ORRHES Meeting Minutes
October 21, 2003

Table of Contents

Opening Session and Introductions
Agenda Review, Correspondence and Announcements
Review of August 2003 ORRHES Meeting Minutes
Review of Current ORRHES Action Items
Project Management Update
Proposed Plan for the Iodine-131 PHA
Community Assessments At Other Sites
Public Comment Period
Work Group Reports
    Guidelines and Procedures Work Group
    COWG
    Agenda Work Group
    HENAWG
    PHAWG
Cancer Incidence Assessment
Public Comment Period
Update on the Community Health Concerns Database
Work Group Recommendations
Unfinished/New Business and Outstanding Issues/Concerns
Closing Session
Glossary Key

Final Minutes of the Meeting

The Department of Health and Human Services (HHS), the Centers for Disease Control and Prevention (CDC), and the Agency for Toxic Substances and Disease Registry (ATSDR) convened a meeting of the Oak Ridge Reservation Health Effects Subcommittee (ORRHES). The proceedings were held on October 21, 2003 at the U.S. Department of Energy (DOE) Information Center, 475 Oak Ridge Turnpike in Oak Ridge, Tennessee.

Opening Session and Introductions

Dr. Kowetha Davidson, the ORRHES Chair, called the meeting to order at 12:20 p.m. She welcomed the attendees to the proceedings and opened the floor for introductions. The following individuals were present to contribute to the discussion.

ORRHES Members
Dr. Kowetha Davidson, Chair
Ms. Peggy Adkins
Mr. Don Box
Dr. Herman Cember
Ms. Karen Galloway
Mr. George Gartseff
Mr. Jeffrey Hill
Mr. David Johnson
Ms. Susan Kaplan
Mr. James Lewis
Dr. Anthony Malinauskas
Dr. Peter Malmquist
Mr. L.C. Manley
Ms. Donna Mosby
Ms. Barbara Sonnenburg
Mr. Charles Washington

ORRHES Liaison Representatives
Mr. Chudi Nwangwa (TDEC)
Ms. Brenda Vowell (TDOH)

Designated Federal Official
Ms. Lorine Spencer,
Executive Secretary

ATSDR Representatives
Ms. Subha Chandar
Dr. Paul Charp
Mr. Burt Cooper
Ms. Melissa Fish (OR Field Office)
Mr. Jack Hanley
Mr. Michael Hatcher
Ms. Marilyn Horton
Dr. Elizabeth Howze
Ms. Sandra Isaacs
Ms. Theresa NeSmith
Mr. Jerry Pereira
Dr. Terrie Sterling
Dr. William Taylor (OR Field Office)
Ms. Dhelia Williamson

Point of Contact
Dr. Timothy Joseph (DOE)

Guests
Dr. Gordon Blaylock
Ms. Faye Martin

Agenda Review, Correspondence and Announcements

Agenda Review. In addition to the project management update, work group reports and two public comment periods, Dr. Davidson announced that the following topics would be presented and discussed during the meeting:

• Proposed plan to address the iodine-131 public health assessment (PHA) by Dr. Paul Charp.
• Examples of health education and promotion projects at other sites by the Division of Health Education and Promotion (DHEP).
• Description of the ORR cancer incidence assessment by Ms. Dhelia Williamson.

Correspondence. No correspondence was noted for the record.

Announcements. Dr. Davidson distributed the current roster for each ORRHES work group. She asked the members to indicate their interest in continuing to participate, serving on another work group or resigning. Ms. Marilyn Horton, the ORRHES Committee Management Specialist, will update the roster for each work group and circulate a new list.

Review of August 2003 ORRHES Meeting Minutes

Dr. Davidson entertained a motion to approve the previous meeting minutes. She pointed out that revisions to the first draft were in bold print on pages 8, 12, 13, 17, 24 and 25. Mr. Lewis conveyed that several members of the Communications and Outreach Work Group (COWG) stated the previous meeting minutes did not contain sufficient detail, their voices were not heard and key comments were omitted. Although the members did not submit written changes, he emphasized the need to note and address these concerns.

