Oak Ridge Reservation: Health Needs Assessment Work Group

Health Needs Assessment Work Group

September 25, 2003 - Meeting Minutes

Attendance

ORRHES Members: James Lewis (Co-chair), Donna Mosby (Co-chair), Kowetha Davidson (ORRHES chair), Karen Galloway, David Johnson, Pete Malmquist (via telephone), Barbara Sonnenburg (via telephone)

ATSDR Staff Attending: In the Oak Ridge Field Office: Melissa Fish and Bill Taylor. Via telephone: Lorine Spencer, Terrie Sterling, Elizabeth Howze, Theresa NeSmith, Subha Chandar, Jack Hanley, Marilyn Palmer.

The meeting agenda was as follows:

1. Call to Order
2. Review August 5, 2003 NAWG meeting minutes
3. Next weeks meeting October 1 (announcement)
4. Setting an agenda for October 1 meeting.
   - Sunsetting NAWG
   - Sunsetting COWG ?
   - New work group charge (Kowetha, ORRHES August 26)
   - New work group name
   - New work group composition
   - New work group ground rules
   - Check By-laws and review work group mission/charge
   - Require resolution go to ORRHES
   - Require By-laws change
5. Review how the August 26 ORRHES presentations were received (5 minutes)
6. Status report of DHEP response to ORRHES recommendations (5 minutes)
7. Discussion of previous community studies and surveys (such as the 1994 UT report) as source material for future actions.
8. Other business.

James Lewis read the agenda. James Lewis asked that someone provide background information for agenda item #4 because he was not involved with putting it on the agenda.

Agenda Item #1. James Lewis called the meeting to order at approximately 6:40 p.m.

Agenda Item #2. The August 4 NAWG meeting minutes were approved without modifications or dissent.

Agenda Items #3 & #4. Concerning next week’s NAWG Meeting, Terrie Sterling stated that it was DHEP’s understanding that they would have a face-to-face meeting with the NAWG in Oak Ridge on October 1. This item was put on the agenda because Bill Taylor suggested that not everyone knew about the meeting.

Terrie Sterling said that she sent out earlier emails indicating that DHEP was concerned—having referred to Kowetha’s original charge for the NAWG at the August 26 ORRHES meeting—that the original meeting agenda that Bill Taylor sent out was moving too fast and that much of that discussion could be done better in the face-to-face meeting next week.

Pete Malmquist said he didn’t understand why, or “about what” we needed to slow down. Pete said that we are almost two years into the project and have accomplished one thing: the Y-12 Uranium Public Health Assessment.

Terrie Sterling said she was not talking about the public health assessments. She said she was talking about where the Needs Assessment Work Group and DHEP should go now that the NAWG’s charge has been completed.

Pete Malmquist asked whether Terrie Sterling said the Needs Assessment Work Group has completed its task, and if so that would mean there is no more need for the NAWG’s work.

Terrie Sterling responded that DHEP wants to move forward from where the NAWG and DHEP have been, and DHEP does not want to redo another full-blown needs assessment. DHEP and NAWG may need more information to move forward but that information may exist or we may be able to get it in different ways.

Donna Mosby said that the way she looked at the NAWG is that the NAWG would find information and support the needs assessment process carried out by George Washington University. Since that task is complete, that no longer needs to be the function of the group. Terrie Sterling agreed with Donna’s description.

James Lewis said that the NAWG provided information for GWU early in the process. Since the report came out the NAWG provided a recommendation associated with the report. James said that the knowledge that the charge has been completed is news to him as co-chair. James asked whoever decided that to explain.

Donna Mosby said this was discussed at the Subcommittee meeting.

James Lewis said that what was talked about at the Subcommittee meeting was a possible name change and possibly combining work groups based upon the charge. James Lewis said that in the first agenda that he had Bill Taylor send out, he included a discussion of the rationale for combining the work groups.

Kowetha Davison said that a name change reflects that the work has been completed and the bylaws say that once the work is done that a work group should be disbanded. If we want to continue in a new direction, it is best to end what we had before and start with a new work group.

Libby Howze said that it will be better to discuss this item at the face-to-face meeting October 1, and these issues should be on the agenda for that meeting rather than debate them over the telephone.

Pete Malmquist agreed with Libby Howze and made a motion that the discussion of a name change be put on the agenda for the October 1 meeting. David Johnson seconded the motion.

