THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
 PUBLIC HEALTH SERVICE
 CENTERS FOR DISEASE CONTROL AND PREVENTION
 

NATIONAL INSTITUTE FOR OCCUPATIONAL SAFETY AND HEALTH
 

convenes the
 

SEVENTEENTH MEETING
 

ADVISORY BOARD ON
 

RADIATION AND WORKER HEALTH
 

VOLUME I
 

The verbatim transcript of the Meeting of the
 

Advisory Board on Radiation and Worker Health held
 

at The Westin Cincinnati, 21 East Fifth Street,
 

Cincinnati, Ohio, on August 18, 2003.
 

NANCY LEE & ASSOCIATES 

Certified Verbatim Reporters

P. O. Box 451196
 Atlanta, Georgia 31145-9196
 (404) 315-8305
 
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C O N T E N T S
 

August 18, 2003
 

REGISTRATION AND WELCOME
 

Dr. Paul Ziemer, Chair. . . . . . . . . . . . . . . . . 7
 

Mr. Larry Elliott, Executive Secretary . . . . . . . . .8
 

PROGRAM STATUS REPORT 

Mr. David Sundin, NIOSH . . . . . . . . . . . . . . . .11
 

DOL PROGRAM STATUS REPORT 

Mr. Peter Turcic, DOL . . . . . . . . . . . . . . . . .35
 

STATUS OF PROCUREMENT 

Dr. Jim Neton, NIOSH. . . . . . . . . . . . . . . . . .48 

DOSE RECONSTRUCTION WORKGROUP AND BOARD DISCUSSION TO 

DEVELOP TASK ORDER

 Mr. Mark Griffon. . . . . . . . . . . . . . . . . . . .50
 

PUBLIC COMMENT PERIOD. . . . . . . . . . . . . . . . . . 85
 

ADJOURN. . . . . . . . . . . . . . . . . . . . . . . . .116
 

COURT REPORTER'S CERTIFICATION. . . . . . . . . . . . . 117
 
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TRANSCRIPT LEGEND
 

The following transcript contains quoted material. 

Such material is reproduced as read or spoken.
 

In the following transcript a dash (--) indicates an
 

unintentional or purposeful interruption of a sentence. An
 

ellipsis (. . .) indicates halting speech or an unfinished
 

sentence in dialogue or omission(s) of word(s) when reading
 

written material.
 

In the following transcript (sic) denotes an incorrect
 

usage or pronunciation of a word which is transcribed in its
 

original form as reported.
 

In the following transcript (phonetically) indicates a
 

phonetic spelling of the word if no confirmation of the
 

correct spelling is available.
 

In the following transcript "uh-huh" represents an
 

affirmative response, and "uh-uh" represents a negative
 

response.
 

In the following transcript "*" denotes a spelling
 

based on phonetics, without reference available.
 

In the following transcript (inaudible) signifies
 

speaker failure, usually failure to use a microphone.
 
 

 

4 

P A R T I C I P A N T S
 

(By Group, in Alphabetical Order)
 

BOARD MEMBERS
 

CHAIR
 

ZIEMER, Paul L., Ph.D.
 

Professor Emeritus
 

School of Health Sciences
 

Purdue University 

Lafayette, Indiana 

EXECUTIVE SECRETARY
 

ELLIOTT, Larry J.
 

Director, Office of Compensation Analysis and Support
 

National Institute for Occupational Safety and Health
 

Centers for Disease Control and Prevention
 

Cincinnati, Ohio
 

MEMBERSHIP
 

ANDERSON, Henry A., M.D.
 

Chief Medical Officer
 

Occupational and Environmental Health
 

Wisconsin Division of Public Health
 

Madison, Wisconsin 

ANDRADE, Antonio, Ph.D.
 

Group Leader 

Radiation Protection Services Group
 

Los Alamos National Laboratory
 

Los Alamos, New Mexico
 

DeHART, Roy Lynch, M.D., M.P.H. 

Director
 

The Vanderbilt Center for Occupational and Environmental
 

Medicine
 

Professor of Medicine
 

Nashville, Tennessee
 

ESPINOSA, Richard Lee 

Sheet Metal Workers Union Local #49
 Johnson Controls
 Los Alamos National Laboratory
 Espanola, New Mexico
 
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GIBSON, Michael H.
 

President
 

Paper, Allied-Industrial, Chemical, and Energy Union
 

Local 5-4200
 

Miamisburg, Ohio
 

GRIFFON, Mark A.
 

President
 

Creative Pollution Solutions, Inc. 

Salem, New Hampshire
 

MELIUS, James Malcom, M.D., Ph.D.
 

Director
 

New York State Laborers' Health and Safety Trust Fund
 

Albany, New York
 

MUNN, Wanda I. 

Senior Nuclear Engineer (Retired)
 

Richland, Washington
 

PRESLEY, Robert W. 

Special Projects Engineer
 

BWXT Y12 National Security Complex
 

Clinton, Tennessee
 

ROESSLER, Genevieve S., Ph.D.
 

Professor Emeritus
 

University of Florida 

Elysian, Minnesota
 

AGENDA SPEAKERS
 

Mr. David Sundin, NIOSH
 

Mr. Peter Turcic, DOL
 

Dr. Jim Neton, NIOSH
 

Mr. Mark Griffon, Workgroup Chair
 

STAFF/VENDORS
 

CORI HOMER, Committee Management Specialist, NIOSH
 STEVEN RAY GREEN, Certified Merit Court Reporter
 
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AUDIENCE PARTICIPANTS
 

STEVEN AHRENHOLZ
 

JOHN ALEXANDER
 

EULA BINGHAM
 

DENISE BROCK
 

HELEN BUELIN
 

JULIA DEHART
 

JOHN DEMENT
 

LOU DOLL
 

JAMES EAST
 

RUSS HENSHAW
 

LIZ HOMOKI-TITUS
 

R. DELON HULL
 

JUDSON KENOYER
 

DAVID KOCHER
 

JEFF KOTSCH
 

MICHELE R. LANDIS
 

JAY MAISLER
 

PAULA MCCREARY
 

RICHARD MILLER
 

JOHN S. MORAWETZ
 

DAVID NAIMON
 

STEVE POWELL
 

LOUISE S. PRESLEY
 

HARRY RICHARDSON
 

D.M. SCHAEFFER
 

MARY SCHUBAUER-BERIGEN
 

BOB TABOR
 

RICHARD TOOHEY
 

BRANT ULSH
 

DAVID UTTERBACK
 
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P R O C E E D I N G S
 

(1:00 p.m.)
 

REGISTRATION AND WELCOME
 

DR. ZIEMER: Good morning, everyone. Now let
 

me call the meeting to order. This is the 17th
 

meeting of the Advisory Board on Radiation and
 

Worker Health meeting here in Cincinnati. I'm
 

Paul Ziemer, Chair of the Board. The Board
 

members are here at the table, with the exception
 

of Leon, who apparently will not be able to
 

attend today, but the other members here are
 

assembled. And for those who are visiting or are
 

members of the public, the names of the Board
 

members -- as you've already discovered -- are on
 

the placards in front of them so I will not
 

introduce them individually at this time.
 

We do welcome members of the public and ask
 

that if you wish to address the Board at the
 

designated time during this meeting that you
 

register in the book that's in the rear to let us
 

know of your intentions to make a public
 

statement.
 

We also ask that all here attending -- Board
 

members, staff and members of the public --

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please register your attendance, as well, in the
 

other registration book that's back on the table.
 

Also as is our custom, we have a number of
 

handouts, items -- some of which are on the
 

agenda, some of which are from previous meetings. 

I believe they're all on the table in the back,
 

is my understanding, so you can peruse that table
 

at your leisure and pick up those items that are
 

of interest to you.
 

At this time then I'll call on Larry Elliott
 

to make further comments and perhaps an official
 

welcome to Cincinnati.
 

MR. ELLIOTT: Good afternoon, everyone. Good
 

to see all the Board members back here in
 

Cincinnati. Meeting 17 -- my, we've covered a
 

lot of ground and done a lot of work, and we
 

certainly all appreciate -- at NIOSH we all
 

appreciate your labors and efforts.
 

I'd like to also welcome the public, and
 

we're looking forward to a productive day-and-ahalf meeting.
 

Some of the Advisory Board members attended a
 

training session this morning in the NIOSH Taft
 

Laboratory offices, working in our database
 

tracking system, getting an understanding of
 

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that. And the rest of the Advisory Board will
 

finish up the same type of training on Wednesday
 

morning, and then I believe everybody will have
 

had a chance to benefit from that experience.
 

So we're -- again, we're glad you're here. 

We're looking forward to a day and a half
 

together. And if there's anything that we can
 

help you with or get for you or provide during
 

your stay, don't hesitate to ask. Thanks.
 

DR. ZIEMER: Thank you. I did fail to
 

mention that this new mike system, you do have to
 

push the on/off button, and perhaps you're aware
 

of that, but just a reminder to all the Board
 

members as you're preparing to speak.
 

Now we have in our packet a couple of sets of
 

minutes -- minutes -- actually three sets,
 

minutes of meeting 14, 15 and 16. Now I need to
 

determine whether or not the Board members are in
 

fact ready to act upon these minutes. The Chair
 

has gone through them carefully -- and actually
 

I've done a lot of editing on them before they
 

have come to you, so they are about one-half the
 

length they originally were. You may think as
 

you read them that I have removed all of your
 

pertinent comments, but in fact we refer you to
 

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the transcript if you want details on some items. 

But nevertheless, you have three sets of minutes. 

It's not obvious to me at this point whether or
 

not you've actually had these in your hands long
 

enough to review them.
 

If the Board wishes, we can defer action till
 

tomorrow, but let me ask that question first. 

Are you ready to act on any or all of these
 

minutes? Or are there any who wish to defer if
 

you've not had a chance, those that perhaps just
 

flew in today?
 

Mark Griffon?
 

MR. GRIFFON: Yeah, I'd like to defer.
 

DR. ZIEMER: You'd like to defer?
 

MR. GRIFFON: I just got them this morning,
 

so...
 

DR. ZIEMER: Is there any objection to
 

deferring the formal adoption of the minutes
 

until our working session tomorrow?
 

(No responses)
 

There appears to be no objection, so without
 

objection the Chair will rule that we will defer
 

action on these minutes until our working session
 

tomorrow. Now that's with the understanding that
 

everyone then will read them carefully this
 

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evening and be prepared for action. Thank you.
 

Incidentally, on the minutes, let me add this
 

point, that if you have minor typographicals, you
 

can simply pass those along to Cori. We're
 

looking, in terms of adoption of the minutes, for
 

significant changes in content or meaning as
 

opposed to minor editorials.
 

Let us then move on to the next item on the
 

agenda, which is our regular program status
 

report. Dave Sundin is I believe on the agenda
 

for that. Dave? Please.
 

PROGRAM STATUS REPORT
 

MR. SUNDIN: Can you hear me all right? 

Well, thanks, Dr. Ziemer, and I'll second Larry's
 

welcome again to -- back to Cincinnati for I
 

think the 14th face-to-face but 17th full Board
 

meeting -- so who's counting?
 

I'll be presenting a brief overview of the
 

program status and I'll follow the basic approach
 

I've used in previous Board meetings. I'm
 

beginning to wonder if maybe the format is being
 

outstripped by the capabilities of our web site
 

because as I returned from leave this week I
 

realized that what I had put together before
 

going on leave was already out of date. So I'll
 

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try and point out where I was able to discover
 

any significant changes in the numbers off of our
 

web site this morning, but again, the web is
 

certainly a very good way to keep current with
 

many aspects of our program.
 

Well, the Department of Labor has transferred
 

over 13,000 cases to NIOSH for dose
 

reconstruction since we began operations in --

way back in October, 2001. You can see the
 

breakdown by years. And as you're probably well
 

familiar by now, we're continuing to contact each
 

and every claimant involved in a case which comes
 

over to us, and also their authorized
 

representatives, if any. We send an introductory
 

letter, fact sheet, brochure on what dose
 

reconstruction means, and a refrigerator magnet
 

with contact information.
 

We also, of course -- and we think this is
 

important -- identify a specific name of a public
 

health advisor that's going to represent their
 

interests which our case -- while their case is
 

with us for dose reconstruction, and that's
 

really the primary point of contact for the
 

claimant to get personal information on the
 

status of their claim.
 

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We also introduce ORAU in this introductory
 

letter. We explain ORAU's role in the process,
 

and we provide the ORAU toll-free number as an
 

additional point of contact for them to use.
 

Recently with our office move we began
 

sending out -- have started, and maybe finished
 

by now -- sending out a letter, an update letter,
 

giving out our new telephone contact information
 

in our new office spaces.
 

After we make that initial contact of course,
 

we log the case into our computer system. We're
 

still scanning each and every document we receive
 

as a -- along with creating and maintaining a
 

paper filing system. And I will say that our
 

data management systems continue to serve us very
 

well in this program. They're quite key to our
 

ability to pull up a case quickly, to access it
 

from remote locations throughout our contractor
 

staff. And we do have a good crew of ITC
 

specialists that are continually tweaking the
 

system to provide us with technical solutions to
 

problems that we -- or challenges that we
 

confront in managing our end of the process more
 

efficiently.
 

As you can see, the percentage of cases that
 

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involve AWE employees has stayed relatively
 

constant over time, 14 to 16 percent.
 

I tried to make this chart a little more eyefriendly than last time by showing -- this shows
 

the trend in cases received from DOL, and this
 

includes of course all four District Offices that
 

submit cases to us, so I broke it down by quarter
 

instead of month. And the number of cases peaked
 

at around 2,800, I guess -- slightly more than
 

2,800 in the fourth quarter of last fiscal year
 

and has trended generally downward since then. 

Of course, again, as you know by now, each case
 

file lists the verified covered sites where the
 

Energy employees worked that the DOL has
 

verified, and then we use that information to
 

direct our requests for radiation exposure
 

information to the appropriate DOE points of
 

contact. And in many places the employee worked
 

at several sites, and so we may need to direct
 

our requests to several points of contact. We
 

try and issue those requests within two weeks of
 

getting the referral from DOL.
 

Give you a little update with where we are
 

with requesting and receiving information from
 

our DOE points of contact. We've sent out more
 

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than 13,000 requests. This number also tends to
 

change fairly rapidly on our web site. Those
 

13,000 requests actually represent a smaller
 

number of cases, representing about 11,700-

something by now cases. And of course the reason
 

for that is that certain people worked at more
 

than one site. We've received approximately
 

17,000 responses, and that's more than the number
 

of requests we've sent. The most apparent reason
 

and most common reason that we get more responses
 

than requests is that certain DOE sites in
 

particular send us several responses to our
 

initial request. They will respond separately
 

with the X-ray information, for example, from the
 

RADCON information or the exposure information. 