Dr. Davidson clarified that members must submit revisions to the minutes to ATSDR in writing to be incorporated. A motion to approve the minutes was properly made and seconded by Mr. Hill and Mr. Manley, respectively. There being no abstentions, opposition or further discussion, the August 26, 2003 ORRHES Meeting Minutes were unanimously approved.

Review of Current ORRHES Action Items

Ms. Lorine Spencer, the Designated Federal Official (DFO), provided a status report of pending and ongoing action items.

1. Phase II of the ORR needs assessment will be changed from “pending” to “ongoing” in the list of action items since these activities will be conducted in conjunction with PHAs.
2. Periodic updates will be given on the briefing books for the media and key community groups. This activity will be noted as “ongoing” in the list of action items since briefing papers, fact sheets and other materials for PHAs will be distributed to community groups on a continuous basis.
3. An update on the cross-index for the ORRHES web site will be given during the meeting.
4. The Public Health Assessment Guidance Manual will be distributed to ORRHES after approval is obtained to circulate the document.

Ms. Kaplan noted corrections to be made on the list of recommendations and action items: change “pending” items color-coded as gray to yellow; change the spelling of the name to Patrick “Lipford” on page 3; and change the spelling of the name to Senator “Frist.” Ms. Spencer asked the members to submit additional changes to the list by e-mail.

Project Management Update

Mr. Jerry Pereira, the ORR Project Manager, reported that activities planned over the next three to four months are on schedule. In November and December 2003, the Public Health Assessment Work Group (PHAWG) will review the draft White Oak Creek (WOC) PHA and make recommendations to ORRHES. ATSDR will provide assistance to PHAWG since the review period is relatively short. Because ATSDR is scheduled to present the public comment version of the draft PHA to ORRHES during the February 2, 2004 meeting, efforts will be made to convene this meeting in Kingston. Staff will scout the area to identify potential locations.

ATSDR made adjustments to its DOE funding to complete COWG meeting minutes under the ERG contract. For meeting minutes of other work groups, the DHEP Director, the Division of Health Assessment and Consultation (DHAC) Director and other ATSDR staff will meet and eventually request more funding from Dr. Henry Falk, Director of the National Center for Environmental Health/ATSDR. ATSDR realizes that work group minutes are extremely important in maintaining ORRHES’s history.

Proposed Plan for the Iodine-131 PHA

Dr. Paul Charp of ATSDR described a tentative plan for the iodine-131 PHA. ATSDR learned that some data may not have been included in the Task 1 Report of the Oak Ridge Dose Reconstruction Project (ORDRP). ATSDR outlined the process to PHAWG on the previous evening and is now presenting the plan to the full ORRHES for consideration. In step 1, ATSDR will continue to review the current literature published after Chernobyl from 1986 to the present. Efforts will be made to locate environmental, radio-epidemiological, dose-response and thyroid cancer studies related to iodine-131. These data encompass more than 100,000 persons who lived in the area during the Chernobyl event. ATSDR estimates a one-month time-line will be needed to complete this task.

In step 2, ATSDR will collect new ORR data related to biota, air and soil concentrations of iodine-131 and iodine-129. The data collection effort will include iodine-129 because this isotope is a solid indicator of the presence of iodine-131 during the radioactive lanthanum runs (RaLa) in the 1950s. During the RaLa process, lanthanum was pulled from the Oak Ridge reactor and shipped to the Los Alamos site for weapons design. ATSDR estimates a one-month time-line will be needed to complete this task. In step 3, air data from the 1950s will be reviewed because these studies were not specifically addressed in the ORDRP. In 1954, Oak Ridge officials moved the HP-8 monitoring station from the confines of X-10 to Rogers Quarry. The purpose of this activity will be to identify differences in the air dispersion of iodine from the HP-8 monitoring station based on its placement at the two locations. ATSDR hopes the data will assist in validating the model. ATSDR estimates a two-month time-line will be needed to complete this task.

