Executive summary/Minutes October 28-29, 2003

NIOSH/CDC Advisory Board on Radiation and Worker Health

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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

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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.

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*****

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

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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

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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.

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*****

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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

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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

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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