Some sites I believe also -- we get separate
 

requests from subcontractors that they then send
 

us separately, so that accounts for that
 

difference there. But the responses received
 

represent 9,600 cases, and not all of those cases
 

have a complete set of responses back, so we're
 

not necessarily ready to go forward on that
 

number.
 

About 12 percent of our requests are more
 

than 60 days outstanding, and we do highlight
 

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that information to our DOE points of contact in
 

periodic e-mail updates. And it looked to me
 

when I got back that one had another update -- or
 

request -- or a status update had been sent out
 

to the DOE points of contact last week.
 

This table profiles how many requests for
 

personal exposure information we're waiting on
 

from the -- or how our requests are going really
 

for the big eight DOE offices, and how many
 

responses we've currently received. Both ORAU
 

and NIOSH are really continuing to work fairly
 

closely with DOE's Office of Worker Advocacy and
 

certainly very closely with each designated point
 

of contact at the site to make sure that we're
 

getting precisely the kind of exposure
 

information we need to go forward with those
 

reconstructions.
 

The telephone interview which is offered to
 

each claimant to permit them to add information
 

which may be relevant to reconstructing their
 

radiation dose is depicted here. ORAU has made
 

significant progress in completing telephone
 

interviews and there are now more than 6,000 for
 

which at least one interview has been completed. 

That's updated as of this morning.
 

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We've conducted also several secure
 

interviews using appropriately cleared
 

interviewers in a secured location to address
 

concerns that have been raised by the claimants.
 

Of course this has all run up to the punch
 

line, I guess, because all of our work at NIOSH
 

and ORAU is directed to getting a final dose
 

reconstruction report back in DOL's hands. And I
 

am happy to be able to report to you that the
 

number of completed dose reconstructions being
 

sent back to DOL for final adjudication is
 

continuing to increase steadily. There've been -

- there's currently nearly 12,000 cases -- or
 

1,200 cases currently assigned to a health
 

physicist for dose reconstruction. Draft dose
 

reconstruction reports are in the hands of 127
 

claimants. And as of this morning, 350 of them
 

have been approved by the claimants and returned
 

as final dose reconstructions to DOL. And of
 

course that includes the complete administrative
 

record, in addition to the dose reconstruction
 

report.
 

I believe that when I last spoke to you -- to
 

the full Board in Oak Ridge, the bottom number
 

was 73, so we've made some progress since that
 

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meeting. We clearly recognize that this is what
 

people's eyes are focused on, including our own,
 

and it continues to rise. But of course everyone
 

wants us to rise as quickly as we can and still
 

do our job.
 

Really, site profiles are key to our ability
 

to complete significant numbers of dose
 

reconstructions, and ORAU's assembled teams to
 

develop these documents for all the major DOE and
 

AWE sites. As you're aware, the Bethlehem Steel
 

site profile's been approved. The Savannah River
 

Site document has also recently been approved. 

Dr. Neton will provide you with more details on
 

technical basis documents and site profiles
 

tomorrow.
 

Claimants continue to phone us and contact us
 

by letter and e-mail, as we want them to be able
 

to do. The number of phone calls received in
 

OCAS has increased substantially each quarter,
 

although I believe it's actually leveled out this
 

last quarter. We're currently receiving about 80
 

calls a day -- in OCAS, anyway -- so we've
 

responded to over 40,000 calls since October. 

ORAU is also now receiving and initiating a
 

substantial number of calls, many of which are of
 

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course related to the interview process.
 

Our web site continues we think to be
 

valuable, not only to claimants, but to the
 

general public. And we field a fair number of
 

claimant e-mails to our OCAS in-box -- over 1,900
 

actually e-mails have been received since the
 

program got started. And we do try to respond to
 

each of those in a timely manner.
 

So just to wrap it up, I'd like to draw your
 

attention to some recent developments and
 

accomplishments which I think are worth noting. 

DOE has asked that we appoint additional
 

physicians to the physician panels to evaluate
 

claims under Subtitle D, and we recently
 

transmitted a list of 44 additional physicians to
 

DOE, which brought the total number of physicians
 

that we've appointed to 123. And we've had a
 

number of discussions with DOE about their need
 

for additional physicians to serve on the panels,
 

and last week we initiated yet another call for
 

nominations of interested and qualified
 

physicians. So we'll soon be evaluating
 

additional applications from people who are
 

interested in being considered for those panels.
 

We're also interested in assisting DOE in any
 

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way we can in identifying any process
 

improvements that may make the physician panels
 

operate more efficiently.
 

As I mentioned, the site profile teams have
 

been staffed up and are developing data. You'll
 

hear more about ORAU activities, including the
 

current version of the negotiated production
 

goals, from Dr. Toohey tomorrow, I believe.
 

A draft of the Residual Contamination Final
 

Report, and this covers DOE, AWE and beryllium
 

vendor facilities, has been prepared and it's
 

undergoing review.
 

And finally, all of the OCAS staff is -- in
 

Cincinnati, anyway -- is currently -- has
 

recently moved into one building, the Taft
 

Laboratory, which some of you have already been
 

to, of course. And I think I speak for more
 

than just myself when I say that we're all glad
 

to be located in offices that are more proximate
 

to each other than we were previously -- and
 

certainly in many cases, nicer than what we were
 

in before. And we're looking forward to the
 

improvements in our processes that we believe
 

this will bring, so I hope you have a chance --

those of you that can -- to visit our new
 

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environment during either this visit or any
 

future visits you might have to Cincinnati.
 

So that concludes my prepared report. If you
 

have questions, I'd be happy to try and answer
 

them.
 

DR. ZIEMER: Thank you very much, David. Let
 

me start the questioning by asking, on the
 

physician panels has there been a sort of an
 

upper limit number identified, either by NIOSH or
 

DOE? The number seems to be growing. Where will
 

the cap be?
 

MR. SUNDIN: DOE has requested up to 500
 

physicians. Now our response to that was we did
 

not believe that we could identify 500 physicians
 

that possess the qualifications that we were
 

looking for. And I think during subsequent
 

discussions with DOE, it became clearer that it
 

was pretty early in the process to be sort of
 

working out capacity calculations based on the
 

relatively small number of start-up claims that
 

these newly-formed panels had seen. So I don't
 

think we've really arrived at a consensus with
 

DOE about the total number, but we did hear that
 

figure sort of expressed by DOE at one point.
 

DR. ZIEMER: Jim has a question.
 

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DR. MELIUS: Yeah, a few questions. One,
 

back to the issue of receiving exposure records
 

from the Department of Energy. If I recall right
 

from the last time you spoke that the main
 

problem sites were the -- I thought were the two
 

I's, Iowa and Idaho, though I don't think Iowa's
 

one you mentioned in -- discussion. Can you -- I
 

notice that Idaho still seems to be a problem and
 

I don't know what the status is of Iowa.
 

MR. SUNDIN: Well, Iowa's a little bit of a
 

different site. Amarillo actually handles some
 

of the Iowa cases that went to Pantex.
 

DR. MELIUS: Uh-huh.
 

MR. SUNDIN: But Iowa itself, we've been
 

working hard to get an appropriate contact point
 

that has authority to turn the records over to
 

us, and DOE's been helpful in that process. But
 

it turns out that the Department of Defense
 

actually is now in a position to provide us
 

records, so I don't know that they've begun to
 

flow, but it looks like we've I believe removed
 

some of the obstacles to obtaining those records
 

that we were hearing about by just contacting the
 

Burlington site.
 

DR. MELIUS: 'Cause what I recall, there were
 

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a significant number of cases --

MR. SUNDIN: Yeah, it's not -- it wouldn't
 

be, I don't --

DR. MELIUS: -- some hundreds, but --

MR. SUNDIN: -- think it would be sufficient
 

to get them on this list. I don't know, it's
 

around 500 probably, though.
 

DR. MELIUS: Okay. 

MR. SUNDIN: Yeah. 

DR. MELIUS: Do that. And then Idaho, what's 

the -- 'cause that still seems to be a fairly
 

large number of case-- of requests that are half
 

a year or whatever.
 

MR. SUNDIN: Yeah, the problem there was the
 

need to index a rather large volume of records in
 

a way that would permit them to retrieve records,
 

so they've been spending a fair amount of time
 

doing the basic indexing that apparently was not
 

done at the time, so -- I've not sat in on any
 

recent discussions with Iowa's -- or I mean INEEL
 

folks, so I don't know how that's actually coming
 

along. But once that's done, then the responses
 

should start flowing to us, so -- go fairly
 

smoothly.
 

DR. MELIUS: Okay. That -- if I understand
 

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your numbers right, the backlog is still
 

continuing to climb of cases -- at least in -- if
 

measured by completion --

MR. SUNDIN: Sure.
 

DR. MELIUS: -- the case -- cases going. And
 

my understanding also is that DOL is -- even
 

though the number of cases coming into DOL are
 

down, there are certainly efforts on the part of
 

DOL to encourage more people that are eligible to
 

file, to file, so --

MR. SUNDIN: Sure.
 

DR. MELIUS: -- I'm not sure we expect the
 

down -- cases to continue to decrease, given the
 

long history and the potential backlog. Is there
 

some sense of -- and maybe this is more
 

appropriate for later presentation, I'm not sure
 

how you're set up today, but when do you expect
 

to be at least, you know, decreasing the backlog? 

Right now you're not, I don't think, even keeping
 

up with what's coming in, and it's -- and what
 

sort of measures do you have, other than
 

completed cases, to say that you are catching up
 

with that? I don't remember the numbers from
 

last time for the number of interviews done or
 

number of dose reconstructions assigned, and I
 

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don't know if that's a meaningful statistic in
 

terms of measuring progress internally. So do
 

you have some indicators that would say now we're
 

getting -- going to get caught up with the
 

backlog or catching up or we're going to get
 

ahead of that?
 

MR. SUNDIN: Uh-huh. I didn't try and build
 

that into my presentation because we are going to
 

hear from Dr. Toohey about I think pretty much
 

the topic you're asking --

DR. MELIUS: Okay.
 

MR. SUNDIN: -- that is, the plans to reduce
 

the backlog. I will say, though, that the
 

numbers that precede the final completed dose
 

reconstruction have been -- if you go back and
 

compare, there's quite a bit of improvement
 

there. They're not the final answer, obviously,
 

but they are a necessary step to get done. So
 

things are lining up. I know you've probably
 

heard this for several Board meetings, but
 

certainly there are more and more cases that are
 

headed toward final dose reconstruction.
 

DR. MELIUS: Uh-huh.
 

MR. SUNDIN: Technical basis documents are
 

very, very key here, too.
 

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DR. MELIUS: Yeah, I think I -- yeah, we
 

talked about this last time, but I think it would
 

be useful, both internally and as well as for the
 

Board, to have some indicators of that that could
 

be presented, other than final cases.
 

My final question is -- and again, this may
 

be deferred until Jim Neton's presentation, but
 

I'm a little bit confused by what your strategy -

- overall strategy is to deal with the backlog,
 

not process-wise, but in terms of how you're
 

going to triage that backlog. Is it going to --

for this first group, you've -- really, the large
 

number of -- high proportion of these first 300
 

or so cases have been really from one site and
 

based -- based on a -- you know, a -- essentially
 

a site profile, a dose reconstruction for that
 

site. Are you planning to go through them by
 

site now, based on site profiles? Is it going to
 

be first come/first served, just based on who --

who applied? I just don't see what the strategy
 

is. Or is it some mix of that in order to deal
 

with these numbers and do it?
 

MR. SUNDIN: It is a mix of that, and I think
 

you are going to get the kind of specific
 

information you're asking for tomorrow.
 

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DR. MELIUS: Okay.
 

MR. SUNDIN: It's not -- it's not site-bysite, exactly. It's -- I guess my quick sort of
 

overview of the process of sequencing things is
 

we'd like to do the greatest good for the
 

greatest number of people in the quickest amount
 

of time, so we may not have a perfect strategy to
 

do all of those things at once, but it's not --

you know, it's intended to develop the sites
 

where the larger numbers of claimants come from,
 

where the data seems to be good enough to do that
 

so that we get the kind of output that everybody
 

wants.
 

DR. MELIUS: Uh-huh.
 

MR. SUNDIN: But I believe there's a couple
 

of discussions, at lea-- well, at least one
 

discussion tomorrow which will give you a lot
 

more detail on that.
 

DR. MELIUS: Well, I just -- one comment is
 

that that -- if you only do the high-number sites
 

and the ones that are easiest to do -- not that
 

any of them are easy -- then what happens to the
 

people that are at a low-profile site that end up
 

applying, you know, two years ago or whatever,
 

and -- you know.
 

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MR. SUNDIN: Right. Well, it is a mixed
 

strategy, and it is an attempt at doing the best
 

things. But there are specific focuses of
 

activity on precisely the kind of people that --

that might be forgotten under a strictly large
 

site-oriented approach, and there are specific
 

teams working that angle.
 

DR. MELIUS: Okay. I'll hold off until we 

hear. Okay. 

DR. ZIEMER: Thank you. Wanda Munn is next, 

and then Roy. Okay?
 

MS. MUNN: I would just wonder where can the
 

Board see the specific requirements that DOE has
 

identified for the physicians it wants?
 

MR. SUNDIN: Actually, the rule lays out very
 

minimal I think, if any, requirements on
 

qualification of physicians. It's NIOSH's role
 

to determine what qualifications we believe would
 

equip a physician to operate on a physician
 

panel. We've sent that -- it's styled as an
 

announcement on the physician panels, which --

and it contains a segment in there, evaluation
 

criteria or words to that effect. It's been sent
 

out to the two major occupational medicine
 

societies. It's also on at least one list or --

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which a lot of occ. physicians visit. We've sent
 

it to anybody that we think might be in a
 

position to either nominate other colleagues or
 

submit a nomination themselves. I don't know
 

that it's up on our web site, though. It's --

MS. MUNN: I wouldn't think it would need to
 

be. I was just wondering where we might find it.
 

MR. SUNDIN: I can certainly bring a copy of
 

that to you later today or tomorrow.
 

MS. MUNN: I'd appreciate that. Thank you.
 

MR. ELLIOTT: We can get it to all the Board
 

members. We can send that to you.
 

MS. MUNN: Thank you.
 

DR. ZIEMER: Roy?
 

DR. DEHART: Thank you. Dave, on the
 

telephone interviews, it's a voluntary activity
 

on the part of the claimant.
 

MR. SUNDIN: Yes.
 

DR. ZIEMER: Are you having any denials? Is
 

it significant at all? Refusals?
 

MR. SUNDIN: Some. I haven't been tracking
 

that number as a specific item, but in talking to
 

the ORAU people that are doing the interviews,
 

they've described a few denials, but not very
 

many.
 

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DR. DEHART: Okay. So it's not really
 

impacting the program as far as --

MR. SUNDIN: No. 

DR. ZIEMER: -- you can judge. 

MR. SUNDIN: Not -- not in my judgment, no. 

