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83–698 PDF 2004

S. HRG. 107–1002

ASBESTOS CLEANUP IN LIBBY, MT

HEARING

BEFORE THE

SUBCOMMITTEE ON SUPERFUND, TOXICS, RISK,

AND WASTE MANAGEMENT

OF THE

COMMITTEE ON ENVIRONMENT AND

PUBLIC WORKS

UNITED STATES SENATE

ONE HUNDRED SEVENTH CONGRESS

SECOND SESSION

ON

TO ASSESS ASBESTOS REMEDIATION ACTIVITIES AND EVALUATE HOME

INSULTATION CONCERNS RELATED TO ASBESTOS

JUNE 20, 2002

Printed for the use of the Committee on Environment and Public Works

(
(II)

COMMITTEE ON ENVIRONMENT AND PUBLIC WORKS

ONE HUNDRED SEVENTH CONGRESS

SECOND SESSION

JAMES M. JEFFORDS, Vermont, Chairman

MAX BAUCUS, Montana

HARRY REID, Nevada

BOB GRAHAM, Florida

JOSEPH I. LIEBERMAN, Connecticut

BARBARA BOXER, California

RON WYDEN, Oregon

THOMAS R. CARPER, Delaware

HILLARY RODHAM CLINTON, New York

JON S. CORZINE, New Jersey

BOB SMITH, New Hampshire

JOHN W. WARNER, Virginia

JAMES M. INHOFE, Oklahoma

CHRISTOPHER S. BOND, Missouri

GEORGE V. VOINOVICH, Ohio

MICHAEL D. CRAPO, Idaho

LINCOLN CHAFEE, Rhode Island

ARLEN SPECTER, Pennsylvania

PETE V. DOMENICI, New Mexico

KEN CONNOLLY, Majority Staff Director

DAVE CONOVER, Minority Staff Director

SUBCOMMITTEE ON SUPERFUND, TOXICS, RISK AND WASTE MANAGEMENT

BARBARA BOXER, California, Chairman

MAX BAUCUS, Montana

RON WYDEN, Oregon

THOMAS R. CARPER, Delaware

HILLARY RODHAM CLINTON, New York

JON S. CORZINE, New Jersey

LINCOLN CHAFEE, Rhode Island

JOHN W. WARNER, Virginia

JAMES M. INHOFE, Oklahoma

MICHAEL D. CRAPO, Idaho

ARLEN SPECTER, Pennsylvania
(III)

CONTENTS

Page

JUNE 20, 2002

OPENING STATEMENT

Baucus, Hon. Max, U.S. Senator from the State of Montana .............................. 1

WITNESSES

Black, Brad, M.D., Lincoln Community Health Officer and Director, Clinic

for Asbestos Related Disease ............................................................................... 22

Prepared statement .......................................................................................... 93

Cohan, Pat, coordinator, Clinic for Asbestos Related Disease ............................. 20

Prepared statement .......................................................................................... 92

Falk, Henry, M.D., Assistant Administrator, Agency for Toxic Substances

and Disease Registry ........................................................................................... 12

Prepared statement .......................................................................................... 51

Horinko, Marianne, Assistant Administrator, Office of Solid Waste and Emergency Response, U.S. Environmental Protection Agency ................................. 8

Prepared statement .......................................................................................... 46

Konzen, John, Lincoln County Commissioner, Libby, MT ................................... 26

Prepared statement .......................................................................................... 94

Murray, Hon. Patty, U.S. Senator from the State of Washington ....................... 5

Prepared statement .......................................................................................... 43

Spence, Michael, M.D., State Medical Officer, Montana Department of Public

Health and Human Services ............................................................................... 18

Prepared statement .......................................................................................... 55

Report, Medical Testing of Individuals Potentially Exposed to

Asbestoform Minerals Associated with Vermilculite in Libby, MT, Year

2000 ................................................................................................................ 57–91

Wagner, Gregory, M.D., Director, Division of Respiratory Disease Studies,

National Institute for Occupational Safety and Health .................................... 10

Prepared statement .......................................................................................... 48

ADDITIONAL MATERIAL

Statement, Rehberg, Hon. Denny, U.S. Representative from the State of Montana ....................................................................................................................... 45

(1)

ASBESTOS CLEANUP IN LIBBY, MT

THURSDAY, JUNE 20, 2002

U.S. SENATE, COMMITTEE ON ENVIRONMENT AND PUBLIC WORKS, SUBCOMMITTEE ON SUPERFUND, TOXICS, RISK, AND WASTE MANAGEMENT, Washington, DC.

The subcommittee met, pursuant to notice, at 9:35 a.m. in room

406, Senate Dirksen Building, Hon. Max Baucus (acting chairman

of the subcommittee) presiding.

Present: Senator Baucus. Also Present: Senator Murray.

OPENING STATEMENT OF HON. MAX BAUCUS, U.S. SENATOR

FROM THE STATE OF MONTANA

Senator BAUCUS. The meeting will come to order, and thank you

all for being here today. I thank Senator Boxer, Senator Chafee

and Senator Reid, members of this committee, for helping arrange

this hearing. I am also a member of this committee, but they hold

leadership positions in this committee, and I want to thank them

for their efforts.

Every community in our country obviously is special, but I must

say that in my State of Montana, even though every community in

Montana is special, I like to speak about one in particular, and

that is Libby, MT. Libby is a small town. Most people there earn

their living in the woods, mills or in the mines. In January 2000,

some very kind people from Libby invited me into their homes to

talk about some of the health problems they were having as a result of exposure to tremolite asbestos from the defunct W.R. Grace

mine.

I have become very good friends with all these people. They are

wonderful, wonderful people. Their stories over the last couple of

years since I first got involved in this matter have kept me focused

on doing what is right for the people of Libby.

As I stood in the home of Gayla Benefield on a January afternoon, I met with nearly 30 people from Libby, all suffering from

the effects of asbestos illness or had already lost loved ones due to

the disease. That afternoon, I also met a man in the living room

of Gayla named Les Gramstad. I want to tell you a little about Les.

He is a father, husband and grandfather. He has made his living

at the W.R. Grace mine. Les shared stories with me about returning home at the end of a long workday at the mine, covered completely with dust. I have to tell you, I have watched these guys get

off the bus. They are just like dust bags. They are just totally filled
2

with dust. He would go home. His children would climb into his lap

and play with him. He would embrace his wife.

You guessed it. He, not knowing he had contracted asbestosis,

gave asbestos-related diseases unwittingly to his children. He gave

the disease to his wife, as they came in contact with the dust. So

not only is Les dying, but he also has this tremendous guilt that

he has caused his loved ones to also have the disease. As we all

know, this is a disease where once you get it, you just do not know

what the consequences are going to be and it is very long-lasting.

Most people have a very difficult time and many eventually die.

I want to show you a picture of the working mine. It is over to

my left. This picture is from the late 1960’s. It is close to the time

that Les worked at the mine. You can just get a sense of the pollution. As you can tell from the photograph, the mill there is spewing

a lot of dust in the air. That is more than 24,000 pounds of dust

expelled each and every day that the mine operated, and 5,000

pounds of that 24,000 was tremolite dust—tremolite asbestos.

There are many, many forms of asbestos. The worst and most

deadly is tremolite. Asbestos is mined at various sites around the

country. There are various forms of asbestos, but the most deadly

is tremolite, and tremolite asbestos is the type of asbestos that is

mined in Libby, MT.

Piles of the dust as waste from the mine were dumped as tailings

that pushed right up into the Kootenai River. That is the river that

runs right alongside Libby, alongside of the mine, and I know it

eventually goes further west into the Columbia River and affects

those States as well.

W.R. Grace gave the stuff away free. Here is what they said,

W.R. Grace at the time, ‘‘Use it in your garden, in the high school

track. Use it in your driveway. Stuff it in your attic for insulation.’’

So people did, because the dust was harmless. At least that is what

W.R. Grace told them. There was no one to contradict those company statements—not the State, even though there is evidence the

State had that this stuff is poisonous; not the Federal Government,

even though they had evidence as well. No one told the people of

Libby the tailings from the W.R. Grace mine was poison. Nobody

told them that.

Let me show you now what a tremolite asbestos fiber looks like

magnified. That is a tremolite asbestos fiber. As you can tell, it

looks like a long needle. These tiny fibers get into people’s lungs

and their lungs cannot get rid of them. It is like a javelin. It is like

a hook. It just gets into the lungs and it gets into the membrane

and it does not get out because like a javelin, it has that hook in

it. Eventually these fibers cause lung cancer or deadly mesothelioma, a very rare cancer caused only by asbestos; or folks get asbestosis and die slowly and painfully as it gets harder and harder

to breathe.

This is a photograph now of a Memorial Day service in May of

this year. Those white crosses clearly represent people who died in

Libby on account of the disease. The first night I visited Les, he

told me he had asbestosis. He was exposed during the short time

he spent working at the mine. Les went on to share, which is the

most troubling part of the story, and I have already mentioned that

not only is Les sick, but so is his wife, Narita and so are their chil-
3

dren who are now in their 20’s and 30’s. Each one of them was exposed to tremolite asbestos fibers contained in the dust Les carried

home on his clothes. Every time he hugged his kids hello, as I mentioned, every time he greeted his wife at the end of a long day, he

was exposing his family to asbestosis poisoning.

Les went on to tell me that his story is not unique. There are

dozens more like him still living in Libby, and many who have already died—died because of their exposure to tremolite asbestos

dust. Hundreds more are sick. In fact, the Agency for Toxic Substances and Disease Registry has found that Libby suffers from asbestos-related disease at the rate of 40 to 60 times the national average. W.R. Grace knew. Federal and State agencies knew. They all

knew that the asbestos that contaminated the vermiculite ore was

deadly.

That afternoon, Les asked me to help him and I told him I

would. I will never forget the next thing he said to me. He is a tall

man, a little taller then than now. He said, ‘‘Max, I will be watching you to make sure you keep your word,’’ because I told him I

would do all I could. Les did not have to say that. The instant I

recognized the problems Les and the people of Libby were facing,

by talking to them at Gayla Benefield’s home that afternoon, I

pledged to myself that I am going to do whatever I possibly can to

help the people of Libby and to make this situation right for them.

That is the most gut-wrenching experience I have encountered in

my recent memory. It was that gripping, that tragic.

Since January 2000, I have visited Libby nine times. I have dedicated one staff person nearly full-time to focus on the issues this

problem has generated. At my direction, that person has visited

Libby 103 times since then. I would like her to stand. Where is Rebecca? There is Rebecca. She is aces. She runs our Kalispell office,

but she has been up to Libby 103 times in the last 2 years only

on this issue.

I held a field hearing during this committee in Libby 2 years ago

and two town hall gatherings since then. I have opposed the Fairness Asbestos legislation during the 106th Congress, because I

think that legislation would improperly restrict victims’ rights to

sue for damages. I have heard from the Agency for Toxic Substance

Disease Registry to secure funds to complete two rounds of medical

screening for the community. I have also urged USATSDR to be

sensitive to developing a customized approach for serving Libby because it is so unique, our situation at Libby. I have asked the

EPA’s efforts in Libby to ask EPA to assist by seeing to it that additional cleanup dollars are sent to Libby—more than otherwise

would have been the case.

Former Secretary of Health and Human Services, Donna Shalala

has helped secure emergency funding for Libby, and Secretary

Tommy Thompson has also been very helpful.

We are also fortunate to enlist the help of the University of Montana and their Center for Environmental Health Sciences as they

begin to identify potential cures for asbestos-related disease.

The bottom line is that Libby is left with a massive asbestos contamination problem, both in town and at the mine site. It is everywhere. Another photo here—This is a picture of the mine site, obviously from the air. Libby is also left with a huge public health cri-
4

sis, as hundreds upon hundreds of folks will need expensive longterm medical care. We will hear from some our Montana witnesses

about that. How should care be provided? Who is going to pay for

it? Who is going to insure those who are ill?

I continue to hope that W.R. Grace will step up to the plate, but

Grace has shown again and again that they will step away from

any and all responsibility for what they did to the people of Libby,

MT. Grace has filed for bankruptcy. Grace has been denying claims

for health coverage. It has been reported that Grace has managed

to hide at least $4 billion in assets, that is, transfer at least $4 billion of assets so the people of Libby cannot seek damages against

the company.

It is just too much to ask a rural community in northwestern

Montana to deal with this all on their own. They need help. That

is what we are here to talk about. I would like to get a sense from

EPA of what they are doing, what they have accomplished so far

in Libby, where they are going, how they plan to get Libby a clean

bill of health. We will also hear from the Agency for Toxic Substances and Disease Registry about their efforts, particular of inspector screenings and care for Libby residents. Dr. Falk testified

at the committee’s field hearing in Libby back in February 2000.

I will be interested to hear his perspective on how far we have

come, and his taking stock approach and how far we have yet to

go.

I hope to also hear about what has been learned from the tragedy in Libby. That is other information that will help us do a better

job of protecting people from the dangers of asbestos. I applaud our

State’s Governor. She, as we say in the vernacular, fired the silver

bullet. As we know under CERCLA law, a State Governor has one

opportunity to trigger a process which speeds up the determination

of whether EPA will designate a site as on the national list of registry of sites to be cleaned up. She did that, and I applaud her for

taking that action. I also appreciate Representative Rehberg’s efforts on the home insulation issue in Libby, and Senator Burns has

been helpful as well.

So essentially we are here to take stock about what has happened and to see what else we have yet to do in Libby. Libby needs

our help. We are here to provide it. This issue is particularly important to me. I am not going to let Les down. I am not going to

let the people of Libby down. I know everyone in this room feels

the same way.

I would also like to introduce our first witness, a terrific Senator,

Senator Patty Murray from Washington. Patty was gracious

enough to let me testify in a hearing that she chairs. That was a

short while ago. It was at that hearing we were able to secure the

promise of various government agencies to come to Montana. We

are very glad that they did. Senator Murray has been extremely

concerned about this issue as it affects her people in the State of

Washington. We are very honored to have you here, Senator. I

know what a fighter you are for your people in Washington. At the

conclusion of your testimony, you are more than welcome to share

the dais and just help your people as we help Montana’s.

Senator Murray.
5

STATEMENT OF HON. PATTY MURRAY, U.S. SENATOR FROM

THE STATE OF WASHINGTON

Senator MURRAY. Thank you very much, Mr. Chairman. Thank

you for your passion on this issue and helping us finally get it to

the attention of the Nation as you have seen the struggles in your

State. It is such a critical issue. We would not be at the point we

are without your tremendous work, and I really appreciate your

having this hearing today on Libby, MT and on the health and environmental problems caused by asbestos contamination from that

W.R. Grace vermiculite mine.

I really appreciate the opportunity to testify before your committee today as well. Your leadership on this issue has just been

essential, and none of us would be where we are today if it was

not for that, and I really appreciate it.

Senator BAUCUS. Thank you.

Senator MURRAY. Mr. Chairman, I first became interested in this

issue in 1999 because of a series of articles by Andrew Schneider

about Libby in the Seattle Post-Intelligencer. As you know, I can

relate to the people of Libby because my mother grew up in Butte,

MT and like Libby, the main industry in Butte is mining. I know

first-hand that these communities believed the government was

protecting them from health problems caused by air and water pollution from mining.

I also became interested in this issue because Libby is only 160

miles from Spokane, WA and many people from Libby have received medical treatment in Spokane. Last year, I chaired a Senate

Health, Education, Labor and Pensions Committee hearing on asbestos exposure and worker safety, and Dr. Alan Whitehouse from

Spokane testified. He has treated about 500 patients from Libby.

While most people thought only miners and their families could be

exposed to dangerous amounts of asbestos from mining, many of

his patients are sick just because they lived in Libby. Approximately 25 percent of his patients did not work in the mine or live

with someone who did. Twenty-four of his patients have died in the

last 3 years, and five who died were sick only from environmental

exposure.

The issue is also relevant to my constituents because like most

other States, Washington has many sites which processed Libby

vermiculite that was contaminated with asbestos. The chart that I

have behind me displays all of the sites in the United States which

have received vermiculite from Libby. This map of the United

States should tell every single Senator that this is not a problem

somebody else has. It is a problem they have.

Of the approximately 300 sites which process this mineral, the

Environmental Protection Agency and the Agency for Toxic Substances and Disease Registries have determined that 22 sites require further cleanup. One of these sites is the former Vermiculite

Northwest, Inc. and then-W.R. Grace plant in Spokane. That plant

began producing Zonolite insulation in 1951. Even though the plant

closed down in the early 1970’s, recent tests by EPA have found

some soil samples from the site still have asbestos concentrations

of up to 3 percent. EPA is strongly recommending that access to

the site be restricted almost 30 years after that plant closed down.
6

At many plants where vermiculite from Libby was processed,

waste rock left over from the expansion process was given away

free, as the chairman noted. People used that free waste rock in

their yards, in their driveways and in their gardens. The other picture you see shows Justin and Tim Jorgensen climbing on waste

rock that was given out by Western Minerals, Inc. in Minneapolis,

MN in the late 1970’s. According to W.R. Grace records, that rock

they are climbing on contained between 2 and 10 percent tremolite

asbestos. This rock produced airborne asbestos concentrations 135

times higher than OSHA’s current standard for workers.

Thankfully, today neither Justin or Tim has shown any signs of

disease, but their risks of developing asbestos diseases, which have

latency periods of 15 to 40 years, are increased from their childhood exposures. Mr. Chairman, I showed this picture several days

ago at a press conference that I had, and this morning I came into

the office and received an e-mail message from Lizzie Jorgensen

who is the mother of the two boys in this picture. I want to read

it to the committee this morning.

Greetings. Yes, please eliminate asbestos. Those two boys playing in the free rock

are my sons. Justin and Tim’s father, Harris Jorgensen, suffered long and hard with

asbestosis and lung cancer. He died June 22, 1991 at the age of 44. An autopsy

shows asbestos in his lungs. We lost that case in Federal court. Like Harris said,

we may not have gotten anything out of this, but maybe it will help someone else.

At this time I wonder, do my sons have to suffer also? It may be too late.

Senator MURRAY. From Lizzie Jorgensen, the mother of the two

boys playing in that rock.

Today, people may still be exposed to harmful amounts of asbestos and vermiculite. Between 12 million and 35 million homes and

businesses may have Zonolite insulation. This may be the case for

up to 150,000 homes in my State alone. EPA has also tested agricultural products, soil conditions, and fertilizers made with

vermiculite and determined that some workers may have been exposed to dangerous amounts.

As I learn more about Libby and how asbestos had ended up in

products by accident, I was shocked to learn that asbestos is still

being used in products on purpose. While some specific uses have

been banned, the EPA’s more sweeping ban was never put into effect because of a lawsuit backed by the asbestos industry. As a result, new uses of asbestos were banned, but most existing uses

were not banned. Today, asbestos is still used to make roofing

products, gaskets, brakes and other products. In 2001, the United

States consumed 13,000 metric tons of it. Asbestos is still entering

the product stream in America despite all of the known dangers to

human health.

In contrast, asbestos has been banned in at least 20 other countries. It is time for the United States to ban asbestos, too. I want

to ensure our government does all it can to minimize future suffering and death caused by asbestos. That is why a few days ago

I introduced the Ban Asbestos in America Act of 2002. I want to

thank Senator Baucus for being an original cosponsor and I appreciate the cosponsorship of Senators Cantwell, Dayton and

Wellstone as well.

The Ban Asbestos in America Act of 2002 has four parts which

I would like to just briefly mention. First, this bill protects the pub-
7

lic by requiring the EPA to ban asbestos by 2005. Like the regulations EPA finalized in 1989 under the TSCA, companies may file

for an exemption to the ban. EPA may issue the exemption if there

is no substitute material available and the exemption will not pose

an unreasonable risk of injury to public health or the environment.

I would like to take a moment to point out to the subcommittee

the connection between what happened in Libby and EPA’s efforts

to ban asbestos. Last year, the EPA’s Inspector General conducted

an investigation into why the Agency did not do a better job of protecting the people of Libby. I was struck by one of the sections of

the Inspector General’s report in which a letter written by EPA in

1983 is as follows: ‘‘Asbestos-contaminated vermiculite is considered a lower priority at this time than problems posed by friable

asbestos-containing materials in school buildings and commercial

and industrial uses of asbestos.’’

In 1979, EPA had issued an advance notice of proposed rulemaking that it intended to explore options to control asbestos

under Section 6 of the TSCA. In 1982, EPA issued a reporting rule

under Section 8(a) of TSCA to gather information about commercial

and industrial uses of asbestos. EPA’s proposed rule to ban asbestos was published in the Federal Register in January 1986 and the

final rule was published in 1989. One of the reasons EPA did not

spend more time focusing on asbestos-contaminated vermiculite

was the Agency was working on the asbestos phase-out and ban

rule. Unfortunately, that rule was overturned by the Fifth Circuit

Court of Appeals in 1991.

There is a clear relationship between EPA’s efforts to ban asbestos and the fact that the problems in Libby were overlooked. I am

saddened that EPA did not spend more focused time in Libby, in

part because of a competing effort to limit asbestos exposure—an

effort which ultimately failed.

Second, the bill requires EPA to conduct a public education campaign about the risk of asbestos products. We need to warn people

today that their home insulation, if made with vermiculite may be

contaminated with asbestos. While EPA has agreed to remove

vermiculite insulation from homes in Libby, the Agency currently

has no plans to do this nationwide. The Ban Asbestos in America

bill requires EPA and the Consumer Product Safety Commission to

educate consumers about how best to handle this insulation within

6 months. The Ban Asbestos in America Act of 2002 also requires

EPA to conduct a survey to determine which foreign and domestic

products consumed in the United States today have been made

with asbestos. EPA has estimated that as many as 3,000 products

still contain this mineral.

