Statement of Brad Black, Libby, Montana

My name is Brad Black. I hold the position of Lincoln Co. Health officer and have lived and practiced medicine in Libby for over 22 years. As cases of asbestosis surfaced in the area that involved people with non-occupational exposure, our health department began the process of determining where they might have occurred. Communication with Dr. Alan Whitehouse gave indication of at least 23 cases of "non-occupationally" acquired asbestos-related lung disease. These cases included youth recreational exposure, service workers to the mine site, individuals that expanded the ore on their kitchen stoves, loggers who worked timber contracts around the mine site, and a report of one case who had lived in the central area of Libby with no other apparent exposure.

The EPA, led by their coordinator Paul Peronard, arrived and efficiently assessed the concerns. EPA toxicologist Chris Weis and Aubrey Miller, MD were professional in their approach to the situation. Their assessments supported the concerns of widespread asbestos exposure.

We discussed the immediate need to determine if there is current risk of significant asbestos exposure (environmental screen), if there was significant past exposure (medical screen) and the future need to develop the medical infrastructure to provide ongoing follow-up and care of persons with evidence of significant asbestos exposure.

In discussions with our medical providers. there was a consensus that we should take a lead role in providing medical evaluation and follow-up care for those affected with asbestos exposure. The Lincoln Co. Health Board was supportive of St. John's Hospital and medical staff taking an active role in developing the necessary infrastructure. Dr. Whitehouse was consulted and was supportive of us proceeding with this plan.

At this stage, our role appeared to be in assisting the EPA in the medical screening process and to proceed with securing the elements necessary to provide medical care and follow-up.

The ATSDR was engaged and with the direction of Jeff Lybarger, MD, we have continued to proceed with development of infrastructure. There was initially concern locally that the EPA and ATSDR might have some problems in developing a consensus on leadership in this project, however, both groups have demonstrated a level of professionalism that has allowed things to move along in a positive direction. They have come to fulfill their role, but have been listening and responding to state and local input quite well.

Development of the community advisory group is seen as an essential element. I would strongly recommend, in the initial phase of development of this interactive process, that the EPA take a more formal role in facilitation. This could help break down community tensions and help create an environment that participants see as comfortable and respectful of individual rights when discussing differing opinions. Then the group function can mature to a level that allows it to sustain an independent character.

As environmental screening and medical screening are in progress, we feel that it is essential to be developing a system to receive, evaluate, continue monitoring, and provide all aspects of care for those people with significant asbestos exposure. This would be accomplished with the assistance of expertise offered by Dr. Alan Whitehouse, a pulmonary specialist who is experienced in the clinical course of this tremolite exposure. In addition, it is our interest along with Dr. Whitehouse to investigate the possibility of finding a therapy for the fibrotic process caused by asbestos fibers. The ATSDR represented by Dr. Lybarger has indicated support for a research component.

As we receive the aid of the EPA in environmental screening and the ATSDR in developing a local program that would begin by being involved with the medical screening and continue the process and be ready to receive the identified population, I am concerned we are not going to be prepared. St. John Hospital is in serious need of operational capital in order to take an active role in hiring a local program coordinator, clerks, interviewers and pursuing education for health providers and respiratory therapists to mention a few immediate needs. As a health care community, we are ready and waiting to move ahead. With adequate capital and expertise from consultants, I'm certain we can construct a quality infrastructure.

Previously, Senator Baucus had indicated he would seek some monetary aid for helping our medical system prepare. I am hopeful that he will be successful in this venture.

Also, our role is to continue negotiation with W.R. Grace to address the long term health care needs of persons affected by asbestos-related disease. This would involve regular monitoring and care with appropriate interventions for those who have been impacted by asbestos exposure.