloway, Chair

Marilyn Palmer explained that the recommendation to form new work groups was passed at the last ORRHES meeting. Also at that meeting, ORRHES passed the new work group names, and therefore, a change to the bylaws to reflect this would automatically be accepted. She said that the old work groups would operate until the next ORRHES meeting on September 14, 2004. At this upcoming meeting, the new work groups would be present. Ms. Palmer stated that, in order for this to occur, the GPWG would need to be first on the meeting agenda to submit the bylaw changes. Also at this time, new work group chairs would be elected.

Bill Taylor said that they would need to introduce the proposed change for selecting work group chairs. If they did not, he said that Kowetha Davidson (Chair, ORRHES) would select the chairs.

James Lewis explained that the GPWG was tasked to develop a voting methodology to select work group chairs. He added that this proposed methodology had to be voted on and approved by ORRHES. In the absence of a new voting system, Mr. Lewis said that the assignment of work group chairs would default to Kowetha Davidson. If this occurred, Mr. Lewis thought that they were subject to be "right back where they started."

Karen Galloway explained that their initial "charge" was to identify problems, and that they had completed this task. In addition, she said that they had attempted to develop solutions to these problems. She thought that the GPWG had performed "over and above" its delegated assignment. Ms. Galloway noted that she had received a lot of feedback on their efforts. She thought that there was "fright" from some ORRHES members on what they were trying to accomplish. Ms. Galloway explained that they have focused their efforts on restructuring and developing new processes to remove some of the factions that have occurred in ORRHES. These factions, in her opinion, should not have been permitted to occur in the first place. She thought that they needed to convey their actions to ORRHES and added that they were developing ways so that the entire subcommittee could conduct business more effectively.

James Lewis thought that if they selected work groups chairs based on a person's personality or on what the ORRHES chair might find appropriate, then they would end up in the same situation.

Marilyn Palmer asked if there were indications that these proposed changes would not be approved by ORRHES. James Lewis said that Ms. Palmer was correct. He said that there had been notions that people were not happy with these proposed changes, but that he had received "illogical reasons" from people who had called him personally. Ms. Palmer said that these work groups had already been approved. Bill Taylor indicated that the issues referred to changing the process for selecting work group chairs. Karen Galloway said that they welcomed any ideas and suggestions about their proposed changes. She stressed that the work group's intention had been to bring the group together, but that they needed to "do a better job."

James Lewis made the following motion, which passed unanimously: An e-mail will be sent to all of the ORRHES members and copies will be sent to ATSDR officials requesting that they provide, in writing, to the Chair of the Guidelines and Procedures Work Group, any questions, comments, or concerns about the approach that has been laid out as far as the democratic process for selecting chairs for these work groups.

David Johnson thought that some "backlash" could result from these proposed changes and noted that there was already resistance to the suggested modifications for selecting work group chairs. Mr. Johnson anticipated ORRHES members asking why it has taken this long for these changes to be proposed. He said that some people may see this as "personal" because they were dealing with issues of self-esteem; he thought that repercussions could result. He added that when the GPWG presented this information, ORRHES would not necessarily vote in favor of the changes.

James Lewis presented a document entitled Suggested Guidelines for Selecting Members of the Hanford Health Effects Subcommittee, which consisted of an introductory paragraph and a list of 13 personal qualities. Mr. Lewis read the following introductory paragraph:

The following list of personal qualities was developed by the Hanford Community Involvement Work Group, including representatives of community interest groups and Native American Nations involved at the Hanford DOE [US Department of Energy] site. These personal qualities should be considered by CDC [Centers for Disease Control and Prevention] and ATSDR in their review of nominees and selection of members to the Hanford Health Effects Subcommittee. It is understood that these are only suggested guidelines and that persons with one or more of these qualities may help the effectiveness of the Subcommittee.

