Centers for Disease Control and Prevention

National Institute for Occupational Safety and Health

Eighteenth Meeting of the

Advisory Board on Radiation and Worker Health

October 28-29, 2003

Meeting Held at the Adams Mark

St. Louis, Missouri
Executive summary/Minutes October 28-29, 2003

NIOSH/CDC Advisory Board on Radiation and Worker Health

Executive Swmnary

The Eighteenth Meeting of the Advisory Board on Radiation and Worker

Health (ABRWH or the Board) was held at the Adams Mark St. Louis Hotel

in St. Louis, Missouri on October 28-29, 2003. All members but one

were in attendance. Others in attendance included staff of various

Federal agencies, as well as members of the public. The Summary

Minutes of Meeting Seventeen were approved with no changes.

*****

Tuesday, October 28, 2003

Claimant Counnunication

Ms. Chris Bllison of the National Institute for Occupational Health

and Safety/Office of Compensation, Analysis and Support (NIOSH/OCAS)

presented an overview of the claimant communications, outlining the

four primary methods. They consisted of phone calls, e-mails, the web

site, and written communications. She announced two new pieces to be

included in the written communications, which are a flow chart and an

activity report.

Following her presentation, Ms. Ellison entertained questions from the

Board.

*****

OCAS Program Status Report

Mr. David Sundin of NIOSH/OCAS announced the number of claims to date

as '14,SOO-some.' He reminded the Board that there is not only an

electronic file, but a paper file of documents on each claim. He gave

a breakdown of percentages of claims involving Atomic WeaP9ns

Employers (AWEs) and Department of Engergy(DOE) site employees and

survivors. A profile was presented of the types of cancers

represented in the claimant population, warning against overinterpretation of the list.

Mr. Sundin noted a marked improvement in the responsiveness of the DOE

points of contact for requests for information. The total percentage

of the outstanding requests more than 60 days or older is now down to

eight percent.
Executive Summary/Minutes October 28-29, 2003

NIOSH/CDC Advisory Board on Radiation and Worker Health

Mr. Sundin announced initiation of another recruitment effort for

physicians for the Physicians Panel under Subtitle D.

Four completed site profile documents are now out on the web site.

They are Bethlehem Steel, Savannah River Site, Blockson Chemical and

the Mallinckrodt Technical Basis Document. The residual contamination

final report is drafted and in final review.

Mr. Sundin answered questions from the Board following his

presentation. *****

DOL Program Status Report

Mr. Jeff Kotsch presented the Department Of Labor's (DOL) program

status report. He gave an update on the number of claims, with a

breakout of claim types. Approximately 53 percent of the total cases

have received final decisions, resulting in compensation payments to

9,143 claims in the amount of roughly $673,991,000 in compensation.

Medical benefits in the amount of $19,765,000 have been paid as of

October 23rd.

Mr. Xotsch updated the Board on the improvement in the ability of the

DOL to get claims through the process. He discussed a continuing

outreach program. The number of cases being received at present was

noted. Long-term projections of future claims were discussed.

Questions were taken from the Board following the presentation. Those

which were outside Mr. Kotschls area of expertise he agreed to refer

to Mr. Pete Turcic for clarification.

*****

DOB Program Status Report

Mr. Tam Rollow of the Office of Environment Safety and Health

presented a status report from the DOE. Mr. Rollow is director of the

office of worker advocacy.

Mr. Rollow presented an overview of the differences between the

Subtitle B portion of the program managed by DOL and the Subtitle D

portion managed by DOE.

Mr. Rollow described accomplishments of and continuing challenges to

his office.
Executive Summary/Minutes October 28-29, 2003

NIOSH/CDC Advisory Board on Radiation and Worker Health

Following his presentation, Mr. Rollow entertained questions from the

Board. *****

Public Comment Period

Public comment was solicited on both days of the meeting. An extra

opportunity was offered on the first day. Public input in the first

session included the following:

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Issues regarding concern for missing records.

Need for clarification to claimants between Subtitle B and

Subtitle D claims.

Continuing outreach efforts.

*****

Dose Reconstruction Workgroup Report

Mr. Mark Griffon led the Board in a discussion of three task orders

which were to be presented for approval by the Board. Changes made to

the draft tasks since the previous Board meeting were highlighted.

After discussion, all three tasks were voted on and approved.

*****

Board Discussion - Claims Review Process

Mr. Larry Blliott announced that the contract for technical support to

the Board had been awarded to Sanford Cohen & Associates.

A suggestion was made by Mr. Elliott that the Board take some time to

discuss the issue of a dose reconstruction subcommittee and the

differences between a subcommittee as an ongoing working group and a

working group, essentially an ad hoc group with a specific, defined

task.

After discussion, the matter was tabled until the following day

*****

The second opportunity for public comment in the day was offered.

Input from that session included the following:

4
Executive Summary/Minutes October 28-29, 2003

NIOSH/CDC Advisory Board on Radiation and Worker Health

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The schedule for issuance of the Special Exposure Cohort rule.

Conflict of interest statements for those parties working on the

site profiles.

Observations from review of the Mallinckrodt Technical Basis

Document.

Interest in worker input to the site profiles.

Vignettes of incidents from the personal experience of a number

of former Mallinckrodt workers and/or their children.

Perceptions of being passed from one agency to another.

Integrated Modules for Bioassay Analysis (IMBA) model

availability.

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Wednesday, October 29, 2003

Review and Approval of Draft Minutes

A motion to approve the Executive Summary and

Minutes of the seventeenth meeting was seconded

and unanimously passed.

* * * *

Administrative/Housekeeping

Mr. Larry Blliott addressed the issue of .Board members receiving

correspondence and/or phone calls from claimants and interested

parties. He offered assistance from NIOSH in Board response.

Ms. Cor! Hamer reviewed several routine administrative and

housekeeping items.

Mr. Robert Presley asked about member interest in visiting the Nevada

Test Site following the December meeting.

Items of interest for the December agenda were solicited

The Board agreed to meet in Augusta, Georgia on February 5th and 6th.

Washington, D.C. was agreed to as a back-up location.

The week of April 19th was decided on for the following meeting,

held in Richland, Washington. No specific dates were decided on.

to be

*****

5
Executive Summary/Minutes October 28-29, 2003

NIOSH/CDC Advisory Board on Radiation and Worker Health

Site Profile Updates

Dr. James NetoD described the purpose of the document, and the status

of other site profiles under development. He then presented a

detailed overview of the Technical Basis Document (TBD) for the

Mallinckrodt Chemical Works.

Dr. Beton's presentation included a history of the use of the

Mallinckrodt site and its evolution over the years the site was in

operation. He described the uranium refining process and how it led

to the radiological characteristics and conditions. A summary was

given of the types of available data and how determinations were made

of radioactivity intakes, both internal and external doses.

Dr. Neton's presentation was followed by questions from the Board and

discussion of the content of the Mallinckrodt TBD.

A motion that NIOSH develop a program for public and site

expert participation in development of site profiles was seconded

and passed.

*****

Working Groups on Options

for Evaluating Claimant Interviews

Dr. James Melius provided an update on the working group. No

recommendations were available at this time, but are expected to be

provided at the December meeting.

*****

Research Issues

Mr. Russ Benshaw, NIOSB/OCAS, presented considerations for adopting

and implementing modifications to cancer risk models and an update on

research topics. He described the differences between the NIOSHInteractive Radio Epidemiological Program (IREP) and National

Institues of Health (NIH)-IREP models.

Mr. Henshaw noted potential effects of risk model modifications, as

well as practical considerations for doing so.

~

6
Executive Summary/Minutes October 28-29, 2003

NIOSH/CDC Advisory Board on Radiation and WOrker Health

Public Comment Period

Public Comment was solicited on both days of the meeting. Public

input on the second day included the following:

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Desire for input from former employees in site profile

development.

Conflicting information given to workers during employment.

Inclusion of Mallinckrodt workers in the Special Exposure Cohort.

Emphasis by employers to employees on the secrecy of the work.

Documents reflecting what workers had to say to keep their jobs,

rather than the truth.

A request for another visit from NIOSH or Oak Ridge Associated

Universities (ORAU) specifically to discuss the Mallinckrodt TBD.

An offer for use by NIOSH of the information gathered over the

years from the site by the Missouri Department of Natural

Resources.

Questions related to the Blockson Chemical Site TBD not

addressing radon exposures.

With all further business to come before the Board requiring action in

Executive Session, the public portion of the meeting was adjourned.