Third, the legislation invests in research, tracking and treatment

of asbestos diseases. It requires a national mesothelioma registry

which would be coordinated with ATSDR’s existing efforts pertaining to Libby, as well as with the National Institute for Occupational Safety and Health. The bill also authorizes funding for seven

mesothelioma treatment centers nationwide to improve treatments

for and awareness of this fatal cancer.

Finally, the bill requires EPA to expand its Blue Ribbon Panel

on asbestos to address issues beyond the six regulated forms of as-
8

bestos, as EPA originally promised in its response to the Inspector

General.

Over the years, asbestos has taken a staggering toll on our country. We have recently been reminded of the dangers posed by asbestos because of concerns about asbestos exposure from the dust

and the debris caused by the collapse of the World Trade Center

towers. Had this country acted swiftly to ban asbestos when public

health evidence about its dangers first emerged, the Towers would

not have been built with any asbestos at all. Now, we will need to

wait probably several decades to determine whether asbestos exposures in New York will cause asbestosis, lung cancer, or mesothelioma for our first responders and residents.

I hope this subcommittee, which has primary jurisdiction over

the Ban Asbestos in America Act, will consider holding a hearing

on this bill in the near future, and move it as quickly as possible.

Thank you again, Senator Baucus, for your tremendous efforts on

behalf of the people in your hometown and really across the entire

country.

Senator BAUCUS. Thank you, Senator, for your very, very dedicated work here. You have done a great job, worked very, very hard

on this. That is clear from your testimony, and clear from your

statement. We would be honored to have you come up to the dais.

OK, let’s hear from our next panel, which consists of Marianne

Horinko, Assistant Administrator for Superfund at Environmental

Protection Agency; Dr. Henry Falk, Assistant Administrator for the

Agency for Toxic Substances and Disease Registry; and Dr. Gregory

Wagner, Director of the Division of Respiratory Disease Studies at

the National Institute for Occupational Safety and Health.

Ms. Horinko, why don’t you proceed? We have a 5-minute rule

here, but due to the nature of this hearing, we may relax that a

little bit. If you could generally stay within 5 minutes, that would

be—and your statements automatically will be included in the

record.

STATEMENT OF MARIANNE HORINKO, ASSISTANT ADMINISTRATOR, OFFICE OF SOLID WASTE AND EMERGENCY RESPONSE, U.S. ENVIRONMENTAL PROTECTION AGENCY

Ms. HORINKO. Thank you.

Good morning, Senator Baucus and Senator Murray. I am

Marianne Horinko, Assistant Administrator of EPA’s Office of Solid

Waste and Emergency Response. It is a pleasure to have the opportunity to appear before the subcommittee once again.

Today, I represent Governor Christine Todd Whitman to discuss

EPA’s efforts to clean up asbestos contamination in Libby, MT and

describe what steps EPA is taking to address potential asbestos

contamination at other sites throughout the country. I wanted to

let you know that although Governor Whitman could not appear

today, I can assure you that protecting the health of the residents

of Libby remains one of her top priorities.

EPA is committed to working with our State and Federal partners to take the necessary steps to protect public health and the

environment in Libby and at related sites. I want to thank Senator

Baucus particularly for his tireless efforts in helping to ensure that
9

the community of Libby is protected through the cleanup of asbestos contamination.

As we all now know, many decades of mining and processing

vermiculite ore contaminated with asbestos has left the community

of Libby with significant health impacts. Those health impacts include cases of mesothelioma, an incurable and often fatal cancer of

the chest cavity, increased risks of lung cancer, and the debilitating

respiratory illness asbestosis. To address the asbestos contamination in Libby and the related health impacts, EPA, working closely

with the Agency for Toxic Substances and Disease Registry or

ATSDR, and the U.S. Public Health Service mobilized an emergency response team to work in Libby. In 1999, ATSDR and PHS,

funded by EPA, started medical investigations in Libby to determine the magnitude of asbestos-related health impacts. The medical investigations documented evidence of widespread disease and

mortality resulting from asbestos exposure.

Starting in 1999, EPA began emergency investigation and cleanup activities in Libby. After interviewing numerous residents and

collecting more than 5,000 samples, EPA found high amounts of asbestos-contaminated vermiculite at the mine, the mine road, processing areas, the mine tailings pile and pond, and in residential

areas of the community. In June 2000, EPA started and provided

oversight for the cleanup of two former processing areas to address

some of the highest levels of asbestos contamination. EPA has also

started cleanup actions at the mine road, the high school track and

city park facilities.

EPA plans to start additional cleanup actions at mining facilities

and in the community.

I am pleased to report that on May 9, 2002, EPA approved a new

action memorandum amendment significantly expanding cleanup

work at Libby, including certain residential contamination in

homes with vermiculite insulation. The Agency determined that

this material did fall within our response authorities, particularly

given the unique circumstances found in Libby with both cumulative exposure and also multiple pathways of exposure. EPA also

determined that the remaining asbestos released in Libby would

not have been addressed by any other authority in a timely manner.

EPA is removing vermiculite ores and mining waste from residential yards and expects to begin removal of vermiculite insulation from homes within 1 week. We expect to complete cleanup at

55 priority properties by the end of this summer. EPA is also working with ATSDR to study other locations across the country that

received shipments of vermiculite from Libby. The Agency initially

identified 240 locations for study, and has determined that 22 require additional investigation. EPA is sharing its findings with

other State and Federal agencies to provide the information necessary to decide whether further action is needed.

One example of a situation warranting a shared Federal and

State approach is the asbestos contamination discovered at the

Western Minerals processing site in Minneapolis, MN. Western

Minerals is estimated to have processed more than 100,000 tons of

vermiculite ore from Libby, MT. The waste material generated

from this processing was made available to residents as foam mate-
10

rial for driveways and yards. The State and EPA have conducted

sampling and have been removing asbestos contamination from the

former plant and from residential yards. ATSDR is currently funding a survey by the Minnesota Department of Health to determine

the health impacts on former plant workers and nearby residents.

In conclusion, you have my commitment and the commitment of

Governor Whitman that EPA will continue its work with other

State and Federal agencies to protect the public health of the residents of Libby, as well as the health of other communities that may

have been affected by asbestos-contaminated vermiculite from

Libby.

Thank you again for this opportunity to share our work, and I

will be pleased to answer any questions that the subcommittee or

Senator Murray may have.

Senator BAUCUS. Thank you, Ms. Horinko.

Dr. Wagner.

STATEMENT OF GREGORY WAGNER, M.D., DIRECTOR, DIVISION OF RESPIRATORY DISEASE STUDIES, NATIONAL INSTITUTE FOR OCCUPATIONAL SAFETY AND HEALTH

Dr. WAGNER. Good morning, Senator Baucus, members of the

subcommittee, Senator Murray.

I am Dr. Gregory Wagner, Director of the Division of Respiratory

Disease Studies of the National Institute for Occupational Safety

and Health, known as NIOSH. I am pleased to be here today to

provide testimony on health risks to workers from asbestos and to

discuss NIOSH research related to Libby, MT.

NIOSH is a public health research institute in the Centers for

Disease Control and Prevention at the Department of Health and

Human Services. We conduct research and make recommendations

to identify and prevent work-related illnesses and injuries. My testimony today will address our knowledge about health risks to

workers from exposure to airborne asbestos and asbestos-like minerals, opportunities for better prevention of asbestos exposure and

disease, past NIOSH findings with respect to asbestos contamination in Libby, MT, and our ongoing research related to Libby.

Asbestos, as you know, is a term that refers to a group of naturally occurring fibrous minerals. The connection between inhalation

of asbestos fibers and a number of serious and often fatal diseases

is well recognized. Asbestos is a known human carcinogen. The diseases it causes, both malignant and non-malignant, are often fatal

and most are preceded by years of debilitating illness.

Although the use of asbestos has been reduced or eliminated in

many commercial products, asbestos and asbestos-containing materials are still found in many occupational and industrial settings

and pose a risk of exposure to workers and others. Asbestos is also

found in manufactured products such as gaskets and building materials. Construction and maintenance workers involved in building, demolition and renovation or in asbestos removal are at particular risk for asbestos exposure. In addition, take-home exposures

to families of workers in which exposed workers bring home asbestos on their clothes, hair or shoes is also a well-recognized hazard.

Asbestos is regulated by the Occupational Safety and Health Administration, the Mine Safety and Health Administration and the
11

Environmental Protection Agency. Federal regulations define asbestos as a half-dozen minerals—chrysotile, crocidolite, amosite,

tremolite, actinolite, and anthophyllite. In 1990, testimony to

OSHA, NIOSH broadened its science-based definition of asbestos

beyond the six specified asbestos minerals, basing our definition on

scientific evidence from studies suggesting that fiber dimension,

specifically length and diameter and fiber durability and persistence in the body, are more critical than the specific chemical or elemental composition in causation of asbestos-related disease. The

NIOSH asbestos definition encompasses certain variance of the six

regulated minerals, as well as so called ‘‘cleavage fragments’’ that

can be generated from non-fibrous mineral forms of these six asbestos minerals.

Our studies of vermiculite workers in Libby began in 1980, when

OSHA asked NIOSH to provide technical assistance to investigate

lung problems in workers at a plant using vermiculite that had

been mined in Libby. Shortly thereafter, the Mine Safety and

Health Administration also requested technical assistance from

NIOSH to investigate the magnitude of health hazards in

vermiculite mines. In response to these requests, NIOSH undertook

epidemiologic studies in Libby, MT between 1980 and 1985. Our

studies showed that occupational exposure to mineral fibers that

contaminated Libby vermiculite caused high rates of asbestos-related diseases among exposed workers. The mineral fibers included

tremolite, one of the currently regulated asbestos minerals. However, some recent evidence indicates that only 10 to 20 percent of

the fibrous minerals contained in Libby vermiculite was tremolite.

The remaining 80 to 90 percent of the fiber contaminant has been

characterized as several other similar fibers, such as richterite and

winchite. These fibers are not currently classified as asbestos by

mineralogists or regulated as asbestos.

NIOSH played a pivotal role in documenting the health hazards

associated with occupational exposure to asbestos-contaminated

vermiculite at the Libby mine and made our findings available beginning in 1985 through meetings in Libby with workers and their

representatives, employer representatives and members of the community. NIOSH also published its findings in several scientific papers to alert the occupational health community.

It is clear in hindsight that further work remained to be done,

specifically further studies of downstream users of Libby

vermiculite products and better tracking of exposed workers and

others. NIOSH is applying what we learned from our experience at

Libby to our current and future activities, both in Libby and

throughout our program.

NIOSH is following up on potential exposures of workers who use

or process vermiculite from sources other than Libby. The degree

to which vermiculite from these other sources is contaminated with

asbestos is not clear. At OSHA’s request, NIOSH is conducting environmental sampling at expansion plants and horticultural operations where vermiculite is used. We are also updating our mortality study of the Libby miners studied previously and working

with the EPA on a variety of their studies as well.

Additional research possibilities that NIOSH is considering include efforts to better determine the physical and/or chemical char-
12

acteristics affecting toxicity of both manufactured and naturally occurring fibers. There is currently no direct evidence by which to attribute particular health effects to each possible fiber type. Epidemiologic studies of people exposed to manufactured and natural

fibers would be useful, as well as studies conducted with animals

to obtain mechanistic and other toxicologic data.

Also, the current analytic method for determining airborne fiber

concentrations do not count the fibers that are too small in diameter or length to be detected. Additional work to improve and standardize the methods for asbestos fiber measurement would further

advance prevention and control measures.

In summary, we know much about the adverse health affects

caused by the inhalation of asbestos fibers. However, many research questions remain. Further research is needed to better characterize the work environments where contaminated vermiculite

may be used and to determine whether vermiculite from sources

other than Libby is also contaminated with asbestos. We need to

increase our understanding of the health effects of fibrous minerals

that fall outside the definition of asbestos and improve tracking of

people potentially exposed to hazardous fibers. While information

continues to be gathered, public health prudence requires that

vermiculite from the Libby mine or products containing vermiculite

originating in Libby be considered potentially dangerous. Proper

precautions should be taken to minimize the generation and inhalation of any dust during the handling of these materials until

analysis of the particular vermiculite or vermiculite-containing

product shows that it does not produce an asbestos hazard.

Thank you, Senator Baucus.

Senator BAUCUS. Thank you, Doctor, very much.

Dr. Falk, welcome back.

STATEMENT OF HENRY FALK, M.D., ASSISTANT ADMINISTRATOR, AGENCY FOR TOXIC SUBSTANCES AND DISEASE

REGISTRY

Dr. FALK. Thank you very much, and good morning Senator Baucus, Senator Murray.

My name is Henry Falk and I am the Assistant Administrator

of the Agency for Toxic Substances and Disease Registry, a public

health agency within the U.S. Department of Health and Human

Services. I am accompanied this morning by Sharon Campolucci,

who was the coordinator of our medical testing program in Libby.

Senator Baucus, ATSDR is grateful for the interest and support

given by you and other members of the subcommittee and of the

Montana delegation since we began working in Libby in late 1999.

As you know, we came to Libby in response to concerns expressed

by yourself, community members, former vermiculite mine workers

and the health department. Over the last several years we have

worked very closely with the U.S. EPA, the State of Montana and

others to address these concerns. Without the support of all of you,

we would not be able to report today on the progress that we have

made in evaluating public health issues in the Libby, MT community.

We have been actively involved with citizens and public health

and environmental officials to determine the extent of harm to hu-
13

mans from asbestos-contaminated vermiculite that was mined in

Libby. In the earliest phase of our effort, we developed a plan to

help guide our activities in the Libby area, and as we have shared

with you in the past, this public health response plan identified the

areas of responsibilities for the conduct of our health-related activities. We have worked on that plan with various members of the

community, including officials there to provide input in developing

our public health efforts.

I am going to give a very brief update on a number of activities

that we have undertaken. First and foremost, in the medical testing program, and, as Senator Baucus noted, in the summer of 2000,

we conducted medical tests on 6,149 adults in the Libby area. Of

those, 18 percent showed pleural abnormalities, and of the former

W.R. Grace workers included in that testing, 48 percent showed

such pleural abnormalities. Most of the participants in that effort

reported multiple routes of exposure.

We conducted a second phase of medical testing in the summer

of 2001 with an additional 1,158 participants. The preliminary

analysis of that data does not suggest any significant change in the

prevalence of abnormalities from the first phase.

Again, as Senator Baucus noted, we conducted a mortality review

for a 20-year period which demonstrated that asbestosis rates in

the Libby area were at least 40 to 60 times higher than expected.

The mortality review also suggested mesothelioma occurrence was

elevated, and we expect to release an updated mortality review by

early July.

We have several other investigations, such as looking at the potential value of CAT scans in addition to chest X-rays in evaluating

individuals. Those are nearly complete and will be reported on in

the near future.

We have done detailed planning and preparatory work for development of a registry of former Libby area miners and household

contacts; and also, a key source of registrants will be those who

participated in the medical testing program. We sponsored a workshop in February to consult with and solicit advice from experts in

respiratory disease and asbestos to help guide the next steps for

the Libby registry. The registry is intended to be a long-term effort

that will not only be a repository of information and facilitate further studies, but also enable information that may come about in

the future on treatment and other medical breakthroughs to be

given to all the members of the registry.

We are currently working with the State to support localized

planning addressing future medical needs. There is a need, as you

know, for extended medical testing to continue in some form for

many years. We would like to see the primary responsibility for the

medical testing program transition to the State and local health departments with ongoing technical and resource support from

ATSDR.

We have worked in close cooperation with Region VIII HHS staff

to help the community identify sources of assistance for medical

care. As you know, HHS Deputy Secretary Claude Allen visited

Libby last September and was instrumental in developing the HHS

response. We are very concerned about the other sites that have received asbestos-contaminated vermiculite. You have seen the chart
14

this morning of the many sites. We are working together with EPA

to evaluate and prioritize those sites. We will be visiting a number

of these sites this summer and we hope to be able to determine the

extent of exposure and possible health effects from those sites as

we proceed.

One site that has already elicited considerable attention is the

Western Mineral Products site in Minneapolis, MN. We have been

working with the Minnesota health department to collect further

information on exposure and potential health effects at that site.

We’ve also developed a protocol for use by State health departments to review their vital statistics and cancer registry data at

many of these sites. We have cooperative agreements with six

States to look at statistics for sites within their State, and we hope

to involve several more States this year.

In addition, we’ve been working with four States to evaluate the

mesothelioma data within their States and look for potential relationships to vermiculite or other sources of asbestos.

In summary, I would like to reiterate that we share your concerns about the situation in Libby. It may seem very dry to summarize results like this very quickly, but we understand the human

impact of these health problems. We share your concerns and we

want to do as much as we can. Much remains to be done.

Our primary goals for the coming year will be to implement the

registry of former workers and family contacts, to establish the

medical testing program on a long-term basis by transitioning primary responsibility to State and local health departments with

technical and resource support from ATSDR, to conduct further

epidemiologic investigations on the links between environmental

exposures and development of disease, and to provide data on potential health effects in other States that had vermiculite processing centers that may have led to harmful exposures. Finally, we

continue to work on the mesothelioma surveillance activities, together with NIOSH.

With your continued support, ATSDR stands prepared to continue our work and we will do whatever we can to help people in

Libby and in Montana and at any other sites that may have been

afflicted with these problems.

This concludes my testimony. I would be happy to respond to any

questions. Thank you.

Senator BAUCUS. Well, thank you very much, Doctor. I know

you’ve worked hard on this. We appreciate it.

Senator Murray has another hearing she has to attend, in fact,

chair in about 10 minutes from now. So I’m going to turn to her

for questions and give her an opportunity to ask all the questions,

take all the time that you want.

Senator MURRAY. Thank you very much, Mr. Chairman, and

thank you all for being here today to testify before this committee

on this really critical project.

Ms. Horinko, I’ll start with you. I did speak a few months ago

with Governor Whitman about this issue, and I am sorry she could

not be with us today. If you could just share with her my concern

again and let her know I appreciate her efforts as we work to clean

up Libby.
15

I am particularly concerned about the other sites throughout the

country which process vermiculite from Libby. Now that Libby has

been declared a Superfund site, do you think that any of the other

sites which require further cleanup, such as the site in Minneapolis, MN, will also be declared Superfund sites?

Ms. HORINKO. Senator Murray, at the moment we are working

under our emergency removal authority, which does not require us

to declare a site a Superfund site in order to conduct emergency actions. That is how we have done the work thus far at Libby. At the

moment, it does not appear that any of the other 22 sites may need

to be declared a Superfund site. Our work at those sites is just

starting, and that may not rule out Superfund site declaration at

some of these others. At the moment, that is not our plan.

Senator MURRAY. At the 22 other sites, you do not think there

is enough contamination at this point that you are going to declare

them to be Superfund sites?

Ms. HORINKO. Not at this point, but let me stress that we are

in the preliminary stages of sampling and cleanup at many of these

sites, and further investigation may reveal contamination that may

lead to listing one of these sites on the NPL, the Superfund National Priorities List.

Senator MURRAY. When do you expect us to know that?

Ms. HORINKO. As we continue to collect data, if additional high

levels of contamination turn up at one of these sites, then we will

inform you of that. At the moment, none of the information we

have indicates that Superfund site listing is warranted.

Senator MURRAY. Could you please talk to us today about the

current status of your efforts to work with MSHA to investigate

contaminant asbestos problems at the other mines throughout the

country?

Ms. HORINKO. We have looked at the other three mines in addition to Libby. We have not found a pattern of asbestos contamination that in any way approaches what we have seen at Libby at

the other mines. I do not know if you want a comment at all about

some of the work that MSHA or NIOSH has done, but at the moment none of the other mines appears to even approach the profile

of contamination that we have seen at Libby.

Senator MURRAY. Dr. Falk, do you want to comment on that?

Dr. FALK. I think in general that I would agree with that. We

had contacted early on the State health departments related to

those other mining areas, and they were not seeing the kinds of

problems that were seen in Libby. I do not have the specific information with me, but I could get that.

Senator MURRAY. Do you mean that you are not seeing people

who have asbestosis, mesothelioma or——

Dr. FALK. It is my understanding from those State health departments that they were not seeing those kinds of increases.

Senator MURRAY. Just out of curiosity, how do you track that,

since sometimes or a lot of times people move away. Libby has a

fairly high retention of citizens, which is one reason it was seen

early on. Some of these other mines—I mean, we are talking 30

years ago. As the people moved away, that public health department may not even be aware of it.
16

Dr. FALK. Yes, you are correct. People will be aware of cases that

occurred in that area, and we are not aware of those that may have

moved away. For example, in Libby the asbestosis rates are so

high, and the mesothelioma cases are apparent. So you are correct

that maybe some further formal study might identify cases elsewhere, but we are not aware, at least from within those communities at the moment, without going back and tracking down people

who moved away, of those increases.

Senator MURRAY. Ms. Horinko, is your office currently participating in EPA’s Blue Ribbon Panel on asbestos?

Ms. HORINKO. We are not formal participants in the panel, but

we work very closely with the Office of Pollution Prevention, Pesticides and Toxic Substances which is headed by my counterpart,

Assistant Administrator Steve Johnson.

