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Libby Community Advisory Group
Meeting Summary

September 12, 2002

Introductions

Gerald Mueller and members of the Libby Community Advisory Group (CAG) introduced themselves. A list of the members and guests in attendance is attached below as Appendix 1.

Agenda

Mr. Mueller reviewed an agenda for this meeting, including the following topics:

Public Comment

ATSDR Report

Changes to ATSDR Personnel
Dan Strausbaugh began the ATSDR report with changes in ATSDR personnel. Sharon Campolucci has been reassigned to New York City projects and will no longer be directly involved with Libby. Sharon Pasika, a NORC employee, who has functioned as Mr. Strausbaugh's assistant, will be leaving this month with the expiration of the NORC contract. Mr. Strausbaugh introduced David Williamson, who has taken over from Dr. Lybarger the position of Director of the ATSDR Division of Health Studies, and Dr. Vikas Kapil, who has assumed Ms. Campolucci's former role of lead for the Libby Project.

September 26 Meetings
Mr. Strausbaugh announced that plans have been finalized for the ATSDR Libby presentations on the results of the mortality study, the combined medical testing, and the CT study. ATSDR will hold two public sessions on the studies on Thursday, September 26, one in the afternoon from 2:00 to 4:00 p.m. and one in the evening from 7:30 to 9:30 p.m. Both sessions will be held in the Ponderosa Room of Libby City Hall. Two of the studies, the combined medical testing and the CT, are still under peer review and will not be finalized by September 26. ATSDR will issue a detailed fact sheet on these two studies. The final report on the mortality study was released last month and copies of it are available. The principle authors of the studies will attend the September 26 sessions.

Public Availability Session
ATSDR will also hold the Public Availability Session for the Public Health Assessment as previously announced on Friday and Saturday, September 27 and 28. These sessions will provide people of Libby with an opportunity to talk about their health concerns related to asbestos exposure with ATSDR scientists and medical officials.

ATSDR Office Staff
The departure of Ms. Pasika will mean that after September 30, 2002, ATSDR will no longer have a full-time person at the EPA/ATSDR Information Center in Libby. The office phone will remain with a message directing people to the toll free number, 1-866-457-2690 X5007, for Mr Strausbaugh's Helena office.

CAG Member Question - Will the Availability Session focus on broader health concerns or only on asbestos exposure related issues?
Answer - The sessions are designed to hear health concerns related to asbestos exposure. ATSDR personnel will be as helpful as possible, but will not provide treatment advice or counseling.

CAG Member Question - When will the peer review of the medical testing and the CT studies be completed?
Answer - They should be completed in about six weeks.

EPA Report

Duc Nguyen and Wendy Thomi reported on behalf of EPA on the following subjects.

Stimson Lumber - EPA began sampling this past Monday at four locations at the Stimson mill at which vermiculite has been observed, the plywood plant, the central building, the log yard, and the finger joint plant. Ambient air and dust samples have been collected and some individuals wore personal samplers. By September 20, sampling should be finished and results should be ready.

Screening Plant - Restoration of the site is underway and should be completed this year. Areas near Rainy Creek are being reworked.

Flyway - Digging will begin the week of October 1 and will be accompanied with ambient air sampling to make sure that no contamination leaves the site. Although they were last year, people living in the River Runs Through It subdivision will not be relocated this year because of the continuous air monitoring and the location of a trailer between the residences and the work area.

Burlington Northern Railroad (BN) - BN provided EPA a work plan for their cleanup activities this Monday, and it is under review. EPA is developing the administrative order in cooperation with BN so that the cleanup will be completed this year.

County Landfill - Construction of the new cell at the County landfill is about 80% complete. Because of difficulty accessing the mine during the winter, all contaminated material will be hauled to the landfill for disposal.

Residential and Business Sampling and Cleanups - Sampling should be finished by the second week in October. To date, 1,847 of the target 2,222 residences and businesses have been sampled. Of those sampled, 50% have Zonolite insulation and 48% have vermiculite outside. The residential cleanups continue to progress slowly. Another contractor will be brought in soon so that four to six teams will be conducting cleanups. Restoration work will be contracted locally. EPA continues to expect 50 to 60 homes to be cleaned this year. EPA will contact the homeowners before announcing the location of the homes to be cleaned.

