Y-12 and Oak Ridge National Laboratory Medical Surveillance Program Phase I: Needs Assessment Queens College, City University of New York Atomic Trades & Labor Council PACE International Union Creative Pollution Solutions, Inc. February 12, 2004 Work performed under DOE Contract No. DE-FCO3-96SF21260 1-12 and Oak Ridge National Laboratory Medical Surveillance Program Phase I: Needs Assessment Steven Markowitz, MD Queens College, City University of New York Carl Scarbrough Atomic Trades & Labor Council Sylvia Kieding PACE International Union Mark Griffon, MS Creative Pollution Solutions, Inc. TABLE OF CONTENTS Page Number Executive Summary Part I: OVERVIEW Section I. Introduction 1 Section II. Methods 3 Section ifi. Principal Findings 6 Section IV. Need for Medical Surveillance and Risk Communication 19 Part H: METHODOLOGY AND RESULTS Section V. Exposure Assessment V 1-58 Section VI. Focus Groups VI 1-11 Section VII. Epidemiologic and Health Studies Review VIE 1-11 Attachments and Appendices: Exposure Assessment Attachment 1: Job Exposure Information Sheet Attachment 2: Descriptive Building Report Appendix Al: X-lO Risk Mapping Results Appendix A2: Y-12 Risk Mapping Results Appendix B1:Y-12 External Dose Appendix B2:Y-12 Urinalysis Data Appendix B3:X-1O External Dose Appendix B4:X-1O Urinalysis Data Appendix B5:X-1O In Vivo Data Appendix Cl: Y-12 Job Titles Appendix C2: X-lO Job Titles Appendix C3: Y-12 and X-lO Department Names and Numbers TABLE OF CONTENTS (cont.) Attachments and Appendices: Exposure Assessment Appendix C4: X-lO Department Names and Numbers and Division Titles Appendix C5:X-1O BuildingNames and Building Numbers Appendix Dl: Y-12 H&S Report Air Sampling Summary Appendix D2: Y-12 H&S Report Urine Data Summary Appendix D3: X-lO Health Physics Report Urine Data Summary Appendix D4: X-lO Health Physics Report Occurrence Data Summary Appendix El: X-lO Questionnaire Results Summary Appendix E2: Y-12 Questionnaire Results Summary Appendix F: External Dose Summary Results EXECUTIVE SUMMARY Purpose We report the results and analysis of a one year needs assessment study evaluating whether a medical monitoring and risk communication program is justified for former and current workers at the Y-12 and Oak Ridge National Laboratory (ORNL). Methods To complete this study, we used available exposure assessment data from paper records and electronic databases and reviewed all studies that have been completed at the plants. We also gathered "expert" former and current workers to conduct risk mapping sessions and focus groups to obtain in-depth information about the plants. We collected and analyzed responses to a questionnaire that was sent to a stratified random sample of 500 former Y-12 and ORNL workers. We obtained employee rosters and basic employment data, to the extent available, from the contractors and other institutions. Findings Former and current Y-12 and ORNL workers have had significant exposure to pulmonary toxins (nickel, asbestos, beryllium, and acids), carcinogens (external and internal radiation, asbestos, beryllium, and cadmium), renal toxins (chlorinated solvents and lead), neurotoxins (mercury, solvents and lead), hepatotoxins (carbon tetrachloride and other solvents) and noise. Epidemiologic studies at Y-12 and ORNL show excess rates of selected diseases, including cancer and selected neurologic effects. Workers are concerned about the effects of previous exposures on their health and are very interested in a medical screening and education program. Former workers have good access to health care and engage in periodic health examinations. However, most do not believe that their primary care providers know much about the exposures that they had at Y-12 and ORNL. The focus groups and questionnaire responses also provided useful guidance about how to establish effective risk communication and medical surveillance programs. The target population for a medical screening program among former and current Y-12 and ORNL workers is conservatively estimated to range from 12,000 to 20,000. This range requires refinement, but the roster with names and addresses that would allow initiation of screening is currently available. Conclusion The findings of this needs assessment study support a targeted medical and cancer surveillance and education program. This conclusion is based on 1) the evidence that large numbers of workers have had significant exposures to detrimental agents, 2) the demonstration among Y-12 and ORNL workers of excess risk of cancer, selected neurologic effects and beryllium-related outcomes in epidemiologic studies, and 3) the need and desire expressed by former and current workers for a credible targeted program of medical surveillance and education. A health protection and risk