DR. DEHART: I believe it was in Oak Ridge 

that an optimistic goal for dose reconstruction
 

was going to be 6,000 at the end of the year. Is
 

that still an optimistic goal?
 

MR. SUNDIN: It is an overly-optimistic goal,
 

I think.
 

DR. DEHART: Perhaps tomorrow when we're
 

talking more specifically --

MR. SUNDIN: Right.
 

DR. DEHART: -- we could get a new estimate.
 

MR. SUNDIN: Yes. I think that's the -- the
 

plan is to have that information presented to you
 

tomorrow.
 

DR. DEHART: We had talked a couple of
 

meetings ago about the program for the physician
 

panel, and it was talked about possibly having a
 

briefing on that so that the Board could
 

understand better what we're talking about in
 

terms of this number.
 

You have mentioned the number of physicians
 

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who have been selected or identified to the
 

panel, but does that include the ones who have
 

withdrawn?
 

MR. SUNDIN: It does include the ones who
 

have withdrawn, so in fact there are fewer than
 

123 physicians that are currently available to
 

work. But we've asked DOE for a current roster
 

of those physicians that have no withdrawn, and
 

also a listing of those that have received cases. 

And a little bit better understanding at our end
 

is to -- what we should be looking for, what
 

their process really entails, so I cannot tell
 

you exactly how many have withdrawn. DOE
 

mentioned that they'd had a handful of physicians
 

withdraw, but I did not get the sense that it was
 

a large number.
 

DR. DEHART: Okay. Thank you.
 

DR. ZIEMER: Mark?
 

MR. GRIFFON: And just a quick follow-up on
 

the interviews, I'm wondering if you did any
 

aggregate analysis of the interviews, the phone
 

interviews. You have a lot of them now
 

completed. Is there any attempt underway to do
 

any aggregate analysis for that, possibly to feed
 

into this worker profile database that's being
 

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developed? Or is that even a -- on the radar? I
 

don't know.
 

MR. SUNDIN: I'm not -- I don't believe we
 

have any plans for aggregate -- are you talking
 

about the content of the interviews or --

MR. GRIFFON: Yeah.
 

MR. SUNDIN: -- the sort of overall
 

performance?
 

MR. GRIFFON: No, the content of the
 

interviews. I imagine -- I don't recall the form
 

itself, but I know it did have lists of isotopes
 

and areas where people worked and --

MR. SUNDIN: Yeah.
 

MR. GRIFFON: -- I thought then there may be
 

some usefulness to doing some sort of aggregate
 

analysis of that data, but I don't know if
 

that's...
 

MR. SUNDIN: I don't believe we've pushed
 

that one down the road much at all. I mean there
 

is a place where coworkers can be identified, and
 

then of course we go follow up there, but that's
 

not quite the -- what you're talking about. It's
 

building a profile.
 

MR. GRIFFON: Yeah, right. Okay.
 

DR. ZIEMER: Rich Espinosa.
 

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MR. ESPINOSA: On the backlog of -- the
 

backlog of dose reconstructions, what's the --

how is ORAU taking care of that? What's their
 

plan?
 

MR. SUNDIN: Well, I believe the second day
 

of the agenda has a specific presentation by Dr.
 

Toohey, so I -- which includes -- which I believe
 

will be covered during that session. Yeah.
 

DR. ZIEMER: Rich, are you okay deferring
 

that answer till tomorrow?
 

MR. ESPINOSA: Yeah, I just didn't see it on
 

the agenda.
 

DR. ZIEMER: Okay. Thank you. Did you have
 

another question then, Rich? No. Okay. Then
 

back to Jim.
 

DR. MELIUS: At the last meeting some
 

discussion about the issue of some sort of
 

interim communication to the claimants about the
 

status of their claims or why the -- was delayed. 

Now you said -- you men-- you sent out a
 

notification about the office being moved. Did
 

that include any information on their claims or
 

do you have plans to do some sort of update for
 

the claimants?
 

MR. SUNDIN: No, we didn't include a broader
 

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communication piece in that update to our contact
 

information. We wanted to get that out to them
 

as quickly as we could so that they could contact
 

us when they wanted to. We have been having
 

internal discussions involving health
 

communication specialists about how to craft --

what the message should be and how to craft it in
 

a way that's going to be most useful to the
 

claimant. So the plan is still live, but we've
 

not yet put together the communication piece that
 

we believe will work.
 

DR. ZIEMER: Thank you. Rich, I didn't see
 

what -- did you put your sign by up or were --

no. Okay. Okay, Jim is back.
 

DR. MELIUS: One other question. Staffing,
 

where do you stand in terms of filling your
 

positions and staffing.
 

MR. SUNDIN: I think we've got only one or
 

two vacancies left -- four. Four, Larry says. I
 

tell you, it's amazing what a week away from the
 

office will do to your brain.
 

Rough numbers, between 40 and 45 OCAS staff
 

now.
 

DR. ZIEMER: Are there any further questions
 

then at this time?
 

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(No responses)
 

Apparently not. I thank you very much,
 

David, for that update.
 

I'm going to suggest that if Jim -- if Jim's
 

in the room, that we go ahead with the next item
 

before the break, which is the status of the
 

procurement. It's not a long item. We're a
 

little ahead of schedule. Jim Neton?
 

MR. ELLIOTT: You've got an old one.
 

DR. ZIEMER: Oh --

MR. ELLIOTT: You've got to go by the book;
 

you've got an old one there. Pete Turcic from
 

DOL. DOL's going to do it.
 

DR. ZIEMER: Dave, you think it's bad when
 

you're out of the office. I've been on vacation,
 

too, and I'm looking at my old agenda. So what's
 

on the agenda here?
 

MR. ELLIOTT: Pete Turcic from DOL.
 

DR. ZIEMER: This is Cincinnati. Right?
 

DR. MELIUS: We were beginning to think
 

you're out to lunch, not to vacation.
 

DR. ZIEMER: Thank you. Okay. Peter, wasn't
 

meaning to overlook you. Thank you.
 

DOL PROGRAM STATUS REPORT
 

MR. TURCIC: Okay. It's a pleasure to be
 

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here this afternoon and to give you an update on
 

where the Department of Labor is on their aspects
 

of administering the EEOICPA.
 

We believe that we have established a
 

credible program, along with NIOSH and DOE, and
 

we've made payments in all facets of the program
 

now. We've made payments for beryllium, for SEC
 

cancer and non-SEC cancer and also silicosis. 

We've forged good working relationships with
 

NIOSH, Department of Justice, DOE, Social
 

Security Administration, the contractors and the
 

labor unions, and we try to build on that as time
 

goes on. And we've paid out, as of last week, in
 

-- over $628 million in compensation benefits.
 

And we've completed initial processing -- and
 

by initial processing, we call that either
 

referral to NIOSH -- because we've made a
 

decision that it was a covered illness with a
 

covered employment -- or recommended a decision. 

And we've processed -- we've issued initial
 

decisions in a little bit over 90 percent of the
 

claims -- the -- in excess of 45,000 claims that
 

we have received since the beginning of the
 

program.
 

As far as administration of the program, we
 

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have about 300 full-time equivalents working on
 

the program at this time. And that does not
 

count the contractor staff that we have working
 

in the outreach areas.
 

The number and types of claims that we've
 

received to date, again, we've received over
 

45,000 claims, and we're anticipating receiving
 

another 15,000 to 20,000 through this year. Of
 

those, as you can see, the vast majority are
 

cancer.
 

Beryllium sensitivity and beryllium account
 

for about 4,000. One point there is that our
 

claims from beryllium vendors or subcontractors
 

of beryllium vendors have dropped off to almost
 

nothing. You know, I think we've received maybe
 

40 claims from beryllium vendors, so we're going
 

to be doing a lot of focusing this year on
 

outreach efforts and try to get to, you know,
 

some of these pockets of claimants that we have
 

not heard from. And RECA and in other, about
 

22,000 claims.
 

And that's just a breakdown showing the total
 

claims and the types of -- as you can see, vast
 

majority are cancer and other. The breakdown has
 

been holding pretty steady now, with about 57
 

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percent of our claims coming from survivors as
 

opposed to employees.
 

And the status of our cases, the current
 

cases, we have -- we've referred 13,700 for dose
 

reconstruction. We currently have a little bit
 

over 1,800 that are pending a final decision. 

That means that there's been a recommended
 

decision and we're either waiting or in the
 

process of writing a final decision, waiting to
 

see if the claimant either objects to the
 

decision and asks for a hearing or a review of
 

the written record or waives their objections.
 

Final decisions in almost 18,000 cases, and
 

we're currently processing -- our working
 

inventory seems to be hanging around 4,000 cases. 

That would be the time period, you know, from the
 

time the case is filed until we get a initial
 

decision.
 

And again, the -- by far, our denials. Most
 

of our denials are still for non-covered
 

conditions, and these are just some of the major
 

ones. And this has been holding pretty steady --

other lung conditions, other heart failure, no
 

condition reported. That seems to have climbed a
 

lot recently where we're getting a number of
 

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claims where -- mostly from facilities that
 

people think are either going to be closed soon
 

or a contractor change or whatever, and a lot of
 

people, when they're retiring, they're just
 

filing a claim. And a lot of them are no covered
 

conditions, so we want to do some outreach in
 

that area to try to get the word out that there
 

is no statute of limitations. People don't have
 

to do that. They're not buying their place in --

you know, setting a place in time, so...
 

Of the final decisions, again, not -- nearly
 

9,500 to approve, 12,500 to deny. Again, most
 

common reason for denying is non-covered
 

condition.
 

The recommended decisions, again, 9,700 for
 

approvals, 14,600 for denials, over 13,000 in for
 

dose reconstruction. We made 8,500 payments in
 

excess of $628 million and we've paid about --

over $14 million in medical benefits -- and
 

that's starting to really increase now that
 

people are starting to have their bills paid by
 

us, their medical bills, as opposed to some other
 

insurance.
 

And the breakdown on denials of the final
 

decisions, again -- they're the ones that approve
 

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of the denials. As you can see, of the 12,500
 

denials, over 8,000 are for non-covered
 

conditions. And everything else, you know, drops
 

down substantially beyond that. And that just
 

shows about 57 percent of the final decisions are
 

being denied at this point in time.
 

One of the things that we track in our goals
 

that we've -- performance goals that we've
 

established for our District Offices is we've set
 

-- we have two different time frames for reaching
 

that initial decision. One for cases that
 

involve an AWE, a beryllium vendor or a DOE
 

subcontractor, which our goal there is 180 days
 

to have 75 percent of the cases completed within
 

180 days, initial decision. And then 120 days
 

for those that are for a -- from a DOE facility.
 

To show what we've done this year, because
 

what we did was we focused early on this fiscal
 

year to eliminate -- and our goal was to
 

eliminate our backlog, so we have completely
 

eliminated any backlog of cases and we're now
 

basically working on a working inventory. As you
 

can see, the average time for the first quarter
 

when we were getting that first group that, you
 

know -- we had 18,000 claims, you know, on July
 

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31st. Once we worked through all that, the first
 

quarter of this year our average time was about
 

242 days. Went down in the second quarter down
 

to 212, and now we're operating and getting an
 

initial decision in about 142 days.
 

For DOE facilities, again, very similar. 

Started out 176 days. We're down to in about 64
 

days. You know, if we get a employment
 

verification and -- on the average, we are
 

getting that case either to NIOSH or a
 

recommended decision within about 64 days on the
 

average.
 

And the status of the claims, again, the case
 

is returned from NIOSH -- and these are slightly
 

different than the numbers because this is
 

anything that comes back, for whatever reason. 

We start out with 293 -- and the time frames
 

could be different, too -- had completed dose
 

reconstructions and 162 dose reconstruction was
 

not required. That could have been like a CLL
 

case or some other issue. Or maybe we found out
 

that it wasn't ready to go to NIOSH, we found
 

more employment or, in several cases, we got
 

information back from National Cancer Institute
 

that something that originally we weren't calling
 

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one of the specified cancers are now considered a
 

specified cancer.
 

Recommended decisions, we have -- or
 

acceptances in 115 of those and 147 are denials,
 

recommended denials; and final decisions, 100 to
 

accept and -- what was that -- and 38 to deny.
 

Our plans -- I guess I shouldn't have put
 

that number up, but -- the plans to complete the
 

approximately 4,000 dose reconstructions that
 

ORAU is projecting that they will complete this
 

year, our goal and what we hold our districts to
 

is that we want to have -- we give them on the
 

average of 21 days in order to have -- once we
 

receive a dose reconstruction back from NIOSH, to
 

have a recommended decision. And then the time
 

from that would be the same, you know, depending
 

on if it was -- you know, if the claimant is
 

asking for a review of the record or a hearing,
 

then that -- actually that time can change
 

significantly.
 

And we have committed and have come up with a
 

plan where we will shift cases. I mean because
 

of the way they're going to come back, they're
 

going to come back in large numbers from a
 

certain facility, so like for example, when
 

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Savannah River -- a big in-rush of Savannah River
 

cases hit our Jacksonville office, what we have
 

done, we have paired up each of our District
 

Offices. If we get an overload, we will move
 

cases for a recommended decision -- to do the
 

probability of causation, write the recommended
 

decision and, you know, share it between two
 

District Offices, and then the case would go back
 

and be administered in the original District
 

Office. So that will be seamless to the -- you
 

know, to the claimant.
 

Just to give you some idea of some of the --

you know, in the Cleveland area, our Cleveland
 

District Office, here are the major -- the major
 

sites that our Cleveland District Office handles. 

As you can see, the area that it -- the
 

geographic area that it covers, it's most-- you
 

know, mostly AWEs and beryllium vendors for the
 

Cleveland office. And again, these are just a
 

number of -- the percentage, the worker
 

population and the percentage of claims. As you
 

can see, they're very low from this in the
 

Cleveland District Office.
 

The work sites in Ohio, the status -- total
 

claims, 3,400 and 1,000 for dose reconstruction,
 

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with about 1,500 recommended decisions and 1,300
 

final decisions. And we've paid about $105
 

million in the state of Ohio. And the case load
 

from Ohio, again, about 95 cases are waiting a
 

final decision and there's about 968 that are
 

under process from the state of Ohio. And the
 

types of claims are pretty consistent again. You
 

know, over 2,300 are cancer, vast majority are
 

the cancer claims. Chronic beryllium disease,
 

here -- you know, in Ohio we have a significant
 

amount. The lion's share of the beryllium cases
 

are out of the Cleveland District Office.
 

DR. ZIEMER: All right. Thank you. Thank
 

you very much, Peter. Our first question will
 

come from Dr. Roessler.
 

DR. ROESSLER: I think just for the record,
 

let's go back to your second slide. I think you
 

have a very large mistake on it --

DR. ZIEMER: A million million?
 

DR. ROESSLER: Yeah. I think that should be
 

corrected. You've paid out a little over $628
 

million --

MR. TURCIC: Million.
 

DR. ROESSLER: -- but not million million.
 