Senator MURRAY. But your office is not involved in the Blue Ribbon Panel itself?

Ms. HORINKO. I do not know if we are formal members of the

panel, but my staff is working very closely with the staff in that

office and we will track the deliberations of this panel very closely

and the research that is gathered.

Senator MURRAY. Can you give me any update on the status of

the panel, where they are?

Ms. HORINKO. My understanding is that the panel will formally

convene its discussions this summer and is expected to produce a

report early in 2003. The panel will also be conducting a web-based

stakeholder outreach and research collection information so that

they can get as much research and as much information as they

can from stakeholders, as well as provide information, disseminate

information about the state of knowledge as we currently understand, as well as information related to safeguards and precautions

that people need to take in dealing with vermiculite products.

Senator MURRAY. Is EPA still planning on limiting the scope of

that panel to just the six regulated forms, or are you looking at expanding it?

Ms. HORINKO. My understanding is that we fully expect the dialog to encompass all forms of asbestos contamination.

Senator MURRAY. One more question for you—in your testimony,

you said that the activities in Libby will require an additional $21

million in fiscal year 2003. EPA’s budget justification for the Superfund program does not list sites, as you know. I assume the Administration included the $21 million needed for Libby in its budget request?

Ms. HORINKO. We fully expect to spend that $21 million in Libby

in 2003.

Senator MURRAY. Are those funds needed just for Libby, or do

they address the other 22 sites as well?

Ms. HORINKO. Whatever funding we need to address all of the 22

sites, in addition to Libby, we will include in the budget request

for 2003.

Senator MURRAY. Is that part or your request now, or are you

going to be looking for future dollars for that?

Ms. HORINKO. That is included in our current budget assumptions.
17

Senator MURRAY. Dr. Wagner, in your testimony you said that

between 80 to 90 percent of the fibrous minerals in the vermiculite

from Libby are fibers that are currently unregulated. Do you think

the Federal Government should reevaluate regulating these minerals?

Dr. WAGNER. I think it is really important to do the scientific

work to be able to understand the importance of durability, bio-persistence and how this creates hazards. At this point, we believe

that fibers that are like asbestos in their physical qualities should

be treated with the same caution.

Senator MURRAY. OK. You said that NIOSH made its findings

about the health affects of vermiculite on workers in Libby available in the occupational health literature way back in 1985. It took

newspaper articles in 1999 and Senator Baucus’ leadership to get

Federal agencies to mobilize to really address this problem in

Libby. Share with us what in your opinion why more attention was

not paid to NIOSH’s findings way back in 1985 and since then?

Dr. WAGNER. I think that we did what was normal at the time,

which was publication in the scientific literature, communication

with the employers and with the employees and with the community residents. The kinds of things that we are doing now involve

a broader communication of the risks that we identified. I think

that the communication was perhaps just pro forma to the regulatory agencies, but not with specific meetings and more direct engagement.

Now, I think the coordination and communication among the

government agencies that are interested and involved in the occupational and environmental hazards is really far better than it was

15 or 20 years ago. I think that we have also been more effective

in our public communications. For example, I opened up my USA

Today and saw on the front page a story relating to an investigation our division is doing on serious lung disease in a popcorn factory. I think we have been more effective in engaging with the

States, engaging with other Federal agencies, engaging with the

media and with the public, and that these are all important lessons

that we learned that we should have done better back in the

1980’s.

Senator MURRAY. Mr. Chairman, I really appreciate you letting

me testify today and ask questions. I do think public education has

got to be part of this because many of these people, it was 30 years

ago that they were exposed. I had a constituent out here 2 days

ago who went to the doctor with lung problems, and the doctor insisted it was not related back to his contamination with asbestos

and absolutely refused to believe it. There is a lot of public education that needs to take place. There is a long time between when

somebody was exposed to this, and when they actually come down

with the diseases. Many doctors, hospitals, health care clinics have

no idea unless we educate people so that these people can be diagnosed quickly. We need to go back and figure out how to treat people and to make sure we are doing the preventive things that we

need to do today, and to make sure doctors are aware of this.

So we have a lot of work ahead of us.
18

Senator BAUCUS. You are right, Senator. In fact, sometimes listening to this conversation and thinking about it, maybe we need

a Homeland Health Protection Act——

Senator MURRAY. Yes, I agree.

Senator BAUCUS [continuing]. To coordinate all the health resources and all the agencies to deal with some of the lethargy.

Senator MURRAY. Well, I hope we can at least ban asbestos so

that 30 years from now we are not having another hearing.

Senator BAUCUS. I very much compliment you for introducing

that legislation.

Senator MURRAY. Thank you.

Senator BAUCUS. Thank you, Senator.

I would like to do something a little bit unconventional here.

That is, in an effort to get to the heart of the matter, I would like

the rest of the panelists here to kind of move over to the end, and

I am going to ask the other panelists to come up and testify right

now. We are going to have a little dialog here among everyone—

that is, the current panelists and the second panelists—so that we

are more likely to get at the heart of the matter. We will try and

find some more chairs. Will you all come up please? All of you—

Dr. Spence, Dr. Black, Ms. Cohan, and Commissioner John.

[Laughter.]

Senator BAUCUS. OK. I deeply appreciate the other witnesses

and the first panel remaining to be part of this effort. Thank you

very, very much. I appreciate taking the time.

OK, Dr. Spence, why don’t you proceed first, and then we will go

on with Dr. Black and Ms. Cohan and Commissioner Konzen.

STATEMENT OF MICHAEL SPENCE, M.D., STATE MEDICAL OFFICER, MONTANA DEPARTMENT OF PUBLIC HEALTH AND

HUMAN SERVICES

Dr. SPENCE. Senator Baucus, thank you very much. I appreciate

the opportunity to be here and discuss this very important Montana issue.

As everyone is well aware, this all started with an article that

appeared in the Seattle Post-Intelligencer in November 1999. I remember it well because it was a week before Thanksgiving. We

were having a meeting with Region 8 discussing bioterrorism and

our grant application. We got a phone call from the then-Administrator, Bill Yellowtail who told us to deploy to Libby and find out

what was going on. We went there. We met with Brad Black. Over

the ensuing months with the help of EPA and ATSDR, we developed a testing program. The testing program over that period was

based on information that we received by conducting meetings with

several experts throughout the Nation on asbestos, on lung disease,

and on asbestos-related problems.

The bottom line is that as Dr. Falk pointed out, 6,149 people

were screened that first summer. Of that population, 18 percent or

approximately one in five was found to have asbestos-related disease. That is to say that if you walked into the Libby Cafe, which

is a downtown eating facility, and looked around and there were

60 people in there, which it will hold, somewhere about 5 or 6 of

those individuals have asbestos-related disease. They are suffering

from this entity. They may have mesothelioma. They may have
19

lung cancer, or they may have asbestosis. But that many do have

it.

A second round of testing was conducted the following summer.

Again, we added another 1,000 to that and preliminary results

show that the rates are going to be about the same, as Dr. Falk

pointed out.

We have a major problem in Libby. This was not minor, and this

many people being affected with this severe disease. We take a look

at those individuals in which there is no evidence of a background

of exposure—5 percent of the population in Libby have evidence of

asbestos-related disease with no known exposure. That is 2.5 times

higher than previously had been reported in any other study of

populations at large. So we know that the background from just the

fallout of being a resident of Libby is significant and puts you at

increased risk. One in twenty develop severe disease.

We looked at the population at Libby and tried to estimate what

our health care needs are going to be over the future months. One

of the things that became very clear—we did a survey of the people

coming in for the first round of testing and found that 24 percent

of the population is uninsured, have no visible means of insurance.

When you take a look at that sub-population of those people that

are insured, interestingly enough many of them have policies in

which their deductible is in the $500 to $1,000 to $2,000 to even

$5,000 deductible—basic catastrophic insurance. So we are talking

about a population that is terribly underinsured or uninsured.

Furthermore, the population has an unemployment rate that is

twice the State average—over 11 percent of the population of Libby

are unemployed, where the State average is 5.3 percent. So we are

talking about individuals that have no visible means of support to

get insurance to pay for their health care costs.

How do we pay for those costs? If they qualify for Medicaid, yes,

they can, but not everyone does. As you know, there are many Federal restrictions on Medicaid. Is a white lung program available?

No, sir, it is not. That might be one of the answers that we may

have to address, because the problems that we are encountering

now are only going to magnify. It is estimated that this will continue on until the year 2030 at least and maybe thereafter with regard to disease because of the latency of this problem. As I think

you know, asbestos does not affect you immediately. It affects you

over years, and it takes 10 to 20 to 30 years before the ramifications of this disease become apparent. The disease has three

forms—mesothelioma that was pointed out, a very unusual and uncommon tumor, one that causes rapid death. The person that gets

this particular tumor can expect a life expectancy of less than 1

year from date of diagnosis. Cancer of the lung is again another

major problem that we have to worry about because the population

has that. In addition, asbestosis—the most common form of disease

that we see, is one in which there is slow scarring covering the surface of the lung, and the scarring is slow and insidious in onset,

and basically the patient is smothering to death over a long period

of time. It takes 10 to 20 years to die, and all that time they are

getting shorter and shorter of breath. It is not a very pleasant way

to die, I would not imagine.
20

As Dr. Falk pointed out, there has been a tremolite asbestos registry initiated, and we are working very closely with ATSDR to do

that. In addition to that, we are looking forward to initiating further screening in the State of Montana of Libby registrants and

also to try to identify individuals from that registry that might be

willing to come to Montana for screening and doing it locally, using

our resources there. We hope that we can indeed identify the large

number.

Another thing that we have done is we have undertaken a look

at mesothelioma in the State of Montana. Since 1979 when we had

tumor registry statistics, we have found over 150 cases of mesothelioma. Not all of them are in Libby. They are throughout the rest

of Montana, which proves the point of the movement of this ore.

It was transferred over to various screening plants, as was pointed

out on that map. In addition to that, it was transported all over

the United States. What we are finding is cases of mesothelioma

in areas where there are major railheads and also where there was

previous screening. When we look at it county by county, we can

find massive excesses in major ports or major cities in our State,

compared to the rest of the State where indeed asbestos was not

transported or the ore was not transported. This is a major concern.

We have to look at other future health care needs. The Health

Department is also looking at immunizations of these people to protect them against respiratory diseases such as pneumonia and influenza and other projects, so there are many health care needs we

are going to meet.

I think as was pointed out by Senator Murray earlier, the Ban

of Asbestos Act, if it were to go into effect today this very minute,

it would not be until the year 2042 until we would start seeing possibly some relief from this terrible illness.

I want to thank you for the opportunity of being here. That is

the conclusion of my remarks. Thank you very much, Mr. Chairman.

Senator BAUCUS. Thank you, Doctor. That was very, very good

testimony. I appreciate that.

Ms. Cohan.

STATEMENT OF PAT COHAN, COORDINATOR, CLINIC FOR

ASBESTOS RELATED DISEASE

Ms. COHAN. Good morning. Thank you for inviting me here.

My name is Pat Cohan. I am a nurse. I have been a nurse for

29 years. For the last 2 years, I have been involved with the health

care needs for a community related to the asbestos exposure. My

introduction to the asbestos disaster was in the year 2000 when I

accepted a grant position funded by HRSA to assist and cooperate

and work with the ATSDR in the screening.

The job was two-fold. One was to serve as the outreach nurse for

the screening, in which I handled any medical emergencies, health

care concerns or urgent referrals relating to the screening. The second part of the position was to help create a clinic that would assess, diagnose and educate people with health care concerns related

to the screenings.
21

The Center for Asbestos Related Disease, also called the CARD

Clinic in Libby, was created through St. John’s Lutheran Hospital

and with the cooperation of all the other health care providers in

the area. The volume of calls, drop-in visits, people with frantic

questions and need for education was just unbelievable the first

year. Of the over 6,000 people who were screened, I probably saw

half of them at one point or another just answering questions. The

clinic now has over 1,000 active charts, and of these close to 800

show signs of asbestos-related disease or asbestos-related changes

that may develop into disease. Each of our clients and their family

members have received health information and education related to

pulmonary health.

In my position as a nurse, the breadth and depth of the psychosocial, the emotional health and financial concerns associated with

this disaster has been without precedent. I have been in most cases

first at hand to see the results of this. As with your introduction

with Les Gramstad, I get to hear a lot of stories that strike home.

To sit and listen to a client talk about going hunting in the hidden

mountain valleys and having accidents because he will not allow

his children to watch him die the way he watched his father die

is pretty hard to take some days.

I have worked to find financial resources for a 47-year-old

woman who never worked at the mine, was the daughter of a

miner, to help her find funding to have a lung biopsy done because

she was suspected of having mesothelioma. This young woman had

quit her job housecleaning because she thought it was the chemicals that were making her short of breath. This person waited over

3 months to hear whether she would even be accepted into the

Grace Medical Plan which right now is a major source of medical

care or help for these folks.

Some of the stories are just so twisted and convoluted it is hard

to sort out what the client really needs. A woman who is approaching 60 who cares for her elderly mother, both of whom have asbestos-related diseases, comes to me with complaints that she has

been washing her dishes in the tub for 2 years because her kitchen

is plastic-sheeted off and duct tape closed because of the leaking insulation in there. It is hard to figure out what she needs first, a

kitchen or a sink or health care needs.

I have a neighbor who resided in Libby for over 40 years. This

gentleman started the ambulance in Libby before there was one.

He has served on every volunteer committee in the town—never

complains, only works hard. He was never a miner. He never gardened with it. The only exposure he could think of was that the

Zonolite was in his home for his insulation. This is a man who has

hiked and skied every mountain in the Cabinet Range and in Glacier before it was the thing to do. He worked tirelessly for our community in this volunteer role. He can no longer hike. He does not

volunteer. He just sits and breathes.

I have used the word ‘‘disaster’’ most deliberately. This is a slowmotion disaster, as we call it. Had a mine had a toxic leak and it

killed 200 people outright and injured another 1,000 with 20 percent of them critically injured, I would not be here. I would be

home in the emergency room. Just because this took 20 to 30 years
22

to come to the surface, does not make it any less of a disaster. It

just makes it slower.

I cannot really talk about what the rock or the mineral properties are. That is not within my scope of care. I can only talk

about the human disaster that I see and the effects on my neighbors and my friends, and strangers who come to the clinic who rapidly become friends because our clinic is about the only place where

people feel safe or comfortable talking about this.

This was not—this disaster did not happen because it was an act

of God. It did not happen because of some ideological conviction or

religious belief or anything. It was created because somebody needed a profit. It was a very profitable enterprise. The people in Libby

did indeed get great benefits from the mine when it was working

and the income because there are not many places to earn a living

back in the north woods. But the people, the miners were treated

with no respect. The citizens of Libby were treated with less regard

than they treated the over-burden of rock up at the mine.

This disaster is not over with. It is going to continue for the next

20 to 30 years. It is not a matter of waiting for the few affected

people right now to die off and the problem to go away. We are

worried about the children and the grandchildren who were exposed up to 2 years ago at the public schools, at the track at the

grade school. We already know the kids and grandchildren were affected financially and emotionally. We are just waiting to see what

the health effects are going to be.

What Libby needs, I see three things. We need research to find

treatment, cure, cause or even a blood test to figure out who has

been exposed. We need health insurance or a health care program

that will be available for the length of time needed. We need the

facility to monitor the health care effects and the progression of

this disease.

I would like to take the opportunity to thank everyone who has

been involved in Libby—the agencies, the ATSDR and the EPA and

Health and Human Services. The representatives that they have

sent in Libby have made an enormous difference in how well this

has progressed. People have come to Libby and rapidly become

adopted Libby citizens just because of the fine job they have done.

I also want to take the opportunity to thank our whole Montana

delegation, and particularly you, Senator Baucus. Your visits, your

care and your concern have been very evident, particularly through

Rebecca’s multiple visits. So thank you.

Senator BAUCUS. Thank you very much, Pat. That was one of the

more compelling statements I have heard. I thank you very, very

much.

Dr. Black.

STATEMENT OF BRAD BLACK, M.D., LINCOLN COMMUNITY

HEALTH OFFICER AND DIRECTOR, CLINIC FOR ASBESTOS

RELATED DISEASE

Dr. BLACK. Good morning, Senator Baucus.

I feel very fortunate to be here. This is a privilege to really be

here where I can do something for Libby. Certainly, without your

support, I would not be here, and I appreciate the committee taking the time to listen to Libby.
23

I have been a physician in Libby for 25 years. I served as the

county health officer for the past 18 years, and have been a very

active community member. I could go on for quite a while based on

my history in Libby. I have a lot of background. But I think I am

going to tell you a brief background story today, and then I would

like to emphasize three points.

Let me start with the background. When I came to Libby in

1977, I was aware of asbestos-related disease in workers because

my partner who was a practicing internist, had related this to me.

It was just somewhat of a surprise because in medical school it had

been indicated that we probably would not see much more of this

disease. They just basically covered the surface on it in medical

school in terms of lung diseases.

So we were both taken back a bit. But he became more inquisitive because he was county health officer then. This is the late Dr.

Richard Irons. In 1978, he started probing into it farther, and entered conversations with the W.R. Grace management. He realized

that they had improved their hygiene some in the mine because

they had put in a wet mill in 1974, but he was still quite concerned

because of the disease he was seeing.

So he actually went all the way to headquarters to try to develop

a working relationship with the company, because he was concerned. He clearly desired to work with them to reduce health risks

from asbestos exposure to the Zonolite workers, their family members and the community at large. He was concerned about them.

He recognize the hygiene concerns at that time. I do have that letter, but it was very clear in his statement that those concerns were

there. Unfortunately, they were not acknowledged.

It was shortly after this, in 1980, the EPA did their assessment

and understood the potential hazards with vermiculite-associated

asbestos. Unfortunately, that was not acknowledged either, and I

think there was a lot of presumption by many of the physicians in

the community that since the agencies had been involved, probably

things were going to get better—that we were not putting people

at risk.

So in 1999, there was a reporter that had come through the community. I was county health officer. He was starting to ask me

questions, and I was somewhat dumbfounded. I was not expecting

those. The questions were about this wider exposure in Libby. So

when this broke finally in the Seattle Post Intelligencer, as county

health officer, I was still in disbelief that we could get that much

exposure in the community to cause significant lung disease. I was

still one of those doubters that we would have that much disease.

It did not take me long, though, once I started probing, talking

to Dr. Whitehouse, looking at the cases that were showing up that

he had started noticing in the late 1990’s. It became very evident

that knowing the activities in Libby and where the ore had gone,

I realized that we were probably into something bigger.

The past several years have been painful, and they have been

very humbling for a person that has been in this community. I

have several friends that have developed lung disease and lost half

their lung function. It was so insidious I did not even realize it. I

was not taking care of them, but it is that subtle a disease, and

insidious. You cannot help but say, ‘‘Where did we go wrong? What
24

could I have done.’’ That is the difficult thing we have to deal with,

especially when it gets to friendship and the closeness and you realize what has happened.

These people do not complain. I think you know, Max, they are

very hardworking people in Libby. They do not complain about very

much, but people are concerned, of course, now.

Let me make three points out of this. No. 1, I have spent these

last 2 years delving into pulmonary medicine a great deal and

working very closely with Dr. Alan Whitehouse, board-certified

chest physician in Spokane, who has seen a sizable number of people from Libby. The Libby exposure was extensive, and you have

heard that already, but Pat and myself follow these people in the

office after the screening. In other words, all the abnormal screens

done by the ATSDR—I should not say all of them, but a high percentage of those—have been seen in our clinic. We found that the

screening process has been very effective. Many of the people who

have been screened out have been subsequently diagnosed with asbestos-related disease. So the figures that we see there are very

real. That is, we may have up to 1,300 to 1,400 people out of the

first screening that do have asbestos-related disease. That does not

include the 2001 screening.

No. 2, this asbestos-related disease in Libby, you have heard now

that it is caused by a mixture of fibers. Tremolite certainly is one

component. There are several other fibers. They are all very similar. They are in the amphibole series of asbestos. I know that is

another confusing term, but it is different. We have seen things

with it we have not seen reported in the chrysotile or the commercial asbestos exposures. Our experience has shown it to have a

higher rate of progressive lung disease. Dr. Whitehouse has actually studied that in a population of his, and has found that there

is up to 70 percent of his people, no matter what they show up with

on X-ray as far as degree of scarring, will tend to progress—I

mean, 70 percent of them tend to progress. Some of them progress

very rapidly. I included in this hearing a report on a gentleman exposed in a California expansion plant just one summer, and 50

years later he died of rapidly progressive lung disease from Libby

asbestos—well-documented.

Some of the non-occupationally exposed individuals have worse

lung disease than the Zonolite workers that have been there more

than 15 years. When you go through their exposure history, you

would not expect that. You get this strong feeling of a potency here

that nobody has recognized yet, and I think it is one of those things

that needs to be sorted out. We do not know that for sure. Are the

other exposures—were they unusually high? It is very difficult to

tell. There is great concern over relative potency that is totally different. I think this needs to be looked into very seriously.

No. 3, the incidence of malignant mesothelioma—the big word—

is exceedingly high in Libby. The reports have been up to 23 cases.

This is a cancer, of course, that is rare—one in a million in the general population. In Libby, MT, it is 100 times that. That rate is incredibly high. It is an ugly tumor. It is non-treatable and uniformly

fatal. The tumor develops in the lining of either the chest cavity

or the abdominal cavity. Those are the pain-sensitive areas of our
25

body—very pain-sensitive. It is an extremely painful and miserable

tumor, to say the least.