End of Executive Summary

««cx:

..
Executive summary/Minutes October 28-29, 2003

NIOSH/CCC Advisory Board on Radiation and Worker Health

Tuesday, October 28, 2003

OPENING REMARKS

Dr. Paul Ziemer, Chairman of the ABRWH, called the meeting to order,

welcoming the attendees. He announced Dr. Henry Anderson would be

absent from the meeting.

Dr. Ziemer called for everyone to register their attendance in the

book provided. He instructed members of the public to sign up if they

wished to address the Board during the public comment period. Dr.

Ziemer reminded the members of the public that the comment period was

not a forum for a question and answer session, but comments on the

program or a specific issue were invited.

Noting that perhaps all members of the Board had not had an

opportunity to review the minutes, Dr. Ziemer inquired whether the

Board's preference might be to defer approval until the following day

The members agreed.

*****

CLAIMANT COlOfUNICATION

Ms. Chris Ellison

NIOSH

In her overview of the claimant communications, Ms. BllisOD outlined

the four methods. They included phone calls, e-mails, visits to the

web site, and written communication. Two new pieces to the written

communication were announced. They are a flow chart graphically

describing the steps of the claims process, and an activity report.

The flow chart will be included in the acknowledgement packet sent to

a new claimant. Pending claimants will be sent the flow chart in a

separate mailing. The activity reports will be mailed quarterly and

will include both a status report on the pending claim, as well as

program information.

Discussion Points

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Dr. Genevieve Roessler asked if a determination had been made as

to the effectiveness of the web site. Ms. Ellison reported that

web site "hits" are tracked, but the majority of contact from

claimants is through e-mail or phone calls.

Dr. Roy DeHart inquired into the number of dead letters.

8
Executive summary/Minutes October 28-29, 2003

NIOSH/CDC Advisory Board on Radiation and Worker Health

t

Ms. Bllison responded that when a letter is returned, DOL is

contacted and those issues are being worked out.

Dr. Paul Ziemer wondered if claimants experienced confusion about

who communications were coming from. Ms. Bllison replied that

there did not seem to be. Mr. Larry Blliott added that, in

anticipation of that problem, each letter sent throughout the

process introduces the claimant to the next person they may

expect communication from. Mr. Blliott noted that the issue of

dead letters was becoming even more important as dose

reconstructions were being finalized, and the matter was being

addressed.

*****

OCAS PROGRAM STATUS REPORT

Mr. David Sundin

NIOSH/OCAS

Mr. Sundin reported on the number of claims to date. He reminded the

Board that both an electronic and a paper file is maintained on claim

documents. Mr. Sundin included a breakdown on percentage of cases

involving AWE and DOE site employees and survivors.

A marked improvement was noted in the responsiveness of DOE points of

contact for requests for information. The total percentage for

outstanding requests more than 60 days or older is now down to eight

percent.

Mr. Sundin presented a profile of the types of cancers represented in

the claimant population, warning against over-interpretation of that

list. Non-melanoma skin cancer predominates.

Announcements were made of the following activities and/or

achievements:

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Initiation of another recruitment effort for physicians to serve

on the Physicians Panels under Subtitle D.

Four completed site profile documents are now out on the web

site. They are Bethlehem Steel, Savannah River Site, Blockson

Chemical and Mallinckrodt Technical Basis Document.

The residual contamination final report is drafted and in final

review.

Discussion Points

9
Executive Summary/Minutes October 28-29, 2003

SlOSH CDC Adviso Board on Radiation and Worker Health

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Dr. Roy DeHart asked who was doing the medical coding of the

cancer types, noting that, as a physician on the Physicians

Panel, mis-diagnosis is often seen. Mr. Sundin replied that it

is DOL's responsibility to ensure the medical record supports the

diagnosis, and they do provide the codes. It was pointed out

that DOL is amenable to reviewing any apparent errors and making

changes where necessary.

Mr. Robert Presley inquired into availability of the residual

contamination report. Mr. Sundin indicated it would not be

available until it had been released to Congress.

Mr. Michael Gibson asked for elaboration relative to staffing and

development of the site profile teams. Mr. Sundin asked if he

might defer to Dr. J~ Meton, who was presenting on site profile

status the following day.

Dr. Paul Ziemer wondered about the time commitment of a physician

serving on the Physicians Panel. Dr. DeHart noted that he

averaged four to six hours per case, though some required less

time. Mr. Sundin added that DOE was interested in identifying

physicians able to devote as many hours as possible and the

latest recruitment announcement emphasized full-time

participation was desirable. The time commitment is significant.

Dr. Ziemer was curious whether there were any projected numbers

for future claims. Mr. Sundin suggested DOL might have a better

answer since they initially develop the cases and are involved

with the traveling resource centers in outreach efforts.

..f

*****

DEPARTMENT OF LABOR STATUS REPORT

Mr. Jeff Kotsch

Department of Labor

Mr. Jeff Kotsch updated the Board on the number of claims, with a

breakout of claim types. Approximately 19,300 cases have gone to

final decision, or 53 percent. This represents approximately 24,000

claimants, roughly 10,200 approvals, and 13,700 approvals. This has

resulted in compensation payments to 9,143 claimants in the amount of

some $673,991,000. Medical benefits in the amount of $19,765,000 have

been paid as of October 23rd. Mr. Kotsch reiterated that the majority

of denials were for non-covered medical conditions.

Mr. Kotsch commented to the Board on the ability of the DOL to get the

claims through the process. He discussed a continuing outreach

10
Executive Summary/Minutes October 28-29, 2003

NIOSH/CDC Advisory Board on Radiation and Worker Health

program and the number of cases being received at present. Mr. Eotsch

indicated he would relate the Board's interest in projected numbers to

Mr. Pete Turcic for an answer.

Discussion Points

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Dr. Paul Ziemer inquired whether it was generally felt the major

sites had heard about the program, relative to past workers. Mr.

Kot8Ch replied that it was his understanding the information had

been pretty thoroughly disseminated. There were some sites where

greater numbers of claims had been expected based on the number

of workers.

Mr. Mark Griffon asked if the DOL had an outreach plan that might

be made available to the Board. Mr. Kot8ch indicated that he

knew a plan existed, and would pass the request on to Mr. Turcic.

Mr. Leon Owens commented that he and Mr. Turcic had been present

at a recent meeting of the atomic council which is composed of a

number of Protocol for Assessing Community Excellence (PACE)

locals. A session on outreach efforts was included, with a

variety of ideas passed back and forth. Mr. OweD. anticipates

DOL will use those ideas for an outreach program once they have

been compiled, noting there had been participation by the active

unions.

Dr. Genevieve Roe88ler asked what was being done relative to

outreach directed at retirees who had left the geographic region

of their employment. Mr. KOt8Ch indicated he knew unions were

aiding in getting information out through union newsletters.

Mr. 0WeD8 observed that privatization had created a challenge

relative to unions accessing employment records from former DOE

sites.

Dr. Zi...r asked if the Board might be provided a summary of Mr.

Kotsch's presentation since he'd used no handouts and it included

a lot of numbers. Mr. Kot8Ch agreed.

*****

DEPARTMENT OF ENERGY STATUS REPORT

Mr. Tom Rollow, Director

Office of Worker Advocacy

Department of Energy

Mr. Tam Rollow began his presentation with an overview of the

differences between the Subtitle B portion of the program managed by

DOL and the Subtitle D portion managed by DOE. In addition, the DOE

11
Executive Summary/Minutes October 28-29, 2003

NIOSH/CDC Advisorv Board on Radiation and Worker Health

provides records from DOE sites to the DOL and to NIOSH in support of

the Subtitle B portion.

The Secretary of the DOE last spring asked Mr. Rollow's office to

begin an initiative to process all cases within a 12-month period.

This takes resources, and he announced their plan for efforts to

accommodate this request. The plan included additional funding and

efficiency measures. These will entail batch processing and possibly

reworking the Physician Panel makeup.

Noting that the Subtitle D program is not federally funded, but works

through state Worker's Compensation, the willing payer issue is a

continuing challenge.

Discussion Points

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Mr. ~cha.l Gibson inquired if Mr. Rollow could comment on the

Department's opinion relative to rumblings that the Senate was

looking at ways to move responsibility for the program to another

agency. Mr. Rollo. responded that the original law placed the

responsibility for Subtitle D with the DOE and they would carry

it out to the best of their ability and complete the job. Should

the Congress or the President decide to make a change, the

Department would support it 100 percent and work with whatever

remedy they chose to put in place.