In his opinion, James Lewis thought that some people in leadership positions within ORRHES had not displayed the qualities listed in this document. He stated that this list contained "excellent qualities," and wondered what qualities ATSDR had looked for during its selection process. Mr. Lewis thought that members needed to be committed and provide time for involvement. He noted that a group needed a leader in order to be a cohesive unit. He added that administrative help was also needed. He said that Bill Taylor did a "good job," but that someone needed to look at these qualities in relation to ORRHES. He stated that they had been operating for 3 ½ years and that some of the members, including himself, had not exemplified these characteristics that were needed to form a cohesive group.

Marilyn Palmer said that this document was part of the nomination package that was received by everyone who applied to be an ORRHES member. James Lewis thought that they needed to "revisit" this list as it related to how they were operating, and that if people did not have time to commit to the effort, then they would need to re-evaluate this as well. Karen Galloway reminded Mr. Lewis that these were volunteer positions, and added that some people have certain strengths and weaknesses.

Marilyn Palmer asked for clarification about the list of qualities that James Lewis presented. She wanted to know if he was referring to the actual criteria for selecting work group chairs or about the qualities of work group chairs. She said that they needed to define the actual process of selecting chairs. Karen Galloway said that the new GPWG work group—Subcommittee Business Work Group—would provide a slate of nominees at the ORRHES meeting and open up the floor for other nominations. She said that they would elect people based on the nominees, but explained that Mr. Lewis thought that it was more important to evaluate the qualities of the person than to name nominees. Bill Taylor said that they needed to select chairs and that people would consider individual qualities of nominees when they voted. Ms. Palmer explained that Mr. Lewis was concerned that if they did not look at these qualities, then they would be in the "same boat as before."

James Lewis thought that people needed this list so that they could factor these qualities into their voting decisions. He gave an example of how Kowetha Davidson "complains that she doesn't have enough time." He said that it was important to have a person who had enough time to carry out his or her position. However, he noted that they did have to be realistic because this structure was set up so that one person was in charge, yet one person might not have the time to commit.

Karen Galloway said that she had canvassed people to assess how much time they could contribute to the new work groups. She often heard reluctance to be a chair because of the time commitment that was required.

James Lewis stated that it was "sad and a shame" that they were discussing a change of this nature and that the ORRHES Chair and key members of other work groups were not present. At a minimum, Mr. Lewis thought that all of the work group chairs should write in, give their opinion, and provide their evaluation. Bill Taylor replied that members had made efforts in the past to take steps to address this type of situation. For example, the Public Health Assessment Work Group (PHAWG) scheduled the first and third Monday of every month so that people could plan ahead for meetings. Dr. Taylor said that some members could not attend this meeting because they did not have the time or because of other commitments. Dr. Taylor did not think that they should be judgmental of these people because they could not attend this meeting. He pointed out that there was little notification for this meeting, which could have added to the small attendance. Dr. Taylor added that, although Mr. Lewis might believe that this was an important meeting, other people should not be judged because they were not present. Mr. Lewis thought that Dr. Taylor made an "excellent point," but said that chairs and other involved members needed to be consistent when making comments about other people.

Bill Taylor noted that "what is fair and desirable" may not always be the same. He said that ATSDR expected members to come to the ORRHES meetings, and that sometimes members could not attend these meeting either. Dr. Taylor said that people needed to be "flexible and forgiving" about these types of situations and that they needed to realize that "work groups are additional work" on top of members' commitments to ORRHES. David Johnson agreed with Dr. Taylor and said that priorities with work and family needed to be considered foremost. He said that they were going through these changes at the end of this process. Mr. Johnson also thought that many people had already made up their minds, but Karen Galloway was not sure that this was true.

James Lewis asked about the time frame regarding the motion to e-mail ORRHES members and ATSDR officials. Marilyn Palmer suggested that Karen Galloway e-mail Ms. Palmer the proposed process for selecting work group chairs. Ms. Palmer would send out an e-mail to have people review the process and provide comments. She said that she was contemplating having a special telephone meeting so that ORRHES members could discuss the proposed changes. Because she was hearing from the group that the changes might not pass, Ms. Palmer wanted to obtain feedback before the material was presented at the ORRHES meeting. She said that she did not want to go to the ORRHES meeting and have the subcommittee not vote on the mission or the work group chair selection process. If this happened, Ms. Palmer said that they would have to operate under the former voting procedures, which required a two-thirds vote to approve changes.