Just to give you an example of the exposure—we have six people

that have developed mesothelioma due to non-occupational exposures. That is just incredibly high. Right now at this current time,

we lost one gentleman that worked 3 months at the company. He

died this year already. He was diagnosed in January; dead in a few

months. He moved away from the community. I have another gentleman—the family called from Nevada. He worked in the Forest

Service and was there 15 years; never handled the materials, just

lived across the river and just a little ways up the river from the

processing facility in town.

Our most recent diagnosis was a well-known community member, school health nurse, and just a loved one of the community

and now she is currently dying of mesothelioma. This has all happened since the—these last two have happened since I submitted

testimony in April when the hearing was originally scheduled. So

if that does not impact you as to adverse effects, the community is

having to deal with now that the asbestos-related illnesses that we

were fearful of are happening.

I want to say this real quickly, because there have not been

many people who have studied Libby asbestos. Dr. Alan

Whitehouse is a clinician that really has studied it a lot clinically.

Now, there is another investigator, Dr. Corbett McDonald from

McGill—well, he was at McGill University and was actually

brought in by W.R. Grace to study the workers at the same time

NIOSH was doing their study. In other words, they carried parallel

studies. Their observations were similar. They realized significant

disease in these workers. What is interesting is Dr. McDonald followed these same workers since this broke in 1999. He had this to

say, ‘‘These vermiculite workers suffered severely from malignant

and non-malignant respiratory disease.’’ He found the death rate

from mesothelioma was 10 times higher than it was for chrysotile

miners—that is commercial asbestos—in Quebec. His opinion clearly is this stuff is significantly more toxic in terms of causing

mesotheliomas. Once again, he has studied chrysotile extensively

in the Canadian mines also, so he has some background in both fibers. So I think it means a lot when these people—the few that

have investigated—recognize significant potency with Libby asbestos.

In closing, I want to express concern pertaining to how we will

be able to meet the asbestos-related health care needs we are sure

to face over at least 20 or 30 years and maybe longer—it is hard

to say. W.R. Grace has been providing funding for our CARD Clinic—that is the Center for Asbestos Related Disease that Pat and

myself, where we see people. There is also a Grace insurance program; however, these past months has shown their commitment to

caring for affected individuals is waning. It suggests that our support there is self-limited. Certainly, we need a lot of research and

developing therapies is a high priority for us.

Additional concerns—one, the exposures from W.R. Grace export

plants all around in the United States and then areas of California

(not related to Libby asbestos), where release into the environment

of naturally occurring tremolite as a result of large-scale construc-
26

tion activities. Those are concern areas because we do not want

things to happen other places when we know this particular type

of fiber has the potency it does.

I just want to thank you for allowing this opportunity, and I cannot thank you enough for your persistence and your advocacy for

your Montana family.

Senator BAUCUS. I appreciate that, Brad. Actually, the thanks

goes to all of you; Pat, Dr. Spence, John, and all the others in the

Libby community who have stepped up. I have seen it. You feel it.

It is obvious and I thank you very much for all that you are doing

to help the people.

Mr. Konzen.

STATEMENT OF JOHN KONZEN, LINCOLN COUNTY

COMMISSIONER, LIBBY, MT

Mr. KONZEN. Thank you, Max. Thanks for the opportunity and

for all the work that you have provided on behalf of Lincoln County

and particularly Libby.

Good morning. My name is John Konzen. I am from Troy, MT,

a community just south and west of Libby, and serve as the county

commissioner for Lincoln County. You have already heard about

Libby, a community I have served both as a commissioner and as

a member of the Board of Directors of St. John’s Lutheran Hospital.

Lincoln County is no stranger to the Federal family. Floods and

forest fires dispatch Federal agencies to us regularly. Our county

shares the Canadian border and a reservoir that straddles the

international boundary, feeding the Columbia River Basin. There

are endangered species and every other natural resource issue you

can imagine. We struggle with double-digit poverty and unemployment rates. On the average day, it is fair to say that we are county

with a lot on our plate.

Before I became a commissioner, I served as a teacher and a

school administrator for many years. I witnessed first-hand the effects that down cycles have on resource-based communities like the

ones I serve today. I can tell you first-hand how families are affected when mills close or mines shut down. But most of you would

have never heard about Libby or Lincoln County if it were not for

tremolite asbestos.

There was a time when the W.R. Grace mine was a good thing

in our community. It meant jobs and good-paying ones. Men went

to work every day to earn a living for their families. They did not

step away from the responsibility, and I bet a lot of them would

have gone to work every day even if they had known the risk that

they were taking for themselves. That is what husbands and fathers do.

But none of those men would have ever put their families—their

wives, their children or their grandchildren—in harm’s way. Never,

not a single one of us in this room, would have ever done that. But

as you have already heard, Grace has allowed all of that to occur.

There is an old saying that goes, ‘‘Many hands make light work.’’

When Grace stepped away from their responsibility, they allowed

the miners and the wives and the children of those men to do all
27

the heavy lifting and to take on the risk Grace was unwilling to

shoulder.

As Grace continues to step away from even the small portion of

responsibility they willingly accepted to help our community cover

prescription drugs, home health and other medical costs, they are

breaking us. Our tiny community’s medical resources are already

stretched very thin.

It is not just our community alone which concerns me and other

Montanans who have traveled here today to speak with you. As

Grace increases the distance between the rightful portion of responsibility they must bear, they further harm the State of Montana.

As Senator Baucus is well aware, people are our most precious

resource in Montana. As I travel across Montana for regular meetings with other county commissioners in our State, commissioners

tell me they are too concerned about the far-reaching impact

Grace’s lack of responsibility will have. Many fear Grace’s recent

decision to no longer help with medical expenses of folks who have

qualified for their own medical plan has the potential to bankrupt

our own State Medicaid program.

We appreciate the help the Federal family has extended to northwest Montana. We do not know where we would be without the

help of the Department of Health and Human Services, the Environmental Protection Agency, the Agency for Toxic Substances Disease Registry, and Congress. Everyone is doing the heavy lifting—

everyone, it seems, but Grace.

I am here to thank Congress and the hard-working folks across

the country for their support of our community. You have all done

your part, and we cannot begin to thank you enough. But I would

also like to add that W.R. Grace still has a place at our table. We

need them to do their part.

As Grace makes it way through the Federal bankruptcy court,

there are several things I would ask this committee and those

present to consider to set aside a separate trust fund, established

by Grace, to cover the short-term prescription drugs and home

health needs of the folks in Libby who are struggling with asbestos-related disease. I would also ask you to consider establishing a

trust fund for the long-term health care needs and also to continue

the support for the important research.

I appreciate the questions that have been raised about the longterm funding for cleanup and the statutory authority for removing

insulation in homes in Libby. Good health is all any of us can ask

for. A clean bill of health is the most profound mark our Federal

friends will leave upon our community.

I appreciate your time and thank you on behalf of Lincoln County.

Senator BAUCUS. Thank you very much, commissioner.

I am going to ask questions now, and I would like various of you

to be thinking of questions or points you might want to make to

various other panelists. All of this is in a constructive mode. That

is, we are not here to badger or to criticize, but we are just in a

constructive mode on where do we go from here just to help the

people of Libby. Although I strongly share Commissioner Konzen’s

view that W.R. Grace is very irresponsible here. They knew that
28

asbestos was there. They knew that it causes disease and did not

adequately warn people about it. They are now also significantly

walking away from their responsibility in the community. So I do

share that criticism with many of the panelists here.

The first set of questions has to do with cleanup. I will ask Mr.

Horinko those questions. Generally, the questions are around, like,

how much? What is the timeframe? How much are you going to

clean up? When do you think you will complete the cleanup? This

is both on the ground and the insulation in the homes. Also the resource question—that is, do you feel you have the resources that

you can dedicate to get the job done in the time that we have established? So Ms. Horinko, why don’t you address those questions

if you could please?

Ms. HORINKO. Thank you, Senator Baucus.

We have had, as you know, a very aggressive cleanup plan underway now since 1999. In fact, we estimate that from 2000

through the end of this fiscal year, 2002, we will have expended

$60 million.

Senator BAUCUS. I am sorry—$16 million?

Ms. HORINKO. Sixty million dollars—six–zero.

Senator BAUCUS. Sixty—6–0.

Ms. HORINKO. Six-zero—$60 million, and as I said to Senator

Murray, we anticipate spending an additional $21 million in fiscal

year 2003, and have planned for that in our budget assumptions,

as well as planning for followup at the other sites nationwide

where there are Zonolite concerns. As I indicated earlier, we have

already addressed a number of the processing facilities, the mine

roads, sealed off the mine, done work at the city park and the

school tracks, and hope to have those completed shortly. We have

done 12 homes on a pilot basis to see if the insulation could be

safely removed and the dust cleaned. That has led us to believe

that in fact we can do it. We plan next week, as I said, to start

interior cleaning, as well as insulation removal in the homes in

Libby and plan on doing 55 priority properties this summer. We

also plan on working out from the export plant to do additional removal in businesses, yards, parks, as well as interior cleaning of

some businesses and some development work to start a secure

landfill cell for storage of the material, disposal of the material.

Senator BAUCUS. Do you have some kind of a timeframe? Is it

a short-term plan or a long-term? Let’s take one at a time here.

Ms. HORINKO. Sure.

Senator BAUCUS. Let’s take first the cleanup of the community

and the site and so forth. We will get into the home insulation

next. But let’s just talk first about the non-home insulation cleanup.

Ms. HORINKO. Sure.

Senator BAUCUS. By when do you expect to have completed all

action? Give us timeframe please.

Ms. HORINKO. Sure. In general, we believe in 2 years we will

have completed all of the work that we currently have underway

or are planning to have underway at Libby. Actually, I have got

here a copy of the action memorandum amendment that we signed

in May that I referenced in my testimony. It sets forth detailed tables, action description and status for each individual property, ex-
29

port plant, screening plant, the Raintree Nursery, the KBC Bus

disposal area, and gives the current status and also our planned

timeline. I will be pleased to make that available for the record.

Senator BAUCUS. Do you have dollar figures representing the dif- ferent aspects there? The $21 million you mentioned, that is for fiscal year 2003. How much do you plan to at least request to the

Congress to spend in the next fiscal year? Do you know?

Ms. HORINKO. In 2003 or 2004?

Senator BAUCUS. In 2004.

Ms. HORINKO. In 2004, we are just in the very preliminary stages

of putting that budget formulation together right now.

Senator BAUCUS. Would you expect it to be about the same?

Ms. HORINKO. I would expect it to be about level, if not more.

Senator BAUCUS. Let me ask Commissioner Konzen, Dr. Black or

Dr. Spence, any questions you have on timetable of cleanup. Does

that fit? Does that seem to be in the ballpark of what you think

can be done or should be done?

Mr. KONZEN. Correct. I think they had some problems with contractors.

Senator BAUCUS. I have heard that, too.

Mr. KONZEN. They got off to a slow spring, but I think they are

talking to the onsite Coordinator Paul that they are moving forward and they expect to do exactly what she is saying now.

Senator BAUCUS. So you feel 2 years is reasonable?

Mr. KONZEN. Two years is very desirable. The quicker we get it

cleaned up, the better we can move forward. I think they are presently working on our landfill situation and they have started clearing the timber in that area. So I believe there were contract issues.

Senator BAUCUS. So if we could right here establish that our

deadline is within 2 years, that is very much agreed upon and that

is a reasonable deadline to get all that cleanup completed.

Ms. HORINKO. I believe we have committed to Governor Martz

that in fact we will be in and out of Libby as quickly as we possibly

can.

Senator BAUCUS. I know that. I am just trying to find out what

‘‘quickly’’ means.

[Laughter.]

Ms. HORINKO. In the Superfund world, 2 years is record time, so

that is EPA thinking.

Senator BAUCUS. We want record time here.

Ms. HORINKO. EPA is placing a very high priority on Libby.

Senator BAUCUS. You have no concern at all about the resources—that is, the dollars will be available?

Ms. HORINKO. Libby is one of our highest priority sites. The

Superfund budget in general is level. I do not see any cuts to

Superfund, and so I am very confident that we will be able to move

forward and continue to have Libby be a very high priority.

Senator BAUCUS. Now, let’s go to insulation. What is your plan

there?

Ms. HORINKO. With respect to Libby or nationally?

Senator BAUCUS. Libby.

Ms. HORINKO. With respect to Libby, as I said, we will begin interior cleaning including removal of the insulation next week. We

have identified 55 priority properties that we hope to have done by
30

the end of the summer, and we plan on continuing on to any homeowner or business within Libby that requests and we feel warrants

removal of their insulation. In our action memorandum, we have

planned for and budgeted 800 homes, when all is said and done.

Senator BAUCUS. When do you expect to have completed removal

in all 800 homes?

Ms. HORINKO. In all 800 homes, that will probably take the entire 2-year timeframe.

Senator BAUCUS. Within 2 years. Let me ask again, does that

sound reasonable to you people in Libby?

Mr. KONZEN. No. I think they have a large task at hand, and I

think they have committed the resources to do it if they have the

funding.

Senator BAUCUS. Do you have the funding?

Ms. HORINKO. Absolutely. That is included in this action memorandum.

Senator BAUCUS. So the $21 million for fiscal year 2003 is both—

is that right?

Ms. HORINKO. That is absolutely right. That encompasses all aspects of the cleanup.

Senator BAUCUS. One slight question—the reason I am asking

these questions is I am picking up that some people in Libby are

wondering whether EPA is beginning to slacken a little—backing

off. That is, there was a time when EPA was there working hard

and Paul Peronard was, boy, he was just going like gangbusters.

There is a bit of a feeling, and this is just rumor, but still—that

while Paul is still going like gangbusters, maybe his regional office

and more particularly at the national office, that Libby does not

have the same high priority that it appeared to have a few weeks

ago. Dr. Black, do you want to comment on that at all?

Dr. BLACK. There is clearly a sense in Libby that there has been

some shift, and we sense, at least what we can tell, activities of Region 8 have been slowed some, but that is a perception we have

had. I left this with—here, we built this trust and it has been

building. We have built a very good trust. The agencies have performed excellently—EPA and ATSDR. Health and Human Services

has initiated some activities also. It has been, you know, but I

think we all respected Governor Whitman coming, and she came by

the clinic, spent time with us. She understands the problem and I

respect her a great deal. I think her commitment means something

to Libby. I think we are worried about other politics, and Governor

Whitman, we still support strongly her commitments and respect

them. I hope they are carried through. I think that is important to

us.

Senator BAUCUS. That is right. Governor Whitman has been very

good. She has visited Libby a couple of times and demonstrated her

commitment. I have talked to her yesterday about appearing here

today, and she had other business. She could not do it. I mentioned

that same point to her, and the reaction I got was that while, like

all Administrators have, they have a lot on their plate and lots of

things they are thinking about and worrying about is—oh, well, gee

thanks, Max, for telling me that; I’ll check up on that to make sure

that is not the case.
31

But nevertheless, there is this perception in Libby that maybe

things are starting to slacken off a little. I do not want to get this

next person in trouble, but Paul Peronard has done a heck of a job

in Libby. My view is whatever Paul wants, Paul should get.

[Laughter.]

Ms. HORINKO. I listen to you, Senator, with some bemusement

because all of us here, and you more so than I because he is with

you every day, know Paul very well. I speak to Paul regularly. Any

characterization of Paul as slacking off is just completely inconsistent with his personality.

Senator BAUCUS. No, no. It is not Paul. The perception is not

Paul. The perception he is not getting the resources that he needs.

He is not getting the attention that he needs from either the regional or the national office. That is the concern.

Ms. HORINKO. Right. Well, I can assure you that at the national

level, there has been significant attention, and at the senior regional level there has been significant attention. In fact, we have

had regular meetings and conference calls. When I say regular

meetings——

Senator BAUCUS. We are not talking about significant attention.

We are talking about full attention—the same full attention that

Libby has been getting.

Ms. HORINKO. Right—the same full attention. In fact, I plan on

traveling to Libby July 22 with our new Regional Administrator,

Robbie Roberts, as well as the Deputy Regional Administrator Jack

McGraw who has been out there many times, and doing a complete

site visit and tour and checking up personally on the status of activities. So Governor Whitman and I are very concerned about

Libby, regularly meet and discuss the status of what is going on

at Libby, regularly checking with Paul directly. So at the very senior levels, you have our commitment and assurance. Governor

Whitman generally is a very hands-on Administrator. She is not

distanced from the field. In fact, in my program, the Superfund

Program, she has been significantly involved in the decision to

dredge the Hudson and cleaning up the Hart Building from anthrax, and emergency response at the World Trade Center, and

then dealing with Libby.

Senator BAUCUS. I appreciate that, but I just strongly encourage

you and the Governor to directly call up Paul, talk to him and

strongly encourage you to listen very favorably to what he says and

recommends.

Ms. HORINKO. Absolutely.

Senator BAUCUS. We have all known Paul now a couple of years,

and he is one of the best public servants I have ever had the privilege to work with or meet.

Ms. HORINKO. I could not agree more.

Senator BAUCUS. He is so dedicated to do what is right.

Dr. Black.

Dr. BLACK. I was going to say, he is really—the trust of the community with the Agency goes through Paul. He has managed to

cross all barriers in the community. I think that we would all say

that, wouldn’t we? He has been remarkable in his ability to work

with people of varying opinions and everything. I think he has

everybody’s respect in Libby. I sense that.
32

Senator BAUCUS. I appreciate that.

Ms. Horinko also, a slight question about hiring local contractors

and local employees. I would appreciate it if you could address that

concern as well, because there is that concern at Libby that maybe

we are going out of State too much.

Ms. HORINKO. I will look into that, Senator. I am not aware of

the mix of contractors that we are using, but I will talk to Paul and

find out what mix of contractors and the extent to which he has

really tried to reach out to local residents and have them directly

involved in the cleanup.

Senator BAUCUS. Why was it not necessary to declare a public

health emergency with respect to the insulation cleanup?

Ms. HORINKO. Our lawyers looked at the situation and determined that we had adequate legal authority to go ahead and do the

interior cleaning and remove the insulation without going to the

step of declaring a public health emergency.

Senator BAUCUS. Would anything be gained by making that declaration?

Ms. HORINKO. From a real-world standpoint, it made no difference. We will be doing exactly the same type of cleanup whether

we declared a public health emergency or not. So from a technical

real-world standpoint, it makes no difference whatsoever to the

quality or the nature or the type of cleanup.

Senator BAUCUS. How can you assure the people of Libby that,

because they know that the Administration or the EPA did not

make a public health emergency declaration? That is probably part

of the concern. If it is not, are they going to work as diligently as

they otherwise might? How can you reassure the people of Libby

that there is no change whatsoever in effect?

Ms. HORINKO. One thing that we can do is share with the community our work plans for the interior cleanups and the insulation

removal that were developed well before we made the decision not

to declare the public health emergency. You can see that those are

identical to the work plans and the technical specifications that are

contained in our action memorandum today. So the work plans, our

technical expertise, the amount of resources we will bring to bear

are exactly the same as we had planned 6 months ago as they are

today. So seeing that technical information, sitting down with Paul

and the other folks at the site, and reviewing the quality of the

work that we plan to do, and the haste with which we plan to do

it will, I am hopeful, reassure the citizens.

Senator BAUCUS. So the quality, the haste and the resources

dedicated are exactly the same.

Ms. HORINKO. They are identical.

Senator BAUCUS. Does the absence of a public health emergency

designation say anything about the hazards of vermiculite home insulation?

Ms. HORINKO. It does not say anything about the hazards of

vermiculite home insulation. Our Office of Pollution Prevention,

Pesticides and Toxics is currently doing a study on vermiculite

home insulation, and they are planning on releasing that study in

August of this year. So that will be EPA’s definitive statement

about the hazards of vermiculite home insulation.
33

Senator BAUCUS. OK, before we move onto other subjects, does

anybody have any questions about the cleanup aspects?

Mr. KONZEN. Max, I have one concern. A lot of these folks work

in about a 20-mile radius of Libby, which includes the community

of Troy and out toward Kalispell. In talking to onsite Coordinator

Paul, I am not sure whether they will go with that. About 20 percent of the workforce lived in my community, Troy. That is not on

the attics to clean up and the homes to clean up. I would like to

urge that that be looked at.

Senator BAUCUS. I am sorry. John, what was that again?

Mr. KONZEN. About 20 percent of the workers that worked at

W.R. Grace lived in my community and traveled. They also traveled the other way, some 15 to 20 miles outside of Libby, toward

Kalispell into the mine. I realize they are very concerned about the

long-reaching effects of this, but these are actual workers. This

community hauled it back to its gardens and yards the same as the

other ones did. That has not been on the plate yet.

Senator BAUCUS. How about that, Ms. Horinko?

Ms. HORINKO. I can promise you that we will look into that, and

if there are actions that are warranted to be taken, we will take

them.

Senator BAUCUS. When can you get back to us as to whether or

not EPA plans to address those concerns as well? What is a reasonable date?

Ms. HORINKO. Within 1 month, we can get back to you.

Senator BAUCUS. A month from now. OK. If you could let the

committee know, and also the county commissioners at Libby

know.

Yes?

Dr. SPENCE. Senator Baucus, another question I would have of

Ms. Horinko is, we know that the ore was transported to various

areas in Montana, including Great Falls where there was a popular

exfoliating plant. I have no idea as to whether these have been

studied, and I know that they have found hot spots along the rail

line in Libby. Are there other hot spots along other railheads

throughout the State of Montana that might be in need of cleanup?