In step 4, ATSDR will validate existing data. Auxier & Associates located additional data indicating that iodine-131 remained within the confines of X-10 and did not travel offsite. ATSDR discussed these findings with SENES Oak Ridge because this company completed the iodine dispersion component of the Task 1 Report. ATSDR will continue to engage Auxier and SENES in discussions since the companies may take different approaches in interpreting the data. ATSDR estimates a one-month time-line will be needed to complete this task. If Auxier and SENES cannot reach agreement, ATSDR will convene an expert panel to address the usefulness of the 1950s air data and document its opinions in a report. ATSDR estimates a two-month time-line will be needed to complete this task if needed.

In step 5, ATSDR will develop an iodine-131 decision tree with potential doses and public health actions based on the literature review and usefulness of the existing iodine-131 data. ATSDR hopes to obtain input and approval of this activity from a qualified and nationally or internationally recognized radio-epidemiologist. Dr. Jerome Hershman will be asked to provide feedback as well. In step 6, ATSDR will combine the information in the PHA based on the conclusions of these tasks. Although the data acquisition, literature review and data analysis are incomplete, ATSDR has already drafted the introduction and background of the iodine-131 PHA. ATSDR may possibly have a draft of the iodine-131 PHA available for ORRHES to review in four to six months.

Dr. Malinauskas questioned whether the ORDRP addressed physicochemical forms of iodine, such as elemental versus particulate. He recalled that the Chernobyl iodine releases were emitted as cesium and in several other forms as well. Dr. Cember asked if ATSDR’s literature review will include thyroid uptake studies of persons who had iodine administered for medical diagnostic purposes. Because these data encompass a large population of individuals who received high iodine doses, the information would be relevant to ORR activities. Dr. Charp replied to the questions as follows. Particulate, organic and elemental forms of iodine are all addressed in the ORDRP. The report shows that materials released from the stack were in elemental form, but were converted to a methyl or particulate form after migrating to monitoring stations.

The iodine-131 PHA will also include a discussion of studies that have been conducted on radio-therapeutic administration of iodine. In response to Mr. Manley, Dr. Charp confirmed that the potential for Rogers Quarry to be downwind from X-10 will be addressed in the PHA. ATSDR will obtain wind rose data from the National Oceanic and Atmospheric Administration and other sources. Dr. Charles Miller, Chief of the CDC Radiation Studies Branch, is an expert in meteorology and will review the ORR air dispersion data. Mr. Lewis recalled that concerns were previously raised about the possibility of some ORR data being shredded. During the ORDRP, a massive effort was undertaken to locate missing records and interview persons with knowledge of site activities. He advised ATSDR to highlight these attempts in the iodine-131 PHA.

Ms. Kaplan reiterated the need for ATSDR to act on Mr. Lewis’s suggestion. For example, ATSDR found gum filter data in a box that had previously been searched during the ORDRP. Dr. Charp and Mr. Jack Hanley of ATSDR provided details about actions that will be taken to address missing data in the iodine-131 PHA. ATSDR has collected weekly reports from 1953, 1955 and 1956, but the 1954 quarterly reports are averaged over a three-month period and contain less information. ATSDR does not have the 1954 weekly reports. ATSDR also has over 20 searchable CD-ROMs of interviews; some of these records relate to iodine. Efforts are currently being made to locate missing data on the HP-8 monitoring station.

ATSDR will act on Mr. Lewis’s suggestion by describing efforts that were made to locate data and explicitly stating if information was not found. Document reference numbers for iodine data on the CD-ROMs will be included in the PHA as well. Additionally, the gum filter data were not newly discovered by ATSDR; the information was actually reported prior to the initiation of the ORDRP. Overall, the missing data will undoubtedly fill some gaps, but the absence of the information will not adversely impact the iodine-131 PHA to a significant degree. Even if the data are not located, ATSDR will still be able to draw conclusions in the PHA. Most notably, the thyroid studies on deer can be used to quasi-validate the model.