MR. TURCIC: Yeah.
 

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DR. ROESSLER: Yeah.
 

MR. TURCIC: All right. Thank you.
 

DR. ZIEMER: Roy DeHart.
 

DR. DEHART: Thank you. When you were
 

discussing beryllium sensitivity --

MR. TURCIC: Uh-huh.
 

DR. DEHART: -- if I'm correct, that does not
 

pay out any -- any bonus or pay or -- it only
 

implies that there will be ongoing medical
 

evaluations.
 

MR. TURCIC: That's correct.
 

DR. DEHART: Is that correct?
 

MR. TURCIC: That's correct.
 

DR. ZIEMER: Jim, you have a question?
 

DR. MELIUS: Yeah, I believe when Shelby
 

spoke to us at the last -- I think it was at the
 

last meeting -- in Oak Ridge, he mentioned that
 

the amount being paid out for medical
 

reimbursement's been relatively small and that
 

you were trying to take steps to encourage that,
 

as well as sort of clarify this issue about noncovered conditions and so forth. Can you speak a
 

little bit about your outreach on those types of
 

issues, what you're doing?
 

MR. TURCIC: Yeah, we just had one area that
 

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we were having a big problem with that was up in
 

Alaska and we were just up in Alaska and we found
 

that some of the problem was with the pharmacies. 

Pharmacies didn't want to take our card and so
 

we've been doing some outreach there. In fact,
 

we'll be back up there at the end of the month
 

meeting with the medical providers and trying to
 

get more of them signed up.
 

The other things that we have done is that
 

we'll go into an area and we recently did one in
 

Paducah, Kentucky with the union, the -- and in
 

an effort to try to get more people, more
 

claimants, to have their bills billed to us. 

That was a -- that's a big issue. So we're --

we've also done a mailing to everyone who is
 

entitled to medical benefits and put together a
 

packet so that -- of information with cards in it
 

so they can pull it out and have a handy way of
 

access to our -- our medical provid-- billpaying, phone numbers and assistance.
 

DR. ZIEMER: Roy DeHart again.
 

DR. DEHART: A follow-up question on that. 

What fee structure are you using to reimburse
 

providers and the pharmacy? Are you using
 

Medicare or some other kind of --

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MR. TURCIC: We're -- we're way above
 

Medicare. We're significantly above Medicare.
 

DR. DEHART: Not hard to do.
 

MR. TURCIC: We have -- pardon me?
 

DR. DEHART: Not hard to do.
 

MR. TURCIC: Yeah. What we do is eventually
 

we'll have the system programmed so that we'll be
 

able to do regional fee schedule. Right now we
 

do a national cap. And I believe the cap is set
 

on somewhere in California, so it's pretty high
 

in a lot of areas. So that -- the fee schedule
 

is -- we've -- we're way above Medicare and most
 

other insurance companies.
 

DR. DEHART: So I gather you're moving toward
 

a usual and customary.
 

MR. TURCIC: Yeah -- well, it is a usual and
 

customary, but it's based on a -- it's based on
 

the fee schedule from California.
 

DR. DEHART: Yes, okay. I'm familiar with
 

that -- you're probably going to be able to get
 

some providers that way. Thank you.
 

MR. TURCIC: Yeah.
 

DR. ZIEMER: Additional questions or
 

comments?
 

(No responses)
 

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Thank you very much, Peter. Appreciate the
 

update.
 

Now perhaps we could go ahead with Jim Neton,
 

if Jim is here. We're still ahead of schedule. 

Jim, are you here?
 

DR. NETON: My and Mark's presentations sort
 

of go together, though. I don't know if it might
 

be --

DR. ZIEMER: Okay.
 

(Whereupon, Dr. Neton and Mr. Griffon
 

discussed the order of their presentations with
 

Dr. Ziemer, off the record.)
 

DR. ZIEMER: The Chair will rule that it's
 

time for a break, and so -- but we will confine
 

the break again to -- we'll let it go 20 minutes. 

How does that sound? 'Cause they do have to do a
 

little discussion during the break. So 20-minute
 

break and then we'll reconvene. Thank you.
 

(Whereupon, a recess was taken.)
 

DR. ZIEMER: We're going to call the meeting
 

back to order. As you know, the Board has been
 

searching for a contractor to assist in the
 

review process -- that is, the audit, as it were
 

-- of dose reconstructions. And Jim Neton is
 

going to report on the status of that
 

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procurement, and then we'll follow that with a
 

discussion on the task order development. Okay? 

Jim.
 

STATUS OF PROCUREMENT
 

DR. NETON: Okay. Thank you, Dr. Ziemer. 

I'd like to preface my remarks by saying I can
 

only discuss this to the extent the procurement
 

regulations allow, so if I seem -- appear to be
 

sketchy, that's because that's what the Federal
 

Acquisitions Regulations require.
 

I am happy to report that we did receive more
 

than one proposal for the task order contract, so
 

that allowed us to move forward for an
 

evaluation. We assembled a technical evaluation
 

panel. That panel has met twice by
 

teleconference to do the technical evaluation and
 

scoring of the proposals that we received. Based
 

on that scoring, we established -- with input
 

from our Pittsburgh grants office -- a
 

competitive range. And the proposals that made
 

the competitive range we went forward with and
 

did a request for a past-performance evaluation. 

So we're at the past-performance evaluation
 

stage.
 

I just got off the phone with our secretaries
 

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over at the Taft Building and we have received
 

the past-performance evaluations for the
 

proposals that remain in the competitive range,
 

so they're being FedExed to the technical
 

evaluation panel members this afternoon.
 

We can review those past-performance
 

proposals, and once we do that, re-evaluate or
 

re-establish the competitive range for the
 

proposals. And at the same time, we're shipping
 

out the cost proposals and we will then review
 

the cost proposals and make our recommendation to
 

procurement as to our selection based on
 

technical merit.
 

We establish a score based on technical
 

merit, and then we put feedback in on the cost
 

proposals to procurement. So we're at that
 

stage.
 

We should be able to wrap this -- well, it's
 

possible this could be wrapped up fairly quickly
 

if we do not enter negotiations, either singular
 

or multiple, with vendors. So we're very close. 

It could be within a matter of -- we may be able
 

to meet or original projected time line, which is
 

by the end of this fiscal year. So that's where
 

we're at.
 

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If there's any questions, I can answer them
 

at this time. Otherwise, I think Mark is
 

prepared to talk about the fleshing-out of the
 

task orders.
 

DR. ZIEMER: Any questions?
 

(No responses)
 

Okay. Thank you, Jim, for that status
 

report. Then Mark, if you'll proceed then with
 

the task order development. And there is a
 

handout. It's been sent around the table. There
 

are copies for the public's -- perhaps on the
 

table by now. It's a single-sheet Power Point 

handout. 

(Pause) 

DOSE RECONSTRUCTION WORKGROUP AND BOARD DISCUSSION TO
 

DEVELOP TASK ORDER
 

MR. GRIFFON: Get my refresher training on
 

the system here. You'll notice that I -- I tend
 

to use the black and white overheads 'cause I
 

usually develop these on the plane ride out here,
 

so no fancy colors with this.
 

This is just a status report on where our
 

working group is. The tasks -- we developed
 

draft procedures for the review process, and
 

that's how we're going to go forward with the
 

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individual case reviews. And you may not
 

remember this, but we had a procedure -- on the
 

next slide I'll go through some of what that
 

procedure contained -- on how we were going to go
 

forward with the individual case reviews. 

Actually Cori's making copies right now for the
 

Board and we're going to give that out as
 

homework here. I'd really like to get comments
 

from the Board tomorrow on that procedure, you
 

know, so mark it up -- read through it tonight,
 

and if you can, mark it up. Now that we know a
 

little more of how this is going forward, I think
 

we'll probably be modifying that a little bit.
 

The second thing was the procedure for the
 

selection process, and I sort of separated those
 

out, review versus the selection. And if you
 

remember, last meeting I brought up Excel
 

spreadsheet, which was a little busy as an
 

overhead, I must admit. But it was the way we're
 

going to sort of matrix how we were going to
 

select cases -- by site, by cancer type, by
 

radiation type, et cetera -- and how we were sort
 

of going to fill in these boxes as we went along,
 

depending on what cases were in the hopper, what
 

cases were completed, and going through the whole
 

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process that would drive how we were going to
 

fill this matrix in, with the ultimate goal of
 

around two and a half percent of the overall
 

cases we were going to do -- we were going to
 

review about two and a half percent of the
 

overall cases.
 

And then the last thing was develop
 

individual task orders, and I think these were at
 

the back table, as well as handed out to the
 

Board members. When you first came in you
 

probably noticed those few pages. And we had
 

drafted these at the last meeting and we got some
 

feedback and reformatting from NIOSH on these. 

And the hope is that we'll get these tasks
 

completed prior -- or right around when the
 

contract is awarded so we can get the tasks out
 

right away to the contractor or contractors to
 

bid on.
 

And the two tasks right now that we have are
 

individual dose reconstruction review, basic and
 

advanced; and the methods review, the procedures
 

review. Okay?
 

So this is that first -- the procedure for
 

the dose reconstruction review process, some of
 

what it contains. We have a section on how we're
 

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going to select cases in there, how we're going
 

to designate Board members for the review, and
 

the distribution of the data, interaction between
 

the contractors and the Board, the report
 

generation -- if you're a member, we also had
 

some draft reports; three different levels, the
 

individual reports, the summary reports and then
 

the Board report to HHS. We talked about three
 

different sort of levels of reporting. And then
 

the Board recommendations to NIOSH regarding
 

individual cases and also aggregate -- you know,
 

do we have general findings from what we've
 

reviewed.
 

And then the case selection procedure, we
 

just briefly had our working group meet over the
 

break. We're going to reconvene tomorrow
 

morning. I've -- I've started to structure
 

another procedure on this along -- to go along
 

with that matrix that I -- that I put up at last
 

meeting and -- just to have some language on --

and some of the things we want to consider in
 

this are the case availability. I think that --

obviously we've got to understand a little bit
 

about how NIOSH is -- is proceeding so we know
 

what cases might be coming avail-- you know,
 

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coming up. We're not going to review cases until
 

they're completed, and so we have to look at case
 

availability.
 

The case selection criteria we're going to
 

outline in the -- in this procedure, as well;
 

sampling strategy. The case assignment process,
 

I think we have to -- you know, there's some
 

logistics involved here. There's also a question
 

about the Advisory Board's conflicts of interest,
 

so we have to figure out first of all who wants
 

to work on different cases and then who can work
 

on certain cases, so -- and then -- and how they
 

will work with the contractor.
 

And then the tracking process, and again,
 

some things to think about here are, you know,
 

who's going to do the tracking? Are we going to
 

have an established subcommittee or working
 

group? Will NIOSH do the tracking for the Board? 

You know, how is that going to work? And also
 

along with this, defining the scope of the -- of
 

the individual task. That might actually be
 

misplaced a little, but I'll come up to this
 

point again. The idea here is that as -- as
 

these tasks are released to the contractor,
 

they're going to come back with a proposed scope
 

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of work. And the question here is is the Board's
 

responsibilities versus NIOSH's responsibilities. 

NIOSH is the contractor. We as a Board I think
 

want to control it to some extent, the scope of
 

work. Maybe not the financials of the contract,
 

but at least the scope of what the contractor
 

will be doing. So we have to figure out how --

where those lines of responsibility lie.
 

Okay. And this --

DR. ZIEMER: Mark, let me interrupt a minute. 

Might I ask if the -- if the Board members have
 

questions as you proceed --

MR. GRIFFON: Sure.
 

DR. ZIEMER: -- would you like them to raise
 

them at that point rather than wait till the end?
 

MR. GRIFFON: That's fine, yeah. Yeah. 

DR. ZIEMER: Then let me ask --

MR. GRIFFON: That means you have a question. 

DR. ZIEMER: -- a question. On the tracking 

process --

MR. GRIFFON: Yeah. 

DR. ZIEMER: -- is there any reason why the 

Board's contractor wouldn't do the tracking that
 

you're talking about versus NIOSH itself? What's
 

-- we're just tracking the cases that the Board
 

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is reviewing here. Right? Is that what you're -

-

MR. GRIFFON: We're tracking the cases that
 

we're reviewing, but also we're tracking them
 

against the matrix that we've established up
 

front. So say we wanted to do 30 Savannah River
 

cases overall, but we also wanted certain other
 

criteria to be met. So you know, as we fill in
 

those blanks -- and we may not do all 30 Savannah
 

River cases, you know, up front, so -- you know,
 

it's tracking sort of what we've done versus what
 

were -- our goal is. And I guess the contractor
 

could be tasked with that responsibility, too,
 

yeah -- yeah, so...
 

So this is the task orders, as I -- I think I
 

mentioned this already, that two of the task
 

orders have been drafted, the methods review and
 

the individual dose reconstruction review task
 

orders. A lot of the language was lifted right
 

from the original contract that we -- the
 

proposal that we let out. The one that I think
 

we need to -- and we're going to work on more
 

tomorrow morning with out working group is the
 

site profile task. And that -- right now we have
 

sort of very broad language about what we mean by
 

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site profile review, and I think we need to finetune some of that. We're going to work on that
 

and try to get at least a rough draft to the full
 

Board tomorrow morning on that.
 

Like the commitments I'm making for us? 

Good.
 

Discussion items. Some of these were at our
 

last meeting, too, and I think we touched on some
 

of them. But I think we certainly haven't
 

resolved all of them.
 

The Board and the contractor access to data,
 

and by this I mean, you know, NIOSH data as well
 

as possibly other data -- DOE data. There are
 

some questions that have been raised in previous
 

meetings about Privacy Act issues, whether we can
 

get this data on CDs, so I think we -- we need to
 

explore that and -- you know, this was also kind
 

of a question for NIOSH, if there was an update
 

on that, on those questions.
 

The Board and the contractor access to site
 

personnel and/or NIOSH staff. And site
 

personnel, I mean DOE or -- primarily DOE site
 

personnel and NIOSH staff that worked on either
 

the site profile or on the individual dose
 

reconstructions, whether they can go back to
 

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59 

those resources and talk to them about
 

assumptions, et cetera, in the cases.
 

This one had a lot of discussion in the early
 

going. We dropped this from our original
 

proposal, but the Board and contractor access to
 

claimants for follow-up. And I think we really
 

need to -- we said after we put the contract out
 

we'd bring this up again, and I think we need to
 

discuss it more, whether the Board feels it's
 

necessary to do follow-up with the claimants
 

about their phone interviews and the issues
 

surrounding that question, I guess I think we
 

need to discuss as a Board. And also the -- what
 

would it take to allow the Board to do that. So
 

that one I think we need to -- further discussion
 

on that.
 