Public Presentations to the CAG - Wendy Thomi reported that she had been contacted by D.C. Orr to request time to address the CAG. Ms. Thomi was not able to return Mr. Orr's telephone call until several hours before this meeting, and Mr. Orr is not present tonight. Both Ms. Thomi and Mr. Mueller stated that one need not reserve time before a meeting to make a statement to or ask questions of the CAG because time is provided for the pubic on each meeting agenda. If you wish to reserve time on the agenda, you can contact Ms. Thomi toll free at 1-866-457-2690X5037 or Mr. Mueller at 1-406-543-0026.

Audience Member Question - In the BN cleanup, will contaminated material be removed or covered in place?
Answer - The work plan identifies the locations from which contaminated material will be removed with by digging or using a vacuum truck. Contaminated material will probably be hauled to the County landfill. The work plan has not yet been approved and further investigation may be necessary.

Audience Member Comment - The current work plan does not address digging but relies on use of a vacuum truck to remove contamination to a depth of two feet. I am concerned that this approach will allow recontamination when it is necessary to replace rail ties.
Response - EPA is aware of this potential problem. Further investigation and confirmation sampling may be required to ensure that such activities do not cause contamination of the rail yards. In approving the work plan, EPA will look at both current and future uses of the rail yard. Cleanup work will not begin until the work plan is approved.

Audience Member Question - What is the plan for paving Rainy Creek Road?
Answer - EPA has received two bids for the paving, and has decided to request a third bid.

Comment by Commissioner Rita Windom - A timber sale is pending in the Rainy Creek drainage that cannot proceed until the road is paved. I request that EPA as soon as possible convene a meeting of the stakeholders, the County, the USFS, the Parkers, and Plum Creek, to discuss the road paving.
Response - EPA will contact Commissioner Windom to set up the requested meeting. We have met with USFS to discuss procedures necessary to ensure that no asbestos contamination will result from the harvest or use of the road. Apparently the specific harvest has not yet been mapped, and the harvest will not occur until late this year.

Audience Member Comment - A local company was scheduled to do the paving last week. Its employees went to school to learn asbestos contamination related procedures. The paving has been postponed because EPA wants another bid.
Response - EPA has asked for another bid because of cost concerns. The bids to date appear too high.

Audience Member Question - Will log trucks for the Rainy Creek timber sale have to meet level C requirements including positive air pressure inside the truck cabs?
Answer - Above the green gate, trucks will have to meet level C requirements, including positive air pressure in the cab and tyvek suits and respirators for the drivers. Proceeding below the gate, level D protection will be in effect and trucks must be enclosed and decontaminated.

CAG Member Question - What will be the cost and time frame for the residential cleanups? Will siding be removed and carpets replaced?
Answer - Residential and commercial buildings will be in one of three groups for cleanup: those with both outdoor and indoor contamination, those with outdoor only, and those with indoor only.
Cleanup will work from outdoor to indoor. It will begin with the first group of buildings, those with Zonolite insulation and outdoor contamination . The next group to be cleaned will have outdoor only, and the last to be cleaned will have only indoor contamination. Outdoor cleanups will involve sod, trees, gardens, and out buildings such as sheds. Contaminated sod will be replaced. EPA prefers to cut down and replace trees because removing soil to a depth of twelve inches may expose tree roots causing damage to the trees and may still not remove all of the contamination. If the building owner insists on leaving the trees, we will excavate around them. We will excavate around sheds. Railroad ties will be replaced because of creosote contamination. To remove the Zonolite insulation, holes may be drilled in walls or cuttings may be made along the wall footings. Based on dust sampling inside the building, vacuuming or carpet replacement may occur. The goal will be to restore the home or building to a close as possible to the original condition. EPA will work with building owners and tradeoffs may occur. The time frame for the cleanup will vary depending on the contamination and will average about three to four weeks, including three to four days to remove Zonolite insulation, two to three days for interior cleaning, and four to five days for yard work. Cleanup pace will probably quicken as we gain experience.