Donna Mosby asked for some discussion. Donna said that part of the purpose for the present meeting was to talk about what kind of group might interface with DHEP and what the charge was and whether the changes were needed. Donna said that she thought they should be doing that before the October 1st meeting.

James Lewis said he understood this similarly to Donna’s understanding, and he had attempted to set up this meeting as soon as possible to try to discuss this. James said that after a teleconference with the work group chairs, Lorine Spencer sent out a “straw man” draft agenda that included a discussion of renaming or combining the work groups and Terrie Sterling had responded by email in a complimentary way. James said he looked at the minutes of the August ORRHES meeting to try to see what we were going to try and do. James felt the NAWG needed to clarify what was meant by “combining” the work groups and made some modifications to the agenda to accommodate that discussion. But after that, the agenda was changed again (to its present form). James Lewis then said that the proposal made by Pete was adequate and if we are going to move through this we need to move on.

Libby Howze asked for a clarification of the motion. Pete Malmquist said his motion was that we stop all discussion of name change, etc., we meet on October 1, and we talk about item #4 at that time.

James Lewis said that as a part of item #4 Kowetha Davidson was going to tell us about the work group charge. The work group then read through the charge from page 17 of the draft August 26 ORRHES meeting minutes (paragraphs 2 and 3). James Lewis said that those meeting minutes are very strange and they don’t flow well.

Kowetha Davidson said that the charge is in the minutes. James Lewis read them:

“The members should closely collaborate with DHEP to identify next steps in the health education process for the ORR site; develop a strategy to achieve these goals; and present the plan to ORRHES for review, comment and approval. HENAWG should be prepared to present the plan no later than the December 2003 ORRHES meeting. Any HENAWG member who needs clarification on the new charge should contact Dr. Davidson.

Dr. Howze asked ORRHES to consider two additions to the charge. First, the plan should also include a clearly defined process for DHEP to collaborate and communicate with HENAWG and ORRHES. Second, HENAWG should be renamed to ensure that the members and DHEP begin developing health education activities for the ORR site without dwelling on past mistakes in the needs assessment. Dr. Davidson amended the charge to include Dr. Howze’s suggestions. The members should develop a strategy for DHEP to collaborate and communicate with ORRHES and HENAWG. The members should review and discuss HENAWG’s current role as outlined in the ORRHES bylaws.”

Kowetha Davidson clarified that the copy of the bylaws that Lorine had at the ORRHES meeting was from the ATSDR web site. It is not the most recent version and it does not list the NAWG as a work group.

James Lewis commented on the part about “dwelling on past mistakes.” James said that there is a difference between dwelling on past mistakes and plugging holes. James said that holes were created in the needs assessment process. If in the sequence of operations there is a hole, or a perceived weakness, something has to be done that relates to that if it is tied into future activities. James said that the needs assessment activities are not necessarily parallel efforts and appear to have been done in a series. James said that he hoped that as a part of the discussion in the future, room is left for discussion in those areas. James said that reviewing other documents is a good way of filling holes and gaps. James said he doesn’t consider that as dwelling on the past—that’s just building on the future.

Next, James Lewis called for a vote on the motion. The motion passed without dissent.

Donna Mosby asked if the work group members could get a mailing of the current bylaws. James Lewis asked if the latest version of the bylaws is on the web site. The answer is no. Lorine Spencer said that the web site version of the bylaws in Article 9, Section 4 does not include a listing of the work group names (PHAWG and NAWG) but the only changes made to the bylaws since the web version was posted is the addition of those names. Lorine said that since ORRHES is discussing making additional changes to the bylaws, ATSDR is waiting to make all the updates to the web site bylaws at the same time. Donna Mosby asked again if they could get a copy of the bylaws. Lorine Spencer asked Marilyn Palmer if she had the latest bylaws electronically. Marilyn said that she would have to get the file from ERG. Kowetha Davidson said she had the current bylaws electronically and she would send them to Lorine Spencer.

Agenda Item #5. James Lewis proceeded to agenda item #5: Review how the August 26th ORRHES presentations were received.

James Lewis said that he brought up this item because he had heard differing opinions from various people about the presentations. James said he wanted to hear from DHEP or anyone else around the table who felt that the presentations were not balanced and fair. James said they had tried to do a thorough job and present in a professional manner.

