|
Testimony Before the Subcommittee
on Superfund, Toxics, Risk, and Waste Management Committee on Environment
and Public Works United States Senate Human Services California State Senate United StatesUUn |
ATSDR=s Public Health Response Plan in Libby, MT Statement
of Henry
Falk, M.D., M.P.H. Assistant
Administrator, Agency
for Toxic Substances and Disease Registry U.S.
Department of Health and Human Services |
For Release on Delivery
Expected at 9:30am
on Thursday June 20, 2002
Good morning, I am Dr. Henry Falk, and I am
the Assistant Administrator of the Agency for Toxic Substances and Disease
Registry (ATSDR), a public health agency within the U.S. Department of Health
and Human Services (HHS). I am
accompanied by Sharon Campolucci, RN, MSN, Deputy Director of the ATSDR
Division of Health Studies; she was coordinator of the medical testing program
in Libby.
Senator Baucus, ATSDR is grateful for the interest and support given by you and other members of the Montana delegation since we began working in Libby in late 1999. As you know, we came to Libby in response to concerns expressed by yourself, community members, former vermiculite mine workers, and the health department. Over the last several years, we have worked very closely with the U.S. Environmental Protection Agency (EPA) to address these concerns. Without the support of all of you we would not be able to report today on the significant progress we have made in evaluating the public health issues in the Libby, Montana, area.
Congress created ATSDR in
1980 under the Comprehensive Environmental Response, Compensation, and
Liability Act (CERCLA), or what is more commonly known as the Superfund
legislation. CERCLA mandates of ATSDR a
broad, national program of Superfund site health assessments, health
investigations, surveillance and registries, applied research, emergency
response, health education, and toxicological database development. Broadly
speaking, ATSDR's responsibilities under Superfund, the Resource Conservation and
Recovery Act (RCRA), and other federal statutes are to assess the effects of
toxic substances on community populations and to recommend interventions to
protect public health where they are needed. This may include medical screening
and epidemiologic investigations of health effects of community populations
exposed to hazardous substances; ATSDR undertook these activities in Libby. We
also conduct investigations to measure human exposure to toxic substances
released from waste sites or other sources of release. We conduct our work in
close collaboration the U.S. Environmental Protection Agency (EPA), state
health departments, local health agencies, and affected communities.
Since being called upon
in November 1999, ATSDR has been actively involved with the citizens and public
health and environmental officials to determine the extent of harm to humans
from asbestos-contaminated vermiculite that was mined in Libby.
In the earliest days of our involvement in
Libby, we developed a plan to help guide site-related public health
activities. As we have shared with you
in the past, this Public Health Response Plan identifies the areas of
responsibilities for the conduct of our health-related activities. All
stakeholders, including officials and the affected community, provided input
throughout the process of both developing and implementing the Public Health
Response Plan. The plan describes specific activities that are designed to
prevent exposures and to mitigate or prevent adverse health effects. Key elements targeted in the plan were:
1) to provide community-based medical
testing to determine the health status of exposed people;
2) to assess disease and illness trends to
characterize the impact of the environmental exposure;
3) to
provide a public health education program to assist residents in obtaining full
and up-to-date information on asbestos-related risks and diseases; and
4) to
collect and analyze medical and epidemiologic data to better characterize the
nature and extent of asbestos-related disease in the community.
Following are updates on activities that
resulted from this action plan.
Medical testing
From July to November 2000, ATSDR staff
conducted medical tests on current and former residents of the northwest
Montana town. Participants included
6,149 adults who lived, worked, or played in Libby for at least six months
before December 31, 1990. Components of
the testing included an in-depth questionnaire to build an exposure history for
each of the participants, three x-ray views to identify changes in the lungs
and lung lining that might be the result of asbestos exposure, and a spirometry
test that measured air flow in and out of the lungs to measure lung function.
Of those 5590 study participants 18 years of age and older who were eligible
for x-ray testing, 18 percent (994) showed pleural abnormalities (chest wall
scarring). According to data reported in the literature, the rates of pleural
abnormalities in the United States among groups without known exposure to
asbestos range from 0.2 to 2.3 percent.
Additional findings included:
!
Forty-eight
percent (159 of 328) of former W.R. Grace employees who participated in the
medical testing had pleural abnormalities.
!
Most
participants reported multiple routes of exposure (household contact,
occupational, recreational, and other) to the asbestos-contaminated
vermiculite. For example, 24 percent of participants who reported six or more
routes of exposure had pleural abnormalities.
!