Ms. Sonnenburg recalled that at a previous ORRHES meeting, an individual made a public comment about his knowledge of unrecorded discharges at ORR. She raised the possibility of ATSDR contacting this individual to clarify his comments. Ms. Adkins mentioned that this individual may be Mr. Harry Williams who was directed to place a large canister of toxic materials into the creek and shoot a hole in the canister for it to sink. Mr. Hanley clarified that Mr. Williams has made public comments about uranium in K-25 and fluoride in nighttime releases. ATSDR noted the concerns and will address these issues in the K-25 PHA. Dr. Malinauskas asked if the iodine releases will also include emissions from K-25 and Y-12. Dr. Charp responded that the primary focus will be on RaLa releases from X-10. The current data do not mention releases from K-25 or Y-12, but the monitoring data will capture all sources.

Community Assessments At Other Sites

Dr. Elizabeth Howze, the DHEP Director, described several health education and promotion projects ATSDR has completed at other sites. The Isle de Vieques in Puerto Rico was used as a bombing range by the U.S. Navy. The site has been a source of controversy for quite some time due to the close proximity of a residential community, weapons storage facility and bombing range. ATSDR completed a focused PHA to identify public health hazards of persons on the bombing range and an informal community needs assessment to document specific concerns of residents about chemicals in the air and water. ATSDR identified health education needs for children, health care providers and the general community. Asthma, cancer and vibroacoustics were the primary community concerns in Vieques.

Residents adjacent to the bombing range were experiencing a thickening of coronary arteries or heart muscles. ATSDR reviewed the literature on potential health effects from bombing vibrations, but found no causal relationship. ATSDR also found no association between the bombing range and concerns about elevated levels of asthma and heart disease. Due to the controversy, strong activism, public protests and threats at the site, ATSDR could not convene public meetings. Information was informally gathered by speaking to residents in their homes and engaging day care center workers in dialogue.

ATSDR also used its environmental medicine case studies to convene training sessions for physicians and nurses and provide continuing medical education credits on Vieques. ATSDR’s other activities on Vieques included assistance with a summer environmental camp for children; implementation of a Spanish environmental curriculum in schools; development of a monthly community newsletter; and participation in establishing an environmental health resource center with books and other relevant materials targeted to children.

At the Vasquez Boulevard/Interstate 70 (VBI-70) site in Denver Colorado, ATSDR identified arsenic and lead in soil. The site is adjacent to three lead smelters and arsenic was previously used in residential yards to control pests. However, the actual source of contamination could not be determined. Interstates that cut through the community and industrial activities also impact the community. Most of the ~4,000 residents are persons of color and low-income. In the VBI-70 PHA, ATSDR found an urgent public health threat for children with soil pica behavior. ATSDR convened a site team of health officials and community representatives; conducted a community assessment in close collaboration with residents; held public availability sessions; and trained community representatives in the PHA process.

ATSDR also developed three activities to address more specific issues. The Community Education Program focused on community concerns, community assessment data and children's health. The Gardening Education Program was created in collaboration with the Cooperative Extension Service and implemented door-to-door in neighborhoods to answer gardening questions. Program materials were developed and distributed and small community meetings were held. The Health Care Provider Education Program was designed as grand rounds in local hospitals. Physician toxicologists and other providers facilitated the courses and also held small meetings in the homes of community residents.

In Fallon, Nevada, ATSDR responded to childhood leukemia cases by conducting a community health education assessment. The site is a small agricultural community located near Reno and a naval air station; the population is primarily Native American and Hispanic. The source of the 20 childhood leukemia cases has not been determined to date, but jet fuel, tungsten mining, excess arsenic levels in drinking water, and agricultural spraying of herbicides and pesticides have been considered as possible exposure sources.

The community also suffers from a great deal of stigma because many Reno grocery stores place “not from Fallon” stickers on produce. In an effort to cohesively, systematically and effectively address the high level of concern among parents and respond to the childhood leukemia cancer cases, community leaders were identified, trained and formed an organizational infrastructure. The Community United Response Team (CURT) attended ATSDR's community stress workshops; participated in training sessions to lead focus groups and communicate risk; and collaborated with ATSDR, the U.S. Environmental Protection Agency (EPA) and agencies at state and regional levels.