Marilyn Palmer said that the only part of the bylaw changes that had not been approved was related to the chair appointing work group chairs. She said that the work group names had been removed, and that this has been approved. She added that the work group missions could be changed as well. Bill Taylor clarified Ms. Palmer's statements. He said that they could have new work groups with missions, but that they could still select work groups chairs under the old system. He added that there were questions and concerns surrounding if ORRHES would pass the proposed changes for selecting work group chairs. He said that a separate issue involved the missions of the work groups and that a special ORRHES meeting could be warranted to discuss the selection of work group chairs. James Lewis said that Ms. Palmer was "trying to avoid fighting on the floor." Dr. Taylor said that they could use other means, such as the e-mail sent out by Ms. Palmer.

Bill Taylor suggested that Marilyn Palmer bring these considerations back to ATSDR because they would need input from supervisors on these issues and on ways to manage the issues.

Karen Galloway said that they needed to develop a slate of candidates for work group chairs. James Lewis asked if she had received interest for the different groups. Ms. Galloway said that she had received interest for all of the groups, except for chairing the Community Concerns and Communications Work Group. Bill Taylor recommended that they continue their candidate searching and to bring names to the ORRHES meeting. If they did not have names, then the floor could be opened up for nominations.

Karen Galloway said that she had received a lot of interest for the Health Outcome Data Work Group. Ms. Galloway stated that people had asked about working in various capacities of a work group. She wondered if these people could have more responsibility in the group, without being a chair. Bill Taylor replied that if people did not serve as a chair, they could still be members.

Karen Galloway had been asked if someone could participate in different work groups, and still receive compensation if he or she was not assigned to a particular work group. Marilyn Palmer said that people had to sign up for the work groups to receive compensation.

New Work Group Descriptions

Presenter: Karen Galloway, Chair

Karen Galloway presented proposed language to add to the descriptions of the new work groups that were developed in the July 12, 2004, GPWG meeting. The first portion of each handout was from these previously developed descriptions, which were quoted directly from ATSDR's Public Health Assessment Guidance Manual (PHAGM). She said that she prepared additional wording so that people would understand the relationship between the former work groups and the new work groups. The new wording was presented at the bottom of each recommendation and placed into parentheses.

Karen Galloway read the proposed language for the new work groups, which is presented below.

Subcommittee Business Work Group: The Subcommittee Business Work Group will include the former Agenda Work Group and the Guidelines and Procedures Work Group. This work group will handle any ORRHES business and will operate on an as-needed basis.

Community Concerns and Communications Work Group: The Community Concerns and Communications Work Group will consolidate activities of the former Needs Assessment and the Communications and Outreach Work Groups.

Exposure Evaluation Work Group: This work group will include the former Public Health Assessment Work Group minus the community concerns and the health outcome data portions of a PHA [Public Health Assessment].

Health Outcome Data Work Group: The Health Outcome Data Work Group should inventory and evaluate the existing databases, identify the gaps, provide recommendations as to how best to fill those gaps, or may advise that more health studies be completed in order to strengthen the remaining PHAs.

Discussion

James Lewis asked why the chairs meeting was not included under the Subcommittee Business Work Group. Bill Taylor replied that the chairs meeting was not a work group. Mr. Lewis thought that it needed to be included under this work group in order to develop meeting minutes and receive feedback. Dr. Taylor suggested that if issues needed to be discussed, then they could be brought to this work group. Mr. Lewis thought that something was "awry" in this process because they had made recommendations, but that nothing was followed through since it was not considered a "work group." Dr. Taylor thought that this could be a fault of the chairs meeting, but that it was not a work group meeting. David Johnson suggested that, if there was a major concern, then it could be sent to the Subcommittee Business Work Group. Dr. Taylor said that it seemed reasonable to forward any issues, recommendations, or items requiring further discussion to this work group.