Mr. Mark Griffon asked who made a determination that records were

too difficult to retrieve if asked for them by NIOSH. Mr. Rollo.

noted that his office funded retrieval of records and generally

went very far and deep in doing so. He indicated he would

discuss the matter with NIOSH to see if something more could be

done to support their efforts.

Dr. Roy DeHart commented that he'd seen a recent article in his

local newspaper which had completely confused the two parts of

the program. He expressed a need for public clarification. Mr.

Rollow replied that it is a complex program, but he has also

noted the confusion. The DOE takes care to separate the two in

every public gathering, noting that it is a continuing challenge

for everyone.

Dr. Paul Zi...r inquired whether the fees for the Physician

Panels came from the NIOSH budget or Mr. Rollow's. Mr. Rollo.

responded that the fees were fixed by law to a certain Federal

government pay scale and came from his budget. However, the pay

scale is on the low end for what the physicians are accustomed to

being paid.

.

*****

12
Executive Summary/Minutes October 28-29, 2003

NIOSH CDC Adviso Board on Radiation and Worker Health

PUBLIC COz.n.mNT PERIOD

Mr. Tom Horgan

Office of Senator Christopher Bond

Mr. Horgan welcomed the Board to Missouri on behalf of Senator Bond.

He pointed out reasons why the program is of great interest to the

State of Missouri. Mr. Horgan commented on the complexity of the

program and the frustration of the Missouri constituency, and offered

his opinion that the presence of the Board and NIOSH would be very

helpful.

Ms. Denise Brock

United Nuclear Weapons Workers, St. Louis

Ms. Brock inquired if she might pose questions to Mr. Rollow regarding

claimants under the Subtitle D portion of the program. Dr. Ziemer

indicated she might pose her question, but the answer may have to be

deferred.

Ms. Brock asked if claimants under Subtitle D were without remedy due

to Mallinckrodt's previous private insurance, statute of limitation

problems, and TyCO, the entity which purchased Mallinckrodt, had its

own issues.

Dr. Ziemer noted that her questions were on the record and some

response may be allowed, but reminded the public that the comment

period was not intended as a question and answer session.

Ms. Brock asked if Freedom of Information Act (FOIA) requests for

documents and memos related to exposure information were considered

under Subpart D. She further inquired how latency periods factored

into a Worker's Compensation claim.

Commenting on the need for outreach, Ms. Brock indicated only 400 of

3,300 direct Mallinckrodt employees have filed claims. She expressed

a further concern that indirect employees were being missed.

Indicating that the Board was interested in the answers to her

questions, Dr. Ziemer asked if Mr. Rollow could respond now or would

need to provide them later to both the Board and Ms. Brock.

Mr. Rollow replied that the willing payer issue was very complex.

law states that the DOE can order its contractors not to contest a The

13
Executive Summary/Minutes October 28-29, 2003

NIOSH/CDC Advisory Board on Radiation and Worker Health

claim in the Worker's Compensation system. The problem is there are

now some facilities where DOE is no longer present and has no

contractor there. A DOE contractor may have employed subcontractors,

whose employees came to the site with their own Worker's Compensation

arrangements. DOE has no legal way to order the subcontractor not to

contest a claim. Worker's Compensation works differently in each

state with its own set of rules.

Mr. Rollow indicated he hadn't understood the question related to FOIA

and getting sick later and asked for clarification.

M8. Brock confirmed she was not so familiar with the Subtitle D

portion of the program, and wondered if a claimant who had been denied

after review by the Physicians Panel was similar to a dose

reconstruction with not enough exposure. She asked if a FOIA request

that may provide further information factored into Subtitle D.

Mr. Rollo. explained that every applicant under Subtitle D was

permitted to submit items for the record. Any information obtained

through a FOIA request can be added, and there are several

opportunities to do so throughout the process. Applicants get a last

look before the package is sent to the Physicians Panel.

Mr. Rollow added that the Physicians Panel denies nothing. They

present a finding that it is more likely than not that illness was a

result of the claimant's work at DOE, or they don't have that finding.

It does not necessarily mean there will be a denial in the state

system.

Ms. Clarissa Eaton, Board Member

United Nuclear Weapons Workers of St. Louis Region

Ms. Baton addressed her concern regarding missing records. Ms. Eaton

expressed her belief that an obligation was owed to the men and women

who worked to protect the country.

Ms. Baton further commented that everyone who had worked at a DOE

facility should be included because of residual contamination. She

observed that after the Cold War weapons workers, facilities were like

a game of hot potato and properties were sold and resold and the

cleanup problems were never addressed. She noted that Missouri has

now become a state of pollution.

Mr. Bob Tabor

Fernald Atomic Trades and Labor Council

14
Executive Summary/Minutes October 28-29, 2003

NIOSH CDC Adviso Board on Radiation and Worker Health

Mr. Tabor described recent outreach efforts at his site. He noted

areas in need of improvement for future efforts, possibly through use

of overheads. He cited confusion among claimants between Subtitle B

and Subtitle D as a problem not eased by the meeting.

Mr. Tabor described some claimants having informed him that

contractors showed up at Worker's Comp hearings with their attorneys

to contest the claim. He expressed the union position as being that

if a contractor takes over a site, he takes over the problems and it

shouldn't matter who was the contractor at a given time. He asked Mr.

Rollow for some clarification.

Mr. Rollow responded that the order from Congress to the DOE is to not

contest claims coming through the Subtitle D program only. The

Workers Compensation program tends to be adversarial, with both sides

challenged to prove their points. That's just the way the process

works. The Federal government has no say in it. The rules are made

by the states. DOE is not asking its contractors to rollover on

every claim.

Mr. Rollow further commented that if there are some overly-adversarial

relations, those issues might be raised either with the Department or

with local management at those sites.

*****

DOSE RECONSTRUCTION WORKGROUP

Mr. Mark Griffon,

Workgroup Chair

Mr. Mark Griffon led the Board in a discussion of the task orders

which were presented for Board approval. Mr. Griffon detailed the

working group's meeting in Cincinnati, noting changes in the draft

tasks covered at the previous meeting. Those changes were a result of

that meeting with NIOSH staff.

The change Mr. Griffon highlighted in the Procedure for Processing

Individual Dose Reconstruction Reviews was that it now included a

recommendation for establishment of a subcommittee.

Of particular interest in the Site Profile Review task was the number

of reviews specified in the Period of Performance.

The Dose Reconstruction Review Tracking task gives responsibility to

15
Executive Summary/Minutes October 28-29, 2003

NIOSH CDC Adviso Board on Radiation and Worker Health

the contractor for developing a database system to track cases and

give reports back to the Board.

Discussion Points

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Ms. Wanda Munn inquired as to the anticipated size of the

subcommittee. Dr. Ziemer recommended it be a minimum of four,

possibly five, and would serve as a steering committee.

Dr. Tony Andrade wondered if the site profile review task would

be delayed. The task calls for 12 reviews and only four are

complete. Dr. J~ Neton explained there were 15 profiles

expected to be completed by the end of the year. Dr. Andrade

asked if they were sites which dealt with only one isotope or had

limited operations. Dr. Neton replied that was not the case.

The site profiles had been scheduled according to the number of

claims and covered the majority of sites having complex isotopic

work, approaching 80 percent of the claimant population.

Mr. Griffon wondered what would happen if there were not that

many completed site profiles of interest to the Board. Dr. James

Melius opined that the site profiles were going to be more

intertwined with dose reconstructions than originally anticipated

and the Board would want to spend time reviewing them.

Dr. Ziemer pointed out that the review process had to be

developed by the contractor, which would come back to the Board

for approval.

Dr. Melius observed the matrix for selecting cases for review may

need to change based upon site profiles reviewed.

Ms. Munn asked what percentage of the total site profiles was the

ten to 12 specified in the task. Dr. Neton responded that since

the number of profiles projected for completion this year was 15,

that was the majority, noting they are major sites.

Mr. Griffon indicated the rationale for the high percentage

selected was because of the impact on individual dose

reconstructions.

Ms. Munn questioned if such a large number could be justified if

early reviews show the process and results to be reasonable and

acceptable. Dr. Ziemer noted the Board's job was to audit and

find weaknesses, not to validate. The number really serves as a

guidance number for the contractor.

Dr. Ziemer observed that the contractor would probably have to do

the tracking for its own purposes, but the task formalizes the

requirement to report to the Board.