And then the Board recommendations from
 

individual case review reports and summary
 

reports. This really is the -- I think this goes
 

into that -- some of those draft reports we
 

discussed. How do we communicate this to NIOSH,
 

to HHS, for the aggregate findings as well as for
 

individual case findings. I think when we're
 

talking about individual case findings, it's more
 

of a case where it would have made a difference
 

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between a favorable claim versus unfavorable
 

claim.
 

And then establish a process for the Board to
 

review contractor's response to individual tasks. 

That's what I -- what I raised a few minutes ago,
 

the question of -- maybe not very clearly stated
 

there, but the question of who -- or where the
 

lines of responsibility for defining -- or
 

refining the scope that the contractor agrees to
 

do under a certain task, so -- so if they bid on
 

the methods and procedures review but their
 

language -- some might feel is broader than was
 

in the original proposal, how do we refin-- you
 

know, who has the responsibility of refining that
 

language and making sure it's -- you know, and
 

where is the line. I know that NIOSH is the
 

primary contractor, but I think that we on the
 

Board have a interest in making sure we keep the
 

technical scope appropriate.
 

And I think that's it.
 

DR. ZIEMER: Okay. Thanks, Mark. Let me ask
 

if other members of the subgroup want to add
 

anything or... Yes, Roy?
 

DR. DEHART: It's not really an add, but
 

Mark, do you have any feel about when we're going
 

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to have -- have to have this information specific
 

so that when the bids are complete and everything
 

is done, when we're going to get this forwarded
 

to the contractor and start this kind of review?
 

DR. ZIEMER: Jim Neton can give us an
 

estimate of when we might be ready with a con--

the earliest date we could have a contract in
 

hand sort of thing.
 

DR. NETON: Boy, I wish Martha -- Martha
 

DiMuzio were here, she could probably answer that
 

better than I. But if all goes and we don't end
 

up going through negotiations with the contractor
 

-- I mean we review the past-performance
 

proposals and the pricing -- cost proposals and
 

we just select a vendor, I mean that could happen
 

in a matter of a week or two. Matter of fact, I
 

think our responses are requested back by next
 

Monday to the contracts. So I don't know. I
 

can't speak for them how long it would take them
 

to process and get an award out the door, but I
 

would think it would be a matter of several weeks
 

after that. And upon award of the contract, I
 

see no reason why we couldn't issue a task order,
 

particularly if it's --

MR. GRIFFON: So you're talking --

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DR. NETON: -- going to be very soon.
 

MR. GRIFFON: -- maybe early October or --

DR. NETON: Yeah, I would think early
 

October. And Larry, you might have a better
 

sense, but I would see -- it's possible. I can't
 

promise that.
 

MR. GRIFFON: Yeah, and that's why -- I think
 

we have two tasks sort of in rough draft form, if
 

folks can look at those tonight, as well, and
 

give some feedback on that. I have already got
 

some comments from NIOSH. I'm going to take
 

those comments into account -- modify it a little
 

bit and bring a new draft tomorrow as well on
 

those, and those are covering the individual,
 

basic and advanced reviews, as well as the
 

methods and procedures review, something to get
 

started on. I think I really want to get a rough
 

draft of the site profile review task out, as
 

well, so --

DR. ZIEMER: Larry has an additional comment
 

here.
 

MR. ELLIOTT: I think that October is a good
 

date for you to target your efforts toward. I
 

fully expect that the contract will be awarded by
 

then. That's what we're all striving for.
 

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I think also that as you think about
 

developing these tasks you should add a task for
 

their contractor to do the tracking, the
 

monitoring assignment. That's not something
 

NIOSH should do nor wants to do. We have plenty
 

of work of our own. We could certainly help, but
 

I don't want to take that on. And I think it's
 

best if your contractor does that for you, but
 

that would have to be done under a task.
 

The other thing I need some clarification on
 

in my own mind is -- you were talking just before
 

your concluding remarks about this defining the
 

scope issue. I'm lost on that. The scope of
 

work is defined in the award. Are you talking
 

about scope within the task?
 

MR. GRIFFON: Yes. 

MR. ELLIOTT: Okay. That helps me understand 

then. Okay. 

MR. GRIFFON: I'm sorry. 

MR. ELLIOTT: 'Cause you mentioned something 

about some proposals seemed to be broad or
 

overly-broad beyond maybe what you're thinking of
 

in a task scope, I guess.
 

MR. GRIFFON: No, no, no. No, no, no, I said
 

-- I said if -- if a proposal to a task was
 

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broader than we thought the task entailed -- in
 

other words, the contractor went beyond --

MR. ELLIOTT: Okay, I understand. To talk
 

process here, the contract's awarded let's say
 

first of October. You're going to need to think
 

about having a meeting with your contractor to
 

present your tasks. And then it -- usually the
 

way this business is done, you give the
 

contractor two weeks to prepare a proposal
 

against that task. You evaluate the proposal,
 

and then there's -- if there's any negotiating
 

that needs to be done at that point, you do it
 

and you refine either the task or the --

typically what's refined is the proposal against
 

the task, not the task itself.
 

MR. GRIFFON: Right.
 

MR. ELLIOTT: So you refine the proposal to
 

where you want it to be.
 

MR. GRIFFON: That's what I meant. Probably
 

not very well-stated, but that's what I meant.
 

MR. ELLIOTT: You're in the driver's seat on
 

that, not NIOSH. That's this Board. So as you
 

think about the process, you're going to have to
 

think about the timing. You're going to have to
 

think about whether you can do this without the
 

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full Board. And we're going to have to think
 

along with you about whether or not some of this
 

needs to be done in closed session. So there's a
 

lot of work to be done in preparing the -- just
 

to issue these tasks in a final form.
 

MR. GRIFFON: Right.
 

MR. ELLIOTT: So -- and we're here and we're
 

glad to help you do that. But I just -- I want
 

you to all think in that -- those kind of
 

frameworks.
 

DR. ZIEMER: Thank you for that
 

clarification. And along those lines, we may
 

need in fact to get opinion of counsel on the
 

extent to which this Board can delegate some of
 

those activities to a working group, for example
 

-- for example, to do an evaluation or to sit
 

down with a contractor or whether in fact that
 

needs to be the whole Board in open session or in
 

executive session.
 

MR. GRIFFON: Right.
 

DR. ZIEMER: And I don't know if this is
 

something that we might ask legal counsel to take
 

a look at, at least give us an early heads-up on
 

what might be coming in that regard. Okay?
 

Anything else at this point, Mark? You're
 

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going to have a distribution for tonight's
 

homework assignment, is that what we understood?
 

MR. GRIFFON: That's right. That's right.
 

DR. ZIEMER: Or does everybody have a copy
 

right now?
 

MR. GRIFFON: I mean I don't know if now is
 

the time, but I think we need a discussion on the
 

question as to whether to re-interview, to have
 

the Board or the contractor get access to the
 

claimants.
 

DR. ZIEMER: I'm -- let me give an early
 

answer to that, and this is not so much an answer
 

as an idea that -- I'm wondering if we would have
 

a better feel for whether or not -- well, before
 

we get into an extensive debate on this, 'cause
 

we had extensive debate before on that issue. 

When we get into the review process, it might
 

become evident one way or the other whether or
 

not such interviews would in fact be needed or
 

helpful. We may find that -- from the
 

established record and other documentation that
 

such interviews would not be required or would be
 

very important, depending on what we find. So
 

I'm not sure that we necessarily need to reach
 

conclusion on that right now. Is there any
 

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reason we need to come to closure on that at this
 

point? 'Cause it could be handled in a task at
 

some point later. Jim?
 

DR. MELIUS: If I recall right, and this goes
 

back several months when we first had some
 

discussion of this issue, I think we deferred it
 

a little bit until we were -- those of us who had
 

not seen the database system and had not seen the
 

records had had an opportunity to look at them. 

Now some of us had our training this morning, a
 

number of others are having -- that's certainly
 

one of the things I spent some time looking at
 

was trying to get a handle was based on the
 

interview record that's available in the NIOSH
 

database, which is a summary document of the
 

interview -- electronic summary. To what extent
 

is that -- is that an adequate document for -- to
 

do a -- you know, a dose review. And I think for
 

the other group that's having a -- their training
 

on Wednesday morning, I think that's something
 

they should also look at 'cause I think -- I
 

don't think we -- I'm very hesitant to wait until
 

we get part-way through the review process
 

because I would be -- I think it would put NIOSH
 

and everyone in a bad position to have a partial
 

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review from the Board. The Board -- the dose
 

reconstructions are fine, but we have questions
 

about the adequacy of our review because we
 

didn't -- weren't able to re-interview and now we
 

need to re-interview. I think to the extent that
 

if we can deal with the issue before we start the
 

review process, I think it would be better for
 

everyone -- for the process itself and for the
 

credibility of our review, rather than having
 

something that we've reviewed it and -- but we
 

still need to go back and look at this. Now --

now our review is never going to be complete, you
 

know, because there's going to be more cases to
 

review and -- as the program goes on. But at the
 

same time I think to the extent that we can we
 

ought to try to make the process as complete and
 

comprehensive as possible up front. Then if we
 

have to modify it later, fine. But I -- I would
 

hesitate on just deferring until we're several
 

months into the review process and then making a
 

decision like that.
 

I think we also have to remember that if we
 

are to add a follow-up -- some sort of follow-up
 

interview or contact with the claimants, that's
 

going to have to go to OMB for approval. There's
 

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a fair amount of bureaucracy and paperwork to do
 

that and a fair amount of time. So we're talking
 

about something that, you know, realistically is
 

going to take some months to do, even -- once
 

we've agreed on what should be done and how to
 

complete it. So I think -- be another reason to
 

try to, if we can, come to some conclusion on
 

that as soon as possible.
 

DR. ZIEMER: Any other comments on that
 

issue? Mark?
 

MR. GRIFFON: And just the other reason for
 

considering it up front instead of waiting is
 

that at several meetings now we've heard concerns
 

about these phone interviews from -- from
 

claimants or representatives of claimants. And -

- you know, so I think if we're hearing from the
 

public that they're concerned that the interview
 

didn't capture everything that they -- and I know
 

they have opportunity to respond and correct the
 

record, but we've certainly heard that on
 

testimony a number of times, so I -- you know, I
 

don't know that we really need to wait. And the
 

other concern would be the delay on getting it
 

through the system, the bureaucracy, to get it --

even approval to do it, so...
 

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DR. ZIEMER: Any other comments, either on
 

that issue or related matters? Jim?
 

DR. MELIUS: I'm just thinking in terms of
 

how we're going to work and work through this
 

process, and even more than about the interview
 

process, I'm concerned that we've got to really
 

sort of -- lot of issues left out there in terms
 

of how we're going to proceed in terms of
 

developing a procedure and a schedule for doing
 

this. And I don't know what the plans are for in
 

terms of further discussions, but to the extent
 

that the work group can try to figure out some of
 

these legal issues and procurement issues and
 

figure out what needs to be done and, you know,
 

what we need to do in terms of subcommittees
 

meeting and so forth, I think it's -- we need to
 

accomplish as much of that as possible by the end
 

of our meeting tomorrow. And I don't know if
 

NIOSH counsel's available to meet or speak about
 

some of these issues or what we need to do in
 

terms of procurement, but seems to me if we
 

don't, either we have to -- if we don't get a
 

good process set up and understood, that we could
 

end up either having to meet as a Board every
 

other week for a while or we're going to have to,
 

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you know -- this is going to get stretched out
 

for a very long time, which I don't think serves
 

the process well.
 

DR. ZIEMER: Other comments? Wanda?
 

MS. MUNN: I continue to be concerned over
 

the concept of re-interviews, especially by this
 

Board or some portion of this Board, as being
 

some kind of next-step -- some kind of appeal
 

process, which I believe we've all agreed -- I
 

think we agreed that that was not going to be the
 

case at all. I'm very concerned that as we move
 

down this pathway, it is very clear that this is
 

not an appeal process and that it is in fact a
 

quality assurance process for reviews that have
 

been done, that are selected in a random way, not
 

because of any additional appeal or any
 

additional action on the part of the claimant. 

Whether such clarification needs to be very
 

clearly spelled out in the statement of work is
 

another issue to me, but as we proceed down this
 

path, I would hope that all the members of the
 

Board would keep that aspect of what we're doing
 

here very clearly in mind, because it's a major
 

concern to me. How things are observed from the
 

claimant point of view is key, I think, here.
 

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DR. ZIEMER: Thank you. Other comments? Gen
 

Roessler.
 

DR. ROESSLER: Are you reopening discussion
 

of whether it should be done or shouldn't be
 

done, or what point are we at on this?
 

DR. ZIEMER: We have no formal motion, but
 

the proposal from the working group included the
 

idea that that item needs to be visited and
 

discussed at some point in the future. As I
 

understand it, Jim is suggesting that perhaps
 

that should come later, perhaps as soon as
 

tomorrow -- if I interpreted that correctly. I
 

mean I don't want to misinterpret, but I thought
 

I heard that.
 

In any event, I think right now we're simply
 

discussing this as a general idea and how that
 

fits in the framework of the task order. So --

and this might be helpful to the working group as
 

they go back and revise things for our perusal
 

tomorrow.
 

Jim, you --

DR. MELIUS: Yeah, just let me clarify. My
 

belief is our first priority ought to be to get
 

this process underway and figure out how we're
 

going to get a schedule set up, what needs to be
 

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done in terms of legal procurement issues, how do
 

we move forward as a Board to develop and approve
 

these task orders and get them out to the --

whatever contract is chosen.
 

I think as a second priority, I think we need
 

to deal with this interview issue, and I was as
 

much reacting to Paul's comment that maybe we
 

should wait until we've already gone through --

done some of the reviews and then decide whether
 

we need to do -- to add interviews with the
 

claimants to the process. And I just was
 

remarking that I thought it should be one -- we
 

should at least try to deal with that issue up
 

front. But I think it's really a -- to me, it is
 

a second priority in terms of the getting this
 

process underway and if we can get to it
 

tomorrow, fine. If we can't, we can't. But I
 

think we really need to get the -- figure out the
 

schedule and how this whole process is going to
 

work.
 

DR. ZIEMER: Okay, thank you for that
 

clarification. And I might add in terms of the
 

interviews, as I see it, if we were to proceed in
 

some manner, either sooner or later on that, it
 

would have to be in the framework of spelling out
 

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what the audit is going to ask for in regard to
 

evaluating interviews. If we have a procedure
 

that spells out for us how we will go about
 

evaluating the quality of the interviews, that
 

might lead us itself to determining whether or
 

not follow-up is needed.
 

I think I expressed before -- at least I
 

think I did -- that we have to be very careful
 

that we are auditing and not doing the work of
 

NIOSH or ORAU. If there is reason to believe
 

that the audits are inade-- or the interviews are
 

inadequate, and perhaps that would emerge from an
 

audit, then in my view it's NIOSH's duty to go
 

back and correct that issue, which might include
 

on their part re-interviewing. I mean I think of
 

analogies as to how auditors -- with the
 

exception of Andersen, perhaps -- audit books. 