Marilyn Palmer asked if the work group chairs could dole out work to a work group if it was not fully discussed in ORRHES. Ms. Palmer explained that the chairs meetings consisted of discussions about past and upcoming meetings, information sharing, and lessons learned. James Lewis thought that this was a "wasteful effort" because nothing came out of the process.

After group discussion, the GPWG removed the following portion from the Subcommittee Business Work Group description: "will handle any ORRHES business." This made the description read as: The Subcommittee Business Work Group will include the former Agenda Work Group and the Guidelines and Procedures Work Group. This work group will operate on an as-needed basis.

James Lewis thought that it would be beneficial if they added mission or workload statements to these descriptions. Bill Taylor was unable to locate mission statements for the previous work groups. Marilyn Palmer said that she had previously used these mission statements for a meeting, and that she would locate these for the group.

Bill Taylor asked Karen Galloway about her purpose for this part of the meting. Ms. Galloway explained that, unless members read the minutes from the last meeting, they would not know this part of the description unless they had read the PHAGM. She said that people have asked her how the old work group duties would be divided into the new groups. She wanted to address these questions to clarify the new work group functions.

Marilyn Palmer asked if the Exposure Evaluation Work Group description dealt with the more technical portion of the PHA. Karen Galloway said that Ms. Palmer was correct.

James Lewis commented that 98% to 99% of exposure evaluation efforts were conducted under PHAWG. He said that they did not have a work group to handle the "concept of health issues." He said that this was an "outstanding issue for the community." He told Maria Teran-MacIver that this could be a parallel effort with the exposure evaluation. She asked if he wanted to know about exposure evaluation. Mr. Lewis said that they wanted to know about health outcome and that people wanted their questions answered, such as "How much cancer is in the area?" and "Is my thyroid disease related to iodine?" In general, Mr. Lewis said that they do not have a forum for the public to discuss health issues and concerns. He noted that the PHAWG focused primarily on technical issues related to exposures, and that it was not set up to handle questions related to health issues. As a result, Mr. Lewis said that the "community doesn't have a place to go."

James Lewis asked Marilyn Palmer if ATSDR's management was "scared" about forming a Health Outcome Data Work Group. Ms. Palmer could not speak for management, but said that she fully supported this effort. She said that they represented the community, and that if this was what the community needed, then she supported the effort.

Karen Galloway explained that evaluating health outcome data is a new focus for ORRHES, and that this work group will be conducting work that was basically done before.

James Lewis commented on the Health Outcome Data Work Group description that said that the work group "should inventory and evaluate the existing databases." Mr. Lewis said that this was part of ATSDR's responsibility and should not be requested of the work group. He said that the work group should review ATSDR's work. Bill Taylor said that the work group would review ATSDR's presentation of its health outcome data evaluation.

David Johnson asked about the medical records that were part of the Health Outcome Data description. Karen Galloway noted that this was a direct quote from the manual, and to her understanding, ATSDR could not review medical records. As a general rule, Bill Taylor said that ATSDR would not look at medical records. However, he said that there were exceptions, usually within the confines of specific studies. David Johnson noted that the Safe Workers Program included medical studies. Dr. Taylor said that they had access to all of the studies conducted by the National Institute for Occupational Safety and Health (NIOSH) and other studies reported in scientific literature. Dr. Taylor explained that these data sources may not necessarily be considered a "database," but that they looked at subsets of populations that could include information about the health of a community.

James Lewis said that he had often heard "I looked at it." He said that the public wanted to see actual numbers and data. Bill Taylor said that the Y-12 Uranium PHA provided examples of data sources and studies in its health outcome data section. Mr. Lewis said that this listed the information, but that it did not detail how the data sources were actually evaluated. If this was the case, then Dr. Taylor said that it should be looked at again. Mr. Lewis said that it bothered people when health assessors said that they "looked at it," but did provide details on their evaluations.