Dr. Andrade asked if the same contractor would be doing all three

levels of reviews on the individual cases. Mr. Blliott answered

16
Bxecutive Summary/Minutes October 28-29, 2003

NIOSH/CDC Advisory Board on Radiation and Worker Health

.

that there was only one contractor, which would perform all tasks

placed before them.

Mr. Griffon indicated that a question had come up in the working

group as to what point in the process individual cases would be

available for review. Mr. Blliott responded that cases would be

available upon final decision from DOL, so long as the case is

not on appeal.

Dr. Zi.mer advised the Board that the recommendation for approval of

the Procedure for Processing Individual Dose Reconstruction Reviews

came from the working group as a motion requiring no second. If

approved, it would become the Board's working document and could be

changed at any time upon action by the Board. With no further

discussion requested by the Board, Dr. Ziemer called for a vote.

The motion to approve the Procedure for Processing

Individual Dose Reconstruction Reviews was passed

unanimously.

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Me. MuDD indicated she was still concerned about the large number

of site profiles being required. Dr. Ziemer asked if tasks

couldn't be changed if needs changed. Mr. BIIiott responded that

tasks could be added to, but once a scope of work was placed

before a contractor, it could not be reduced.

Dr. Genevieve Roe..ler stated she didn't feel it was a large

number. The phrasing of the task afforded some flexibility, and

the contractor should have a variety of different types of sites

to evaluate.

Dr. Andrade suggested perhaps starting with five and increasing

the scope, given Mr. BIIiott's information and M8. Nunn's

comments.

Mr. Leon Owen. commended the working group for its job and called

for the question.

Dr. Ziemer acknowledged calling for the question as a formal motion to

end debate, which required a two-thirds majority vote to pass.

The motion to end debate was seconded and passed

by a vote of eight to two.

Dr. Ziemer called for a vote on the motion to approve the Site Profile

Review task.

The motion to approve the Site Profile Review task

17
Executive Summary/Minutes October 28-29, 2003

NIOSH CDC Adviso Board on Radiation and Worker Health

was passed, with one abstention.

The motion to approve the Dose Reconstruction Review Tracking task

required no second. With no further discussion requested by the

Board, Dr. Ziemer called for a vote.

The motion to approve the Dose Reconstruction

Review Tracking task was passed unanimously.

*****

BOARD DISCUSSION, CLAIMS REVIEW PROCESS

Mr. Larry Blliott announced that the contract for technical support to

the ABRWH had been awarded to Sanford Cohen & Associates. The

announcement will be placed on the web site following determination of

the portions appropriate for public dissemination by the Procurement

Office.

Mr. Blliott suggested taking some time to discuss the subcommittee

recommendation and the differences between that entity and a working

group.

Ms. Cor! Bamer of the Atlanta NIOSH office presented the Board with a

description of the differences between the two. Applicable

requirements for establishment under FACA rules, as well as authority

of a subcommittee, were discussed.

Since the subcommittee recommendation was made to effectuate

efficiency, Mr. Elliott offered to walk the Board through the task

order process. This was an effort to help the Board come to an

understanding of specified time periods for each required step.

Following Mr. Blliott's description of the process and extensive

discussion, Dr. Ziemer pointed out to the Board that an agreement at

this meeting was not necessary. The issue was tabled until the

following day in order to stay with the agenda and proceed to public

comment.

*****

PUBLIC CO~ PERIOD

Mr. Richard Miller

Government Accountability proj ect

18
Executive Summary/Minutes October 28-29, 2003

NIOSH/CDC Advisory Board on Radiation and Worker Health

Mr. Miller inquired into the schedule for the Special Exposure Cohort

(SEC) rule being available. Mr. Blliott responded that the rule has

been revised and is under review. It will be published when released

by the Department, and available for petitions to be generated

against.

Mr. Miller raised the issue of conflict of interest statements for

those working on the site profiles. Mr. Blliott noted they are now on

the web site.

Mr. Miller queried policy that applies to dose reconstructors not

applying to those doing site profiles. Mr. Blliott responded that

they didn't want to see anyone working on their products serving on

the opposite side of litigation. Dr. MetoD commented on the issues

Mr. Miller has raised about people who have worked at a site and are

now doing site profiles, noting that the expertise to do the site

profiles lies with those who have experience at a site.

Mr. Miller contended it was an incongruity to have different

professional standards of conduct applied to those doing dose

reconstruction than for those who do site profiles and wondered if

that were "spelled out" anywhere. Mr. Elliott was concerned that Mr.

Miller's example had been accurately portrayed for the record. The

situation is one individual from a particular company working on one

site profile, with another individual from that company testifying

against a Subtitle D claim in Alaska. Mr. Blliott clarified that Mr.

Miller was inquiring into whether that was a perceived conflict, even

with affiliations disclosed, and how it was handled. Mr. Miller

confirmed that it was.

Dr. Dan McKeel

Washington University

Dr. McKeel commented on the TBD for the Mallinckrodt site. Specific

areas of concern from his perspective as a pathologist were cited.

noted that the document's recent release had not allowed for an indepth review. He cited two additional studies by Dr. Nancy DupreEllis which were not included in the profile and wondered why.

He

An additional concern expressed by Dr. McKeel is disclosure of the

number of workers for whom there is incomplete radiation exposure

data.

19
Executive Summary/Minutes October 28-29, 2003

NIOSH CDC Adviso Board on Radiation and Worker Health

Ms. Nancy Adams

United Nuclear Weapons Workers

MS. Adams spoke on behalf of her father, a long-time Mallinckrodt

employee. Ms. Adams described difficulties she had encountered

relative to missing records for his employment period, noting that her

father had been a part of the Dupre-Ellis study referred to by Dr.

McKeel.

Mr. James Mitulski

United Nuclear Weapons Workers

Mr. Mitulski spoke on behalf of his father, a former Mallinckrodt

worker. Mr. Mitulski was also familiar with the issue of missing

records, noting some people had only been able to prove their

employment through Social Security records. Some of those people are

now claimants.

Hr. Mitulski described incidents his father had been involved in

during his employment at Mallinckrodt. He expressed an opinion that

granting of SEC status is dependent upon effectiveness of a state's

legislators.

Ms. Barbara Smiddy

G. B. Windler Florist

Ms. Barbara Smiddy spoke to the Board about her father's employment at

the Small Arms Factory at Weldon Spring during World War II. She

believed his health problems were related to his employment. She

described what she perceived as being bounced from one agency to

another.

Ms. Denise Brock attempted to respond to some of Ms. Smiddy's

questions with information she had gathered through her efforts.

Mr. Richard Miller

Government Accountability Project

Mr. Miller asked to be allowed to raise a follow-up question on the

availability of the IMBA model so that dose reconstructions can be

independently evaluated. Dr. Neton responded that they had inquired

of the contractor who provided the program and was advised that a webbased version was not available. It is a proprietary-type calculation

engine customized for NIOSH application.

20
Executive Summary/Minutes October 28-29, 2003

NIOSH/CDC Advisory Board on Radiation and Worker Health

Dr. NetoD added that, while not convenient, it is available for use in

the NIOSH public reading room.

Mr. Miller asked if money was necessary to make it accessible to the

public, and how the Board was going to do its work if it were not

available to them. Dr. NetoD answered that their licensing agreement

allowed use by the Board and the contractor.

Mr. Miller asked if there were anywhere on the earth other than

Cincinnati where it could be made available, or if there were some

practical solution, like $10,000, to make the problem go away. Mr.

Blliott replied that the only practical solution for those who cannot

make use of the availability NIOSH can provide is to purchase the

software and get a license themselves. It is a licensure issue only.

Mr. Miller contended it was a real problem to use proprietary software

not available to the public to make decisions about a public

compensation program. Mr. Miller opined that he had been patient, but

NIOSH needed to Rgrapple" a bit more on the licensure issue as it was

beginning to pose a question. Dr. MetOD reminded Mr. Killer that it

was the software that is proprietary. The methodology is generally

available to the public.

Mr. Mark Griffon suggested the DOL resource centers might be a place

it could be made available. Dr. Ziemer noted the point had been made

and the staff could explore whatever was out there. Mr. ~tu18ki

suggested the public library or some government building. Dr. Ziemer

observed that probably no one present was fully aware of the licensing

issues. The point had been made and may be worth following up.

Dr. Melius asked if any progress had been made on providing public

access or opportunity for input and comments on the site profiles.

Mr. Blliott deferred elaborating due to Dr. Neton's scheduled

presentation on the subject the following day. He did explain that

the site profiles have been placed on the web site. Hard copies are

available for those with no internet access, if requested. They ask

for written comments to be provided the Docket Office, which tracks

written comments on a variety of publications. Comments would then go

on the web site or be available upon request.