Senator BAUCUS. Do you know, Ms. Horinko, whether EPA has

addressed that issue?

Ms. HORINKO. I know that we have tracked some 243 other

places in the country where Libby ore was transported, processed

or otherwise came to be located. We tracked that not only relying

upon records that W.R. Grace maintained, but we separately went

back to the Bureau of Land Management at the Department of Interior and looked at their records. This is part of this followup

study that Henry Falk alluded to where he is working with a number of the States. So we can get to you the list of the places that

we have tracked. If we have missed something, then we will certainly followup.

Senator BAUCUS. Can you within that same month report on the

question that Dr. Spence raised?

Ms. HORINKO. Absolutely. Yes, we will do that.

Senator BAUCUS. I would appreciate that very much.

OK, let’s get off now into screening. Let me ask Dr. Spence, Dr.

Black and Dr. Falk, I guess, where are we on screening in your
34

judgment, and what more do we have yet to do? I suppose a lot of

this is a resource question—where are the dollars to continue to

screen, because this is a disease that sometimes is not noticed or

is not determined and diagnosed until sometimes later.

Dr. SPENCE. Well, interesting that you should ask this question

because just this past week, I was in Atlanta and met with some

of Dr. Falk’s staff and we discussed ongoing screening activities.

We will be initiating a request—they have initiated a request for

proposal and we plan to put one in by July 10, to address screening

in the future years. We hope to look at it for at least the next 5

years minimally, and this could possibly go to the year 2030, as I

indicated when I was making my discussions with them.

We hope to do the screening very similar to what has been done

in the previous two rounds of screening—that is, to take a look at

individuals that are indeed eligible by the criteria that we established when we initiated this process; that is, anyone that lived in

Libby for a period of 6 months or more prior to January 1, 1991.

Once that person is identified as being eligible, then we will request them to undergo similar screenings such as an epidemiologic

questionnaire, radiographic evaluation, pulmonary function testing,

and then followup looking at the current standards that are employed by the Occupational Safety and Health Administration for

worker following, for pneumonic diseases.

We would think that these individuals that show no evidence of

any active disease should be screened on a periodic basis based on

their age. At least currently, our thoughts are to put possibly two

plans into effect, one that affected workers or those at highest risk

and then another screening program at periodic intervals that

would affect the nonworker population, but still individuals with

risk based on the data that we have.

Senator BAUCUS. What is this going to cost?

Dr. SPENCE. A lot of money, Senator. I cannot put a dollar value

on it today. I can tell you that to do such screening obviously we

are going to need someone to staff an 800 line because we want

people to call in and identify themselves. We will make the same

services available. We will have the 800 line. We will also need a

coordinator for this program—an individual that is knowledgeable

in asbestos-related disease; one that can be assured that the people

get their educational needs met, as well as their health screening

needs met; and that we do the entire testing—we do not just leave

any part out.

We are probably going to have numerous individuals that are

going to call in from all over the United States. We do not think

this is going to be limited to people in Libby or people in Montana

in general. These individuals also are going need to be reassured

and also given instruction in the event that they cannot come to

Libby for the screening as to what they can do to identify whether

they are indeed at risk or have evidence of disease.

Senator BAUCUS. I appreciate that. Dr. Black, do you want to

comment on this plan, please? How does it sound to you?

Dr. BLACK. Well, we just had a moment to briefly talk about it.

I think Dr. Spence knows we have always asked him when is it

going to happen, because we have people coming every day now,

saying, well, we couldn’t get into town for the screening. That be-
35

comes a pretty regular question, I think, wouldn’t you agree, Pat,

with that? So we have the demand there, and I guess we are all

for getting it going. But once again, it sounds like we are moving

in the right direction.

Senator BAUCUS. So when will this begin? Maybe Dr. Falk, do

you want to chime in here? We’re not going to get the proposal for

a little while yet.

Dr. SPENCE. I beg your pardon?

Senator BAUCUS. We are not going to get the proposal—that is,

you are not going to have this plan put together—or is it now?

Dr. SPENCE. It will not be put together before July 10.

Senator BAUCUS. July 10—OK.

Dr. SPENCE. But I anticipate that I will have a written proposal

in the hands of ATSDR on or before July 10 of this year.

Senator BAUCUS. All right. Do you want to comment, please, Dr.

Falk?

Dr. FALK. Yes, thank you. I feel very strongly that we must establish the screening program to go on over time, and probably a

very lengthy period of time. I think in the acute setting for the last

several years, we have done this as a special feature in the summertime. We gear up and do it. But I think it is important for the

long term to establish it on an ongoing basis to be done locally. It

does not have to be done just in summer. People can do this

throughout the year. It can be built into the facilities in Libby. We

very much want to work with Dr. Spence and Dr. Black and figure

out the best way to conduct this in Libby. We will be as supportive

as we can of that.

Senator BAUCUS. When do you think you will have this again?

July 10, did you say?

Dr. FALK. Yes, sir.

Senator BAUCUS. How much do you think it is going to cost? Will

you have a price tag?

Dr. FALK. I am assuming a proposal that comes to us will come

with a price tag, yes. We will look for that.

Senator BAUCUS. You might also give some thought to where the

dollars would come from. Be a little creative about that, too. I

would like you to work with me and others in the delegation, because we have to work together to figure out how we are going to

get the resources and make sure this is all done quickly.

Dr. FALK. Yes, I think once we embark on something of this magnitude, if it is done properly and it should be, that we are not talking about a 1-, 2-, or 3-year program. We are talking about something for the next three decades.

Senator BAUCUS. Right.

Ms. Cohan, do you have a reaction to all this? Does it sound right

to you or good to you, or what?

Ms. COHAN. Yes. We get at the clinic an average of four to six

requests a week from people out of town or people in town who for

some reason or other missed the other screenings, who have worries and concerns about their lung health, but do not have the resources to go in and get a chest X-ray done. At the clinic, we work

with different ways of getting this done, whether they have had a

chest X-ray done in the last several years, and have them send to

us. Dr. Black will review it and I will do an exposure history.
36

So we have been trying to meet the needs in that way of people

who have urgent concerns. I also have a waiting list of people who

are saying, ‘‘Well, when or if the screening comes up, let me know.’’

So yes, it is definitely going to be needed. I am not sure what the

volume will be, but it will be steady.

Senator BAUCUS. Have you and Commissioner Konzen addressed

sort of the psychological, social and financial scars at Libby as a

consequence of this disaster, and what we might do to help the

healing?

Ms. COHAN. There is probably not a person in Libby today who

does not know someone, love someone, or hated someone who has

been affected by this disease. Even those people in Libby who do

not believe that it exists—there are still those who believe it has

been blown all out of proportion because it is easier not to believe

than it is——

Senator BAUCUS. In denial?

Ms. COHAN [continuing]. In denial—definitely in denial. But they

still all know somebody who has died of it. So that the psychosocial

impacts have been such that at the clinic we came up with some

key phrases or hand signals when either myself or my assistant,

Ruth, start the interview process of seeing how scared somebody is,

just to you know kind of give a hand clue of how much time it is

going to take to spend with them. In an average medical clinic, it

is very unusual to spend 45 minutes to an hour with each new client or individual, but that is common. It is what we need to do just

to get the education and bring the fear level down to a point where

people can hear what you are saying.

They just want to hear yes or no, but if you say yes, I see

changes, then the panic level is so high they do not hear, which is

why the education piece is so high. Through a contract, through

FEMA and SAMSHA, which I think you are aware of, we do have

a person in place who has been working to pull all the resources

in the community together. We call it the C.O.R.A. project, Community Outreach Recovery Assistance, the outreach project in which

the clergy, the schools, counselors, everybody—senior citizens center—anybody who will be involved with these people, are actually

pulled together and being educated on the same level so that when

someone comes to them, that the information is there to flow out.

It has been a huge impact. There are third generation kids that

I see who have been affected—definitely financially. At the time of

life when most kids look to their parents for future support, getting

through college, buying your first house—something of that nature,

if your parents have used up all their resources treating an illness,

these young adults do not have the kick-out money that we were

fortunate enough to have to get started in life. So it has been devastated on more levels than just the illness part.

Senator BAUCUS. I also want a comment on the group community

efforts, and your long counseling sessions certainly help. Is there

anything else that comes to mind here? Maybe John, Dr. Spence

or anybody?

Mr. KONZEN. Just a couple of quick comments—there are still

people in Libby that will not get tested because the ultimate is they

find out they have it and it is incurable and they cannot do any-
37

thing about it, so why do they want to know. That element is still

out there.

We found it difficult to recruit teachers, doctors, forest service

employees who have options where they want to go, when they

hear about Libby. They think it is a valley of death. They want to

stay away from it.

So we need desperately to get that bill of health stamped on

Libby, and we need to get it cleaned up. We need to start re-selling

the community, and we need to make sure people understand that

it is a beautiful place and it is a safe place. If anything, that is the

stigma that is attached to our community. We need to erase that.

Senator BAUCUS. How would you go about erasing it?

Mr. KONZEN. The press has been very friendly for the biggest

part. I think they can play a very important role in doing that,

along with folks in the Federal family who may have expertise in

that area. Maybe we can get some marketing company or something to come in and help us do that.

Senator BAUCUS. I don’t know. Maybe Dr. Wagner, is that something that NIOSH could do, or Dr. Falk—to help out a little bit?

This denial issue—or Ms. Horinko, you are raising your hand.

Ms. HORINKO. Senator Baucus, we actually are getting more and

more into the revitalization business at EPA, particularly with the

passage of the new brownfields legislation, which really seeks to

help de-stigmatize these communities. More and more, we are realizing our goal is not just to clean up communities, but to help revitalize them.

Senator BAUCUS. That is very important, because that is a real

concern.

Ms. HORINKO. When we stamp the cleanup done, we will not

walk away is my promise to you.

Senator BAUCUS. Again, it is one of the problems that the Commissioner has mentioned. It is not only that, but you know, if I

have it, do I want to know and it is all that.

Mr. KONZEN. Max, one other thing—the affected population with

tremolite asbestos is in Libby or the large portion of it is in Libby.

I cannot encourage enough that the research occur there. I think

it can be beneficial to the Nation as a whole as a result of that.

Currently, we are going to be flying people to Missoula to have

them tested, as part of the ongoing research at the University of

Montana. I desperately would like to see that occur within our

community—fly the pulmonary folks up to our community and

have them do it there, rather than fly 12 people down there.

Senator BAUCUS. Dr. Wagner, can you help there, too, with the

research? And Dr. Falk? I am just trying to look for some research

efforts her from both of you. I think—and he makes a good point—

the Commissioner makes a good point.

Dr. FALK. It is a very good point. I think that when one looks

at the time that it takes, for example, to develop pleural changes,

it may be as little as 10 to 20 years, but mesothelioma diseases

may take, let’s say, 40 years to develop. There is that period of

time between those two stages where people can be greatly benefited if we come up with new ways of intervening to stop progression of asbestos-related disease.
38

So I think this research is absolutely essential. I am going on

Monday to the conference in Missoula, and basically I would like

to stress that challenge. As I think Dr. Black and Dr. Spence know,

we did a workshop a while back with the National Institutes of

Health to see what they knew about potential drugs or treatments

on the horizon.

Senator BAUCUS. Could we get somebody in Libby, because that

is on the spot. That is where the action is.

Dr. FALK. I think that is a very good point. It came up at one

of the CAG meetings that I attended, and I was really very impressed that people said that they would be very eager to participate in that kind of research.

Senator BAUCUS. You could work with Dr. Holian for example.

Dr. FALK. Yes, I think maybe as we talk about how to develop

the research program, some facility or some part of the

program——

Senator BAUCUS. I want to help, too, because the University of

Montana was recruiting Dr. Holian from Houston a couple, 3 years

ago. So they asked me to call him up so I did. He said, ‘‘Yes, I

would like to come to the University of Montana, but I need a lab.’’

How much, $20,000 or $30,000? So we helped to get an appropriation for the lab and we have Dr. Holian. So all I am saying is I

want to help. If you find somebody that we can designate to get up

to Libby full-time on the research that is really good, let me know.

Pat.

Ms. COHAN. Thanks, Max. At this present time, Dr. Black and

I are working with or cooperating with the University of Montana

on a voluntary basis. I collect blood samples and do the histories

and then freeze the samples. When I get enough to justify a trip

to Missoula, I will go down and visit my godson and drop off the

blood samples at the same time, which has helped. They have got

over 200 blood samples. We are working on getting lung washing

samples, which is the flying down to Missoula part, just because

or the expertise needed in having the cells fresh and ready to be

prepared there in Missoula, rather than in Libby, because it is,

particularly in the summer, getting from Libby to Missoula with

dry ice, it is pretty well melted by the time you get down there.

So that having some facilities or a more convenient way of doing

it, having someone who has got dedicated time right now. It is a

voluntary basis that has been——

Senator BAUCUS. Who is in charge of getting this aspect together? We are setting up dates and deadlines and things. We need

somebody in charge of this. Who do you want to—Dr. Black, or you

Pat, or Dr. Falk or Dr. Spence—who is most appropriate?

Dr. SPENCE. Senator Baucus, this coming week, as Dr. Falk

pointed out, we are going to be meeting in Missoula with Dr.

Holian. In my former life, as I think you know, I was in academic

medicine for 23 years. One of the things I did was a lot of research.

I dealt with patients the last 9 years with HIV disease, and we did

many of the same types of sampling of these individuals with regard to pulmonary samples as was required by this particular protocol.
39

We did it in a storefront clinic that I had operated, and I think

there are ways that we can do this. So I will look at it and get back

to you.

Senator BAUCUS. I was going to say, you are the man.

Dr. SPENCE. Thank you.

Senator BAUCUS. You have just been designated. You are in

charge. We are talking about 1-month deadlines here. A month

from now is going to be a big day. OK.

Dr. SPENCE. I will call you on the 20th, sir.

Senator BAUCUS. OK, fine.

Dr. Falk, do you have anything to add?

Dr. FALK. I will be happy to work with Dr. Spence.

Senator BAUCUS. OK, I appreciate that.

OK, now a little bit to the help. People get screened. They have

the disease. They need help. They need treatment. I would like to

talk a little bit about that. What is being done? What is available?

What yet is needed? I think the Commissioner talked about a couple of trust funds. I don’t know if that was with respect to this

question or not. But you, Dr. Black, could you kind of lead off in

terms of treatment? How far along are we? What needs yet to be

done? These are people most of whom just do not have the resources to have the proper treatment. Somebody mentioned that 25

percent have no health insurance, and many of those who do are

underinsured, very high deductibles, and the company is backing

off and not helping very much. Why don’t you lead off, Doctor?

Dr. BLACK. As I have mentioned before, we have already had a

number through here, and have currently about 850 people with

asbestos-related disease. These people, because of the nature of this

particular disease, we do not discard the so-called plaques or beauty marks that have been described in the past as being insignificant. We do not deal with them that way. We think these people

need following on a regular basis.

Dr. Whitehouse has indicated once a year. That is not typical.

With chrysolite asbestosis, it is frequent to follow people at longer

intervals. With this particular type of fiber, it requires closer—because of complications, higher complication rates and progression.

Senator BAUCUS. What treatment is needed now?

Dr. BLACK. The treatment is—well, that is—I think by the monitoring process, Senator Baucus, by monitoring people and doing the

blood work and looking for markers in the blood and getting lung

cells to study what is going on there with our cells of defense in

trying to understand what is going on in the immune system with

this disease, it will help elucidate some form of treatment. I think

we certainly—there are some drug trials going on right now and

there are things like that, but they are very limited because we

have limited resources. Basically, those are dependent on a pharmaceutical company for the ongoing studies right now. I guess we

see a need for more clinical research. I think it would be very important to correlate what is going on with the individuals, what is

going on in their blood, what is going on with—those pieces.

Senator BAUCUS. Let’s break this down a little bit. One is, I

guess, needed research. Does the state of medical knowledge now

know enough to know what the treatment should be, given infinite
40

resources? Or do we still need more research to find out what the

treatment should be?

Dr. BLACK. That is right. There is no treatment, certainly for the

fibrosis that occurs with asbestosis and asbestos-related disease,

there is no treatment that has been shown to be effective. We only

have one trial that I am aware of right now that we are looking

at and needs further looking. But no, we are very—it has not been

done, and the past has had poor outcomes in terms of the drug

trials.

Senator BAUCUS. How do we go about getting it done? Who

wants to take a crack at that? Dr. Falk?

Dr. FALK. There are two aspects to treatment. One is how to care

for people who have, let’s say, lung cancer or mesothelioma, which

does not require research, but requires a lot of medical care and

attention and time. But effective treatments will require research.

That type of clinical research, I think, by and large has been the

province of NIH and clinical centers. There are medications on the

horizon that are coming along that may be helpful in intercepting

the inflammatory process, the fibrosis process, but it will be an intensive effort to actually test those. I think part of Senator

Murray’s proposed legislation involves treatment centers as well.

So I think there needs to be some really focused attention on intervening to prevent progression of these diseases.

Senator BAUCUS. I am asking you as somebody who has worked

in the area what is the best way to go about accelerating treatment? What is the most efficient way and the most effective way

to begin? Maybe Dr. Spence, you have got some thoughts.

Dr. SPENCE. Well, one of my thoughts on treatment, sir, is secondary prevention. We know that once a person developed the

changes that they will progress, so we cannot prevent what has already happened to them. But hopefully we can in some ways delay

the onset of some of the terrible aspects of this disease. One of the

things that is a co-factor in the rapid progression of these diseases

and also of asbestosis as well as the development of lung cancer is

tobacco use.

Certainly, we need a more concerted effort. We need more funding. We need an awful lot of work in the area, because we have

people now that still smoke. We recognize full well that when you

are diagnosed with lung cancer, once you get that diagnosis, you

will probably quit smoking, but most people will smoke right up to

the time they get that diagnosis. We still have many people with

asbestos-related disease or at least asbestos changes in our community up there, as well as throughout the Nation, that continue to

smoke cigarettes. I think we need some good smoking education.

Certainly, the tobacco bill has helped to some degree, but as you

know in Montana, that bill does not address all of our needs.

Senator BAUCUS. What about resources? Given what is available

in medical knowledge today, what about resources? Are people able

to have the dollars to spend on the—I know the answer already—

treatment that is available today? I would like you to just give us

a—quantify the inadequacy of resources, if somebody could deal

with that.

Dr. BLACK. Here is an example. We do not know what our funding will be next year. Will W.R. Grace be there to support the clin-
41

ic? We are seeing really negative directions there. We have uncertainty as to whether our clinic structure will—you know, what is

the support of it? Because around that clinic, it would generate the

capabilities of doing the ongoing screening, the monitoring and the

research. So there are a lot of pieces here that are lacking resources. But the clinic’s existence, I think, is critical to——

Senator BAUCUS. The clinic is one. So what else in addition to

establishing more certainty at the clinic—if you all knew the clinic

is going to be there, and well-financed, what other needs are there?

Mr. KONZEN. Well, day one, when this thing first broke, there

was a group of us that worked on a health trust with W.R. Grace,

and never got off base. W.R. Grace would not accept our concept

of a trust. Other companies have done this. We are aware of Asarco

in East Helena and we thought that would have been a good clean

way to take care of this problem.

I just have some quick figures here that the medical plan that

W.R. Grace now has in place, in the year 2000 spent $19,475 on

patient care in Libby. In 2001, it went up to $745,000 and at 2002,

5 months into this year, it is already at $728,000. This gives you

an idea what is going to happen as the sickness progresses along.

That is a very big concern for the long-term health care for these

folks. If there is not a stable source of funding, it is going to bankrupt not only the hospital situation, but also our doctors. That is

a tremendous burden to put on them. And now the pharmaceuticals—they spent $171,000 in 2001 and $160,000 in the first 4

months before they came in and started doing their audit.

Senator BAUCUS. Who spent that money?

Mr. KONZEN. That is the medical plan that W.R. Grace has.

Those are the benefits that are being paid out.

Senator BAUCUS. I see.

Mr. KONZEN. The question that we have asked W.R. Grace is,

How long is this health plan going to be in place? Can you give us

some time duration? The health plan is as good as the company,

and the company is in bankruptcy. So what does that tell you?

That scares us.

Senator BAUCUS. Even with the health plan, though, can you address the adequacy of the health plan?

Mr. KONZEN. Correct. I think Dr. Black can maybe speak to the

holes within the health plan.

Dr. BLACK. Well, let me go back to when we started this. The

Grace health plan was initiated. There was a lot of trepidation because the wording in their document really eliminated local physicians from being part of the diagnosis. As we got into the program,

they were very lenient and they actually allowed myself and other

physicians to apply or get people into the health plan. So it was

a very nice gesture on their part to show they wanted to take care

of Libby. I sent them a nice letter in February 2001 and Mr. Corcoran, I guess, had responded very favorably, saying it is nice to

get something positive from Libby. I thought maybe they might

change and show some interest in really trying to take care of the

problem.

Unfortunately, since earlier this year, we have seen an interest

now to second-guess, question and utilize outside readers and
42

things that insurance companies generally do not do, to assess

these people and deny access to the plan.