Libby Howze said that DHEP did not have any negative comments and so if James had heard them, he didn’t hear them from DHEP. Libby said that they certainly appreciated the work that everyone on the NAWG contributed. In terms of critiquing the report, she thought the observations, criticisms and comments were very good and on target. She said she appreciated the comments and thought it was good for the ORRHES to hear them as well.

James Lewis said that, on behalf of all of those who took the time to work on this, he appreciated Libby’s comments. A lot of people committed time to do the work and gave their volunteer time to this. James said that some of the comments he heard from some ORRHES members were that some of their comments at the ORRHES meeting were not picked up in the meeting minutes. James said when people put extensive amounts of effort and free time to drive up here, and get in work sessions, and review these things, as a minimum we should consider ensuring that when they put this kind of effort forward and we fill up this place with new people and with as many new people that came up here to listen to this, that we ought to at least see that the minutes are reflective of this type of effort. James said that it hurts when their comments are not put forward. Others had indicated to James that their comments were not in the minutes. James said that some ORRHES members had had a number of discussions about meeting minutes and it is an issue that needs to be reviewed at this level and maybe taken to ORRHES to get some resolution of the level of detail people appreciate and need. James Lewis said thank you to Libby Howze; they had worked hard as a group, the community showed up, they were focused, and pulled together to try to give DHEP the best answer that they could.

Libby Howze responded to James and said that she could only say again that DHEP very much appreciated what they all did.

James Lewis added that the NAWG wants to work with DHEP and provide some corrective action, but as Pete indicated at the beginning of the meeting, the train has already left the station. James said we are talking about the need to sit down and get things together again. It’s nice to get ideas on the table, especially if we’re behind and we’re complaining about resources. Why can’t we just get ready and start moving on with life? James said that the community—and most of the Subcommittee people and work group members that he comes in contact with, would like to get this out of the way, get these things done, and move forward.

Libby Howze said that DHEP would like to do the same. But there are fundamental issues that we need to talk about, and they are listed in item #4, and came out of the ORRHES meeting, and from previous conversations with the NAWG, and DHEP’s own discussions. And once we deal with them, moving on will be very much easier. Libby said she thinks we can use some of the October 1 meeting, if we have time at the end, to begin looking at next steps. But Libby said she feels very strongly that we need to all be in agreement on how we communicate, how we make decisions, how we want to operate, and who ought to be involved. Libby said that DHEP does not have a predetermined view of how that ought to be, but since she is saying they want to define a different way of working than has been the case in the past, we need to spend time on doing that.

Agenda Item #6. James proceeded with agenda item #6: Status report of DHEP response to ORRHES recommendation.

James Lewis asked DHEP staff how it would respond to the ORRHES recommendation. Would ORRHES get a written response?

Terrie Sterling said they do plan to respond. DHEP is still gathering information from George Washington University to help them (DHEP) understand some issues that they could possibly share with ORRHES to answer some of the questions that were brought up. On the one-page resolution, there are several items that DHEP will definitely respond to, some which were verbally responded to already at the last Subcommittee meeting. But there will definitely be a written response to those items that will come to ORRHES. DHEP is still pulling that together.

Pete Malmquist asked about Terrie’s wording about information that DHEP was going to share, or was willing to share. Did she mean there was some information DHEP did not want to share?

Terrie Sterling said there is nothing DHEP is trying to keep secret.

Pete Malmquist said that what he heard was there were some things DHEP would share with them (the work group or ORRHES) but there were some things DHEP did not want to share with them.

Terrie said she did not know what she said.

Pete Malmquist said, “That’s fine. If you don’t want to tell us about some things, that’s fine. Just tell us what you don’t want to talk about.”

Terrie Sterling said she didn’t intend to imply that.

Kowetha Davidson asked Pete Malmquist to explain to her what he is saying. Kowetha did not get the same sense as Pete from Terrie’s response.

Pete Malmquist said that when Terrie started speaking, she said there were some things she would like to share with us, implying there were some things they did not want to share with us. Now, if that’s the case, then just say there are some things that we don’t want to share with you. If that’s not the case, that’s fine. Just tell us what you want to share and what you don’t want to share.