NIOSH will go to sites where the TBD or site profile has been approved

and share it in a meeting with labor representatives from the site,

explaining it to them. They will provide examples of dose

reconstructions built from the document so they understand how the

reconstructions work and where the profiles are critical in the

process. They will ask for their comments.

21
Executive Summary/Minutes October 28-29, 2003

HIOSH/CDC Advisory Board on Radiation and Worker Health

Dr. Meliu8 inquired if a meeting is scheduled in St. Louis for the

Mallinckrodt profile. Dr. MetoD answered that he would be discussing

the Mallinckrodt document the following day, but they did not have a

general meeting to discuss Mallinckrodt. Since the facility is no

longer in operation, it's difficult to identify organized labor

representatives to present it to.

Dr. Meliu8 expressed his disbelief, given the comments heard from the

public. He opined it wouldn't be difficult to pull together a group

of people with knowledge of the facility and representational

interest.

Mr. Michael Gib8on asked if it wouldn't be more efficient to add

workers to the site profile teams before the documents are finalized

rather than getting comment afterwards. Dr. N.~on asked if he might

defer responding until after his presentation tomorrow. Mr. Gibson

agreed.

Mr. Tam Horgan of Senator Bond's office asked if there was not going

to be a discussion of the Mallinckrodt site profile the next day with

feedback from the Board. He pointed out that, because he worked with

the authorizing committee that has legislative oversight over NIOSH,

DHHS and DOL, that was his primary purpose for being present. Dr.

Ziemer indicated that was included in tomorrow's schedule.

Dr. Xeliu8 explained he had been referring to having workers from a

site involved in the development of the site profile. A second

portion had been to have a public session for NIOSH to present the

site profile and receive comment or answer questions.

Ms. Denise Brock observed that while Mallinckrodt had once been

independent, the union for the facility became the UAW. She noted

that the biggest wealth of information is the former workers, who have

amazing stories and memories. She asked if there would be time to let

those workers speak tomorrow if she could get them to the meeting.

Mr. Blliott commented that at the August Board meeting in Cincinnati,

individual comments were heard and considered. His reponse to Dr.

Melius had addressed how NIOSH will handle the roll-out of the TBDs or

site profiles. The documents will be taken into the field to solicit

comment and input. This Board meeting in St. Louis is the first step

to talk about the recently-developed TBD for Mallinckrodt. Tomorrow

will provide an introduction, with Board and public comment welcome.

As with all the TBDs, it will be brought back. It is not the final

step.

22
Executive Summary/Minutes October 28-29, 2003

NIOSH CDC Adviso Board on Radiation and Worker Health

The suggestion from Mr. Gibson to put workers on the site profile

teams was heard and was not a viable solution. NIOSH has opted to go

out and present the documents, present examples of dose

reconstructions, help people understand how the documents are used and

what a dose reconstruction looks like and take their comments. NIOSH

needs comments to the written record. Due consideration was given to

individual comments of the Board, and NIOSH is proceeding along the

course outlined.

Mr. Melius expressed his confusion because Dr. NetoD had said there

was no meeting and Mr. Blliott was saying there would be meetings.

Mr. Elliott noted that Dr. Melius had asked if a meeting had been

scheduled. It has not. This Board meeting is the first step.

Mr. Gibson offered that the legislators and the President who signed

the bill felt it necessary to balance the Board with doctors,

scientists and workers. Those workers should be involved in every

step possible in the process. And while workers may not fully

understand the science, they know when they were sent into a room and

an alarm went off; the professionals turned the alarm off and told

them to go back in, it was just radon when it was something else. Mr.

Gibson opined those may be the same people who wrote the site profile,

and it seemed blatantly unfair.

Mr. Blliott responded that he agreed with Mr. Gibson, and that there

are points in the process where that information is solicited. One

step is the interview. With the site profiles has been added the

opportunity for field visits, hearing comments and asking those people

to make written comment. Mr. Blliott expressed his hope that Mr.

Gibson understands effort has been made to bring worker perspective

into the process in more ways than just sitting on the Advisory Board.

With no further comments, the Board officially recessed

until the following morning.

*****

23
Executive Summary/Minutes October 28-29, 2003

NIOSH CDC Adviso Board on Radiation and Worker Health

Wednesday, October 29,2003

ADMINISTRATIVE/HOUSEKEEPING

Dr. Ziemer called the second day to order. The meeting commenced with

administrative and housekeeping matters. The first issue before the

Board was review and approval of the draft minutes of the seventeenth

meeting.

REVIEW AND APPROVAL OF DRAFT MINUTES

A motion to approve the Executive Summary and

Minutes of the seventeenth meeting was seconded

and unanimously passed.

Mr. Larry Blliott offered the assistance of NIOSH in response to any

correspondence and/or telephone calls Board members may be receiving

from claimants or interested parties. He noted NIOSH would like to

have a sense of the types of inquiries being received by Board

members. The staff would be happy to assist in members preparing

their own responses, or NIOSH could handle the response for them and

provide a copy for their files.

Drs. Paul Ziemer, Roy DeHart, and Genevieve Roessler all indicated

they had received such communications. Ms. Wanda Munn offered her

manner of responding to verbal inquiries and telephone calls, noting

that she had not received any written communications.

Mr. Elliott agreed Ms. Munn's response was appropriate.

NIOSH stood ready to help in any way the Board preferred.

He indicated

MS. Cori Bomer reminded the Board of the importance of providing her

with their e-mails of meeting time, prep time, and working group time

She also requested that Board members not make their own flight

arrangements, if at all possible, because reimbursement could not be

guaranteed.

Ms. Bamer announced that the annual report to GSA covering

accomplishments and activities of the Board would be available around

mid-December. She asked if anyone had interest in receiving a copy of

the report.

Dr. Ziemer inquired into the length and format of the report. MS.

Bamer responded it was approximately four to five pages, covering

general financial information and activities of the Board for the

24
Executive Summary/Minutes October 28-29, 2003

NIOSH/CDC Advisory Board on Radiation and Worker Health

preceding year.

be available.

electronically,

She was uncertain as to the format in which it would

Dr. Ziemer suggested they be made available

if possible, or by hard copy if necessary.

Mr. Robert Presley indicated he was speaking with personnel at the

Nevada Test Site relative to a tour while the Board is in Las Vegas in

December. The tour will take an entire day and is being scheduled for

the day following the meeting. Names and Social Security numbers will

be needed for those wishing to participate. Ms. Bomer offered to

assist in that effort.

Items of particular interest for the December agenda were solicited.

Mr. Elliott indicated NIOSH would put a travel task before the Board's

contractor to facilitate a face to face meeting in Las Vegas. Mr.

Griffon inquired into the possibility of a presentation on the IMBA

program, which Mr. Elliott agreed to look into. It was suggested that

any items that come to mind prior to November 15 when Federal Register

notice has to go out, be provided to Dr. Ziemer or Mr. Blliott.

Future meeting times and sites were discussed. The Board agreed to

meet in Augusta, Georgia on February 5th and 6th to coincide with the

Health Physics Society meeting the next week and because of its

proximity to the Savannah River Site. The timing allowed for review

and possible approval of early deliverables in the support contract.

Washington, D.C. was agreed to as a back-up location.

The week of April 19th was decided on for the following meeting, to be

held in Richland, Washington for its proximity to the Hanford site.

No specific dates were decided on.

*****

SITE PROFILE UPDATES

Dr. James Neton

NIOSH

Dr. James Neton provided the Board with an update on progress on TBD

and site profile development. He reiterated the purpose of the

documents, supporting dose reconstructors by providing site-specific

information, helps minimize interpretation of data. With

approximately 130 health physicists slated on dose reconstructions,

the document helps provide consistency and is used much like a

handbook. They are dynamic documents, under review whenever new

information becomes available.

25
Executive Summary/Minutes October 28-29, 2003

NIOSH/CDC Advisory Board on Radiation and Worker Health

All completed TBDs may be viewed at the web site. Comments are

encouraged and can be made to the NIOSH Docket Office. The Docket

Office address is located at the introduction to the individual site

profile.

Briefings are being arranged with union representatives to solicit

input as each document is completed. A meeting is scheduled at the

Savannah River Site on November 11. Arrangements are currently being

made to visit Hanford. The six TBDs making up the site profile for

Hanford have just been completed.

Team members on individual site profiles are now listed on the ORAU

web site, along with their associated conflict of interest statements.