And they make recommendations, but they don't go
 

back and do the work of the organization. So
 

somewhere there's a fine line in what we will get
 

from that, yeah.
 

Go ahead, Mark, please respond. I'm talking
 

off the top of my head a bit here, so --

MR. GRIFFON: I don't want to regenerate all
 

the discussion -- we've had discussions on this
 

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before. But I think, you know, part of my notion
 

also is that to -- if you just look at -- if you
 

-- in the final form, you're not necessarily
 

going to see everything that an interviewee
 

brought up. And something that they thought was
 

very significant, the interviewer may not have
 

captured. And then we also in the past have
 

raised the question of if the interviewer didn't
 

have site-specific knowledge, they may have
 

missed something that could have been very
 

relevant. And so therefore re-interviewing a --

and we're talking about -- from the audit
 

standpoint, we're talking about not reinterviewing everyone. We're talking about reinterviewing a small percentage to determine if
 

in fact the form did capture all the relevant
 

information. And we're having -- you know, you
 

also have to -- I mean I do understand that --

you know, even though the form didn't capture
 

every word a person said on the phone, it doesn't
 

mean that it's not a quality final product, so
 

we're asking the audit contractor to work with us
 

and do a sampling of that and say okay, well,
 

yes, it didn't capture every word they said, but
 

it captured all the relevant information. It
 

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looks like they did a fine job on, you know, 95
 

percent of them or whatever. So that's what I
 

was thinking.
 

DR. ZIEMER: Yeah. Tony.
 

DR. ANDRADE: Thank you. I guess perhaps a
 

senior moment here, but I'm trying to recall
 

whether we were really talking about a quality
 

improvement process, which is an extremely
 

important issue to clarify right now, and then
 

also address the question of the types of -- that
 

the kind of re-interview or approach to asking
 

about an interview that has taken place -- what
 

sort of results we expect to get and what sort of
 

metrics we would have for success, so two things.
 

One, if we are dealing only with cases in
 

which -- that have been closed, adjudicated and
 

settled, then we're not going to -- we are
 

indeed, by definition, not going to go back and
 

open them up again or re-interview, as it were. 

In other words, if we find that interviews are
 

considered inadequate in general, then that
 

should be clearly stated up front and that will
 

be a quality improvement process for NIOSH-OCAS
 

to deal with. That's number one. So I need to
 

get that clarification from Mark or somebody else
 

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77 

now.
 

Number two is if indeed we're looking at
 

cases that have been closed, then they've either
 

been adjudicated positively or negatively. And
 

so I can already anticipate the result. Those
 

that have been paid out or positively adjudicated
 

were probably going to get -- or the staff is
 

going to get high marks, and there may be
 

contentious issues with those for which
 

compensation was denied. Therefore, if you're
 

going to start thinking process, then I think in
 

parallel you'd better start thinking about these
 

human issues that you're going to deal with.
 

So I'd like a response to my first one at
 

least.
 

DR. ZIEMER: Thank you. Larry is prepared to
 

respond in part.
 

MR. ELLIOTT: I'll respond to your first
 

com-- question. The Board will only review and
 

its contractor will only review adjudicated
 

claims, those that have been -- a final decision
 

has been proffered, they're not in appeal,
 

they're done. You won't be looking at cases that
 

a recommended decision's been proffered but
 

they're not finally adjudicated. You won't be
 

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looking at appeal cases. You look at those that
 

are finally adjudicated only.
 

DR. ZIEMER: Right. And Gen?
 

DR. ROESSLER: The reason I asked if we were
 

still discussing was I wanted to bring up pretty
 

much what Tony has brought up. I can't picture
 

this being an unbiased process. When it's final,
 

if the claim has been denied, there's going to be
 

a -- very much of a bias toward -- whether they
 

think there's an appeal or not, toward a
 

criticism of the process. If the award has been
 

made, that person I think is just going to want
 

to just say it's done; I don't have any comments. 

I don't know if that's -- I think that may be a
 

bias, too. So I can't really see and I guess I'd
 

like to be convinced of this because I can see
 

some of the motivation for wanting to evaluate
 

it. But I can't see much but down sides to it.
 

DR. ZIEMER: Jim?
 

DR. MELIUS: Yeah. I think as we've
 

discussed this before, my understanding is this
 

is not a consumer satisfaction survey that's
 

being done, so we're not going to ask questions
 

of, you know, was the interviewer nice to you,
 

you know, polite and were you happy with the
 

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79 

results. It's -- I think the issue is whether
 

obtaining additional information from the
 

claimant would have some effect or potential
 

effect on the case. Was there additional
 

information that was relevant to the dose
 

reconstruction to be obtained. And that that
 

would have to be -- the relevancy of that
 

information would be assessed. So yes, would
 

there be a claimant that would say, you know,
 

some information wasn't considered. There may be
 

even claimants that did get compensated, may be
 

confused about why they got compensated, so it's
 

not an easy process necessarily to understand,
 

particularly for people -- worked a multiple
 

sites or multiple cancers and so forth. So --

but I don't see this being done as a way of
 

measuring consumer satisfaction. It's really is
 

there relevant information that was -- or
 

different information or whatever that was -- be
 

relevant to the claim and would have changed the
 

way the dose reconstruction would have done in
 

either direction. It may not be necessarily to
 

find higher doses or whatever.
 

DR. ZIEMER: Thank you. Tony?
 

DR. ANDRADE: Thank you. I don't see it as a
 

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consumer satis-- if we go through with this
 

process and it's approved and we put it into
 

place, I don't see it ever being a consumer
 

satisfaction interview or re-interview, either. 

But I just can't help but feel that the
 

mechanisms that are in place today -- that is, a
 

quality check and the transcript check by the
 

interviewee of the sorts of -- well, okay, the
 

information, the information that was tracked and
 

that was actually written down, okay, is one
 

pretty good indicator to the interviewee as to
 

whether information was -- important information
 

was captured or not. And again, I'm shifting
 

over from just being completely factual to now
 

the more human side of this. Somebody who's been
 

denied is going to -- we're going to have to be
 

extremely careful in dealing with somebody who's
 

been denied a claim, whether the person was a
 

petitioner or was a survivor. There are going to
 

be strong sensitivities, strong emotions and --

let's put it this way. I wouldn't be the
 

contractor to bid on doing that kind of work.
 

DR. ZIEMER: Let me suggest again to the work
 

group that they give further thought to
 

developing the criteria for which the interviews
 

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will in fact be evaluated. I think that'll be
 

helpful to us. What are the measures that will
 

be used to initially -- assuming you had the
 

power to do interviews, how are you going to, as
 

a starting point, evaluate the material that's in
 

the file. And if you were -- had the power to
 

interview, how would you decide which ones you
 

would do? Is it all of them that are being
 

reviewed or are there certain criteria that would
 

trigger to say we -- there's something here that
 

triggers us to think that either something was
 

omitted or left out or what. I'm trying to get a
 

feel for some sort of standard operating
 

procedures by which we would evaluate to start
 

with and then go from there. Jim, can you add --

DR. MELIUS: Well, no, I just want to clarify
 

back to our original discussion, and I don't
 

think this has changed. There is no transcript
 

or recording of the interview, so that can't be
 

referred to. All we have is the report from the
 

interviewer. There's no routine process for
 

going back and doing quality control on the
 

interview process itself, as might be done, you
 

know, in other types of studies or whatever,
 

interview studies and so forth. So you know,
 

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82 

what we have is only from basically one person
 

interviewing. The only sort of quality control
 

or whatever you want to call it is the fact that
 

the record of the interview is sent to the
 

interviewee for review and comment and they can
 

send it back. So that's the one quality controls
 

check. I think -- and that's the process we're
 

being asked to look at. Were some of these other
 

things in place, were there transcripts of it,
 

that might very well change how we would want to
 

go about doing our quality control, quality
 

assurance that we're mandated to do.
 

DR. ZIEMER: I guess what I would be -- and I
 

understand those points. I guess what I would be
 

looking for, you know, as a starting point, the
 

claimant at some point agrees that -- either
 

agrees or disagrees that the trans-- not
 

transcript, the summary captures the information. 

I would be -- if it were me -- looking for some
 

evidence that the claimant finally agreed to that
 

out of frustration rather than well, you know, I
 

can't get this claim going unless I finally sign
 

this thing, or something like that, as opposed to
 

everybody agreeing that the information has been
 

captured. I mean if the claimant is agreeing
 

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that the interview has captured the information,
 

then -- then it becomes a matter of do we have
 

other information that the claimant didn't know
 

about in any event, which might -- which might
 

very well be. There might have been something
 

occur on that site, maybe it's in the site
 

profile, that the claimant knows nothing about,
 

and that's not a deficiency in the interview
 

process, per se. So again, that's why I'm trying
 

to get a feel for how we go about, as a starting
 

point, evaluating interviews. It seems to me we
 

can't just arbitrarily say that -- well, maybe we
 

can -- that they are faulty because there's no
 

transcript. I'm not willing to say that as an a
 

priori condition if the claimant is willing to
 

say that the content has been captured. So I
 

would more be looking for some evidence that the
 

claimant is sort of browbeat into that position
 

or enters it out of frustration or some other
 

factor. So help me out.
 

DR. MELIUS: Well, I don't think that's
 

necessarily what we're looking for evidence of. 

I think we have to remember that these claimants
 

are of limited education in many cases, have
 

limited understanding of the processes that they
 

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were involved in. They were sworn to secrecy
 

about what they were being exposed to and were
 

given, you know, relatively little information in
 

many cases about their exposures. To then go
 

back, you know, 40 years later or 30 years later
 

and then try to ask them to -- you know,
 

interview them and have them, you know, recreate
 

the -- what happened to them, what their
 

exposures were is I think a very challenging
 

process from any perspective. And I think that
 

is what we're trying to assess. I'm not -- I
 

think it's going to be very hard for this process
 

to look at is there a bad interviewer. I mean
 

our review process is just not -- you know, is
 

there a -- were they being coerced in some way or
 

being ignored. I mean that's a very hard -- hard
 

to get at, but I think there really is an issue
 

of what kind of information is being ascertained
 

in the interview, given those circumstances and
 

given the information available, given the time
 

frame that's gone by and so forth. And I think
 

we have to take a serious look at how that -- how
 

that's being one. And I mean there are reasons
 

why a transcript isn't being kept. I just think
 

that limits our ability to review the process. 

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85 

I'm not saying that that's -- should be required,
 

but it's something that might have -- if it had
 

been -- if it were available, then maybe we would
 

think of other approaches.
 

DR. ZIEMER: Well, perhaps you've made my
 

point for me, and that is that given then -- in
 

many cases, the limited knowledge of the people
 

being interviewed, that how do we in fact
 

determine whether or not the interview is
 

adequate? I think you're asking in a sense the
 

same question. How do we determine adequacy,
 

that's what I'm asking. What are our measures? 

So --

DR. MELIUS: I agree. 

DR. ZIEMER: Yeah. Okay. Roy. 

DR. DEHART: I think the point of audit is to 

assure that the interview has captured any
 

corrections that is later made by the subject. 

In other words, the interview is given. He or
 

she or the family says no, this is not complete
 

and blah, blah, blah, and lists three or four
 

additional things. Has that additional
 

information been incorporated in the process. 

That we can do with the record, and I think
 

that's appropriate to do with the record.
 

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86 

DR. ZIEMER: Thank you. And that certainly
 

would be one measure that one could look at, as
 

well. Uh-huh. Other discussion on this item or
 

any of the related work group recommendation?
 

(No responses)
 

Okay. Mark, remind us again what it is we're
 

going to get tonight for our bedtime reading.
 

MR. GRIFFON: Yeah, Cori's got it right now.
 

DR. ZIEMER: You want that to be distributed
 

at this time?
 

MR. GRIFFON: Yes. Yes, it's the review
 

process, the procedure for review process. And
 

if you could take some time and red-line that
 

tonight, we can discuss that tomorrow.
 

DR. ZIEMER: So were there any other comments
 

you have on this at this time or has -- it's
 

pretty well been covered. Okay. Thank you very
 

much.
 

Any final comments on development of the task
 

order?
 

(No responses)
 

PUBLIC COMMENT PERIOD
 

Thank you. Then we'll move on with our
 

agenda. We're a little bit ahead of time, but I
 

think we will proceed with public comment period. 

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87 

I have just one request so far. I will open the
 

floor after that. Denise Brock is with us again
 

from St. Louis. Denise, I drove by the arch
 

yesterday, but I didn't stop. But we're glad to
 

see you again and --

MS. BROCK: Thank you.
 

DR. ZIEMER: -- pleased to hear your
 

comments.
 

MS. BROCK: Thank you. And I am here today
 

on behalf of my mother -- again, Evelyn Cofelt --

and also on behalf of all the Mallinckrodt
 

claimants.
 

Before I forget, though, I just want to speak
 

to what you all were discussing. What I did
 

during my mother's telephone interview was just
 

got a voice-activated recorder and I used a
 

speaker phone, and that's what we used actually
 

after we got our draft or hard copy back to go
 

back over, and we had our notes in front of us,
 

and I'm sure not everybody is quite that extreme
 

when they do things, that's just my personality. 

But that's what we did and we sort of went over
 

that process to make sure that everything that
 

was asked was touched upon and -- and it was
 

basically a summary, and we had a few kinks in it
 

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88 

that were eventually corrected.
 

But I agree with Dr. Melius. These workers
 

had no idea what they were exposed to in most
 

cases. I mean there were code names. I think I
 

mentioned that before -- tube alloy, biscuit --

they didn't know about transuranics and things
 

like that. So I really don't know what sort of
 

questions to -- that you would even ask in a
 

situation like that. I mean I'm kind of on the
 

other end of it.
 

I do have a letter from one of -- I call them
 

my claimants -- and this is a female. She didn't
 

want her name mentioned, but at the end of it --

and I don't know how pertinent this is, but she
 

says (Reading) I worked nine years for a company
 

that I had no idea what was being done there. 

Yes, I knew it had to do with uranium, but I
 

don't think any one of us had any clue as to the
 

dangers of this uranium or the presence of other
 

chemicals and what it could do to our bodies. I
 

had no reason not to trust Mallinckrodt or the
 

Atomic Energy Commission. When I first read
 

about the compensation and why it was being
 

given, I felt anger and disappointment that our
 

government had put us in harm's way without our
 

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89 

knowledge or consent. Thank you for listening to
 

my statement.
 

And that's just part two of her letter. But
 

I think that that seems to be not an anomaly. I
 

don't think these people knew what they were
 

exposed to. And then years later we have all
 

these sick or deceased individuals.
 

And as far as the process itself, would there
 

not be a way perhaps for NIOSH or ORAU or whoever
 

is conducting the interview itself to somehow
 

record that? I mean -- because I mean we could
 

try to tell all the claimants to try to get a
 

speaker phone and a voice-activated recorder, but
 

I think it would be much easier for somehow the
 

Federal officials to -- to record these. Is that
 

a possibility?
 