Audience Member Question - How will you notify people that cleanup will begin? Will you give a week or longer notification?
Answer - We will notify people directly and will provide ample notice. I do not know the specific notification time.
Audience Member Question - Will people whose houses are undergoing indoor or outdoor cleanups be relocated?
Answer - Yes, they will be relocated.

CAG Member Question - Concerning the Stimson air sampling, what standards will be applied, and when will the results be available?
Answer - We expect air sampling results next week. They will be given to Stimson, and Stimson can then release it.

CAG Member Question - So once the sampling results are given to Stimson, they decide whether it will be released?
Answer - That is EPA's current policy. Individuals can request release of information obtained with government funding through a Freedom of Information Act (FOIA) request.

CAG Member Question - What about Stimson's employees?
Answer - Stimson has an obligation to inform its employees.

CAG Member Comment - Since 1999, results of residential air sampling has been released to the public.
Response - The information released was general. Specific names and home locations were not released.

CAG Member Comment - This information policy is what caused the existing problem in Libby. For forty years, W.R. Grace and the state kept information about the asbestos contamination secret. It is outrageous that EPA cannot release the sampling results.
Response - Information will be available via a FOIA request.

Comment by Commissioner Rita Windom - As chair of the County Board of Health, I request that the Stimson sampling results be released to me.

CAG Member Comment - We need not assume that past behavior will be repeated. Stimson has been working cooperatively with us, and we should assume that it will continue to do so. Also, other agencies than EPA have the responsibility for employee safety.

CAG Member Comment - Stimson wants to come to the table and take care of this. We should be vigilant and continue to maintain our relationships and communicate our expectations, but we need not be critical of agencies if we don't have to.

CAG Member Comment - We don't expect Stimson to withhold information, but we do have a problem here and in America. Corporations have the privilege of withholding information from their employees and the public.
Response - When federal funds are used to collect information, that information must be released publically. EPA has requested that Stimson release information about the threat of asbestos exposure. We will discuss with EPA attorneys about release of information and report back to the CAG.

CAG Member Question - What standards will be applied to the air sampling, EPA, OSHA, NIOSH? What are you testing for?
Answer - We are testing for asbestos fibers. We will apply the same standard as in the other cleanups in Libby. We are applying new analytical sampling technique and conducting a risk assessment. We are aware of the toxicity of the tremolite amphibole. However, all of the results are not yet in, so we have not decided the cleanup level.

CAG Member Question - We need logs for the Stimson mill. Libby is surrounded by trees. It is unbelievable that the contaminated Rainy Creek drainage is the location of the timber sale and that the USFS won't release trees anywhere else.

CAG Member Question - Would EPA hold a meeting to discuss the sampling results with Simson's 320 employees and the public?
Answer - A public meeting is a good idea, and we will discuss it with Stimson.

State Report

Dr. Spence reported on behalf of the State. He stated that in a teleconference last Thursday with ATSDR, he is reworking his proposed budget for the continuing medical screening.

St. John's Lutheran Hospital Report

Rick Palagi reported on behalf of the Hospital and covered the following topics.

Senator Baucus Letter - The letter to Senator Baucus addressing a possible "white lung" program and the need for federal assistance to help Libby project the cost of health care services that will be required in 30 to 40 years to care for those sick with asbestos related diseases was circulated to CAG members for comment after the last CAG meeting. The letter was mailed to Senator Baucus with only one change. Reference to a national "white lung" program was deleted so that the letter supported only a "white lung" program. Mr. Palagi reported that the letter received amazing support from other Libby groups. The Heathy Forest/Healthy Community group sent a similar letter. Governor Martz also sent a letter supporting the "white lung" program, federal funding to estimate the total health care costs facing Libby as a result of asbestos exposure, and funding that the Libby community can use to support its health care needs until the "white lung" program is established.