communication program should center on workers at risk for 1) cancer, 2) chronic respiratory disease, including chronic obstructive lung disease and the pneumoconioses, 3) kidney, liver and neurologic disease, and 4) hearing loss. These conditions are amenable to early intervention, amelioration, and/or primary prevention. A risk communication delivered by a credible source will reduce uncertainty and distrust. After participation in the proposed screening program, former and current Y- 12 and ORNL workers will have increased real knowledge about their personal health status, what is known about their risks, and how they can promote their own health. We believe that mounting such a program in Phase II will make a tangible contribution to the health of former and current Y- 12 and ORNL workers. PART I: OVERVIEW I INTRODUCTION In January 2003, a consortium led by the Queens College of the City University of New York, the Atomic Trades & Labor Council, the Paper Allied-Industrial Chemical and Energy (PACE) Workers International Union, and CPS, Inc. initiated a needs assessment study to evaluate whether former Department of Energy (DOE) workers at the Y-12 and Oak Ridge National Laboratory (ORNL) would benefit from the establishment of a program of medical surveillance under Section 3162 of the 1993 Defense Re-Authorization Act. This assessment was conducted under a contract from and with the guidance of the Department of Energy The needs assessment at the Y-12 and ORNL facilities benefited from the experience that PACE, Queens College, and CPS, Inc. gained by conducted similar needs assessments at the three DOE gaseous diffusion plants in 1996-1997 and at INEEL in 1998, and by the conduct of medical surveillance by this consortium at these four facilities from 1997 to the present. To conduct this needs assessment, the Queens College/ATLCIPACE/CPS, Inc. consortium identified the need for four domains of information. These include: •Exposure characterization for the workforce at Y- 12 and ORNL •Epidemiologic and other health studies, to the extent available • Educational and health care needs and expressed interest in medical surveillance program • Demographic profile of target population These domains corréspoñd to the criteria established by the DOE in its document, Guidance for Phase I Reports and Phase II Applications. Through a focused 12 month effort organized in these domains, we have addressed the specific issues raised by the Department of Energy in determining whether a medical surveillance program is needed and would benefit the targeted populations. These specific issues include characterizing the type and degree of relevant detrimental exposures; defining essential health impacts; defining the size of the target populations, and finally, documenting the need for establishing a program that will combine medical monitoring with risk communication. To provide answers to these questions was an ambitious task. Y-12 and ORNL are large complex facilities that have been in operation and evolution for 60 years. Much of the current work at Y-12 is classified. Information on exposures, both radiologic and chemical, are diverse and inexactly related to known information on health outcomes in the Y-12 and ORNL workforces. The limited period of the needs assessment required that we use secondary data sources and published studies. Nonetheless, given the goals of the expected medical surveillance program, sufficient information was available to allow a description of the rationale for such screening and to provide the information that is needed to conduct such medical surveillance. The study team had the great advantage of having excellent access to and high credibility with many members of the workforce that have operated and continue to operate Y-12 and ORNL and excellent cooperation of the DOE, NNSA, and BWXT personnel at the sites. The needs assessment has also benefited from previous in-depth epidemiologic and exposure assessment studies. Our challenge during the past 12 months has been to combine current study-based knowledge of these sites with the collective knowledge possessed by the Y-12 and ORNL 1 workforce in order to gain a sufficient understanding of cumulative exposures at these facilities and how they might impact current health This report provides a snapshot of this combined knowledge. It is anticipated that understanding how exposures impact workers' health at these facilities will be an ongoing task during the medical surveillance phase. Throughout the needs assessment process, the Queens College/ATLC/PACE/CPS consortium has abided by a central principle of the project: to maximize involvement of workers and scientists from Y-12 and ORNL in all aspects of the conduct of the needs assessment process and