Terrie Sterling said that all she could say was that that was not her intent, and she was sorry if that came across that way. DHEP intends to share with them all that they learn.

Pete Malmquist said all right; he understands and accepted Terrie’s explanation. Terrie Sterling said thank you.

James Lewis asked if DHEP had a general idea as to when they would have a response. Terrie Sterling said that they could have a response to the recommendations at the next Subcommittee meeting. Terrie said that when they learn more information from GWU, they would share that information as soon as they get it. Terrie reiterated that they—at the Division of Health Education and Promotion—do not think that the product they have for the needs assessment can be used as a basis for health education/health promotion efforts. She said they can put that in writing, but that was one of the main recommendations that came from the work group/ORRHES, and DHEP agrees with that and thinks that is a good recommendation.

James Lewis said that he appreciates that because Terrie Sterling said DHEP was going back to GWU for some clarifications, and he wondered whether the needs assessment was going to come alive again. Terrie said she did not mean to mislead them. James said there was no problem.

Kowetha Davidson added that there were some things that came from the Subcommittee meeting that may get lost, and they have to do with general health concerns expressed in the needs assessment report. Those were concerns that were included in the report that should not get lost.

James Lewis said that there had been some discussion in that area. When we get information from the public, regardless of the expertise, how do we treat that? There is a major charge for us as related to trying to capture the community’s issues and concerns.

Pete Malmquist said that the health council groups of each of the eight counties determine the priorities of health concerns such as heart disease. Pete said he thought the NAWG could look at the priorities of those eight counties and assign a number to each and come up with a list of concerns that the health councils had compiled in the last couple years. Pete said he thought this is an exercise that the NAWG or the new work group could accomplish and bring back information. Pete said he talked with Brenda Vowell and learned that a lot of these concerns are not reportable diseases. Also, many of them are probably not applicable to what the ORRHES/work group is doing. But at least we can say, as a group, we have looked at these things. And we can say they do not fit into our criteria of what we are studying or doing and we can move forward from there. At least we can then tell the public we have looked at these things and say so if the concerns are not in our charge.

Libby Howze said she thought that is an excellent idea. Libby thought the health departments probably have some really good data or they could be generated. Pete said the data are already generated and they are in the literature review. Libby said we need some newer data. Pete said they are from the last couple years. Libby said that that would be something we would want to look at together. And even if the data are not in the domain we decide we are working in, it might be important to say we looked at it. Also, it might be important to see what is being done to become familiar with heart disease prevention, and screening activities that are going on.

Pete Malmquist said that in Roane County, among the primary concerns are drug addiction, teenage pregnancy, and diabetes. Roane County started a “Stars” program that involved students going into the schools and talking about teenage pregnancy, which has reduced the rate in the county. That is not in our purview up here and we can explain that to people. If we move in that direction we can show that we have done some work here.

Kowetha Davidson said that these things should be put into a general overall plan of action for what we are going to do next. Kowetha said her concern is that they develop a plan and lay out what they are going to do and not go bouncing around doing one thing here and one thing there. The group should lay out the plan for what they are going to do and how they are going to do it. Pete’s suggestion could be put into that. But we need to know what we are going to do and where we are going.

Pete Malmquist agreed with Kowetha. He said that his concern was that Jeff Hill brought up at the last ORRHES meeting that heart disease is a concern. And it is probably a high concern in each of the eight counties. We aren’t going to do anything about heart disease. But let’s say we have looked at it and this is a local problem—or whatever we want to call it—but we have considered this, and let’s go forward.

Libby said that we can do that with a number of issues in the county, and what will evolve from that—review of documents, review of agenda, and talking with people—will give us some pretty clear ideas of where we need to go and the plan Kowetha is talking about. But we have to do our “taking a look” as Pete is saying, to know what is going on.

James Lewis said that he would like to add to the discussion: Karen Galloway issued a memo that James thought did a good job of explaining how technical arrogance has a tendency to overflow into what people say or think about what needs to be done. James said he thinks people have been hurt by that and Karen’s memo really needs to be read by those who are involved in community involvement who are going to be out here educating the people, to get a better idea of the feelings resulting from some of the things they are doing. James said he thinks Pete has an excellent suggestion. James said we have had these types of discussions and people want to get these things on the table. James said he applauds Kowetha for talking about an action plan, which he thinks of as a project plan with some dates to do things in an organized manner. He said he doesn’t think the work group has been as bad as some people think. He said Barbara Sonnenburg has had some very good ideas about some holes that need to be filled. There are people who are taking time to get involved and dig into these issues and there are already a lot of ideas on the table. James said to Libby if people had listened and these ideas had been documented, we would be further along than we are now.