CARD Clinic Changes
Mr. Palagi passed out a press release from St. John's Lutheran Hospital announcing two changes regarding the CARD Clinic. See Appendix 2 below. Since its creation, the Clinic has been a part of the Hospital. The first change is to move the Clinic from the Hospital into a separate not-for-profit entity. The second change relates to CARD's billing policies. Until now, the Clinic billed the W.R. Grace plan for some of its services, but did not bill other insurance plans or patients. The Hospital supported the Clinic with the $250,000 annual contribution from W.R. Grace. As of October 15, 2002, the Hospital will begin to bill applicable insurance plans and Clinic patients will be responsible for co-payments and unpaid services. While the Hospital would prefer not to bill patients for co-payments and deductible items, legally it cannot wave these requirements. If patients are unable to pay, the Hospital will work with them on a payment plan.

Future Health Care Costs
The state has received federal funds to conduct an actuarial study of Libby's future asbestos-related health care costs, and is proceeding to select a contractor to conduct the study. Actuaries from the Montana Department of Labor and Industry will assist the study.

CAG Member Question - What happens to people in the future who under the new billing policy will have to pay for CARD services?
Answer - The Hospital will work with them. People will have to pay Medicare and other insurance co-payments and deductibles. We hope to have additional funding support in twelve to eighteen months.

CAG Member Question - So if I don't have insurance, I will have to pay the whole bill?
Answer - Historically, the Hospital has provided $3.5 million in free services annually. The total hospital budget is $12 million. We will make every effort to get uninsured people on the W.R. Grace Medical Plan.

CAG Member Comment - The Community Health Center is also available to help people with their medical needs.
Audience Member Question - What will W.R. Grace's $250,000 annual contribution to the Hospital be used for now?

Answer - It will continue to be used for direct patient care.

Rural Health Outreach Grant

Dennis Alexander, a grant writer under contract to Lincoln County, reported on the
addressed the CAG about a Rural Health Outreach Grant that he and Tracy Velazquez have prepared and will be submitting tomorrow to the Health Resources Services Administration (HRSA). Mr. Alexander summarized the grant goals and plan elements. See Appendix 3. He then requested CAG support for the grant and passed out a support letter for CAG members to sign.

CAG Member Question - Will the grant funds be used for direct medical care?
Answer - Grant funds will be used for drugs and transportation to treatment, but not for personal medical care.

CAG Action - Those CAG members present unanimously agreed to support this grant request and to sign the letter.

Mr. Alexander also reported that a environmental justice grant will be submitted to support tracking of former Libby school children.

TAG Update

Sandy Wagner reported that the TAG Steering Committee has been notified by EPA that the TAG grant request has been approved and that they will receive an award letter for a $50,000 grant on October 1, 2002.

CAG Member Question - Did the grant proposal identify specific expenditures?
Answer - No, the grant identified only conceptual expenditures; we will now have to decide on specific expenditures.

CAG Member Question - Has a TAG 501(c)(3) been formed?
Answer - The Steering Committee will now proceed with forming a 501(c)(3). The Steering Committee includes an attorney who will help us with the 501(c)(3) application.

CAG Member Question -How soon do you expect to receive the actual funding?
Answer - Funds are received to reimburse actual expenditures. We now have to proceed with establishing a board of directors.

Public Comment

CAG Member Question - What is the status of funding for the Community Health Center (CHC)?
Answer - We expect approval for three years of funding on November 1.

CAG Member Comment - To date, 600 elementary school children have seen the CHC dental coordinator.

Audience Member Question - How long before there is a pharmacy in the CHC?
Answer - A pharmacy is not in the current CHC plan. The CHC is now assisting people with a drug program.

Audience Member Comment - People are now using the County indigent services program to obtain help for paying for drugs.

Comment by Dr. Elizabeth Putman of the Center for Environmental Health Studies in the School of Pharmacy and Allied Health Sciences of the University of Montana - The Center has received notification from NIEHS of the award of a $1 million grant over 5 years. The purpose of the grant is to provide services to ensure that scientific information is passed to the Libby community in an understandable manner. The grant will also allow the Center to provide outreach to school children concerning asbestos related issues.

