Presentation by Janet Michel to the Advisory Committee on Energy Related
Epidemiological Research
April 22, 1999
RECENT HISTORY OF EXPOSURE RELATED ILLNESSES
o Health concerns first reported to LMES VP in March 1995.
o Throughout 1995, employees filed medical incident reports (MIRs) related
to exposures.
o In fall of 1995, an employee went to the Union and requested a NIOSH
review, which was denied.
o 2 salaried employees met with then K-25 site manager Harold Conner to
request the same only to be told that employees could not submit a request
for a NIOSH Health Hazard Evaluation.
o In January 1996, a group of employees submitted a request for a NIOSH
Health Hazard Evaluation.
o The NIOSH petition consisted of two requests - 1. Cyanide 2. Anything
causing thiocyante in urine.
o NIOSH conducted an inadequate and limited study, yet claimed conclusive
results. The study focused on hydrogen cyanide and ignored nitrile,
compounds also convert to thiocyanate in the human body and are found at K-25.
o LMES conducted air sampling tests; however, the University of Alabama
(Dr. Weems) pointed out many technical problems and errors.
o Employees wrote hundreds of letters to DOE and LMES management, the
Governor, and elected representatives in Nashville and in Washington.
o In response to the numerous MIRs, LMES began sending employees to
Vanderbilt (Dr. Edelman) for evaluation.
o Employees were not given a choice of three physicians as required by
Workman's Compensation.
o Edelman did a limited review of employees and concluded that there was no
occupational exposure, thereby denying employees rights under worker
compensation laws. Under oath, Edelman admitted that he did not have enough
information to determine exposure to cyanide.
From Dr. Edelmen's deposition on 3/22/99
From page 63: "..... the scope of my evaluation was the relevance of the
thiocyanate and related testing and the potential for cyanide poisoning.
That was the scope of what I was addressing." "It was my understanding
that the health department -- state health department or other entities had
exposure evaluations ongoing and investigations, and the scope of that was
far greater than I was in a position to bring to the table. I didn't have
the resources and time available to study all the potential exposures at
the K-25 site and agreed only to evaluate this limited area".
From page 95: "I might talk about -- I might publish something about the
fallacies of thiocyanate testing that was done. But in terms of the
overall health and problems at Oak Ridge, I don't have the data. I didn't
have the ability to study the problem sufficiently so I was not going to
publish anything about it."
o Note: Before the NIOSH study was completed. LMES announced plans to
conduct some testing for cyanide exposure. The state purpose was to
establish acceptable reference ranges. Ironically Edelman who had
previously insisted that spot samples were worthless, now insisted on spot
samples instead of the 24-hour samples we had requested. We feel that it
is significant that LMES refused to sample spouses and children of effected
employees, or even the affected employees themselves. NIOSH concluded all
testing was unnecessary.
o LMES established a Working Group to address employee health concerns.
o The Working Group made recommendations to LMES' management which were
never acted upon.
o ATSDR's physician (Dr. Garrelson) sent to OR to educate physicians and
answer questions was not able to address any compound other than cyanide.
ATSDR able to tell Congress their mandate was fulfilled.
o Local physicians began refusing to test and treat employees. Some of the
ill workers were literally "fired" by their personal phsycians and told to
never return.
o One employee was refused access to a company physician at K-25 Health
Services, and K-25 Health Services refused to enter exposure documentation
into her file, saying that Lockheed Martin Corporate had called this a
"sensitive and controversial issue".
o A company physician was forbidden to even say the word cyanide to any of
his patients by then corporate medical director Dr. Daniel Conrad. Oddly,
the word cyanide was not classified at the time.
o Many sick workers have NOT filed MIRs because they are afraid-the U.S.
Department of Labor has, in fact, determined that LMES did retaliate
against one worker who raised health and safety concerns.
o DOE has accepted no responsibility for contractors other than the primes.
These contractors are not required by DOE to honor long term benefits.
o October 1997, presentation and recommendations made to DOE, EPA, and the
HSS agencies. No reply.
OUTSIDE OCCUPATIONAL PHYSICIANS HIRED TO HELP
o At the request of employees and under pressure from DOE HQ, LMES hired
outside physicians in September 1996 to evaluate employee health problems.
o The evaluation was closed to anyone beyond the original 53. Dozens more
have presented with similar symptomology and lab results.
o The physicians have violated the Hypocratic Oath and the Occ Med ethics.
o The physicians have been accountable to no one.
o Local physicians, elected officials, attorneys have delayed treatment,
determination for disability, and other actions.
o The physicians spent resources on a poorly executed study to create a new
urine thiocyanate reference range study that was neither peer reviewed or
published.