ATSDR partnered with CURT to conduct a community assessment that included a series of focus groups. This activity was designed to address large Hispanic and Native American populations that were not receiving information; parents who requested additional information about leukemia; other health concerns of the community; and information about children. ATSDR introduced an environmental curriculum into the Fallon school system and ensured that Hispanic and Native American schools were included.

At the Herculaneum, Missouri site, ATSDR detected lead contamination throughout the community in soil, air and street dust. ATSDR learned about concerns at the site from the Community Assistance Group (CAG) and data from the census outreach and education initiative. The small community has contained an active lead smelter since 1892; the site has been continuously contaminated and cleaned since that time. The smelter was conclusively identified as the source of exposure at the site. ATSDR used materials from effective local lead programs to develop community education activities. ATSDR also provided technical assistance to the state health department by reviewing fact sheets and the health education plan; participating in weekly conference calls; and implementing onsite health education activities.

Health education activities by the state include door-to-door delivery of educational packets and monthly presentations to CAG members, K-12 schoolteachers and a local church group. The presentations are given by physicians with expertise in lead poisoning. One-on-one conversations are also held with the community and politicians at local, state and federal levels. The Herculaneum site has received a great deal of attention and interest from federal politicians. Articles are written for a multi-governmental agency newsletter, while health consultations are implemented through the state health department web site and direct mailings to CAG leaders and other community members.

At the Orote Landfill in Guam, the community was concerned about PCB contamination in water and fish. ATSDR conducted health care provider education courses for nurses, environmental public health staff, physicians and other providers. ATSDR also developed a “Safe Cooking” brochure and plans to implement an environmental curriculum in schools and throughout the community.

At the Anniston, Alabama site, the community was concerned about lead exposure and health effects from PCB contamination. However, ATSDR has not determined adverse impacts from PCBs to date. A Gardening Education Program was designed with community meetings, a calendar and other specific materials. ATSDR also developed documents on PCBs, screened children for lead, and convened public availability sessions on lead. ATSDR's Pediatric Environmental Health Specialty Unit and a community-based work group jointly address lead concerns and developmental disabilities at health fairs.

The West Anniston Foundation was established as a non-profit organization to evaluate access to health services and ensure children in the community have the best education, health care and remedial services. Overall, ATSDR conducts both site- and non-site-specific community assessments. Strong efforts are always made to closely collaborate with communities and other partners as well as to tailor activities to specific community concerns and needs.

Ms. Sandra Isaacs and Ms. Theresa NeSmith of ATSDR provided additional details about some of the sites in response to ORRHES’s questions. Because the infrastructure of the Vieques cancer registry was extremely weak, ATSDR and CDC signed a cooperative agreement with government officials to gather data for the cancer registry. Information is still being entered into the system, but a preliminary report from the local health clinic showed a 25% higher rate of cancer on Vieques compared to Puerto Rico. The community is ~7 miles from the bombing range, but ATSDR found no completed exposure pathways through groundwater or air. The environmental curriculum developed for Vieques school children can be replicated for ORR and other sites.

ATSDR did not consider coal-burning stoves in VBI-70 homes as a source of arsenic in the community. The lead smelters were analyzed as the source for low arsenic levels, but neither ATSDR nor EPA could identify the source for high arsenic levels. Mr. Hill noted a similarity between the ORR and VBI-70 sites. On the one hand, ORR residents have been informed that coal-burning furnaces and steam plants in the community are not sources of arsenic. VBI-70 residents used coal-burning stoves and arsenic was also found to be a problem in this community. On the other hand, ATSDR did not relate coal usage in either site to arsenic levels.