CAG Member Comment - I understand that the Healthy Forest/Healthy Community Coalition is seeking a unrestricted grant from the federal government of $3.5 million. I am concerned that we not go to the federal funding well without a specific need identified. We need to coordinate our funding requests or multiple voices may end up conflicting. We need a unified community voice.
Response by David Latham - I attended the Healthy Forest/Healthy Community Coalition meeting that was reported on in the local press. The only specific funding request at the meeting was for $100,000 to hire a forester. There was discussion of the need for an appropriation so that Libby's future medical needs can be assessed, but no request was made at the meeting for $3.5 million.
Response by Kerry Beasley - My understanding is that the Healthy Forest/Healthy Community Coalition has discussed requesting money from the federal government to be used until we have a satisfactory health insurance product, i.e. one that is portable and allows adequate access and patient treatment choices. A range from $3.5 to $150 million has been mentioned which demonstrates the need for the actuarial analysis of this community's future asbestos related health care costs. I agree that we do need to coordinate our funding requests.

CAG Member Comment - I am aware of a person here with asbestos disease who was disqualified from the W.R. Grace Medical Plan and who is selling his assets because he thinks he will be turned away from financial assistance. We do have a need for more money to go into a community fund such as LeRoy Thom's 501(c)(3) group.

Next Meeting

The next meeting is scheduled for Thursday, October 10, 2002 at 7:00 p.m. in the Ponderosa Room of Libby City Hall.


Appendix 1

CAG Member & Guest Attendance List
September 12, 2002

Members

Group/Organization Represented

Les Skramstad

Asbestos Victim

Gary D. Swenson

Libby Fire Department

Gayla Benefield

LCAVRO

Leroy Thom

Former W.R. Grace employee

Dan Strausbaugh

ATSDR

Gary Spencer

Citizen

Rev. Robert Foote

Libby Ministerial Association

George Bauer

City of Libby

Ken Hays

Senior Citizens

Dr. Brad Black

Lincoln County Health Officer/CARD

Duc Nguyen

EPA On Scene Coordinator

Sandy Wagner

Community Health Center

Clinton Maynard

Area Asbestos Research Group

Rep. Eileen Carney

State Representative

Wendy Thomi

EPA Community Involvement Coordinator

David F. Latham

The Montanian Newspaper

Bob Dedrick

Asbestos Victim

Kerry Beasley

St. John's Lutheran Hospital

Craig French

Montana DEQ

Rick Palagi

St. John's Lutheran Hospital

Don Wilkins

Lumber & Sawmill Workers

Visitors

Dr. Michael Spence

State Medical Officer

John Wardell

EPA Montana Office

Sharon Campolucci

ATSDR

David Williamson

Director of the ATSDR Division of Health Studies

Vikas Kapil

ATSDR

Dennis Alexander Grant

Writer for Lincoln County

Appendix 2

St. John s Lutheran Hospital

PRESS RELEASE
For Immediate Release

Contact Person: K.C. Hoyer
Contact Phone: 293-0106
Date: September 12, 2002

CARD Group Plans Changes

The Center for Asbestos Related Disease (CARD) Advisory Board announced Thursday that it will be working with St. John s Lutheran Hospital to move the CARD into a separate not-for-profit entity. The transition is targeted to be complete by March 31, 2003.

"Our intent is to keep our focus on patient care, while expanding our work in research," said Dr. Brad Black of the CARD Clinic. "Rural hospitals are not set up to handle major research projects, and we can t get some of the available grant finding if we re part of the hospital. Being a separate organization will give us more flexibility to branch into different areas and get the federal dollars we need. It s another step in the evolution of the CARD, and we are excited about it."

The CARD Advisory Board has been working with Hospital Trustees to assess the need for the change, and begin planning the changes necessary to make it work, according to LeRoy Thom, Board Member.

"We have had a lot of support from the hospital to branch out and continue the evolution of the CARD Clinic," stated Thom. "What started as a temporary service to help people understand their screening reports has now expanded, and it s time for the CARD to be on its own."

The CARD Clinic has been supported financially by the Hospital since it opened in May 2000. Contributions to the Hospital from W.R. Grace were used for this support. The Clinic also billed the Grace Libby Medical Plan for some of its services, but for the most part, did not bill any other insurance plans, or any patients.