DR. ZIEMER: Thank you, Denise. I think
 

we've addressed that before and perhaps one of
 

the Federal officials will address it again. Did
 

you have additional comments that --

MS. BROCK: Oh, yes, I do.
 

DR. ZIEMER: Okay, please -- please proceed
 

and then we'll --

MS. BROCK: And that's another thing I wanted
 

to say is that this is probably going to be quite
 

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90 

lengthy, so if at any time you need to cut me
 

off, that's fine. I'll be here tomorrow, too.
 

Today I have some comments I'd like to make
 

that are rather personal, and I also have some
 

questions that I'd like to raise with the Board. 

I don't know if anybody prefers which I do first
 

-- okay, then I'll just start. Again, the
 

comments I have to make at this beginning part
 

are personal. The remaining amount will be as to
 

the Mallinckrodt claimants.
 

August 15th, Friday, was my father's
 

birthday. My father's been dead since 1978, so
 

obviously we've went through many birthdays
 

without him. But this year seemed to be a little
 

bit different, and I think that's for numerous
 

reasons. Probably one because of this whole
 

process that I've been doing for a little while
 

now.
 

But secondly, there's been a lot of publicity
 

in the state of Missouri with what I'm doing. 

Poor Larry I think has gotten part of that
 

because I know that they call him, the reporters
 

and senators and so on and so forth. But in the
 

process of that, I have met some very wonderful
 

people and one woman reporter has just been
 

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91 

amazing. Her name's Gerri Dryling*. She did a
 

Riverfront Times article in St. Louis, very
 

lengthy article. She's very empathetic, just a
 

wonderful person.
 

And in doing that, there's a lot of questions
 

that are asked that brings up a lot of memories. 

In one way it's therapeutic, but in another way
 

it -- it brings up a lot of things that maybe you
 

wouldn't really want to remember. And that's
 

when I'm going back to my father's birthday or
 

Christmases that we spent. And I'd just like to
 

say that as a child I grew up knowing my father
 

had cancer. I believe I was probably five or six
 

when he was diagnosed with lung cancer, and I
 

grew up knowing that word.
 

I grew up knowing the word "terminal", and
 

probably never really, unfortunately, thought
 

much about that. I guess you would say
 

unfortunately. My parents had a very good knack
 

of protecting us. I didn't even know we were
 

poor, but I guess we were. We lost our home due
 

to the financial problems. I mean it ravaged our
 

family. We lost our home, our car, our
 

furniture. And we lived in a really nice house,
 

but I was kind of a goofy kid and thought that
 

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92 

moving to something with wheels on it would be
 

just really an adventure, and that's what we did.
 

And I never knew that until recently when I
 

talked with my brother that on Christmases -- my
 

father had seven sisters -- and he would do
 

whatever had to, he and my mother of course, to
 

make sure that we had everything we wanted for
 

Christmas. Christmases and birthdays were pretty
 

weird, though, because the biggest part of those,
 

from what I can remember, were spent in a
 

hospital. It was called Barnes Jewish and there
 

was a special area called Queenie Towers is what
 

I remember mostly. And I can remember being
 

pretty young and sitting on the floor playing
 

with Barbie dolls on Christmas day. And there
 

would be a tree in his room and sometimes a
 

priest giving him last rites or his sisters being
 

around him.
 

I can even remember leaving the room at one
 

time for whatever reason I had to leave, and I
 

had a -- this is silly. I had a purse that had
 

this long fringe on it, I just loved it, and my
 

dad was in the hospital and he -- I knew he
 

bought these things. They were called Little
 

Kiddle dolls. They were these little bitty dolls
 

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93 

with like a bubble over them. And when I left
 

the room I had went to the downstairs part of the
 

hospital by myself and was actually robbed. 

Somebody stole my purse. I think I was probably
 

about seven or eight.
 

Those are the kind of memories I have, along
 

with remembering that when I was old enough
 

sometimes my brother and I would be home alone
 

with my father. And back then they had those
 

real big oxygen tanks where you had to adjust the
 

knob to get the right flow of oxygen. He had
 

Tupperware containers full of medication. I know
 

it sounds silly now, but when we were little I
 

would be afraid that maybe I turned it up too
 

high to too low or gave him the wrong medicine at
 

the wrong time.
 

Sometimes I remember being afraid -- sorry --

thinking that if he slept too soundly maybe he'd
 

be dead, and I wouldn't want to go in the room. 

But I had a younger brother, so I would make a
 

lot of noise. I didn't care if I got in trouble. 

I just wanted to -- to hear him. And I would go
 

in and I would shake him really hard, just to
 

hear him, you know.
 

And that brought me to the day he died, which
 

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94 

is really significant because I don't know if it
 

was out of habit or just being a smart ass, but I
 

can remember standing at my door waiting for the
 

bus. And I hollered to him and he didn't answer. 

So I thought well, I don't care, I'm going back
 

to his room. I don't care if I miss the bus. I
 

went back and I shook him really hard and I said
 

goodbye, I love you. And he looked at me right
 

in the eye and said I love you, too. And about
 

five hours and ten minutes later, my brother came
 

to school -- I was a senior in high school -- and
 

he walked into my classroom and told me that my
 

father sat up and clutched his chest and died in
 

his arms.
 

We buried him a couple of days later in a
 

cemetery across the street with a real small
 

headstone. You know, again, I was real young and
 

didn't pay attention to not having anything until
 

maybe -- maybe six months or a year later, phone
 

calls started coming in. Bill collectors, my mom
 

even got served with some sort of subpoena to go
 

to court. They were going to try to get a
 

judgment against her over a headstone.
 

And now that I think of this stuff and I
 

think about I'm groveling for her for $150,000
 

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95 

from a vendor that poisoned -- and a government
 

that poisoned my father, gave him cancer, it ate
 

and ravaged his body, it just -- to me it's
 

obscene. It's just absolutely obscene and I have
 

no hard feelings against anyone in this room, but
 

I just think it's appalling. This is not an
 

anomaly.
 

My story -- I didn't tell this for anybody to
 

feel sorry for me. I hear stories like this
 

every day. And I think it's one of the saddest
 

things there is. These people protected their
 

government and died because of that, and now they
 

or their survivors are having to jump through
 

hoops and come up with details of stuff that has
 

been long since destroyed. And again, if this
 

was for me, they could stick it. But this is for
 

my mom who's 80 years old, who lives on under
 

$1,000 a month that can't even afford her
 

medication. And I'm hoping that she gets a check
 

so she can at least live long enough to see that
 

and maybe kind of have some of the burden lifted
 

off of her, as well as the other claimants. 

Thanks.
 

And do I have time to ask questions now? Do
 

I? To Larry, is there any idea of the time frame
 

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96 

of when the rule may be finalized in order to
 

petition for Special Exposure Cohort?
 

MR. ELLIOTT: The rule you're referring to is
 

the rule on adding classes to the Special
 

Exposure --

MS. BROCK: Yes.
 

MR. ELLIOTT: -- Cohort? And we have been
 

addressing the public comments received under
 

public comment period, redrafting the rule in
 

accordance in how we have addressed those
 

comments. We're hopeful that by the end of the
 

year we will see a new rule issued.
 

MS. BROCK: Okay, thanks. Also, in a letter
 

to one of my claimants -- I think Dr. Toohey and
 

I touched on this -- from Dr. Toohey, it was
 

dated July 15th, 2003. It stated -- I understand
 

that it is expected to have completed dose
 

reconstructions for most of the Mallinckrodt
 

claimants by this fall.
 

And also I'd read an e-mail that says by
 

September. Would that -- is that close to
 

accurate? I mean do you expect to have most of
 

these dose reconstructions done by fall or
 

September?
 

DR. ZIEMER: Yeah, I guess we'll probably get
 

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97 

a detailed report tomorrow on that, but is there
 

a brief answer, Jim?
 

DR. NETON: Yeah, that's right, tomorrow
 

we're going to talk about the performance plan in
 

a little more detail, and particularly the
 

technical basis documents I'll be addressing
 

tomorrow. But we're very close on the
 

Mallinckrodt technical basis document. I think
 

latest indications are maybe within a week or two
 

the first draft will be available. And once it
 

gets approved by us -- I mean NIOSH has to review
 

it and bless it. Once that's done, then it -- it
 

takes a little while to get the technical basis
 

document implemented. It's not like you can
 

write the document and then tomorrow start
 

generating the dose reconstructions. There's
 

about a month in between there where it needs to
 

be -- the process needs to be worked out a little
 

better.
 

MS. BROCK: By technical base (sic) document,
 

is that the site profile? I'm sorry, is that
 

what that is?
 

UNIDENTIFIED: (Inaudible)
 

MS. BROCK: Okay. And that was my next
 

question, is was it finished. With your site
 

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98 

profile -- I'm curious because I'm just not real
 

familiar with that -- do you also, when you --

when you do those, do you base it on the
 

epidemiological studies that were also done on
 

those facilities?
 

DR. NETON: No, the site profile is an
 

exposure model. It has nothing to do with the
 

epidemiologic evidence. It has to do with the
 

facts surrounding the source term of the
 

materials that were there, the air sample data,
 

the bioassay data, those type of parameters are
 

included in the document. But the epidemiologic
 

evidence is not included in there. The
 

probability of causation model of course is the
 

model that does the -- that uses the
 

epidemiology. And as we've discussed at past
 

meetings, currently there are no DOE worker
 

epidemiologic studies that are used in the
 

probability of causation model at this time.
 

MS. BROCK: I guess that kind of confused me
 

a little bit. I've got something that I thought
 

was interesting and I just wanted to comment. It
 

says (Reading) In order to estimate exposure, it
 

is essential to know the amount of a pollutant
 

released to a particular medium such as air or
 

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99 

water from a source pollution, called a source
 

term, or to have an accurate history of
 

concentrations of pollutants in air, water and
 

soil.
 

So I'm curious, with Mallinckrodt, because
 

there is such a loss of records -- and I
 

understand you state that you have quite a bit on
 

site profile -- but what about situations -- and
 

again, I probably have asked this before -- where
 

you have like the daughter products? I mean like
 

if you have naturally occurring Pu-244 from this
 

Belgian Congo pitchblende and if you have
 

actinium and polonium and the radon, can you --

is that -- is there enough there to get an idea
 

about where this was and how much these people
 

were exposed to if there's not individual data? 

And if there was not any internal or a lot of
 

internal, there was just breath -- some breath
 

radon and mostly external, is there enough to do
 

that on?
 

DR. NETON: I think it'll be more evident
 

when the model comes out and -- or the technical
 

basis document or the profile, and it'll be on
 

our web site, by the way, for anyone to evaluate. 

But the short answer is we try, whenever we know
 

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100 

that there are materials that weren't monitored
 

that were included in the exposures, we'll add
 

them in to the claimant's dose. And that would
 

be reflected in the site profile itself.
 

As most things go with this program, if we
 

don't know and we have to make a judgment call,
 

then we will err on the side of being favorable
 

to the claimant.
 

MS. BROCK: Thank you. And to the epi
 

studies, I wanted to ask a question about
 

Elizabeth DuPre Ellis*. I understand that she
 

had published some studies quite some time ago,
 

the mortality studies. It's my understanding she
 

completely excluded internal dose. Is that what
 

you would be looking at, because she also has
 

some non-published -- for some reason, some nonpublished documents and I was kind of curious why
 

that was non-published. And I also have
 

something -- let me look through my paperwork,
 

but I believe I have something -- there was like
 

20.8 percent that actually was missing on the
 

published. Which do you use, do you use the
 

published, the non-published?
 

DR. NETON: Again, back to one of the earlier
 

questions, we would not use the epidemiologic
 

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101 

study to do the dose reconstruction at all. I
 

mean those are independent datasets. And it's
 

true and many times internal dose is difficult to
 

decipher and many epidemiologic studies in the
 

DOE work force have tended to not evaluate the
 

internal dose completely. But we would not be
 

using either of those epi studies to do the dose
 

reconstructions themselves.
 

MS. BROCK: And I think I just kind of wanted
 

to comment, because I know my concern is also the
 

concern of many of the claimants, probably
 

because we are not scientists or health
 

physicists, but it is very difficult to
 

understand. But I just wanted to read something. 

(Reading) The Department of Energy occupational
 

epidemiologic studies constitute one of the
 

world's largest and most extensive follow-ups of
 

people exposed to low level ionizing radiation
 

and other substances. The studies were initiated
 

36 years ago and cover some 600,000 people who
 

worked for Federal contractors at industrial and
 

research sites. These workers helped produce
 

tens of thousands of nuclear weapons for the
 

United States. Many were followed for more than
 

50 years when the first nuclear weapons were made
 

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102 

during World War II. From the very beginning it
 

was recognized that the risks posed to nuclear
 

weapons workers over time were not well
 

understood. Dr. Robert Stone, the head of the
 

health division of the Manhattan Project, noted
 

that worker radiation protection rested on rather
 

poor experimental evidence. He concluded the
 

whole clinical study of the personnel is one vast
 

experiment. Never before has so large a
 

collection of individuals been exposed to so much
 

irradiation.
 

And I think sometimes that that's kind of
 

scary for some of us because we're not really
 

sure how accurate the site profiles are and how
 

accurate the epi studies are. And I guess I was
 

rather confused because I -- I know there were --

Merrill Eisenbud* had talked about Harshaw* and
 

Mallinckrodt being the two worst I believe in AEC
 

history. And I understand in one of his
 

biographies he had stated quite a few things to
 

Ms. Dupre Ellis and a lot of that wasn't even
 

commented on in some of her studies, so I think I
 

was a little bit concerned, but I feel better
 

now.
 

And I also wanted to make comment, and I
 

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103 

don't know -- with the Department of Energy, I
 

think somebody had touched on it earlier about
 

waiting for exposure data to come back to the
 

Department of Labor. I've had a personal
 

experience with the Department of Energy. I
 

think I had spoke to that once before about I had
 

filed a FOIA request, actually several, one on
 

behalf of my father and one on behalf of all of
 

Mallinckrodt -- not had much response at all. 

But what I did get on behalf of my father, as I
 

stated previously, was from the Department of
 

Energy a document stating that he was under Q
 

clearance, had the issuance date, the termination
 

date, with a letter stating all other files had
 

been destroyed.
 

A couple of months later, actually June 13th,
 

I receive a letter from the Department of Labor
 

stating DOE has verified his employment. And
 

they had some records -- actually things that I
 

had never gotten and they told me they never had,
 

showed him as a powerhouse operator. They were
 

actually equating the dates of employment with
 

the issuance and termination dates of Q
 

clearance. They -- it was just kind of peculiar
 

to me.
 

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104 

When I asked them about it, they denied it,
 

said it didn't come from them. Well, I have
 

those files and it did come from them. And so my
 

concern here is that if we're waiting for the
 

Department of Energy to come up with records that
 

we can't get -- and I know nobody can comment on
 

this -- but my concern is are they incompetent,
 

are they lying, and is this what we're waiting
 

for for people to base dose reconstruction on? 