Fifteen DOE facility TBDs are under development in parallel, with

targeted completion by end of the calendar year. Completion of those

15 documents will provide the ability to address approximately 77

percent of the claims currently pending at NIOSH.

Mr. Michael Gib80D interrupted to ask how many health physicists and

parties involved in development of site profiles were Q-cleared and

how classified relevant data was being included in the TBDs. Dr.

MetOD replied NIOSH had three and ORAU had 15 to 20 Q-cleared

individuals. Q-cleared individuals have reviewed data to determine

applicability to the site profiles. Thus far no classified

information has been discovered that needed to be included in dose

reconstruction.

Dr. MetoD noted an additional issue with UCNI data, which is not

classified but similar to Privacy Act information. Mr. pre.ley

clarified UCNI as the acronym for Unclassified Controlled Nuclear

Information. Mr. Blliott added NIOSH had successfully worked with

classification officers to provide data or information couched in a

way that it could be used but not jeopardize national security.

Returning to the Mallinckrodt document, Dr. MetoD noted the scope of

the document was limited to aid in reconstruction of radiation doses

to workers at the St. Louis downtown site only, specifically plants 1,

2, 4, 6, 6E, 7, and 7E. The time period addressed is from April 1942

through July 1958. CUrrently reserved, residual contamination in the

1959-1995 time period will also be covered in the document.

The introduction covers the Manhattan Engineering District asking

Mal 1 inckrodt Chemical Works to begin research on uranium refining and

processing operations. That was April of 1942. Three months later,

they were in production. Between 1942 and 1957 more than 50,000 tons

of natural uranium products were processed.

26
Executive Summary/Minutes October 28-29, 2003

NIOSH/CDC Advisory Board on Radiation and Worker Health

All completed TBDs may be viewed at the web site. Comments are

encouraged and can be made to the NIOSH Docket Office. The Docket

Office address is located at the introduction to the individual site

profile.

Briefings are being arranged with union representatives to solicit

input as each document is completed. A meeting is scheduled at the

Savannah River Site on November 11. Arrangements are currently being

made to visit Hanford. The six TBDs making up the site profile for

Hanford have just been completed.

Team members on individual site profiles are now listed on the ORAU

web site, along with their associated conflict of interest statements.

Fifteen DOE facility TBDs are under development in parallel, with

targeted completion by end of the calendar year. Completion of those

15 documents will provide the ability to address approximately 77

percent of the claims currently pending at NIOSH.

Mr. Michael Gib8oD interrupted to ask how many health physicists and

parties involved in development of site profiles were Q-cleared and

how classified relevant data was being included in the TBDs. Dr.

NetoD replied NIOSH had three and ORAU had 15 to 20 Q-cleared

individuals. Q-cleared individuals have reviewed data to determine

applicability to the site profiles. Thus far no classified

information has been discovered that needed to be included in dose

reconstruction.

Dr. _eton noted an additional issue with UCNI data, which is not

classified but similar to Privacy Act information. Mr. pre.ley

clarified UCNI as the acronym for Unclassified Controlled Nuclear

Information. Mr. Blliott added NIOSH had successfully worked with

classification officers to provide data or information couched in a

way that it could be used but not jeopardize national security.

Returning to the Mallinckrodt document, Dr. .etan noted the scope of

the document was limited to aid in reconstruction of radiation doses

to workers at the St. Louis downtown site only, specifically plants 1,

2, 4, 6, 6E, 7, and 7E. The time period addressed is from April 1942

through July 1958. CUrrently reserved, residual contamination in the

1959-1995 time period will also be covered in the document.

The introduction covers the Manhattan Engineering District asking

Mallinckrodt Chemical Works to begin research on uranium refining and

processing operations. That was April of 1942. Three months later,

they were in production. Between 1942 and 1957 more than 50,000 tons

of natural uranium products were processed.

26
Executive Summary/Minutes October 28-29, 2003

NIOSH/CDC Advisory Board on Radiation and Worker Health

A full-scale health program was not started until 1948. Film badging

began in late 1945, with urinalysis some time later. Both

Mallinckrodt and the AEC performed periodic air sampling, including

radon breath analysis. External dose records are missing from 1942-

1945. Internal dose records are missing for the 1942-1947 period.

This section also establishes the context for interpretation of

existing records, along with the basis upon which to determine missing

doses for periods in which records are non-existent.

Dr. MetoD explained the history of site use provided a summary

chronology, with descriptions of the work performed in major plants

and the safety problems and solutions noted. The section covers

decontamination and surveys performed. It moves through the recycling

performed commencing in 1957 and waste residues taken to the St. Louis

Airport Storage Site.

The section describing the uranium refining process explains the basic

process, and defines three specific periods of time of significance.

They are the wartime period (April '42 to April '45), the early

postwar period (May '45 to December '49), and the later postwar period

(1950 to 1958). The section discusses other processes, the ores and

other feed forms used, as well as residues and effluents.

The next section covered radiological characteristics, conditions,

considerations, and available date. It described units, limits and

recommendations. Radioactivity content and handling of the ore,

uranium produces, and residues was discussed.

Internal dose considerations included particle size, solubility,

composition and sampling methods. Also reviewed were airborne dust

levels, respirator use, radon and surface contamination. Information

and available data included urinalysis, breath radon analyses, wac and

lung counts.

External dose considerations included film badges, extremity

dosimeters and occupational X-rays. Other areas of interest were

number of workers, number of hours worked per week, job types and work

areas.

Determination of radioactivity intakes and internal doses included

assumptions, estimating intake using surrogate worker data and timeweighted daily average exposure data, as well as calculation of

internal doses for missing periods or for comparison.

Determination of external doses was covered by general considerations

unmonitored workers. Application of dose data from available film

badge dose monitoring, external exposure geometries and photon energy

27
Executive Summary/Minutes October 28-29, 2003

NIOSH CDC Adviso Board on Radiation and Worker Health

ranges was discussed

Discussion Points

.

..

f

.

t

.

#

#

i

4/:

Mr. Mark Griffon queried whether there is any feeling for an

inability to reconstruct dose for any subpopulation of worker at

the Mallinckrodt site. Mr. Neton answered there was not.

Dr. James Meliu8 asked what happened if a worker had been

employed at the other facilities, too. Dr. Neton replied that if

a dose reconstruction based on Mallinckrodt alone took the

claimant into the compensable range, it was completed. If it did

not, the claim would have to wait for the TBD on the other

facility to make a determination.

Dr. Roy DeHart asked if any incidences of adverse events had been

discovered through the document review. Dr. Neton answered that

a few incidents were addressed in the document. Where

documentation was available, they were characterized.

Dr. Genevieve Roessler inquired how long the development process

had taken. Dr. Meton reckoned some six to eight months.

Dr. Roessler asked what part of total dose was assumed for the

chest X-ray. Dr. Richard Toohey responded that since they were

done at a hospital, it was presumed that both AP and lateral

views were shot, and that they were given the typical exposures

for the time.

Mr. Leon Owens wondered what the mechanism was for incorporating

an undocumented significant event in the '45-'49 time period that

was mentioned in several claimant interviews and necessary for a

claim to be compensable. Dr. Neton replied that corroboration

and plausibility would factor into the event being considered and

put into the claimant's dose.

Mr. Mark Griffon asked how use of surrogate worker data was being

validated. Mr. Meton indicated they would match as closely as

possible. If you can't match, pick the next highest value to be

found in the table.

Mr. Griffon wondered if any past experts had been interviewed in

the process. Dr. Meton indicated they had not.

Mr. Griffon asked if the references would be posted on the web

site. Dr. Meton replied that, to the extent that the Privacy Act

would not be violated, that could be looked into.

Dr. James Melius commented that in the future it would helpful to

have reports to be discussed in a meeting available beforehand.

He added he found it disconcerting that in a process taking eight

to ten months, no attempt was made to consult experts. He asked

what plans were to do that in the future. Mr. Blliott answered

28
Executive Summary/Minutes October 28-29, 2003

NIOSH CDC Adviso Board on Radiation and Worker Health

*

it

.

*

.

f

t

t

.

.

that consultation was sought where needed, as in the Bethlehem

Steel document. The wealth of information available at

Mallinckrodt allowed them to proceed without that need. The

first goal is to get the documents out. Comment is welcome.

Dr. Meliu8 said he still had a question about whether NIOSH

planned to hold meetings. Mr. Blliott reiterated that it was the

plan to do so.