Because services given to patients have cost more than the available finding, the CARD Advisory Board has had to begin their transition with some specific changes to make the CARD financially sustainable long-term. As of October 15, 2002, the Clinic will be adopting normal billing policies, according to Rick Palagi, CEO at St. John s. This means all insurances will be billed when applicable, and the patients will be responsible for co-pays and any unpaid services, just as they would with any other provider.

"As with any medical bill, if a person is financially unable to pay, we will explore every avenue of assistance," stated Palagi. "We want to help those who need our services, no matter what. We just have to start running this Clinic like other businesses so we can stay in business long term. If that means billing Medicare or Blue Cross, then that s what we need to do."

Hospital Board Members will continue to work to find avenues of long-term finding for direct patient care, including at the CARD Clinic, according to Kerry Beasley, SJLH Board Chair.

"We want to make it clear that, although the CARD may be a separate organization, the Hospital is still committed to making sure that long-term, direct patient care is available and funded," stated Beasley. "We will continue to work on the White Lung Program efforts, and other plans for a Libby Medical Trust. In the meantime, if we receive any further contributions from W.R. Grace, you have our promise that every dime of that will go to pay for direct patient care for people with asbestos related diseases."

This direct patient care may be for services at the CARD Clinic, or for medical care in the Hospital, added Beasley.

"Asbestos patients have had over $1,000,000 in care at St. John s in the past year," stated Beasley. "Many of those patients don t have insurance, or the means to pay their bills. Donations that are intended for asbestos patients will help make up that difference, and will be used to help people pay for their direct care needs."

A team of people from the CARD Advisory Board and the Hospital are beginning work on legal and logistical details for changing the CARD to its own organization. Community input is welcomed, and can be given through any of the members including LeRoy Thom, John Righter, Gayla Benefield, Alvin Bitz, or Kerry Beasley.

Appendix 3

MEMORANDUM

TO:
DATE: August 24, 2002
FROM: Lincoln Co. Public Health Department
RE: Rural Health Outreach Grant Project

Request for Letters of Support -
Asbestos Related Disease CARD) Health Support Project

The ARD Health Support Project will be funded by the Health Resources and Services Administration (HRSA), through a three year Rural Health Outreach Grant. A coalition that includes the Lincoln Co. Board of Health, the St. John s CARD, the Lincoln County Community Health Center, and the Asbestos Related Disease Health Care Project will be contributors to the project. The program will be administered by the County Health Board, and will use the grant funds to staff two half time positions - a case manager and a health educator/program administrator - dedicated to the following goals:

  • To improve the coordination of Asbestos Related Disease (ARD) care in our county.
  • To increase the use of existing health entitlement programs and benefits.
  • To meet the unmet medical and psycho-social needs of ARD patients.
  • To increase community capacity for coordinated ARD health care.
• To improve access to health care, and ancillary services (such as respite care, and assistance with meals, shopping and transportation) for those limited by ARD.
• To develop the community s capacity for continuing services over the long term.

Some specific elements of the plan are:

  • The location of services at the CARD, for convenience and accessibility, and the utilization of existing transportation and outreach case management to provide service in Troy and Eureka.
    Use of a case manager to assist people with applications for benefits, to increase referrals to needed health care, and to advocate for un-met needs.
    The coordination of community organizations to address health related needs such as personal care, respite care, transportation, shopping, and meal preparation.
    The development of web pages dedicated to ARD health education and resource information.
  • The creation of a system of integrated case management for people with ARD
  • Media campaigns to educate the public about ARD health issues and strategies.
• The recruitment o~faith and community based organizations to provide non-medical support services to those limited by ARD.
• The coordination and development of access to low cost medicines.

We sincerely NEED your letter of support, by Friday, September 6th. Letters should be adressed to the Lincoln County Commissioners, and can be sent to: Karol Spas, Lincoln Co. Health Nurse 418 Mineral Ave. Libby 59923, or dropped off at that address OR at the St. John s CARD clinic, 308 Louisiana Ave.


Photos courtesy of Dudley Dana, Dana Gallery