Let me give you an example, and then maybe it will make more

sense to you. I had a recent case. A gentleman comes in. He had

been short of breath. Anyway, we assessed him and I clearly

thought he had some asbestos-related scarring on his lung, or the

lining of his lung. I did another X-ray because it had been several

years since his screening, actually. That is how late he was coming

in. He had a new nodule, a possible cancer. So I referred him, and

I told him, ‘‘look clearly, you have plaques not only on your chest

X-ray, but on your scan.’’ So I sent his application into the health

plan. I assumed he would get on the program. I told him I think

they will help you with this, because lung cancers have a strong

association. Especially with smokers, the asbestos exposure tremendously increases the cancer risk.

And so, he had a surgery. Fortunately, we got an early cancer

and it was cured. But also when the surgeon was there, he saw the

plaqueing that I had described, the scarring on the lining of the

lung that I had seen on my studies. I was very shocked when just

a few weeks ago, I got a letter from the health network saying this

gentleman has been denied on our plan. Our expert reader says he

does not have asbestos-related disease, therefore the good news is,

Mr. So-and-So, you do not have that disease that Dr. Black told

you, and you do not qualify for the plan. That is the letter he gets.

We are seeing this over and over, and I think they are going to

question everything that we see. I am not saying we are that great,

but I think we know a lot more about this particular type of scarring on the lung. It is not the typical look you see with the commercial type, and I think if you send a lot of our X-rays out to other

people that are accustomed to looking at them, they miss this disease. It is subtle. It has a subtle, diffuse, thin scarring that builds

up gradually. It is not seen by a lot of people.

So we are just accustomed to it. I think it is a clinical diagnosis.

They are taking it out of the clinical setting and they are just taking it to a radiologist, saying, does this person have disease or not?

That is not the way we diagnose asbestosis.

Senator BAUCUS. I appreciate that.

We are going to have to conclude this hearing. I am trying to figure out, though, in my mind how on July 20 we get a health plan

together here. I guess I will take that responsibility myself, to figure out how we develop that, but I am going to need a lot of help.

The trust fund idea is a start, if we can persuade Grace to participate in addition to other appropriations. I do not know what we

can come up here to help people who are suffering through no fault

of their own, particularly as you explained, Commissioner. I agree

with you. Some of these guys, even if they knew what was going

on, they would go to work to put food on the table. But they certainly would no if they knew they were going to affect their families. That is just the nature of the people in Libby. That is really

true.

I thank everybody for coming today. I know you have taken a lot

of time out of your day. Your morning is now over, virtually, so

thank you so very much.
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Does anybody want to add anything? Has anybody said anything

so outrageous it needs a response? Here is an opportunity to say

something that is constructive and helps address—I see your leaning forward, Doctor.

Dr. SPENCE. I have one parting salvo, Senator Baucus. We might

note that a large number of our people in Libby that have this disease are over age 65. We have also demonstrated they have low

levels of insurance. Many of them are eligible for Medicare, however, and they do not have a prescription plan for Medicare and

they need these medications. We need to look at a national effort

to get Medicare to put in a prescription plan.

Senator BAUCUS. I could not agree more. I work as hard as I can

to get that.

Dr. SPENCE. I know you do, sir.

Senator BAUCUS. I am working hard on that. That is another

committee—the Finance Committee—that has jurisdiction over prescription drug benefits under Medicare. I just very much hope that

Members of Congress realize the need and therefore do not politicize this issue as some are inclined to, that is one party blaming

the other for not getting the job done. I am trying so hard to prevent that from happening. Just get the job done and get the benefits because people need the help, and forget the politics. I could

not agree with you more, Doctor, and I am very glad that you made

that point because I will be using that, too, in addition to all the

other ammunition I have to help get the job done.

Thank you very much. You are great Americans and I appreciate

your service to the people of Libby and to our country. Thank you

very much.

[Whereupon, at 12 o’clock p.m., the subcommittee was adjourned,

to reconvene at the call of the chair.]

[Additional statements submitted for the record follow.]

STATEMENT OF HON. PATTY MURRAY, U.S. SENATOR FROM THE

STATE OF WASHINGTON

Senator Baucus, thank you for calling today’s hearing on Libby, Montana and on

the health and environmental problems caused by asbestos contamination from the

W.R. Grace vermiculite mine there. Thank you also for giving me the opportunity

to testify before this subcommittee. I applaud the leadership you have shown on this

issue on behalf of the people of Montana and the entire country.

I first became interested in this issue in 1999 because of the series of articles by

Andrew Schneider about Libby in the Seattle-Post Intelligencer. I can relate to the

people of Libby because my mother grew up in Butte, Montana. Like Libby, the

main industry in Butte is mining. I know first hand that these communities believed the government was protecting them from health problems caused by air and

water pollution from mining.

I also became interested in this issue because Libby is only 160 miles from Spokane, Washington, and many people from Libby have received medical treatment in

Spokane. Last year, when I chaired a Senate Health, Education, Labor and Pensions

Committee hearing on asbestos exposure and worker safety, Dr. Alan Whitehouse

from Spokane testified. He has treated about 500 patients from Libby. While most

people thought only miners and their families could be exposed to dangerous

amounts of asbestos from mining, many of his patients are sick just because they

lived in Libby. Approximately 25 percent of his patients didn’t work in the mine or

live with someone who did. Twenty-four of his patients have died in the last 3 years,

and five who died were sick ONLY from environmental exposure.

The issue is also relevant to my constituents because like most other states,

Washington has many sites which processed Libby vermiculite that was contaminated with asbestos. The chart you see displayed shows all of the sites in the United

States which received vermiculite from Libby. Of the approximately 300 sites which
44

processed this mineral, the Environmental Protection Agency (EPA) and the Agency

for Toxic Substances and Disease Registries (ATSDR) have determined that 22 sites

require further cleanup.

One of these sites is the former Vermiculite Northwest, Inc. and then W.R. Grace

plant in Spokane. The plant began producing Zonolite insulation in 1951. Even

though the plant closed down in the early 1970’s, recent tests by EPA have found

some soil samples from the site still have asbestos concentrations of up to 3 percent.

EPA is strongly recommending that access to the site should be restricted almost

30 years after the plant closed down.

At many plants where vermiculite from Libby was processed, waste rock left over

from the expansion process was given away for free. People used this free waste

rock in their yards, driveways and gardens.

The other picture you see shows Justin and Tim Jorgensen climbing on waste rock

given out by Western Minerals, Inc. in Minneapolis, Minnesota in the late 1970’s.

According to W.R. Grace records, this rock contained between 2 and 10 percent

tremolite asbestos. This rock produced airborne asbestos concentrations 135 times

higher than OSHA’s current standard for workers. Thankfully, neither Justin nor

Tim has shown any signs of disease, but their risks of developing asbestos diseases,

which have latency periods of 15 to 40 years, are increased from their childhood exposures.

Today, people may still be exposed to harmful amounts of asbestos in vermiculite.

Between 12 million and 35 million homes and businesses may have Zonolite insulation. This may be the case for up to 150,000 homes in Washington. EPA has also

tested agricultural products—soil conditioners and fertilizers—made with

vermiculite, and determined that some workers may have been exposed to dangerous amounts.

As I learned more about Libby, and how asbestos has ended up in products by

accident, I was shocked to learn that asbestos is still being used in products on purpose. While some specific uses have been banned, the EPA’s more sweeping ban was

never put into effect because of a lawsuit backed by the asbestos industry.

As a result, new uses of asbestos were banned, but most existing uses were not

banned. Today, asbestos is still used to make roofing products, gaskets, brakes and

other products. In 2001, the U.S. consumed 13,000 metric tons of it. Asbestos is still

entering the product stream in America, despite the known dangers to human

health. In contrast, asbestos has been banned in at least 20 other countries.

Now it’s time for the United States to ban asbestos, too. I want to ensure our government does all it can to minimize future suffering and death caused by asbestos.

That is why yesterday we introduced the Ban Asbestos in America Act of 2002. Senator Baucus, thank you for being an original cosponsor of this important legislation.

I also appreciate the cosponsorship of Senators Cantwell, Dayton and Wellstone.

The Ban Asbestos in America Act of 2002 has four parts which I would like to

briefly mention. First, this bill protects the public by requiring the EPA to ban asbestos by 2005. Like the regulations EPA finalized in 1989 under the Toxic Substances Control Act (TSCA), companies may file for an exemption to the ban. EPA

may issue the exemption if there is no substitute material available and the exemption won’t pose an unreasonable risk of injury to public health or the environment.

I’d like to take a moment to point out to the Subcommittee the connection between what happened in Libby and EPA’s efforts to ban asbestos. Last year, the

EPA’s Inspector General conducted an investigation into why the agency didn’t do

a better job of protecting the people of Libby. I was struck by one of the sections

of the Inspector General’s Report, in which a letter written by EPA in 1983 is

quoted as follows, ‘‘. . . asbestos-contaminated vermiculite is considered a lower priority at this time than problems posed by friable asbestos-containing materials in

school buildings and commercial and industrial uses of asbestos.’’

In 1979, EPA had issued an Advanced Notice of Proposed Rulemaking that it intended to explore options to control asbestos under Section 6 of the TSCA. In 1982,

EPA issued a reporting rule under Section 8(a) of TSCA to gather information about

commercial and industrial uses of asbestos. EPA’s proposed rule to ban asbestos was

published in the Federal Register in January 1986, and the final rule was published

in 1989.

One of the reasons EPA did not spend more time focusing on asbestos-contaminated vermiculite was that the agency was working on the asbestos phaseout and

ban rule. Unfortunately, this rule was overturned by the 5th Circuit Court of Appeals in 1991.

There is a clear relationship between EPA’s efforts to ban asbestos and the fact

that problems in Libby were overlooked. I am saddened that EPA didn’t spend more

time focused on Libby in part because of a competing effort to limit asbestos exposure—an effort which ultimately failed.
45

Second, the bill requires EPA to conduct a pubic education campaign about the

risks of asbestos products. We need to warn people that their home insulation—if

made with vermiculite—may be contaminated with asbestos. While EPA has agreed

to remove vermiculite insulation from homes in Libby, the agency currently has no

plans to do this nationwide.

The Ban Asbestos in America Bill requires EPA and the Consumer Product Safety

Commission to educate consumers about how best to handle this insulation within

6 months. The Ban Asbestos in America Act of 2002 also requires EPA to conduct

a survey to determine which foreign and domestic products consumed in the United

States today have been made with asbestos. EPA has estimated as many as 3,000

products still contain the mineral.

Third, the legislation invests in research, tracking and treatment of asbestos diseases. It requires a national mesothelioma registry, which would be coordinated

with the A.T.S.D.R.’s existing efforts pertaining to Libby as well as with the National Institute for Occupational Safety and Health. The bill also authorizes funding

for 7 mesothelioma treatment centers nationwide to improve treatments for and

awareness of this fatal cancer.

Finally, the bill requires EPA to expand its Blue Ribbon Panel on Asbestos to address issues beyond the six regulated forms of asbestos, as EPA originally promised

in its response to the Inspector General.

Over the years, asbestos has taken a staggering toll on our country. We have recently been reminded of the dangers posed by asbestos because of concerns about

asbestos exposure from the dust and debris caused by the collapse of the World

Trade Center Towers. Had this country acted swiftly to ban asbestos when public

health evidence about its dangers first emerged, the Towers would not have been

built with any asbestos at all. Now we’ll need to wait several decades to determine

whether asbestos exposures in New York will cause asbestosis, lung cancer and

mesothelioma for first responders and residents.

I hope this Subcommittee, which has primary jurisdiction over the Ban Asbestos

in America Act, will consider holding a hearing on the bill in the near future.

STATEMENT OF HON. DENNY REHBERG, U.S. REPRESENTATIVE FROM THE

STATE OF MONTANA

Thank you Mr. Chairman, for the opportunity to provide testimony before the

Committee today.

Mr. Chairman, I have visited the Libby community three times within this past

year to learn first hand of the health crisis that has plagued my constituents for

more than a decade. At my invitation, EPA Administrator Christie Whitman joined

me for a tour of Libby, where she had the opportunity to meet with community leaders and families affected by years of asbestos contamination. Her reaction to the

tragic situation was a common one: she wanted to help.

With each return visit to the community, it has become increasingly clear to me

that this issue reaches far beyond asbestos, Superfund designation, cleanup, or economic loss. The situation in Libby is nothing short of a health emergency, spurred

on by corporate greed, that has drastically altered the lives of good, hard working

Montanans.

As we analyze the difficult lessons learned from Libby, Congress cannot lose sight

of the residents and their long-term healthcare needs. As time goes by and as research continues to offer new information, we may find that the tragedy of Libby

is far greater than currently understood. However, regardless of future discoveries,

we must be relentless in our efforts to clean up the contaminated homes, schools

and businesses and provide a more secure future for the people of Libby, Montana.

During my numerous visits to Libby, both as their Congressman and as their Lt.

Governor, I have pledged my steadfast commitment to the residents to see this

through to the end. And as the cleanup is completed and the stigma associated with

this town fades, it is incumbent upon the government to continue to assist the individuals whose health and quality of life have been affected by asbestos exposure.

Mr. Chairman, I appreciate your efforts in addressing this public health crisis. I

look forward to working with my colleagues in Congress to once and for all bring

about a positive conclusion to the public health nightmare that has plagued the citizens of Libby for more than a decade and to. ensure that the terrible mistakes that

led to this disaster are not revisited on any another American community.

Thank you, Mr. Chairman.
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STATEMENT OF MARIANNE HORINKO, ASSISTANT ADMINISTRATOR, OFFICE OF SOLID

WASTE AND EMERGENCY RESPONSE, U.S. ENVIRONMENTAL PROTECTION AGENCY

Good morning. I am pleased to appear today to address the cleanup of asbestos

contamination in Libby, Montana, and the Agency’s efforts to identify other sites nationwide that received vermiculite from Libby. EPA views the Libby asbestos site

as one of the most significant Superfund sites nationally, and the Agency is committed to working with our state and Federal partners to take all steps necessary

to protect human health and the environment in Libby and related sites.

BACKGROUND

Libby is a small town of about 2,600 residents in northwest Montana. Approximately 10,000 more people live in about 2000 homes located in the surrounding valley. Between 1924 and 1991, a vermiculite mine owned originally by the Zonolite

Corporation and purchased by W.R. Grace in 1963, was one of Libby’s largest employers. The now-closed vermiculite mine once produced a large proportion of the

world’s vermiculite—with an estimated output of more than 5 million tons from

1963 to 1990. The processed vermiculite ore mined in Libby has been used as a soil

conditioner and in the manufacture of insulation, packaging and other materials.

Over the years it operated, the mine and related facilities employed a total of

about 2000 workers in Libby. The ore was milled and beneficiated (partly cleaned

of impurities) on the mine property. After milling, the ore was transported to a

screening plant at which the ore was graded prior to shipment by railroad to other

processing plants around the country. It also went to one of two processing plants

which operated in Libby during different periods in the mine’s history, prior to bagging for shipment.

One of the impurities in the vermiculite ore was asbestos. Contamination resulting from operation of the mine and related processing facilities has led to serious

public health impacts among members of the Libby community. Asbestos health effects include malignant mesothelioma, an incurable and often fatal cancer of the

chest cavity which in many cases is associated with asbestos exposure. Further, asbestos exposure is associated with an increased risk of all lung cancers, particularly

when combined with smoking. Asbestos exposure can also cause asbestosis, a debilitating respiratory illness caused by progressive scarring of the lung tissue that can

also be fatal.

INVESTIGATIONS AND CLEANUP RELATED TO LIBBY ASBESTOS

EPA is working closely with our Federal partners to address the asbestos contamination and related public health concerns in Libby and other communities

across the country. EPA, the Agency for Toxic Substances and Disease Registry

(ATSDR) and the U.S. Public Health Service (PHS) have mobilized an emergency

response team to work in Libby. Coordinating closely with the community, the team

conducted inspections of the former mine and processing facility, interviewed local

physicians, and collected environmental samples to determine the need for environmental clean up. The team discovered significantly elevated incidence of asbestosrelated disease in Libby, as well as evidence of asbestos contamination in several

areas within the town.

EPA is currently taking action under the Comprehensive Environmental Response, Compensation and Liability Act (CERCLA or Superfund) to protect human

health and the environment in Libby. W.R. Grace, an owner and operator of the

vermiculite mine and facilities, filed for Chapter 11 bankruptcy protection in late

2000. The United States continues to pursue reimbursement for Superfund activities

through action in the Montana Federal District Court.

MEDICAL INVESTIGATIONS

In November 1999, ATSDR and the PHS undertook medical investigations in

Libby to determine the magnitude of asbestos-related health impacts in the community. These investigations, which were requested and funded by EPA, consisted of

a morbidity/mortality study, development of a formal epidemiological case series,

and health screening.

The mortality study for the period 1978–1998 showed that mortality in the Libby

community from asbestosis was approximately 40–60 times higher than expected for

such a community. ATSDR conducted health screening of roughly 6,200 individuals,

including former workers, family members of workers and current and former residents of Libby. Preliminary results of the health screening of these groups showed

up to 18 percent with lung abnormalities. Significantly, more than half of this sample were not former W.R. Grace workers or their family members. In short, all of
47

the medical investigations documented evidence of wide-spread disease and mortality resulting from exposure to asbestos.

ENVIRONMENTAL INVESTIGATIONS AND CLEANUP

EPA initiated a Superfund emergency investigation and cleanup actions in Libby.

The initial investigations focused on the mine and processing areas, residences,

parks and schools. From December 1999 though April 2002, EPA collected more

than 5,000 samples and conducted interviews to characterize the extent and severity

of asbestos contamination in and around the town of Libby. Preliminary results

showed that high amounts of asbestos-contaminated vermiculite remained at the

mine, the mine road, processing areas, the mine tailings pile/pond, and in residential and shared community areas.

In June 2000, EPA initiated and oversaw cleanup actions at two former processing areas to address the worst asbestos contamination. EPA has since started

cleanup actions at the mine road, the high school track and city park facilities

where vermiculite ore tailings were found. Cleanup has also started at several residences where piles of vermiculite or contaminated equipment from the mine were

found. More cleanups are planned to address elevated levels of asbestos, both at

mining facilities and in the community.

Federal agencies have maintained a program of early and meaningful outreach

and coordination with the Libby community. This has included meeting frequently

with the Libby Community Advisory Group, maintaining a storefront office in an

accessible downtown location and frequent one-on-one communication with concerned Libby residents.

On May 9, 2002, EPA approved a new Action Memorandum Amendment for the

Libby Asbestos site, authorizing additional work at known locations and sources, including certain residential contamination in homes associated with vermiculite insulation.

EPA determined that it was appropriate to address the insulation in Libby based

upon the unique circumstances in Libby. EPA has determined that this material

does fall within our response authorities, as detailed in the Agency’s Action Memorandum Amendment of May 2002. In addition to the level of known cumulative exposure and multiple pathways, EPA determined that the remaining asbestos releases in Libby would not have been addressed by any other authority in a timely

manner.

EPA has made progress with residential cleanup in Libby. We have resumed the

removal of vermiculite ores and mining wastes from residential yards. We are starting to address two homes with elevated amphibole asbestos concentrations in interior dusts. EPA expects to begin the removal of vermiculite insulation from homes

within 1 week. There are currently 55 properties on the ‘‘priority list’’ for clean up.

These are properties that have high levels of amphibole asbestos in their yards, plus

either vermiculite insulation or interior contamination as well. EPA expects to complete the response at these 55 properties this summer.

In support of these activities, EPA is completing designs, plans, and contracts to

construct an asbestos cell at the Lincoln County Landfill. This will create a permanent disposal location for the vermiculite insulation, and facilitate year round operations. Region 8 should begin construction in mid-July.

Work is also completing clean up and restoration actions already underway. EPA

expects to finish the restoration of the High School, Middle School, Screening Plant,

Export Plant and remove the remaining contamination at the KDC-Flyway this season.

EPA has committed more than $60 million in fiscal years 2000 through 2002 for

environmental investigations, cleanup actions and medical investigations in Libby.

Current estimates place fiscal year 2003 needs at approximately $21 million. These

future funding need projections are based upon assumptions about the number of

homes or additional properties which may require clean up, and may be subject to

significant revision as field work progresses.

The ongoing work of EPA and our partners will help determine how best to complete the long-term remediation in Libby. To date, site investigation and cleanup activities have taken place under Superfund emergency or ‘‘removal’’ authorities.

Given the widespread contamination and public health concerns in Libby, the Governor of the State of Montana designated the Libby site as the State’s one-time, top

priority site for cleanup. In response, EPA listed the Libby site on the Superfund’s

National Priorities List (NPL) of contaminated sites. EPA is committed to working

with our partners to see that all necessary actions are taken to protect public health

in the Libby community.
48

EPA INVESTIGATIONS AND CLEANUP OUTSIDE OF LIBBY

While EPA is currently taking action under Superfund to protect human health

and the environment in Libby, the Agency is working with ATSDR to study other

locations across the country where vermiculite ore from the Libby mine was shipped

for processing.

Between 1924 and 1991, the Libby mine produced much of the world’s supply of

vermiculite. EPA identified 240 locations across the U.S. that may have received

Libby vermiculite for processing and distribution. Of these locations, EPA determined that 22 require further investigation by the Agency. When it appears that

another agency may need to be involved, EPA shares its findings with other Federal

or state agencies so that they can determine if additional followup is warranted.