Five percent (6
of 122) of those participants who reported no apparent exposure had pleural
abnormalities.
The second phase of
initial medical testing was conducted between July and September 2001, and
included 1,158 participants.
Notification letters have been sent to these participants, and ATSDR is
in the process of analyzing these new data and combining them with results from
those tested in 2000. Once the analysis
is completed, ATSDR will produce and make available to the community a final
report combining results from both medical testing phases. The preliminary analysis of this combined
data does not indicate any significant change in the prevalence of
abnormalities when compared to data from the first phase of testing.
ATSDR is working to
Alocalize@ the medical testing program B transitioning it to the state and
local health departments with our ongoing technical and resource support.
Mortality review
In addition, after
consultation with the National Institute for Occupational Safety and Health
(NIOSH), CDC, we investigated an association between contaminated vermiculite
and human health through a mortality review in which we compared death rates
for residents of the Libby area with those in Montana, and the United States,
for selected diseases that have been associated with asbestos. ATSDR staff
reviewed death certificate data from 1979 to 1998 for the Libby community. The
review focused on the underlying cause of death in Libby-area residents. We found that mortality from asbestosis in
the Libby area was at least 40 to 60 times higher than expected. We also found that death from mesothelioma
appeared to be elevated. This mortality
review is continuing; additional data are being reviewed to support these early
findings. We expect to release this
mortality review by early July.
These two investigative tools B the medical
testing and mortality review B clearly indicated a public health problem in
Libby. Based on these findings, ATSDR
recommended many follow-up activities, several of which already have been initiated.
!
Working with a
local pulmonary physician who treats referrals from the Libby area, ATSDR has
conducted a focused review of patients with an asbestos related
diagnosis and no known link to vermiculite mining. This review was conducted to address community concerns about
environmental asbestos exposure outside the workplace. Final revisions for the report are now in
progress and preliminary results will be released later this month.
!
A
computerized tomography (CT) scan study is nearly complete. This study was
designed to evaluate the sensitivity of the medical screening tool (chest
x-rays) and to help in planning possible future medical testing activities. All
353 scans have been completed and reviewed by expert CT radiologists, and
letters providing individual scan findings have been sent to participants and
their physicians. Analysis of these
data for the study report is underway.
!
Detailed
planning and preparatory work has begun on the development of a registry
to track former Libby-area miners and their household contacts. This focuses on
the members of this community who were at greatest risk based on exposure
levels and on the results of the medical testing program; a key source of
registrants would be those who participated in the medical testing program. ATSDR sponsored a workshop in February to
consult with and solicit advice from experts in pulmonology and
asbestos-related disease to help guide the next steps for the Libby
registry. The recommendations from this
group will assist in addressing the concerns of the Libby community while also
meeting ongoing surveillance needs and in the collection of valuable scientific
data. In addition, the registry will help us stay in contact with all of the
identified individuals and provide updated information on diagnosis and
treatment options. The registry is
intended to be a long-standing fixture that will not only be a repository of
information about the registrants, but will also be a source of the latest
information about treatments and other medical breakthroughs.
!
ATSDR is
working with the State to support localized planning to address future
medical needs. Extended medical testing will need to continue in some
form for many years. People who have tested positive will need to be followed
to note any progression in the course of the disease. People who have tested
negative to date, but who were substantively exposed, will also need periodic
testing, but probably on a different schedule.
Primary responsibility for the medical testing program will be
transitioned to the State and local health department with ongoing technical
and resource support from ATSDR.
!
ATSDR worked in
close cooperation with HHS Region VIII staff to help the community identify
sources of assistance for medical care.
In fact, HHS Deputy Secretary Claude Allen personally visited Libby last
August and was instrumental in developing an HHS response. HHS now supports the Community Health Clinic
(CHC) in Libby which provides primary health care services to people in the
Libby area. ATSDR has also worked cooperatively with the Center for Asbestos
Related Disease (CARD) in Libby. This
facility, operated by St. John's Hospital, provides ongoing medical care for
persons diagnosed with asbestos related medical conditions or those requiring
further evaluation after undergoing initial medical testing.
!
The Lincoln
County Department of Environmental Health and the University of Montana in
Missoula, in cooperation with ATSDR and the Montana Department of Public Health
and Human Services, are organizing a research conference for later this
month (June 24-26) to discuss current asbestos-related research and plan for
future projects. Conference co-sponsors
include EPA, the National Institute for Environmental Health Sciences, and the
National Science Foundation.
!
this June to facilitate development of the
future research agenda related to the Libby site.