32 MONTHS LATER THERE ARE STILL FEW ANSWERS
o Interim reports were filled with many unconscionable errors and, for
some, were received 22 months into the study.
o No testing was requested until employees were off site for 1-3 years.
Acute exposures will not be found. There is little medical data in the
literature on effects of chronic exposures.
o There has been no testing for metals or immune factors and very
inconsistent testing overall.
o The scope of industrial hygiene sampling was extremely limited.
Workplaces have not been investigated.
o A few have had diagnoses that we are aware of: 2 with CBD, 3 with Be
sensitization. 1 with cardiac problems due to chemical exposures.
SYMPTOMS
o Immune and auto-immune disorders
o Cardiopulmonary dysfunction
o Vision and hearing loss
o Neurological problems
o Gastrointestinal problems
o Reproductive problems
o Chronic pain and fatigue
o Endocrine abnormalities
Note: Symptoms encompass all bodily systems. When viewed individually,
they may appear to be vague, non-specific or unexplainable, particularly to
those unfamiliar with toxicology. When viewed over the entire group, one
sees amazing consistency and similarity. We live in different towns and
the only unifying factor is working is the same place or living nearby.
OUR MEDICAL DILEMMA
o There is evidence of environmentally-induced disease clustering in Oak
Ridge and no rigorous clinical studies have ever been done. Most studies
involved documenting off-site releases, were directed by company officials,
or did not include physicians.
o In 1987, the Institute Medicine identified the need to learn more about
chronic exposures and very little has been done.
o Few physicians have any experience with clinical toxicology-none in
Knoxville or Oak Ridge area and none in LMES insurance providers' networks.
o Requests to LMES for workers compensation benefits have been denied.
o Some physicians have refused to test employees for toxins and have
refused to refer employees to appropriate specialists.
o Local physicians cannot diagnose and treat the unexplained illnesses,
and many have dismissed them as psychological disorders.
o A Tennessee Health Department official has stated that local physicians
will not diagnose anything that will hurt DOE.
o Problems with Classification have hindered ability to help and get help.
Until last week, employees were unable to discuss with their doctors what
they may have been exposed to.
o There have been problems with specimen samples being lost and/or
contaminated.
o LMES's insurance providers refuse to honor referrals to physicians with
experience in, expertise in or a willingness to investigate toxicology,
hence effectively denying treatment to sick workers and rendering their
insurance virtually useless. [Because LMES is self insured, all decisions
and policy pronouncements by the insurance providers are being directed by
LMES.]
o Employees have had a very difficult time obtaining a copy of the LMES
agreement with insurance providers. There are two providers and only one
contract exists.
o LM has limited the physicians we can see, the tests that may performed,
the medicines we can take.
o Tissue specimens are lost or compromised.
o DOE has directed LM to reduce benefits' costs, especially long term
benefits.
o Retired employees' health benefits have been cut by 50%.
o DOE reluctant to release data and do anything which may imply or admit
liability.
o Little or no action while health deteriorates.
SCIENCE HAS FAILED IN OAK RIDGE
Public and occupational health have failed in OR.
DOE's standard health studies (epi studies, risk assessments, dose
reconstruction) have failed in OR. DOE's foundational data is suspect.
The dosimetry program is a farce.
POLITICS REIGN IN OAK RIDGE
We have politically incorrect illnesses.
We have experienced political science not good medical science.
We are being forced to prove causation before we get medical help.
We have experienced unethical, incompetent science, withholding and
falsification of data.
Our requests for information are forwarded to the Department of Justice.
WE DEMAND
o Access to health care (proper testing and treatment) which may allow some
of us to get well and possibly to return to the work force.
o Access to future health care to address health effects we haven't even
seen yet.
o Answers and to prevent others from having our illnesses.
o Aid and answers as Cold War Veterans who have served our country.
o Research funds be spent on projects which will directly benefit those
affected by DOE's operations.
All of these are possible.
Teams of the nation's best physicians worked hard on developing treatment for
leukemia. If the patients had had to prove how people got leukemia before
they were
treated, new leukemia treatment modalities would have never happened.
RESEARCH THAT IS NEEDED
o Health effects research on the thousands of hazardous materials that are
in use in commerce today that have never had research on them before.
o Health effects research on long-term, low-dose exposures.
o Health effects research on exposures to multiple toxicants - synergistic
effects and additive effects.
o Research on treatments for chronic exposures.
o Research on living people, with their consent, where they can see benefit
- e.g. Framingham study
o "Real" disease registries
THE BOTTOM LINE
DOE must transcend the fear of liability and allow:
o More "real" science to occur.
o Researchers and those who advise them to ask questions and raise issues
without fear of retaliation.