One notable example of a situation warranting a Federal / state agency approach

is the significant asbestos contamination at the Western Minerals site in Minneapolis, Minnesota. Western Minerals operated as a vermiculite processing facility

from 1937 until 1989. Between 1964 and 1989, Western Minerals is estimated to

have processed more than 118,000 tons of vermiculite ore from the Libby, Montana

mine. The waste material generated during the processing of vermiculite was made

available to the public for use as fill material for driveways and yards. Since September of 2000, EPA and the State have been sampling and removing asbestos contamination at the former plant site and nearby residential yards. EPA and the Minnesota Department of Health (MNDOH) have received many reports of asbestos-related disease in residents who have lived in the predominantly residential area surrounding the facility. An ATSDR-funded survey is being conducted by the MNDOH

to determine the health impacts in former workers and nearby residents at the

Western Minerals site.

ATSDR is currently working with state health departments to conduct or initiate

reviews of health statistics for asbestos-related disease in areas of former

vermiculite processing facilities across the country. EPA will continue to coordinate

with ATSDR on this effort to identify any additional locations that may require environmental sampling or cleanup.

RESPONSE TO INSPECTOR GENERAL REPORT

On March 31, 2001, the EPA Office of Inspector General (IG) issued a report titled, ‘‘EPA’s Actions Concerning Asbestos-Contaminated Vermiculite in Libby, Montana.’’ The IG report focused on EPA’s role in addressing asbestos contamination in

Libby, as well as EPA’s role in regulating asbestos. The IG report concludes that

EPA’s activities in Libby should continue, and emphasizes the importance of addressing potential asbestos contamination concerns associated with mining and

other operations unrelated to Libby. EPA is coordinating closely with the Mine Safety and Health Administration (MSHA) and ATSDR to identify additional asbestoscontaminated sites associated with Libby or otherwise identified that may require

cleanup actions under Superfund.

CONCLUSION

EPA will continue to work closely with our Federal and state partners to take the

steps necessary to protect the public health of the residents of Libby, Montana, as

well as the health of communities outside of Montana that have been affected by

Libby asbestos.

Thank you for the opportunity to appear before you today to discuss cleanup

issues associated with asbestos in vermiculite ore from Libby, Montana.

STATEMENT OF GREGORY WAGNER, M.D., DIRECTOR, DIVISION OF RESPIRATORY DISEASE STUDIES, NATIONAL INSTITUTE OF OCCUPATIONAL SAFETY AND HEALTH CENTERS FOR DISEASE CONTROL AND PREVENTION, U.S. DEPARTMENT OF HEALTH AND

HUMAN SERVICES

Mr. Chairman and members of the subcommittee, I am Dr. Gregory Wagner, an

occupational health expert at the National Institute for Occupational Safety and

Health (NIOSH), Centers for Disease Control and Prevention (CDC). I am pleased

to appear before you today to provide this testimony on behalf of NIOSH.

NIOSH is a research institute within CDC, a part of the Department of Health

and Human Services. CDC, through NIOSH, is the Federal agency responsible for

conducting research and making recommendations to identify and prevent work-related illness and injury.

My testimony today will address the current scientific knowledge about health

risks to workers from exposure to airborne asbestos. I also will discuss NIOSH’s
49

past findings and current research related to asbestos contamination in Libby, Montana.

BACKGROUND

Asbestos is a term that is generally used to refer to a group of fibrous minerals

with exceptional resistance to degradation by heat, acids, bases, or solvents. The

minerals are not combustible and have a high melting point and low thermal and

electrical conductivity. These and other useful properties had resulted in the development of thousands of commercial uses for asbestoscontaining materials by the

early 1970’s. However, as the use of asbestos dramatically increased, the lethal effects of airborne asbestos became clear. Regulatory action and liability concerns related to the now well-established connection between inhalation of asbestos fibers

and a variety of serious and often fatal diseases have reduced or eliminated the use

of asbestos in many commercial products. However, asbestos and asbestos-containing materials are still found in many residential and commercial settings and

pose a risk of exposure to workers and others.

Asbestos is defined in Federal regulations as the minerals chrysotile, crocidolite,

amosite, tremolite, actinolite, and anthophyllite. The Occupational Safety and

Health Administration (OSHA), the Mine Safety and Health Administration

(MSHA) and the Environmental Protection Agency (EPA) regulate these six minerals. All of the minerals, except for actinolite, have been used commercially. The

results from epidemiologic studies of workers exposed to these minerals provide the

scientific evidence of a causal relationship between exposure and adverse health effects in humans.

ASBESTOS-RELATED DISEASES

Exposure to asbestos significantly increases the risk of contracting several diseases. These include:

(1) Asbestosis—a disease characterized by scarring of the air-exchange regions of

the lungs;

(2) Lung cancer—for which asbestos is one of the leading causes among nonsmokers, and which occurs at dramatically high rates among asbestos-exposed

smokers;

(3) Malignant mesothelioma—an almost invariably fatal cancer of the tissue lining

the chest or abdomen for which asbestos and similar fibers are the only known

cause; and

(4) Nonmalignant pleural disease—which can appear as a painful accumulation of

bloody fluid surrounding the lungs, but which more commonly is seen as thick and

sometimes constricting scarring of the tissue surrounding the lungs.

In addition, asbestos exposure is associated with excess mortality due to cancer

of the larynx and cancer of the gastrointestinal tract. The malignant diseases—the

cancers including mesothelioma—are often fatal within a year or a few years of initial diagnosis. In contrast, asbestosis deaths typically occur only after many years

of suffering from impaired breathing.

We do not know exactly how asbestos fibers cause disease. We do know that microscopic fibers can become airborne during various industrial processes or from

handling of asbestos-containing materials and can then be inhaled and/or swallowed. As much as 50 percent or more of inhaled asbestos fibers can remain lodged

in the lungs, where it is almost impossible for the body to eliminate them. Asbestos

fibers are extremely resistant to destruction in body fluids, and many of these fibers

are too long to be engulfed and removed by the cells that normally scavenge and

remove particles that happen to deposit in the lungs. Generally, as the burden of

retained fibers increases in the body, so does the likelihood of disease. Most asbestos-related diseases, particularly the malignant ones, have long latency periods often

extending 10–40 years from initial exposure to onset of illness. While asbestos-related lung cancer and mesothelioma are frequently not curable, they and other asbestos-related diseases are clearly preventable by eliminating or limiting exposures

to asbestos. The amount and duration of exposure are factors that can determine

the risk of adverse health effects.

THE DEFINITION OF ASBESTOS

In 1990 testimony before OSHA, NIOSH broadened its science-based definition of

‘‘asbestos’’ as a result of concerns about the microscopic identification of the six regulated asbestos minerals. The six minerals can also occur in a non-fibrous (so-called

‘‘massive’’) form. The non-fibrous mineral forms of the six asbestos minerals can be

found geologically in the same ore deposits in which the fibrous asbestos minerals

occur or in deposits where other commercially exploited minerals are mined (e.g.,
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industrial grade talc). ‘‘Cleavage fragments’’ can be generated from the non-fibrous

forms of the asbestos minerals during their handling, crushing, or processing, and

these ‘‘cleavage fragments’’ are often microscopically indistinguishable from typical

asbestos fibers of the (fibrous) minerals.

The elemental composition of the six asbestos minerals can vary slightly as a result of geological conditions such as pressure, temperature, or proximity of other

minerals. Recognizing these variations in elemental composition, NIOSH believes

that the six asbestos minerals can be defined by their ‘‘solid-solution’’ mineral series.

For example, the mineral series tremolite-ferroactinolite contains the asbestos mineral actinolite. These mineral series are considered solid-solutions in which cations

(i.e., sodium, calcium, magnesium, iron, etc.) are replaced by other cations which can

affect the elemental composition of the mineral without significantly altering the

structure.

NIOSH bases this expanded ‘‘asbestos’’ definition—encompassing the entire solidsolution mineral series for each of the six currently regulated asbestos minerals and

including cleavage fragments from the non-fibrous forms of these minerals-on scientific evidence from cellular and animal studies suggesting that dimension, specifically length and diameter, as well as durability, may be more critical factors in

causing disease than chemical or elemental composition.

NIOSH STUDIES OF VERMICULITE WORKERS IN LIBBY, MONTANA

In June 1980, OSHA asked NIOSH to provide technical assistance to investigate

lung problems in workers at a plant using vermiculite that had been mined in

Libby. Shortly thereafter, MSHA also requested technical assistance from NIOSH

to investigate the magnitude of health hazards in vermiculite mines. MSHA was

particularly concerned about two reported cases of ‘‘dust-related lung disease’’ in

workers at the Libby mine.

In response to these requests, NIOSH initiated epidemiological studies in Libby,

Montana. The epidemiological studies carried out by NIOSH between 1980 and 1985

showed that occupational exposure to mineral fibers that contaminate Libby

vermiculite caused high rates of asbestos-related diseases among exposed workers

at the Libby mine complex. The fibers these workers were exposed to included

tremolite, one of the minerals within the definition of asbestos as currently regulated. Some recent evidence indicates that only 10 to 20 percent of the fibrous mineral content of the Libby vermiculite was tremolite. A much higher proportion–80

to 90 percent—of the fiber contaminant in this vermiculite has been characterized

as several other similar fibers that are not currently regulated as asbestos, such as

richterite and winchite. Richterite and winchite are fibrous minerals that are not

classified as asbestos by mineralogists.

NIOSH played a pivotal role in documenting the health hazard associated with

occupational exposure to asbestos-contaminated vermiculite at the mine in Libby,

Montana. NIOSH made its findings available beginning in 1985 through meetings

in Libby with workers and their representatives, employer representatives, and

members of the community. NIOSH also published its findings in several scientific

papers to alert the occupational health community about the identified problem. It

is clear in hindsight that further work remained to be done, in particular, with respect to further studies of downstream users of Libby vermiculite products. NIOSH

is applying what we learned from our Libby investigations to our current and future

activities both in Libby and throughout our program.

CURRENT NIOSH STUDIES

At present, NIOSH is following up on potential exposures of workers who use or

process vermiculite from other sources. Since closure of the Libby mine in 1990,

most of the vermiculite now being produced for domestic use is obtained from one

of four mines, three of them domestic and one located in South Africa. The degree

to which the vermiculite from these other sources is contaminated with asbestos is

not clear. At OSHA’s request, NIOSH is conducting environmental sampling at expansion plants and horticultural operations where vermiculite is used. NIOSH will

complete asbestos exposure assessments at two expansion plants for each

vermiculite ore supplier, along with a number of horticultural sites. We expect the

field data collection to be completed by the end of 2002. At present, field sampling

has been completed at four expansion plants and three horticultural operations.

From these studies we expect to learn the degree to which an asbestos exposure

hazard exists in vermiculite from sources other than Libby, Montana. Once these

studies are completed, we plan to produce and disseminate a technical report that

describes the extent to which newly mined or imported vermiculite presents an as-
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bestos risk to current vermiculite worker. Based on the findings, we may issue further guidance for protective measures to be taken.

FUTURE RESEARCH ACTIVITIES

Additional research possibilities that NIOSH is considering include efforts to better determine physical and/or chemical characteristics affecting toxicity of fibers including those occurring naturally and those manufactured. Direct evidence by which

to attribute particular health effects to each possible fiber type is not currently

available. Epidemiological studies of people exposed to naturally occurring or manufactured fibers would provide important new information, and studies conducted

with animals could provide mechanistic and other toxicologic data.

Asbestos fibers have many different lengths and diameters. Additional work to

improve and standardize the methods for asbestos fiber measurement is being considered because it would help advance prevention and control efforts to protect exposed workers. Human assessment of risk and occupational exposure limits is based

on airborne fiber concentrations determined by the use of phase contrast microscopy

(PCM). This analytical method leaves an undetermined number of asbestos fibers

collected on each sample uncounted because many fibers are too small in diameter

to be detected and because the standard procedure for counting fibers using PCM

takes into account only fibers longer than 5 micrometers in length. Current asbestos

exposure risk assessment is based only on a subset of fibers that can be detected

using PCM techniques. More sensitive analytical methods are currently available,

but these methods could benefit from better standardization.

CONCLUSION

In summary, we know much about the adverse health effects caused by the inhalation of asbestos fibers. Increased understanding of the health effects of fibrous

minerals that fall outside the existing definitions of asbestos will help us find ways

to provide appropriate protection for workers exposed to those materials. Further

identification of workplace sources of vermiculite exposure and the tracking of persons potentially exposed to fiber-contaminated vermiculite and other contaminated

materials will help us develop appropriate public health strategies for preventing

exposure to these materials. While information continues to be gathered, public

health prudence requires that vermiculite from the Libby mine or products containing vermiculite originating in Libby be considered potentially dangerous and

that proper precautions be taken to minimize the generation and inhalation of any

dust during the handling of these materials until analysis of the particular

vermiculite or vermiculite-containing product shows that it does not produce an asbestos hazard.

STATEMENT OF HENRY FALK, M.D., M.P.H., ASSISTANT ADMINISTRATOR, AGENCY FOR

TOXIC SUBSTANCES AND DISEASE REGISTRY, U.S. DEPARTMENT OF HEALTH AND

HUMAN SERVICES

Good morning, I am Dr. Henry Falk, and I am the Assistant Administrator of the

Agency for Toxic Substances and Disease Registry (ATSDR), a public health agency

within the U.S. Department of Health and Human Services (HHS). I am accompanied by Sharon Campolucci, RN, MSN, Deputy Director of the ATSDR Division

of Health Studies; she was coordinator of the medical testing program in Libby.

Senator Baucus, ATSDR is grateful for the interest and support given by you and

other members of the Montana delegation since we began working in Libby in late

1999. As you know, we came to Libby in response to concerns expressed by yourself,

community members, former vermiculite mine workers, and the health department.

Over the last several years, we have worked very closely with the U.S. Environmental Protection Agency (EPA) to address these concerns. Without the support of

all of you we would not be able to report today on the significant progress we have

made in evaluating the public health issues in the Libby, Montana, area.

Congress created ATSDR in 1980 under the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA), or what is more commonly

known as the Superfund legislation. CERCLA mandates of ATSDR a broad, national

program of Superfund site health assessments, health investigations, surveillance

and registries, applied research, emergency response, health education, and toxicological data base development. Broadly speaking, ATSDR’s responsibilities under

Superfund, the Resource Conservation and Recovery Act (RCRA), and other Federal

statutes are to assess the effects of toxic substances on community populations and

to recommend interventions to protect public health where they are needed. This
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may include medical screening and epidemiologic investigations of health effects of

community populations exposed to hazardous substances; ATSDR undertook these

activities in Libby. We also conduct investigations to measure human exposure to

toxic substances released from waste sites or other sources of release. We conduct

our work in close collaboration the U.S. Environmental Protection Agency (EPA),

state health departments, local health agencies, and affected communities.

Since being called upon in November 1999, ATSDR has been actively involved

with the citizens and public health and environmental officials to determine the extent of harm to humans from asbestos-contaminated vermiculite that was mined in

Libby.

In the earliest days of our involvement in Libby, we developed a plan to help

guide site-related public health activities. As we have shared with you in the past,

this Public Health Response Plan identifies the areas of responsibilities for the conduct of our health-related activities. All stakeholders, including officials and the affected community, provided input throughout the process of both developing and implementing the Public Health Response Plan. The plan describes specific activities

that are designed to prevent exposures and to mitigate or prevent adverse health

effects. Key elements targeted in the plan were:

(1) to provide community-based medical testing to determine the health status of

exposed people;

(2) to assess disease and illness trends to characterize the impact of the environmental exposure;

(3) to provide a public health education program to assist residents in obtaining

full and up-to-date information on asbestos-related risks and diseases; and

(4) to collect and analyze medical and epidemiologic data to better characterize

the nature and extent of asbestos-related disease in the community.

Following are updates on activities that resulted from this action plan.

MEDICAL TESTING

From July to November 2000, ATSDR staff conducted medical tests on current

and former residents of the northwest Montana town. Participants included 6,149

adults who lived, worked, or played in Libby for at least 6 months before December

31, 1990. Components of the testing included an in-depth questionnaire to build an

exposure history for each of the participants, three X-ray views to identify changes

in the lungs and lung lining that might be the result of asbestos exposure, and a

spirometry test that measured air flow in and out of the lungs to measure lung function. Of those 5590 study participants 18 years of age and older who were eligible

for X-ray testing, 18 percent (994) showed pleural abnormalities (chest wall scarring). According to data reported in the literature, the rates of pleural abnormalities

in the United States among groups without known exposure to asbestos range from

0.2 to 2.3 percent.

Additional findings included:

• Forty-eight percent (159 of 328) of former W.R. Grace employees who participated in the medical testing had pleural abnormalities.

• Most participants reported multiple routes of exposure (household contact, occupational, recreational, and other) to the asbestos-contaminated vermiculite. For example, 24 percent of participants who reported six or more routes of exposure had

pleural abnormalities.

• Five percent (6 of 122) of those participants who reported no apparent exposure

had pleural abnormalities.

The second phase of initial medical testing was conducted between July and September 2001, and included 1,158 participants. Notification letters have been sent to

these participants, and ATSDR is in the process of analyzing these new data and

combining them with results from those tested in 2000. Once the analysis is completed, ATSDR will produce and make available to the community a final report

combining results from both medical testing phases. The preliminary analysis of

this combined data does not indicate any significant change in the prevalence of abnormalities when compared to data from the first phase of testing.

ATSDR is working to ‘‘localize’’ the medical testing program—transitioning it to

the state and local health departments with our ongoing technical and resource support.

MORTALITY REVIEW

In addition, after consultation with the National Institute for Occupational Safety

and Health (NIOSH), CDC, we investigated an association between contaminated

vermiculite and human health through a mortality review in which we compared

death rates for residents of the Libby area with those in Montana, and the United
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States, for selected diseases that have been associated with asbestos. ATSDR staff

reviewed death certificate data from 1979 to 1998 for the Libby community. The review focused on the underlying cause of death in Libby-area residents. We found

that mortality from asbestosis in the Libby area was at least 40 to 60 times higher

than expected. We also found that death from mesothelioma appeared to be elevated. This mortality review is continuing; additional data are being reviewed to

support these early findings. We expect to release this mortality review by early

July.

These two investigative tools—the medical testing and mortality review—clearly

indicated a public health problem in Libby. Based on these findings, ATSDR recommended many followup activities, several of which already have been initiated.

• Working with a local pulmonary physician who treats referrals from the Libby

area, ATSDR has conducted a focused review of patients with an asbestos related

diagnosis and no known link to vermiculite mining. This review was conducted to

address community concerns about environmental asbestos exposure outside the

workplace. Final revisions for the report are now in progress and preliminary results will be released later this month.

• A computerized tomography (CT) scan study is nearly complete. This study was

designed to evaluate the sensitivity of the medical screening tool (chest X-rays) and

to help in planning possible future medical testing activities. All 353 scans have

been completed and reviewed by expert CT radiologists, and letters providing individual scan findings have been sent to participants and their physicians. Analysis

of these data for the study report is underway.

• Detailed planning and preparatory work has begun on the development of a registry to track former Libby-area miners and their household contacts. This focuses

on the members of this community who were at greatest risk based on exposure levels and on the results of the medical testing program; a key source of registrants

would be those who participated in the medical testing program. ATSDR sponsored

a workshop in February to consult with and solicit advice from experts in

pulmonology and asbestos-related disease to help guide the next steps for the Libby

registry. The recommendations from this group will assist in addressing the concerns of the Libby community while also meeting ongoing surveillance needs and

in the collection of valuable scientific data. In addition, the registry will help us stay

in contact with all of the identified individuals and provide updated information on

diagnosis and treatment options. The registry is intended to be a long-standing fixture that will not only be a repository of information about the registrants, but will

also be a source of the latest information about treatments and other medical breakthroughs.

• ATSDR is working with the State to support localized planning to address future medical needs. Extended medical testing will need to continue in some form

for many years. People who have tested positive will need to be followed to note any

progression in the course of the disease. People who have tested negative to date,

but who were substantively exposed, will also need periodic testing, but probably

on a different schedule. Primary responsibility for the medical testing program will

be transitioned to the State and local health department with ongoing technical and

resource support from ATSDR.

• ATSDR worked in close cooperation with HHS Region VIII staff to help the

community identify sources of assistance for medical care. In fact, HHS Deputy Secretary Claude Allen personally visited Libby last August and was instrumental in

developing an HHS response. HHS now supports the Community Health Clinic

(CHC) in Libby which provides primary health care services to people in the Libby

area. ATSDR has also worked cooperatively with the Center for Asbestos Related

Disease (CARD) in Libby. This facility, operated by St. John’s Hospital, provides ongoing medical care for persons diagnosed with asbestos related medical conditions

or those requiring further evaluation after undergoing initial medical testing.

• The Lincoln County Department of Environmental Health and the University

of Montana in Missoula, in cooperation with ATSDR and the Montana Department

of Public Health and Human Services, are organizing a research conference for later

this month (June 24–26) to discuss current asbestos-related research and plan for

future projects. Conference co-sponsors include EPA, the National Institute for Environmental Health Sciences, and the National Science Foundation.

• This June to facilitate development of the future research agenda related to the

Libby site.
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ADDITIONAL ACTIVITIES PLANNED FOR NEXT YEAR

Now that cases have been identified through the various methods I have outlined

(e.g., mortality review, case series review, and medical testing), other recommended

activities include: • epidemiologic studies to better evaluate the relationship of exposures and exposure pathways to disease; • follow-up evaluation of individuals in the medical testing program who were referred for medical care to assure that this referral worked effectively; and • a better determination of the clinical course and natural progression of pulmonary disease related to tremolite asbestos.