After discussing the verbiage, the Health Outcome Data Work Group description was changed to: The Health Outcome Data Work Group should review ATSDR's inventory of and evaluation of existing health outcome data, identify the gaps, provide recommendations as to how best to fill those gaps, or may advise that more health studies be completed in order to strengthen the remaining PHAs.

James Lewis believed that ATSDR should address any correlations found between issues raised by the general public and findings in an exposure evaluation.

Karen Galloway thought that the general public, on average, had a "big problem" with ATSDR's process that starts with looking at exposure and evaluates pathways, times, places, and then determines if a health effect is possible. Ms. Galloway said that the general public says, "I was here, I have this, and could it possibly be tied to this at the end of the line." She said that ATSDR and the general public looked at these issues in two different ways.

Marilyn Palmer asked if the Cancer Incidence Review would be incorporated under the Health Outcome Data Work Group. James Lewis said that Ms. Palmer was correct, as this work group consisted of the tumor and disease registries.

Changes to the Bylaws

Facilitator: Karen Galloway, Chair

Karen Galloway explained that she had made copies of different versions of the bylaws. She separated the bylaws into two sets: 1) bylaws that dealt with removing work group names from the bylaws, and 2) bylaws that dealt with electing work group chairs as opposed to chairs being appointed.

Bill Taylor said that they needed to review these changes tonight and send them out. He asked Karen Galloway if it appeared that all of the necessary changes had been made. Ms. Galloway explained that she had compared the two documents and believed that the changes were incorporated.

Bill Taylor appreciated Karen Galloway's hard work on the bylaws. Marilyn Palmer suggested only using one copy of the bylaws. She said that they could bold the text to indicate where changes and deletions had been made. Ms. Palmer explained that she would take the amended bylaws from Ms. Galloway and would prepare them for distribution.

A Primer on Effective Health Promotion Planning

Presenter: James Lewis

James Lewis presented "A Primer on Effective Health Promotion Planning" to the group. He said that this document depicted five phases that he thought would have happened in their process. He wanted to consider attaching the document to the health outcome data piece of the descriptions. Bill Taylor did not see how this document "rolled together" with the statement of the work group. Mr. Lewis thought that these phases demonstrated what they had expected to receive from ATSDR. He directed the group to Phase 1. Social Assessment. He said that once they received issues, they should "document community concerns and needs" as described in the document as part of Phase 1. Dr. Taylor was concerned that the document looked like a plan or outline for all work groups because it encompassed concerns, exposure evaluations, health outcome data, conclusions, and recommendations.

James Lewis suggested that they study this primer and that a presentation be given on the material to assess how the work groups were aligned with this effort.

Karen Galloway recommended that Bill Taylor give a presentation to ORRHES on the primer to show its association with the new work group functions. James Lewis said that they could look at the document with Dr. Taylor's assistance and then ask ATSDR for a presentation. Mr. Lewis stated that he was "stunned" when he found out that the Project Manager had never seen this document. He thought that this primer was a "simple visual aide" to illustrate ATSDR's process.

David Johnson asked if the document would be sent to the Agenda Work Group for review. James Lewis said that it could possibly be brought to the Communications and Outreach Work Group (COWG) for evaluation as a communications tool. He suggested that they put all of the material from the primer into a matrix and have all of the PHAs on one side.

Bill Taylor noted that there were different ways to present the same information. He said that this primer looked as though it covered material for all of the work groups and the entire expanse of a PHA. He explained that this information had been presented to them before, but in different ways.

Additional Items

James Lewis asked Maria Teran-MacIver about the differences between ATSDR's Division of Health Education and Promotion (DHEP) and the Community Involvement Branch (CIB). Ms. Teran-MacIver replied that some states were associated with ATSDR. In these states, there was usually a person to carry out the community involvement and health education. In Oak Ridge, DHEP was responsible for teaching efforts in the community. She added that CIB also worked on educational products, such as fact sheets and communication strategies. She said that there was a little overlap between the groups, but noted that they were different.