Now that cases have been
identified through the various methods I have outlined (e.g., mortality review,
case series review, and medical testing), other recommended activities include:
!
epidemiologic
studies to better evaluate the relationship of exposures and exposure pathways
to disease;
!
follow-up
evaluation of individuals in the medical testing program who were referred for
medical care to assure that this referral worked effectively; and
!
a better
determination of the clinical course and natural progression of pulmonary
disease related to tremolite asbestos.
Other sites that received
asbestos-contaminated vermiculite
Processing of vermiculite
ore shipped from Libby has occurred at approximately 300 sites in 40 states
over the last 50-90 years. These sites
are being reviewed to consider the potential for health problems similar to
those experienced by Libby-area residents and former mine workers. ATSDR staff
have been working with EPA to determine if any of these sites pose a public
health hazard. This review has included site visits to assess the extent of
current or past operations, and to determine the extent of human exposure and
possible pathways of exposure to the asbestos. One site that has already
elicited considerable attention is the Western Mineral Products site in
Minneapolis, Minnesota.
This Minnesota site was
used for insulation products manufacturing from 1936 to 1989. The plant
received vermiculite ore from Libby, Montana, and processed the ore into
insulation, fireproofing material, and other vermiculite products. Under a
cooperative agreement with ATSDR, the Minnesota Department of Health (MDH)
conducted a health consultation to identify health concerns related to asbestos
exposure from the site. Plant workers were exposed to levels of asbestos in
excess of current occupational standards for much of the time the plant was in
operation, and cases of asbestos-related disease have been reported in former
workers. Additionally, approximately 100 properties around the former plant
have been identified as contaminated with asbestos-containing wastes from the
site. The EPA is in the process of removing asbestos-contaminated soil from
these properties and adjoining alleys.
The extent of past and
current exposures to asbestos is difficult to estimate at this time. Based on
available information, past exposure to workers in the plant, residents who
lived near the site and children who played on piles of vermiculite waste
material may have been at risk for asbestos exposure. To address this concern, MDH initiated the Northeast Minneapolis
Community Vermiculite Investigation (NMCVI), a population survey to identify
and characterize asbestos exposure in a community cohort. This study involves a
door-to-door interview and visual inspection of properties in the immediate
vicinity of the Western Mineral Projects Plant in Minneapolis, as well as a
telephone interview of former residents in the target area and other
individuals who may have had exposure to vermiculite. This investigation will
determine the size and demographics of the population at risk.
The EPA, Minnesota Pollution Control Agency, and MDH will continue to
investigate and clean up the site and surrounding community.
ATSDR staff have
developed a protocol for use by the state health departments to review vital
statistics and cancer registry data to determine if there might be a health
impact in any affected community that warrants further investigation. During FY 2001, ATSDR developed cooperative
agreements with six states (Utah, Colorado, Massachusetts, California,
Louisiana, and Wisconsin) to conduct health statistics reviews around sites
that received asbestos contaminated vermiculite from Libby and to determine
whether there is an excess of asbestos related disease. Later this summer, other states will have an
opportunity to apply for support of similar health-related activities; we
anticipate supporting up to four additional states. In addition, ATSDR has awarded funds to conduct evaluation of
mesothelioma cases in three states (New York, New Jersey and Wisconsin). This
surveillance process enables states to use their cancer registry data to
identify all mesothelioma cases and then look backward to see if the disease in
any portion of the cases could be associated with asbestos exposure from
contaminated vermiculite or vermiculite insulation from Libby. ATSDR staff also is working with health
officials in Montana to review mesothelioma cases in that state.
I would like to reiterate
that ATSDR shares your concerns about the situation in Libby B both the
environmental contamination and the health concerns. While we have done a great
deal of work in Libby, much remains to be done. To summarize, our primary goals
for this coming year are:
1) implement the registry of former workers
and family contacts;
2) establish the medical testing program on
a long-term basis by transitioning primary responsibility to State and local
health departments, with technical and resource support from ATSDR;
3) conduct epidemiologic studies to
formally investigate the links between the various environmental exposures and
the development of disease;
4) provide data on potential health effects
in other states that had vermiculite processing centers that led to harmful
exposures; and
5)
pilot
mesothelioma surveillance activities, in coordination with NIOSH.
With your continued
support, ATSDR stands prepared to continue the important work we have begun and
do whatever we can to help the Montana and Libby community, and any other sites
that may be identified with similar problems.
Mr. Chairman, this
concludes my testimony; I would be happy to respond to any questions you may
have.