It's very, very disconcerting.
 

Also I notice that the Department of Energy
 

-- we have something called SLAP, St. Louis
 

Airport storage site, and they had removed the
 

DOE designation off of there -- really nice man,
 

Roger Anders, I called him. I called him
 

repeatedly. And I asked him about that and he
 

said well, he didn't think that DOE had done any
 

cleanup there. And I asked him to give me about
 

ten minutes and I would send him the documents to
 

show that they had. I know they did at least two
 

rounds. And I've done that and they are making a
 

formal change.
 

But that also scares me, too, because what
 

that does is leave my subcontractors out there
 

who possibly were involved in cleanup without any
 

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105 

remedy.
 

They also said there was no beryllium there. 

I've got beryllium added and I'm getting ready to
 

add it to two other sites, as well, because I've
 

got the documents to prove that. So all of this
 

is kind of scary because you've got lay people
 

such as myself -- and this is not my forte -- and
 

I'm having to dig this stuff up to help people.
 

And talking about reports, the Labor Tribune,
 

which is a paper that our unions have for the
 

building and construction trades, did a story and
 

it went out to 90,000 people. So they
 

accidentally put the wrong number in for Paducah
 

so all the claims are coming to my house, so I
 

forward those on. That's all right. My daughter
 

kind of goes insane with it, but I think that
 

that's going to generate numerous claims, as
 

well.
 

And I don't know if anybody knows, but is it
 

true that the Department of Energy can come in
 

and screen these subcontractors? I've got guys
 

that need to be tested for CBD and for cancer. 

Do they have some sort of -- I thought they did
 

that in other areas. Can I have them -- somehow
 

get them to come in and test these workers? Are
 

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106 

there mobile units or does anybody even know
 

that?
 

UNIDENTIFIED: You need to talk to DOE.
 

MS. BROCK: DOE, yeah. And why is it that
 

DOE is never here? There's never a
 

representative. Is that because this has nothing
 

to do with DOE, because I see the things on the -

- no? I really think we should invite them.
 

And the last thing I think I wanted to say
 

today --

DR. ZIEMER: Incidentally, we have not closed
 

this meeting to DOE, so...
 

MS. BROCK: And the last thing I wanted to
 

ask today was to please come to St. Louis because
 

I betcha I could fill up a room with at least 400
 

people for you. Thank you.
 

DR. ZIEMER: Okay. Thank you, Denise, for
 

your comments.
 

Okay, we have a request from Richard Miller
 

from GAP. Richard, please address us.
 

MR. MILLER: Dr. Ziemer, thank you. Good
 

afternoon. My name is Richard Miller. I'm from
 

the Government Accountability Project. I had a
 

couple of brief questions and points. The first
 

is, in reviewing the site profiles I've noticed
 

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107 

that apparently there's a NIOSH version of IMBA,
 

and I wondered whether this could be made
 

available to the public on NIOSH's web site, the
 

way that IREP is available, so that we can take
 

the dose information that is presented and uptake
 

and convert it into individual organ dose. That
 

makes it somewhat difficult to have to find
 

people with IMBA and waste their time running the
 

numbers. And it does seem that if you've
 

purchased such a model, it would be very helpful
 

to the public to have it available so that the
 

site profiles can be converted into something
 

useable for the lay person.
 

DR. NETON: IMBA currently, as it exists, is
 

a stand-alone program that runs on a PC. I'm not
 

sure that anything precludes it from running as a
 

web-based software, but we would have to check
 

into our licensing agreement with the vendor
 

before we'd even be able to entertain that
 

possibility.
 

MR. MILLER: Well, at this point then you
 

will have the monopoly on converting the data if
 

it's not made available, so I appreciate you have
 

a licensing issue, but I -- and certainly if you
 

want to -- if you want to have people write in
 

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108 

for a CD, we're happy to do that. But you know,
 

as a -- a task order contract?
 

DR. NETON: (Inaudible) task order contract
 

will have access to IMBA.
 

MR. MILLER: Well, that's great, but what
 

about the rest of us? I mean we've got access to
 

IREP. Now unless -- unless -- do we need more
 

than one program? Do we need more than IMBA to
 

be able to convert it? Because I also noticed
 

that there was a second program that was
 

mentioned in the Savannah River, I believe, site
 

profile -- forgive me, I don't have the document
 

with me, but there -- I mean if there's --

whatever program you need to convert dose, you
 

know, that information, whatever -- whatever
 

combination or individuals are, I think it would
 

be immensely valuable. And I think -- otherwise
 

this program's going to lose transparency. 

Right?
 

DR. NETON: We can explore that possibility
 

and see what can be done to make that available.
 

MR. MILLER: Okay, that'd be great. Thank
 

you.
 

The second question has to do with the --

sort of the shift in the program and the audit. 

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109 

I remember sitting -- it must be a year ago --

through meetings about the development of the RFP
 

for the audit and what would go into the scope. 

And what's happened to the program -- at least
 

this is my observation, and maybe it's a
 

mischaracterization, but site profiles were going
 

to be these things out there and there were going
 

to be these worker profiles, and the RFP that
 

went out said you were going to do five sort of
 

worker profile/site profiles I think per year,
 

and then you'll do so many in depth and so many,
 

you know, standard dose reconstructions and so
 

many blind and so forth. But what it looks like
 

now is that as you've gotten more experienced
 

with the program and you've tried to find ways to
 

get some efficiencies, you're doing a lot --

looks like a lot more site profiles than was
 

discussed a year ago when the RFP was in its
 

development stages. And it seems to me at this
 

point -- this is my observation -- that given the
 

high degree of reliance upon the site profiles to
 

inform the dose reconstructions -- and I'm only
 

basing this on having watched what happened with
 

the exposure assessment, at least at Bethlehem
 

since that seems to be the lion's share of the
 

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110 

cases that have cranked through and I have the
 

great pleasure of receiving the phone calls from
 

people who were denied mostly so I get a little
 

bit of insight into some of these cases.
 

Would it make sense for the Advisory Board --

and it may even be an efficiency method for you
 

all, as well -- to think about auditing all of
 

the site profiles, 'cause there's a discrete
 

fixed population of them, many of which it
 

appears are going to serve as a cookie cutter for
 

"me, too" sites, so your uranium rolling mills, 

you'll use the basic same method, you know, as
 

tailored. Or the same uranium extraction process
 

where you have phosphate fertilizer plants that
 

also extract uranium and so you'll have a sort of
 

a cookie cutter there, and you can sort of see
 

how this program's shaping around types of
 

production where there's common -- particularly
 

in the AWEs -- some commonality and probably in
 

some of the production sites, the DOE productions
 

sites, to audit all of them. In other words, to
 

think about whether it makes sense.
 

Now I don't know whether this implicates your
 

RFP or not and your procurement process and its
 

integrity and whether people will come in
 

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111 

complaining after the fact that, you know, they
 

bid on one thing and awarded a contract for
 

another. But you know, I just would sort of
 

float that as a thought, that -- that -- I'm not
 

sure if five site profile reviews are going to be
 

sufficient in the first year if the productivity
 

of these site profiles starts pouring out and
 

they are then the foundation for knocking out
 

scores of dose reconstructions thereafter based
 

on that model. So I would just offer that as a
 

suggestion. You might even be able to audit
 

fewer dose reconstructions but do more site
 

profiles. It just seems that way.
 

The next -- the next question was -- and
 

maybe this can be addressed tomorrow, but I
 

noticed in the handouts that there was a vast
 

increase in staffing in this program from the
 

last time we saw it in terms of contractor, ORAU
 

staffing. It looked like it was over 250 staff
 

at this point, contractor staff. And it would be
 

very helpful -- if not tomorrow or at some point
 

-- for there to be some discussion about who are
 

these people, where are they, where did they come
 

from. That's a big pump -- are these people
 

employed by DOE contractors today and they're
 

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112 

working as consultants to the program? Are these
 

people who are, you know, retired and they --

consultants? Are they competitors that were
 

disappointed? I mean where did they come from to
 

get such a huge boost in staffing, and are all
 

these people sort of cognizant of kind of the
 

approach to the program and -- and -- and vetted
 

for conflict of interest?
 

And then the last comment I guess I would
 

offer sort of spoke to Subtitle D. DOE abolished
 

its advisory committee. The Secretary apparently
 

saw fit to eliminate it on January 1st, so what
 

was known as WAACee*, or the Worker Advocacy
 

Advisory Committee, is no more. Which was too
 

bad 'cause it was a pretty distinguished group of
 

individuals.
 

The problem arises that your program
 

interfaces with that in a very important way, and
 

that is this. There are many radi-- there are
 

many dual filings of claims. I mean people filed
 

under D and B simultaneously, and a number of
 

those are for cancer cases. And what's happening
 

is that the physicians panel are being given
 

cancer cases to evaluate without dose
 

reconstruction or probability of causation
 

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113 

findings. Now DOE has a different standard of
 

causation than this program. This is an aslikely-as-not standard for Subtitle B. Subtitle
 

D is the -- well, by the time they worked out the
 

rule, it was sort of a significant factor which
 

aggravated, caused or contributed to the illness
 

or death. So you have a lower standard of
 

causation under the -- or lower threshold for
 

establishing causation under the DOE program.
 

Nevertheless, DOE is now sending to
 

physicians claims without the benefit of your
 

work. And it seems to me -- although this is not
 

DOE I'm speaking to and obviously they didn't see
 

fit to come to very many of your meetings, and I
 

don't mind that being put on the record; it sort
 

of shows some kind of indifference which is not
 

lost on the public -- that the dilemma is they're
 

going to now deny claims because there's an
 

absence of information which you all are going to
 

be developing at some point which is either going
 

to be lost or have to be re-adjudicated again
 

with the benefit of your new information. And I
 

don't know whether it's appropriate or not for
 

this body to take up that question, but I think,
 

given that there's 18,000 claims at DOE and there
 

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114 

are at least 4,000 claims that have nothing to do
 

with any radiation-related cancers -- asbestosis,
 

you know, chronic obstructive pulmonary disease
 

from, you know, caustics or whatever -- that it
 

might be appropriate to take that up and wait for
 

y'all's work product before they -- you know,
 

kind of triage matters, I guess that's the nice
 

way of putting it. Because there is a lot of
 

valuable work and investment going into this that
 

will not -- whose fruit will not be enjoyed by
 

another program.
 

Now I know you don't advise Secretary Abraham
 

nor profess to, but if there's some way to
 

facilitate communication -- I mean really I
 

think, at the risk of being inappropriate here, I
 

believe you're somehow tied to the physicians
 

panels in some respect and maybe --

UNIDENTIFIED: (Inaudible)
 

MR. MILLER: Yes, I think -- I mean I don't
 

know whether it's possible to give some insight
 

to your colleagues here, but I think it's a huge
 

waste not to take advantage of your work at DOE. 

We don't have an advisory committee to talk to
 

there anymore, so you're it. Those are my
 

thoughts.
 

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115 

DR. ZIEMER: Thank you, Richard. Any
 

comment?
 

MR. ELLIOTT: Richard, I appreciate your
 

comments. You're certainly very correct that we,
 

too, would like to see DOE hold the cancerrelated claims until our dose reconstructions are
 

finished. And in our coordination with other
 

agencies, we've talked about this. But for this
 

Board's perspective, this is not within your
 

charter. It's not something the Secretary is
 

asking you to do. Richard, your comments are on
 

the record and that's where they can stand and be
 

heard. I think that's enough said.
 

MR. MILLER: Great, well, we'll -- I mean
 

that's great. I -- I know, it's a hard problem. 

We used to talk about pushing on a string --

right? -- when you couldn't lower interest rates
 

any further and you still can't push people
 

along. Sometimes I feel like that's where we
 

are. But -- and I will look forward to your
 

response with respect to the IMBA question at --

and see what you can get for us. Thank you.
 

DR. ZIEMER: Okay. Thank you very much. 

We're coming to the close of today's session. 

Let me ask if there's any housekeeping items we
 

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116 

need to address today, Cori, or other staff?
 

MS. HOMER: Just remove your laptops and
 

bags. 

DR. ZIEMER: Don't leave things in this room 

tonight. Right? Thank you very much. 

MR. GRIFFON: One thing, Paul. 

DR. ZIEMER: Right. 

MR. GRIFFON: Just a question. The working 

group is going to meet in here at 7:00 --

assuming that the door will be open, in here at
 

7:30 tomorrow morning, and I would ask maybe if
 

Jim Neton -- I didn't ask Jim before -- if you
 

can meet with our working group tomorrow morning?
 

DR. NETON: What time?
 

MR. GRIFFON: 7:30, and possibly somebody to
 

help with the procurement questions, too, legal -

- if someone from legal is available --

DR. ZIEMER: Okay, and then --

MR. GRIFFON: -- for our breakfast meeting.
 

DR. ZIEMER: Right here?
 

MR. GRIFFON: Yeah.
 

DR. ZIEMER: And then --

UNIDENTIFIED: Is it going to be open?
 

MS. HOMER: I'll make sure.
 

DR. ZIEMER: Yeah. Our open time -- or our
 

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117 

meeting begins at 8:00, which is the -- the
 

normal registration period, with the formal
 

meeting beginning at 8:30.
 

MR. ELLIOTT: We have that agenda change.
 

DR. ZIEMER: The agenda change is we will be
 

moving up -- the agenda item that appears as
 

scientific issues work group report, that report
 

is -- will be deferred or at least will not occur
 

tomorrow. I don't know if John Till is prepared
 

to start early, but --

MR. ELLIOTT: Probably not. You'd better let
 

him start when he was scheduled to start.
 

DR. ZIEMER: Right. So unless John Till
 

wants to start early, and we don't know
 

necessarily that he would even be here at that
 

hour -- well, in any event, we may have to start
 

at 9:00 then, unless there's something we can --

I'm wondering if -- I wonder if -- or perhaps we
 

can move one of these other ones up on this
 

agenda, but I'll work that out separately, so
 

let's plan to begin at 8:30 and we'll just shift
 

things around a little bit.
 

So we are recessed till tomorrow morning.
 

(Whereupon, an adjournment was taken to
 

August 19, 2003, at 8:30 a.m.)
 

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C E R T I F I C A T E
 

STATE OF GEORGIA )

 )
 COUNTY OF FULTON )
 

I, STEVEN RAY GREEN, being a Certified Merit
 

Court Reporter in and for the State of Georgia, do
 

hereby certify that the foregoing transcript was
 

reduced to typewriting by me personally or under my
 

direct supervision, and is a true, complete, and
 

correct transcript of the aforesaid proceedings
 

reported by me.
 

I further certify that I am not related to,
 

employed by, counsel to, or attorney for any parties,
 

attorneys, or counsel involved herein; nor am I
 

financially interested in this matter.