Dr. Melius commented he was presuming NIOSH was rejecting

involvement by labor or other interested parties prior to

publication. Mr. Blliott replied it was not being rejected; it

will be sought where it is felt necessary and appropriate to put

out a quality document.

Mr. Melius inquired where that was being done on the 15 documents

in development. Mr. Blliott responded that he could not comment

with specificity on each individual document and where they were

in their development.

Dr. Melius offered that he found Mr. Blliott's answer

unsatisfactory since nothing was scheduled and there was no

commitment. Noting that the conflict of interest issue had been

raised in public comment, he opined that the development of a

policy in that regard was imperative.

Dr. Paul Ziemer observed that the document was probably never

going to be complete and every resource will never be tapped.

But it has to be put out sometime, and there appeared to be a

wealth of information to support the Mallinckrodt document.

Other information will be added as it becomes available. While

further refinement may be helpful and useful, this document has

already helped to process claims.

Mr. Blliott agreed, noting that NIOSH was concerned at the time

involved if a participatory process were adopted. This was

considered more expeditious.

Mr. Griffon asked if claimant interviews had been used in

development of the TBD. Dr. Neton responded that they were

checked to make sure there was nothing inconsistent with what

the TBD is saying.

Dr. Melius opined that responding to a web site is not an open

public process, noting that the documents were going to be used

to reject claims. Mr. Blliott clarified for Dr. Melius that the

TBDs or site profiles were not used to reject claims. They are

to support dose reconstruction. The dose is either compensable

or not.

Mr. Blliott offered that individual comments had been heard and

reacted to, but if there was Board consensus, he needed to hear

that.

Ms. Wanda Munn reminded the Board of Dr. Till's recent appearance~

29
Executive Summary/Minutes October 28-29, 2003

NIOSH/COC Advisory Board on Radiation and Worker Health

41:

before the Board in which he spoke of the need for establishing a

policy of when the science one has is what one will use, and

recognize what is the reality in terms of imponderables that

cannot be defined clearly. Failure to do so creates more

confusion.

Mr. Gibson observed the science of health physics was not being

questioned, but rather the adequacy of records of people for whom

a Federal agency has already gone on record to say they were

improperly monitored.

A motion was made by Dr. Meliu8 and seconded by Mr. Griffon that the

Board recommend NIOSH develop a process for public and site expert

participation and involvement in the development of site profiles,

that this participation include both prior to publication on the web

site and comment after initial publication. Dr. Ziemer opened the

motion for discussion.

Board Discussion

Mr. Owens agreed with Mr. Gibson's comment, adding that measurements

don't mean anything to a lot of people, they just feel lied to. The

site profile development process needs to be as transparent as

possible.

Dr. Tony Andrade agreed with transparency, but noted measurements have

everything to do with the process. Assuming are all records are false

and untrue and that folks who ran a radiation protection organization

would falsify such things is unconscionable. He pointed out one must

start somewhere dispassionate, which has everything to do with the

records. The starting point is what is on paper. Agreeing that a

larger outreach effort to let people know they can comment is needed,

Dr. Andrade asserted his belief that the process currently in place is

appropriate.

Dr. Roessler queried Dr. Meliu8 about specifically what he would have

done differently and how he would have gone about it.

Dr. Melius responded that his motion was to develop a process, and he

felt the process should be flexible and would have to be different for

different sites. Speaking from a greater familiarity with the

Savannah River Site, Dr. Melius noted there were several opportunities

to seek information from other resources which were not taken in the

development of that TBD. He stated he was trying to defer to NIOSH as

much as possible to let them develop a program that doesn't hamper

their progress, but at the same time gives people a chance for input.

Dr. Ziemer opined that NIOSH, its staff, the Board and all its

30
Bxecutive Summary/Minutes October 28-29, 2003

BIOSH CDC Adviso Board on Radiation and Worker Health

representative facets were after the same thing: A good quality

product. What needed to be recognized is that what appears to be

issues of being lied to reflects ignorance. The changing dose limits

themselves reflect changes in knowledge of the biological effects of

radiation. Mistakes were made by even some of the best professionals

simply as a result of ignorance or lack of information. Dr. Ziemer

went on to say that while there may have been instances of

falsification, he believed they were few and far between. If

specifics were known, they should be taken into consideration. The

issue of getting input from the worker side should be respected and he

felt NIOSH wants to accomplish that. If it needs to be formalized,

that may be useful. Dr. DeHart offered his support of the motion, but

wanted to make clear his belief that NIOSH has made a good faith

effort to do the best they could with what they have. His support is

because the issue is divisive. The need for worker and expert

participation has been expressed and this is an opportunity to

continue that participation. Dr. DeHart cautioned that it is a

mistake to assume this will resolve or remove any issues. It will,

however, provide NIOSH with one more step of protection as it moves

forward.

Mr. Gibson commented he was not questioning the credibility of any

particular rad professional, but knew of some in the complex who put

production over safety. He likened it to having to represent union

employees caught sleeping on the job; there are some out there.

Dr. Roessler observed that from her evaluation of the Mallinckrodt

document, it was very well done. She felt the motion would give the

Board direction in prioritizing when its support contractor began

their work.

Ms. Munn indicated that while all sources of valuable information

should be incorporated into the final document, she has observed that

what happens with public hearings and wide open input prior to having

something to work from is cumbersome and time-consuming for everyone.

It has been her experience that it is most effective to have a

document based on the best evidence that can be supported by record

and have input to that if there are shortcomings or errors to it.

Ms. Munn offered her opinion that the motion was incorrect

procedurally.

Dr. Ziemer pointed out that the motion does not mandate how the

process is to be carried out other than to ask that there be input

The process could in fact be exactly what has occurred.

Dr. Ziemer further noted that the Board must recognize it is not a

management board for NIOSH. If the motion passes, it simply reflects

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Executive Summary/Minutes October 28-29, 2003

NIOSH/CDC Advisory Board on Radiation and Worker Health

the sense of the Board. It is Mr. Blliott's prerogative to use it or

not use it, as he sees fit.

The motion that NIOSH develop a program for public

and site expert participation in development of

site profiles was passed.

*****

WORKING GROUP ON OPTIONS

FOR EVALUATING CLAIMANT INTERVIEWS

Dr. James Melius

Workgroup Chair

Dr. James Melius reported that the working group had met with NIOSH

staff by conference call and requested certain materials. Those items

had been provided yesterday when the working group again met briefly.

Dr. Melius described how the working group planned to approach their

evaluation of the process. No recommendations were available at this

time, but are expected to be provided at the December meeting.

*****

RESEARCH ISSUES

Mr. Russ Henshaw

NIOSH/OCAS

Mr. Russ Benshaw presented considerations for adopting and

implementing modifications to cancer risk models and an update on

research topics. He described some differences between the NIOSH-IREP

and NIH-lREP models.

Mr. HeDshaw explained that the interpretation of research findings is

complex. When NIOSH last year observed that the thyroid cancer and

leukemia models were the only ones to confer zero risk at short

latency periods, they felt science did not support those exceptions.

BENES-Oak Ridge, developer of NIOSH-IREP, was asked to create new

models conferring some risk at short latency, with the caveat that

doing so should not lower the PC for any potential claimant. NCI

eventually agreed with the interpretation and modified NIH-IREP so

that the two models now match NIOSH-IREP.

Scientific value and applicability of findings range from weak to

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Executive Summary/Minutes October 28-29, 2003

NIOSH/CDC Advisory Board on Radiation and Worker Health

substantial. Prudence should be exercised in considering any

findings. Scientific evidence may be sufficient for modification a

risk model in some cases, not in others, depending on the potential

impact on pc. Generally the greater the impact, the more stringent

the standard should be for implementing any findings.

Uncertainty is a major contributor to compensability in many claims.

As study results that would have an effect on the uncertainty built

into the risk are incorporated, there's a domino effect. As

uncertainty is reduced, compensation is also likely to be reduced.

Usefulness of research is another issue, including time frame for

conducting and completing studies. It would not be in the best

interest of the claimants or this program to commission a prospective

cohort study slated to last ten years or more.

Updating research topics, Mr. Henshaw reported that NIOSH's Healthrelated Energy Research Branch is conducting a multi-site leukemia

case-controlled study and intends to look at the CLL cases in that

study. There are a number of issues related to smoking and the lung

cancer model that are to be looked at on a high priority basis. Age

at exposure is another controversial topic, with age at exposure

workshops expected to commence before the end of the current fiscal

year.

Comparing NCI-IREP and NIOSH-IREP, Mr. Henshaw noted the new NCI lung

model is favorable to some claimant profiles, unfavorable to others.