Pete Malmquist said he had to leave the conference at this time and said he looked forward to seeing everybody on October 1.

Libby Howze said the group could start the discussion of filling holes after we have dealt with the agenda item #4 at the October 1 meeting.

James Lewis said that there are undercurrents that are associated with item #4 that maybe should not be discussed in the present meeting. James said people don’t always have time to come to various meetings when they have to drive to them. Sometimes we need to take into consideration that when people do have the time to speak, we need to listen to them, capture those issues, put them together, keep them some place, roll them up into something and move forward. That’s why the minutes have been so beneficial to us. James said we try to reach out and check everybody’s dates for the best meeting times; but sometimes you have to take it where you can get it. James said some people, like Pete, have given of themselves. And when others come to the meetings unprepared and not understanding the issues, they get things out of context and say others are running over them. But those things were discussed. In another example, we had some suggestions from Barbara in the chairs meeting. If Barbara doesn’t show up for the October meeting, and nobody captured those suggestions—since we don’t have minutes from the chairs meeting—this is the kind of problem that we run into. And this is truly an issue for volunteer help.

Libby Howze said this is an issue we need to talk about and why we need to have the conversation (item #4 at the October 1 meeting). There are a lot of questions about how to make decisions that are perceived as having everybody’s input, that are equitable. That just needs to be the discussion that we have on October 1.

James Lewis said he agreed with Libby but said it is bigger than just NAWG. This thing permeates a lot of areas that we’re dealing with and that truly has to be addressed.

There was a short discussion of where the group was on the agenda. Libby Howze said she thought they would talk about agenda item #7 after they had talked about #4 at the October 1 meeting. James Lewis said that he felt strongly that they needed to have some discussion about the items in #7 before they had a discussion about those in #4. James said sometimes we put the cart before the horse. Libby Howze said that she didn’t think we can begin to talk about #7 until we have a way that we can agree to agree—at least on some of the items that we talk about. Item #4. How we’re going to just do business should precede #7, which is really the next step. Item #7 takes us past or into the transition. James Lewis said he thought he understood Libby Howze but his point is that he doesn’t want to lose the recommendations and suggestions or ideas. Libby Howze said she didn’t think that any of us wanted that but that they need to deal with the (item #4) stuff up front. James Lewis said that his remarks were not directed to Libby Howze but to the process that we have had here. He said that when one looks at the process, some of the minutes of the meetings are helping people. Even when we got to the process of giving our comments we had been told, quit the sidebar. So we put our comments in writing. Now our comments are negative. James said his point is the work group is going to give DHEP as much information as it can. And whenever it is collected he would like to see it made available and put into the discussion.

Donna Mosby said she had concerns about how we work as a group, how we call meetings and how meeting agendas are established. Although it will be part of the conversation that the work group is going to have, her concern is how it will be handled for next week. James Lewis said we need to be thinking about something similar to PHAWG and setting one day a month, or something, for meetings because all the bouncing around, trying to figure out who is where and when has been total confusion. Libby Howze agreed.

The group discussed the meeting time for the October 1 meeting and agreed upon 6:00 p.m. The group discussed the meeting agenda and agreed that it would include item #4. Libby Howze said that if there was time we would begin discussing item #7.

Kowetha Davidson said she would like to see a plan of action developed, something laid out. She said her fear was that they would end up with another disjointed effort like with GWU. Terrie Sterling said that that would not happen. Kowetha Davidson said she wants to see something laid out and see where they are going. She said right now she feels like the blind are leading the blind and she wants a plan of action. Kowetha said if you want to do like PHAWG, PHAWG has a plan of action. The dates concern her. She wants to see what we are going to do and how we are going to get there.

James Lewis said PHAWG has check points for the plan of action, and that is the way you control things so that you don’t wind up, two and a half years into a project, with nothing. Nobody had check points with the needs assessment, and that was stated pretty clearly in previous discussions. That’s the key.

James Lewis adjourned the meeting at approximately 7:40 p.m.