OTHER SITES THAT RECEIVED ASBESTOS-CONTAMINATED VERMICULITE

Processing of vermiculite ore shipped from Libby has occurred at approximately

300 sites in 40 states over the last 50–90 years. These sites are being reviewed to

consider the potential for health problems similar to those experienced by Libbyarea residents and former mine workers. ATSDR staff have been working with EPA

to determine if any of these sites pose a public health hazard. This review has included site visits to assess the extent of current or past operations, and to determine

the extent of human exposure and possible pathways of exposure to the asbestos.

One site that has already elicited considerable attention is the Western Mineral

Products site in Minneapolis, Minnesota.

This Minnesota site was used for insulation products manufacturing from 1936

to 1989. The plant received vermiculite ore from Libby, Montana, and processed the

ore into insulation, fireproofing material, and other vermiculite products. Under a

cooperative agreement with ATSDR, the Minnesota Department of Health (MDH)

conducted a health consultation to identify health concerns related to asbestos exposure from the site. Plant workers were exposed to levels of asbestos in excess of current occupational standards for much of the time the plant was in operation, and

cases of asbestos-related disease have been reported in former workers. Additionally, approximately 100 properties around the former plant have been identified as

contaminated with asbestos containing wastes from the site. The EPA is in the process of removing asbestos-contaminated soil from these properties and adjoining

alleys.

The extent of past and current exposures to asbestos is difficult to estimate at this

time. Based on available information, past exposure to workers in the plant, residents who lived near the site and children who played on piles of vermiculite waste

material may have been at risk for asbestos exposure. To address this concern,

MDH initiated the Northeast Minneapolis Community Vermiculite Investigation

(NMCVI), a population survey to identify and characterize asbestos exposure in a

community cohort. This study involves a door-to-door interview and visual inspection of properties in the immediate vicinity of the Western Mineral Projects Plant

in Minneapolis, as well as a telephone interview of former residents in the target

area and other individuals who may have had exposure to vermiculite. This investigation will determine the size and demographics of the population at risk. The

EPA, Minnesota Pollution Control Agency, and MDH will continue to investigate

and clean up the site and surrounding community.

ATSDR staff have developed a protocol for use by the state health departments

to review vital statistics and cancer registry data to determine if there might be a

health impact in any affected community that warrants further investigation. During fiscal year 2001, ATSDR developed cooperative agreements with six states

(Utah, Colorado, Massachusetts, California, Louisiana, and Wisconsin) to conduct

health statistics reviews around sites that received asbestos contaminated

vermiculite from Libby and to determine whether there is an excess of asbestos related disease. Later this summer, other states will have an opportunity to apply for

support of similar health-related activities; we anticipate supporting up to four additional states. In addition, ATSDR has awarded funds to conduct evaluation of mesothelioma cases in three states (New York, New Jersey and Wisconsin). This surveillance process enables states to use their cancer registry data to identify all mesothelioma cases and then look backward to see if the disease in any portion of the cases

could be associated with asbestos exposure from contaminated vermiculite or

vermiculite insulation from Libby. ATSDR staff also is working with health officials

in Montana to review mesothelioma cases in that state.

I would like to reiterate that ATSDR shares your concerns about the situation in

Libby—both the environmental contamination and the health concerns. While we

have done a great deal of work in Libby, much remains to be done. To summarize,

our primary goals for this coming year are:

(1) implement the registry of former workers and family contacts;
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(2) establish the medical testing program on a long-term basis by transitioning

primary responsibility to State and local health departments, with technical and resource support from ATSDR;

(3) conduct epidemiologic studies to formally investigate the links between the

various environmental exposures and the development of disease;

(4) provide data on potential health effects in other states that had vermiculite

processing centers that led to harmful exposures; and

(5) pilot mesothelioma surveillance activities, in coordination with NIOSH.

With your continued support, ATSDR stands prepared to continue the important

work we have begun and do whatever we can to help the Montana and Libby community, and any other sites that may be identified with similar problems.

Mr. Chairman, this concludes my testimony; I would be happy to respond to any

questions you may have.

STATEMENT OF MICHAEL R. SPENCE, M.D., CHIEF MEDICAL OFFICER, MONTANA

STATE DEPARTMENT OF PUBLIC HEALTH AND HUMAN SERVICES

Madam Chairperson and members of the committee, for the record my name is

Michael R. Spence. I am a medical doctor licensed to practice medicine in the state

of Monlana. I am currently the chief medical officer in the Montana State Department of Public Health and Human Services, a position that I have held for the past

5 years. In my current capacity I have the charge of addressing public health issues

that impact the citizens of Montana.

In November 1999 a newspaper report indicated that there was a potential, major

public health problem in Libby, Montana related to previous mining activities and

community contamination. The substance in question of causing the problem was

vermiculite ore, a product with many industrial applications and known to be contaminated with asbestos minerals. Large numbers of residents of Libby were described as being ill with asbestos related disease and many were said to have died

from this illness. The publication of this report resulted in a team of health professionals being deployed to Libby to assess the situation. The groups of individual that

met for the evaluation of the potential problem consisted of members from the Environmental Protection Agency and Health and Human Services from Region 8 located

in Denver, Colorado, the Chief Medical Officer for the State of Montana, the Montana State Epidemiologist and the Lincoln County Montana Health Officer.

Over the ensuing weeks, after meeting and consulting many of the foremost world

authorities on asbestos minerals and related diseases, it was determined that there

was a need to evaluate Libby residents for the presence of asbestos-related disease,

assess the environmental situation for asbestos mineral contamination and, if necessary, initiate remediation. The population was assessed, protocols were developed

and in July 2000 the Agency for Toxic Substances and Disease Registry (ATSDR)

initiated a medical screening program for the presence of asbestos related disease

in the Libby population. The medical screening continued into November of that

year and resulted in over 6,000 persons being evaluated. The initial screening initiative resulted in the ATSDR issuing two reports. The first was entitled ‘‘Preliminary

Findings of Medical Testing of Individuals Potentially Exposed To Asbestoform Minerals Associated with Vermiculite in Libby, Montana: An Interim Report for Community Health Planning’’ and was provided to the community in February 2001.

The second report entitled ‘‘Year 2000 Medical Testing of Individuals Potentially Exposed to Asbestoform Minerals Associated with Vermiculite in Libby, Montana: A

report to the Community August 23, 2001’’ included all of the results of the testing

activity that took place in 2000. (Exhibit A) In the summer of 2001 a second screening activity took place and an additional 1,150 persons were evaluated for asbestosrelated disease.

It became apparent from the results of the screening that the problem of asbestosrelated disease was not limited to Vermiculite Mine and Mill workers and their families but was also found in other individuals in the community. The ways by which

these other individuals, that were neither workers nor family members, acquired

their disease, based on extensive epidemiologic investigation, was thought to be

through exposure to asbestos mineral contaminated vermiculite insulation materials, gardening soil and ambient dust.

It is well established by medical science that Asbestos minerals cause three major

disease processes. One form is a restrictive airway disease that results from progressive damage to the lung and the tissues that surround it. The damage is that of

scarring of the membrane or tissue that surrounds the lung and restricts its’ ability

to expand. This form of disease results in the individual being unable to take deep

breaths and receive enough oxygen to support life. In essence the individual is slow-
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ly smothering to death. A second form is the development of lung cancer. It has

been estimated that a person exposed to asbestos minerals has a significantly greater risk of developing lung cancer than a person not exposed to asbestos minerals.

If the asbestos exposed person also smokes cigarettes their risk of developing lung

cancer is increased even more. The third major disease is a rapidly fatal cancer,

mesothelioma, which is known to be caused by asbestos. The average time from diagnosis to death in individuals with mesothelioma is less than 1 year. An extensive,

epidemiological investigation entitled ‘‘Mortality in Libby, Montana, 1979–1998’’

(Exhibit B) has demonstrated an excess in mortality of Libby residents from lung

cancer, mesothelioma and non-malignant respiratory disease.

Asbestos minerals in causing disease do not act immediately. There is a latency

period between the time of exposure to the asbestos minerals and the development

of disease that is measured in tens of years with the average period being between

twenty (20) and thirty (30) years. It is for this reason that a person that develops

restrictive airway disease can be exposed to asbestos minerals and remain well for

20–25 years. They will then develop progressive lung disease that kills them slowly

over the next 10 or more years. If they develop either lung cancer or mesothelioma

after the 20–25 year time period they will usually die more quickly.

The problem of asbestos-related disease in Montana is not limited to Libby. A recent and ongoing survey of mesotheliomas that were either reported to the Montana

State Tumor Registry or were found as a result of a search of death certificates of

people dying in Montana has disclosed that there is an increased number of deaths

from this asbestos specific cancer. These deaths are not limited to Libby and distributed throughout the state of Montana. Most of the deaths from mesothelioma that

have been identified so far have occurred in towns where the asbestos mineral contaminated vermiculite ore was shipped and/or milled or along major ore shipping

routes. In view of these findings it is important to realize that much of the ore that

was mined in Libby was shipped to over 100 destinations outside of the state of

Montana where it was milled and/or incorporated into insulating materials for

houses and gardening soil.

In summary, asbestos mineral contaminated vermiculite has been unequivocally

established as being causative of a progressive fatal lung disease as well as a rapidly fatal cancer, mesothelioma, in exposed individuals. The exposures resulting in

the illness and/or death are not limited to mine and mill workers and their families.

The problem is not limited to Libby, Montana but is widely disseminated throughout

the state of Montana and over 100 sites in the United States.
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STATEMENT OF PAT COHAN, COORDINATOR, CLINIC FOR ASBESTOS RELATED DISEASE

My name is Pat Cohan. I am a registered nurse with 29 years of experience. For

the last 2 years I have been involved with the health needs of our community related to asbestos exposure. My introduction to the asbestos disaster was in 2000

when I accepted a grant position funded by HRSA for the asbestos health

screenings. This position had two integral parts. The first was to be the outreach

nurse for the ATSDR’s screenings that summer. Over 6,000 respondents were

screened and I handled any medical emergencies, health concerns, or urgent referral

issues that arose after the chest X-rays were viewed. The second part of the position

was to help create a clinic that would assess, diagnose, and educate people with

health care concerns resulting from the screening results.

The Center for Asbestos Related Disease (CARD) was created by St. Johns Lutheran Hospital to fill this need. The volume of phone calls, visits, and drop-in visits

was incredible. It seemed that everyone in town and their relative was frantic for

information. We now have over 1,000 active charts and of these over 800 have some

asbestos related changes evident. Each of our clients and family members has received health information and education relating to pulmonary health.

The breadth and depth of the psychosocial, emotional, health and financial concerns associated with the amphibole disaster has been without precedent and I have

usually been first at hand to hear the many different life stories. To listen to a client calmly speak of hidden mountain valleys and hunting accidents because he will

not allow his children to watch him die the way he watched his father suffer and

die, is a reality of my job. I have worked to find financial resources for a 47-yearold woman, who has less than half of her normal lung function and no health insurance, so she can afford to have a lung biopsy done. Her chest X-ray was suspicious

for a mesothelioma, a type of cancer associated with asbestos exposure. This woman,

a daughter of a Zonolite miner, waited over 3 months to hear if she would qualify

for Grace’s medical plan.

Some of the stories are so convoluted that it’s hard to sort out what is most urgent. A woman with asbestos related illness, who cares for her mother with asbestosis, has been washing her dishes in the tub for the last 2 years. Her kitchen is

plastic sheeted and duct taped closed to keep the leaking Zonolite insulation from

further contaminating her home.

I have a neighbor who has resided in Libby for over 40 years. He never worked

at the mine, never gardened with vermiculite, and never had any contact that he

knew of other than the insulation in his home. This is a man who started the Libby

volunteer ambulance and who has hiked and skied every mountain in the Cabinet

Mountains. He has worked tirelessly for the community in every conceivable volunteer role. Because of the asbestos damage to his lungs he can no longer ski, hike,

or volunteer. His major activity now is breathing.

I have used the word disaster most deliberately. This is a slow motion disaster.

Had a mine leaked a toxin into the air of Libby and 200 people immediately died

with 2000 others injured, 20 percent critically, I would not be here. I would be back

home in the emergency room, taking care of the sick and wounded and we would

all be trying to figure how quickly the remaining toxins could be removed. We would

not be struggling to find health insurance, low cost medicines, or funding for long

term care and monitoring. Just because the toxin took 30–50 years to kill and maim

our community, it is no less a disaster.

The damage done to this community was not an act of God; it was not for an ideological principle or for a religious conviction. It was done for profit. The exposure

and the responsible parties’ disrespect for people need to stop. The miners were

treated as a disposable resource and the citizens of Libby were treated with no more

regard than the overburden of rock at the mine. The survivors of this disaster continue to be exposed, continue to be at risk for worsening disease, and continue to

worry about how they will pay for their health care needs. It is not a matter of waiting a few years for the affected people to die off and for the problem to go away.

It is a matter of waiting another 20 years to see if their grandchildren’s health is

affected. We already know the children and grandchildren have been affected emotionally, socially and monetarily.

What does Libby need? The need for Libby is research for treatments, for health

insurance that will be available for the length of the disease process, and the facility

to monitor progression of this disaster for the next twenty years.

I wish to take the opportunity to thank our Montana delegation for all that has

been done for the community of Libby. I especially want to thank Senator Baucus

for all his attention and efforts in our community.

Thank you.
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STATEMENT OF BRAD BLACK, M.D., LINCOLN COUNTY HEALTH OFFICER, LIBBY,

MONTANA, MEDICAL DIRECTOR OF CENTER FOR ASBESTOS-RELATED DISEASE

Good morning Chairperson Boxer, committee members, and our Montana Senator

Max Baucus. As a physician and community member of Libby, Montana for 25

years, I could orate a lengthy story, but with 5-minute time constraints, I would like

to tell a brief background story and then emphasize 3 important points as they relate to the Libby asbestos exposure.

I became aware of the occurrence of ARD in workers in 1977–1978-my first year

in Libby. In 1978, my medical practice partner, the late Dr. Richard Irons, had engaged in conversations with WR Grace management pertaining to his desire to work

with them to reduce health risk for asbestos exposure to Zonolite workers, their

family members of the community. Unfortunately his concerns were not acknowledged. Nor were the EPA’s concerns regarding the 1980 assessment of vermiculiteassociated asbestos acknowledged. In 1999, a Seattle PI article depicted a broad

scale asbestos exposure in Libby. As Lincoln County Health officer, my first response was disbelief that any widespread environmental exposure could cause lung

disease. Subsequently, the past several years have been a painful and humbling

educational process for myself. During the past few years I have seen numerous

community workers whose lives have been significantly impacted by asbestos-related disease. Several friends have developed lung disease and have lost over onehalf of their lung function. From this experience, I would like to share with you the

three important observations.

(1) The Libby exposure was extensive. The ATSDR has conservatively and efficiently screened for ARD. As Medical Director of CARD in Libby, we have followed

up a large number with abnormal screens and evaluations. I have recently done

analysis of our patient population and found the ATSDR’s observations to be very

accurate. Somewhere between 1,300 to 1,400 individuals are very likely to have asbestos-related abnormalities. This does not include the ATSDR’s screening in 2001,

which could add another 200–300 individuals.

(2) The ARD related to Libby asbestos has appeared different then that related

to commercial asbestos called chrysotile. Experience has shown it to have a higher

rate of causing progressive lung disease. Dr. Alan Whitehouse has studied a group

of Libby patients and observed a progression of disease in 70 percent of diagnosed

patients. Some patients develop a rapidly progressive lung disease (note included

case report). Nonoccupationally exposed individuals have developed lung disease

that is more severe than WR Grace employees of >15 yrs. work.

(3) The incidence of malignant mesothelioma is exceedingly high. This type of

tumor involves the lining of the chest or abdominal cavities. This invasive cancer

eats into the chest wall and spinal column causing severe pain and is uniformly

fatal. It has a high causal relationship to asbestos exposures and is termed the sentinel tumor of asbestos exposure. The occurrence of this tumor is 1 in 1 million in

the general population. In Libby we are experiencing 100 times this expected incidence. Twenty-three mesotheliomas have occurred as a result of Libby asbestos exposure, with six having resulted from non-occupational exposure. Since I had submitted testimony for this hearing in April, two more individuals have been diagnosed. Their exposure history was living in Libby, one working as a forest service

administrator and the other as a school health nurse. Another lady with the tumor

was exposed simply working in a professional office where Zonolite workers attended appointments in dusty work clothing. Mesotheliomas can occur with relatively low asbestos exposure.

Few investigators have studied or observed the health effects of Libby asbestos.

In addition to Dr. Alan Whitehouse (Board-certified chest physician, Spokane, WA)

whom I mentioned, Dr. Corbett McDonald (McGill University) has familiarity.

At the request of WR Grace, Dr. McDonald studied a group of Zonolite workers

in 1986. Subsequently, he has done a followup of this group and noted ‘‘these

vermiculite workers suffered severely from malignant and non malignant respiratory disease.’’ Death from mesothelioma was 10 times higher than commercial

(chrysotile) asbestos miners in Quebec. He concludes that study of workers exposure

to Libby tremolite is important in that it is the only study that quantifies the risk

of exposure to tremolite-like asbestos in the absence of any other fiber types.

In closing, I want to express my concern pertaining to how we will be able to meet

the asbestos-related health care needs we are sure to face over the next 20–30

years. WR Grace has been providing funding for the CARD Clinic and an insurance

program. However, their commitment to caring for affected individuals is waning

and suggests that their support is short-lived. The need for research and developing

therapies is high priority.
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Additional concerns extend beyond Libby to: (1) exposures from WR Grace export

plants all around the US (2) areas of California where release into the environment

of naturally occurring tremolite is a result of large-scale construction activities.

I thank the Superfund subcommittee for allowing us this opportunity, and our

Montana delegation for their support, and special thanks to Max with his perseverance in advocating for Montanans.

STATEMENT OF JOHN KONZEN, COUNTY COMMISSIONER FOR LINCOLN COUNTY

My name is John Konzen. I am from Troy, Montana and serve as County Commissioner for Lincoln County. You have already heard about Libby, a community

I serve both as an elected County Commissioner and as a member of the Board of

Directors for St. John’s Lutheran Hospital in Libby.

Lincoln County is no stranger to the Federal family. Floods and forest fires dispatch Federal agencies to us regularly. Our county shares the Canadian border and

a reservoir that straddles the international boundary, feeding the Columbia River

Basin. There are endangered species and every other natural resource issue you can

imagine. We struggle with double-digit poverty and unemployment rates. On an average day, it’s fair to say we are a county with a lot on our plate.

Before I became a commissioner I served as a teacher and a school administrator

for many years. I witnessed first hand the effects down cycles have on resourcebased communities like the ones I serve today. I can tell you first hand how families

are affected when mills close or mines shutdown.

Most of you would have probably never heard about Libby or Lincoln County if

it weren’t for tremolite asbestos and a mine operated by W.R. Grace.

There was a time when the W. R. Grace Mine was a good thing in our community.

It meant jobs and goodpaying ones. Men went to work every day to earn a living

for their families. They didn’t step away from their responsibility. And I bet a lot

of them would have gone to work every day even if they had known of the risk they

were taking on for themselves. That’s what husbands and fathers do.

But none of those men would have ever put their families—their wives, children

or grandchildren—in harms way. Never. Not a single one of us in this room would

have done that. But as you have already heard, Grace allowed all of that to occur.

There is an old saying that goes: ‘‘Many hands make light work.’’ When Grace

stepped away from their responsibility, they allowed the miners and the wives and

children of those men, to do all the heavy lifting, and to take on the risks Grace

was unwilling to shoulder.

And as Grace continues to step away from even the small portion of responsibility

they willingly accepted to help our community cover prescription drug, home health

care and other medical costs, they are breaking us. Our tiny community’s medical

resources are already stretched too thin.

But it isn’t just our community alone which concerns me and the other Montanans who have traveled here today to speak with you. As Grace increases the distance between the rightful portion of responsibility they must bear, they further

harm the State of Montana.

As Senator Baucus is well aware, people are our most precious resource in Montana. As I travel across Montana for regular meetings with other county commissioners in our state, commissioners tell me they too are concerned about the farreaching impact of Grace’s lack of responsibility. Many fear Grace’s recent decision

to no longer help with medical expenses of folks who had qualified for their own

medical plan, has the potential to bankrupt our own state Medicaid program.

We appreciate the help the Federal family has extended to northwest Montana.

We don’t know where we would be without the help the Department of Health and

Human Services, the Environmental Protection Agency, the Agency for Toxic Substance Disease Registry and Congress have provided us. Everyone is doing

heavylifting. Everyone it seems, but Grace.

I am here to thank Congress—and hard-working folks across the country for supporting our community. You have all done your part and we can’t begin to thank

you enough But I would also like to add that W.R. Grace still has a place at our

table. We need them to do their part too.

As Grace makes its way through Federal bankruptcy court there are several

things I would ask this committee and those present to consider to set aside a separate trust fund, established by Grace to cover the short-term prescription drug and

home-health needs of folks in Libby who are struggling with asbestos-related disease. I would also ask you to consider establishing a trust fund for longer-term

health care needs. I appreciate the questions that have been raised about long term

funding for cleanup and the statutory authority for removing insulation in homes
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in Libby. Good health is all any of us can ask for. A clean bill of health is the most

profound mark our Federal friends will leave upon our community.

I appreciate your time and on behalf of Lincoln County, I thank you for this opportunity.

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