James Lewis said that they had difficulty looking at this because they did not have an educational piece to evaluate. He added that they had not seen "teaching efforts" up to this point. Maria Teran-MacIver said that she wanted to review and assess the needs of the community and to determine the necessary activities for ATSDR to meet those needs.

James Lewis explained that education was also needed to inform people why they would not need to be concerned based on particular findings. For example, people needed to understand why clinics were not set up. Maria Teran-MacIver agreed with Mr. Lewis.

James Lewis asked Maria Teran-MacIver how she had addressed questions related to health issues at other sites. She said that she had used different methods. In Vieques, Puerto Rico, Ms. Teran-MacIver explained that she used small community groups and taught information about cancer and children's environmental health issues. She stated that there were numerous ways to reach the community, such as working through different churches in their area.

James Lewis asked Maria Teran-MacIver how she identified the community's issues. She said that issues were collected during the first public availability session, which was where the community voiced its concerns. She said that in Vieques, the community was scared of developing cancer and asthma. To respond to these concerns, she explained that ATSDR set up teaching groups on these topics and on children's developmental pathways.

James Lewis thought that ATSDR sometimes limited its access to talent and availability because of the organizational structure of ORRHES. Bill Taylor said that they could think about ways to invite more people to the meetings, such as conducting outreach activities to reach people with expertise. David Johnson thought that the upcoming ORRHES meeting was a good opportunity to send public service announcements (PSAs), which would hopefully increase the level of participation.

James Lewis said that he had received input from Susan Robinson (ATSDR), who noted that she was pleased with how the COWG had worked at its last meeting. In contrast, Mr. Lewis said that he had received input from people who did not attend the meeting, but questioned the activities that took place during the meeting. Mr. Lewis said that this was a good example of how they ended up challenging each other in meetings. He added that "good things" were happening, but that these were not highlighted.

Karen Galloway asked about the list of qualities presented by James Lewis. She asked if these could possibly be used as a basis for Peggy Adkins's climate survey for ORRHES. Bill Taylor said that Ms. Adkins had already described the survey that she had intended to prepare, which was somewhat different from this list. Dr. Taylor thought that they should use the survey developed by Ms. Adkins because it would examine needed issues.

James Lewis presented a document that was handed out at the first work group meeting, 3 months into their operations. The draft document included proposed ground rules for work group meetings, public involvement, and suggestions for improved communication. Bill Taylor asked if Mr. Lewis wanted this document resubmitted to ORRHES members. Mr. Lewis said that Dr. Taylor was correct.

Karen Galloway adjourned the meeting at 7:25 pm.

Please see the following page for one motion that was passed during the meeting and a list of the descriptions added to the previously recommended (July 12, 2004, GPWG meeting) descriptions for the new work groups.

The following motion was passed unanimously during the meeting: An e-mail will be sent to all of the ORRHES members and copies will be sent to ATSDR officials requesting that they provide, in writing, to the Chair of the Guidelines and Procedures Work Group, any questions, comments, or concerns about the approach that has been laid out as far as the democratic process for selecting chairs for these work groups. The work group added the following descriptions to the work group definitions developed during the July 12, 2004, GPWG meeting: Subcommittee Business Work Group: The Subcommittee Business Work Group will include the former Agenda Work Group and the Guidelines and Procedures Work Group. This work group will operate on an as-needed basis. Community Concerns and Communications Work Group: The Community Concerns and Communications Work Group will consolidate activities of the former Needs Assessment and the Communications and Outreach Work Groups. Exposure Evaluation Work Group: This work group will include the former Public Health Assessment Work Group minus the community concerns and the health outcome data portions of a PHA. Health Outcome Data Work Group: The Health Outcome Data Work Group should review ATSDR's inventory of and evaluation of existing health outcome data, identify the gaps, provide recommendations as to how best to fill those gaps, or may advise that more health studies be completed in order to strengthen the remaining PHAs.