Mr. Lewis pointed out a difference in ATSDR’s site activities. On the one hand, members of the clergy, nurses and other community residents in Fallon were convened to describe specific issues and concerns. On the other hand, generic comments were captured during the ORR needs assessment. He remarked that the ORR community would benefit more from ATSDR’s strategy used at the Fallon site. Dr. Malmquist advised ATSDR to appropriately design educational activities and dissemination strategies for the specific needs of ORR. Most notably, ORR covers a large geographic area and multiple school systems.

Ms. NeSmith clarified that ATSDR’s Tox Rap environmental curriculum is designed for large geographic areas. For example, ORRHES could recruit a small group of teachers to attend train-the-trainer sessions. ATSDR would train the teachers in implementing the curriculum in classrooms; the teachers would then train other community residents in conducting the course on a broader scale. Ms. Adkins mentioned that environmental education is a priority for extensions of the University of Tennessee as well as those in each county. This initiative is targeted to nearly all fifth and sixth grade students in the state. She raised the possibility of ATSDR integrating its Tox Rap environmental curriculum into existing activities being conducted by the academic extensions.

Dr. Howze confirmed that ATSDR will explore the academic extensions in Tennessee as potential sources to implement the Tox Rap environmental curriculum. Feedback from students in areas where ATSDR has introduced the curriculum has been overwhelmingly positive to date. Dr. Cember explained that low blood lead levels (BLLs) have been associated with learning deficiencies. He questioned whether this health effect was measured in Herculaneum children.

Dr. Davidson added that 10 µg/dL is the level of concern among children, but no “safe” threshold for lead has been detected. To date, no beneficial effects from lead in the human body have been found. She pointed out that health effects from low BLLs are extremely subtle; high BLLs will cause illness and indicate to EPA the need to clean a site; and acute lead exposures result in death. Although children and adults can have the same BLLs, effects between the two groups will be different since children are a much more sensitive population. Mr. Washington mentioned that rates of mental retardation, kidney problems and other adverse health effects should be high in the Herculaneum community since the lead smelter has been active since 1892.

Dr. Howze provided additional details about the Herculaneum site. Test results show that BLLs have declined in the community because children in the area are periodically screened for lead. A community group is undertaking a major effort to ensure that the polluter complies with regulations on air emissions from the stacks. Dr. Howze committed to locating and distributing to ORRHES results of BLL studies conducted at the site. At the national level, a movement is underway to decrease the level of concern from 10 µg/dL because lower BLLs have been shown to adversely impact learning, behavior and neurological development.

Ms. Sonnenburg noted that ATSDR was unable to make an association between adverse health effects and sources at most of the sites. She asked if ATSDR has ever made a causal relationship. Dr. Howze replied that in the Anniston community, Solutia was releasing PCBs during the electro-generation process and contaminating the site. ATSDR and EPA definitively concluded that the plant was the source of health effects in the community. A lawsuit was recently settled with local property owners. ATSDR also found a causal relationship at the Libby, Montana site. The W.R. Grace Company mined and processed vermiculite ore and also gave the material to residents to use as insulation and for other purposes. ATSDR found that asbestos in vermiculite ore was a direct cause of deaths and illnesses from asbestosis, mesothelioma and other lung diseases in the Libby community. W.R. Grace has declared bankruptcy and no longer produces vermiculite ore.

Mr. Lewis recalled that a group of Anniston residents was invited to visit ORR residents. The community described steps that are needed for a site to obtain an evaluation, compensation or other type of remedial action. He urged ATSDR to educate communities about situations that will trigger a PHA category, such as “no public health hazard,” “apparent public health hazard” or “public health hazard.” He also asked ATSDR to present its conclusions from the Anniston PHA to determine if these findings can be applied to the ORR PHAs. Dr. Howze confirmed that ATSDR looks forward to exploring this issue with ORRHES in the future. Dr. Davidson questioned whether a disease registry has been initiated at the Anniston site. If efforts are now taken to monitor PCB levels of residents, a causal relationship could be identified in the future. Dr. Howze replied that a health study will be implemented in Anniston, but no plans have been made to develop a disease registry at this time.

Public Comment Period

The Chair called for public comments; no attendees responded.

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