The changes made by NCI do not apply to radon exposures. It does take

into account age at diagnosis and age at exposure. NIOSH-IREP does

not. Other examples of differences were described, with Mr. Henshaw

noting that NCI believes their change represents the best science

available currently.

Mr. Henshaw summarized by stating that some modifications seem

relatively non-controversial. Other potential changes are

substantially more significant, and policy does playa role. NIOSH

intends to use science to its fullest extent within the confines of

current policy. Attention must be given to practical issues.

Generally the more good quality data accumulated, the less the

uncertainty and possibly the lower the probability of causation.

Research projects are being planned that it is hoped will prove very

relevant to the program.

Discussion Points

. Dr. Melius suggested consideration should be given to

participation in the age at exposure workshop and that a workshop

for the smoking issue might be a good way of handling that, too.

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Executive Summary/Minutes October 28-29, 2003

NIOSH CDC Adviso Board on Radiation and Worker Health

*****

PUBLIC COlontmNT PERIOD

Public Comment was solicited on both days of the meeting.

input on the second day included the following.

Public

Dr. Ziemer again reminded the public that the session design allowed

for comment for the record on the program, the policies or concerns.

Questions on individual claims should be directed privately to the

NIOSH staff.

He also noted that the format is not one of a question and answer

period, but a period to make statements.

Ms. Dolores Stuckenschneider

Fo~er Mallinckrodt Employee/Claimant

Ms. Stuokensohneider described her work history with the company and

some of the frustrations she had experienced with the program.

Mr. Robert Leach

Former Mallinckrodt Employee

Mr. Leach described some of the working conditions at facilities

within the complex. He noted things not taken care of were too

numerous to go into, offering an opinion that there was no way an

accurate exposure record could be developed because monitoring was

done incorrectly.

Ms. Kay Drey

Nuclear Information and Resource Service

Ms. Drey explained that it was in 1974 that she began learning about

the hazards of uranium mill tailings. In 1978 she learned St. Louis

had uranium tailings from some of the most radioactive ore in the

world.

Since that time she has met with many people who have told her about

working for Mallinckrodt Chemical Works and the workplace hazards they

faced. No one told the nuclear weapons workers, who were not allowed

to use the words "uranium" or "radiation" that radiation is harmful.

Decision-makers are only now reluctantly beginning to level with them.

Ms. Drey described situation that a worker had recounted to her

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Bxecutive Summary/Minutes October 28-29, 2003

NIOSH CDC Adviso Board on Radiation and Worker Health

After spending an extended period of time just two years ago digging a

trench at the downtown site as part of the cleanup, someone told him

the gamma readings were not ten to 20 counts per minute, as in nature,

but were 1,500,000 per minute.

As a request to the Board, Ms. Drey asked it consider including in its

findings the observation that more than 60 years of radioactive waste

has been accumulated in the world.

Mr. James Mitulski

United Nuclear Weapons Workers

Mr. Mitulski agreed with an earlier comment that there was no reason

to assume company supervisors were not people of integrity. He noted

there was also no reason to assume they were people of truth. He gave

examples of conflicting information disseminated to workers. He

commented that people sometimes say things to keep their jobs, so

input from the people who were in the plants is needed. He described

several incidents from his father's work experience, indicating that

many people were told to drink beer on their way home and it would

rinse everything out.

Mr. Mitulski suggested the only way to check out the validity of what

the company says is to bounce it off what the laborers are saying, and

then try to arrive at the truth.

Mr. Mark Bruening

United Nuclear Weapons Workers

Mr. Bruening spoke as a 17-year worker at both Mallinckrodt downtown

and Weldon Spring who was diagnosed with colon cancer two years ago.

He noted that Senator Bond had managed to appropriate $1.5 million for

a city to build a street, but the workers wait months and years for

compensation.

Mr. Don Cams trader

United Nuclear Weapons Workers

Mr. Cams trader recounted some of his experiences at the Weldon Spring

site from 157 to '66, noting things were pretty primitive. As an

example of how inaccurate monitoring records are, Mr. Camstrader

described working with another employee on a particular job for

several days. One day that employee told Mr. Camstrader he couldn't

go back on the job because he'd come up "hot" the day before. Because

they'd been together the whole time, Mr. Camstrader went to check his

levels and was told he was fine.

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Executive Summary/Minutes October 28-29, 2003

NIOSH CDC Adviso Board on Radiation and Worker Health

Mr. Norbert Hier

United Nuclear Weapons Workers

Mr. Bier, who had worked with Mr. Cams trader , described scooping out

uranium wearing a respirator he later found was barely approved for

cutting grass. Mr. Bier expressed concerns that it wasn't just

radiation exposures they had to deal with. He described using

asbestos and was particularly distressed that people who surely knew

better never warned the workers.

Mr. Tom Horgan

Office of Senator Christopher Bond

Mr. Horgan indicated he felt the scientific guidance and advice from

the Board is very important as they try to work out some of the kinks

in the legislation and implementation of the program. He asked for

individual feedback from every Board member on the Mallinckrodt TBD,

particularly those with scientific and medical knowledge.

Mr. Horgan expressed concern about the lack of records prior to 1948

and encouraged NIOSH to do what it could to finalize the SEC rule in

the near future.

Ms. Donna Erlmann

United Nuclear Weapons Workers

Ms. Br1mann appeared on behalf of her father, who was too ill to

attend. He had worked at both Destrehan Street and Weldon Spring

a number of years. She read a statement her father had written.

In his statement, he described in great detail working conditions and

specific events at a variety of locations within the complex. He

commented that DOE has spent $900 million covering up mistakes at

Weldon Spring and it's time to take care of the workers.

Ms. Denise Brock

United Nuclear Weapons Workers

Ms. Brock explained the United Nuclear Weapons Workers is an

established worker advocacy group. She noted it seemed it would be

efficient to utilize the group when NIOSH meets with the public to

review the Mallinckrodt TBD. She offered to share any information

they had, as well as her access to the UAW and retirees.

She questioned how it could be stated that Mallinckrodt wouldn't be

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Executive Summary/Minutes October 28-29, 2003

NIOSH CDC Adviso Board on Radiation and Worker Health

considered for Special Exposure Cohort in view of missing records

prior to '48, particularly when the SEC rule isn't final. Ms. Brock

expressed her belief that Mallinckrodt claimants deserve the same

consideration and benefit of the doubt as the four Special Exposure

Cohorts. She asked a variety of questions specific to the TBD,

indicating a response bye-mail would be fine.

Mr. James Werner

Missouri Department of Natural Resources

Mr. Werner announced his main message was to offer the technical

resources of his Department. Staff have been at various sites for

decades reviewing technical documents and have built a lot of

expertise over the years. With that background, Mr. Werner observed

the Mallinckrodt TBD was probably the most comprehensive document he'd

ever seen on the site.

No longer speaking on behalf of DNR, Mr. Werner asked that due

consideration be given to establishing a Special Exposure Cohort for

Mallinckrodt, given the uncertainties connected with the site.

Mr. Richard Miller

Government Accountability Project

Mr. Miller asked if anyone could explain why the Blockson Chemical

site profile was posted on the web when it excluded any discussion of

radon exposures. He wanted to know if it was available for use in

dose reconstruction without addressing the radon issue. Mr. Blliott

confirmed that it was available for use.

Mr. Miller indicated he lacked the imagination to understand how NIOSH

could go forward with that significant exclusion. Dr. Reton advised

Mr. Miller that the radon issue was not excluded, but rather reserved.

It has not been addressed yet. The TBD is solid for all exposures at

Blockson, excluding radon. To the extent claims not involving radon

can be moved forward, they will do so.

Mr. Miller offered that the Board should be aware that incomplete

documents were being posted as site profiles. He noted he'd not had

answers to e-mails he'd sent and now the site profile is posted and he

still didn't have an answer. He wished the incompleteness of the

document had been advertised to the Board.

Mr. Miller read a number of lengthy memos into the record which he

felt should have been included in the references. He elaborated

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Executive Summary/Minutes October 28-29, 2003

NIOSH CDC Adviso Board on Radiation and Worker Health

further on what he perceived as weaknesses in the TBD.

With all further business to come before the Board requiring action in

Executive Session, the public portion of the meeting was adjourned.

End of Summary Minutes

«tt:«<z:«

I hereby confirm that these Summary Minutes

are accurate to the best of my knowledge.

~~:~;;~ .

Paul L. Zieme

~

38