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Libby Community Advisory Group
Meeting Summary

June 12, 2003
Introductions

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

Agenda

The CAG agreed to the following agenda for this meeting:

Presentation by Dr. Andrij Holian and Dr. Jean Pfau

Dr. Andrij Holian, Director of the University of Montana Center for Environmental Health Sciences (CEHS), and Dr. Jean Pfau, a CEHS faculty member, presented a series of computer slides to the CAG concerning the research underway at CEHS. A copy of the presentation on a computer disc will be available at the EPA Information Center in Libby. Research is underway in four areas: respiratory/immunotoxicology, molecular/genetic toxicology, neurotoxicology, and cardiovascular development toxicology. Concerns being addressed by the research include asbestos, particulate matter and reactive chemicals, metals and metalloids (e.g. arsenic, lead, copper, manganese, and zinc), creosote and PAH, and pesticides. Dr. Holian stated that Libby is the only location west of the Mississippi River that is a non-attainment area for particulate matter (PM 2.5). In addition to Dr. Liz Putnam, who summarized her research on genes and asbestos-related disease at the last CAG meeting, three CEHS faculty are researching topics particularly relevant to Libby, Dr. Mark Pershouse who is studying genes and mesothelioma, Dr. Jean Pfau who is studying auto-antibodies and asbestos-related disease, and Dr. Holian who is studying immune dysregulation and asbestos-related disease. Dr. Pershouse has been successful at inducing mesothelioma in mice exposed to tremolite asbestos, a significant fact because other research groups have had difficulty doing so with other forms of asbestos. UM's CEHS is getting support and encouragement from the National Institute of Health for its studies of asbestos-related disease mechanisms.

Dr. Jean Pfau - Dr. Pfau recently submitted for publication the results of a pilot study that she previously presented to the CAG (see the summary of the June 13, 2002 CAG meeting). The pilot study which considered samples for 36 people in Libby paired by sex and age with 36 people from Missoula suggested a relationship between asbestos exposure and increased presence of auto-antibodies, antibodies that attack a person's cells rather than foreign material such as bacteria or viruses. Dr. Pfau is now attempting to answer two questions: does the increased level of auto-antibodies have health consequences, i.e. does it lead to disease, and how does asbestos exposure lead to auto-antibody formation/activation? Answering the second question might lead to possible interventions that might halt disease progression. Her continuing research on more Libby people has confirmed that people in Libby have elevated levels of auto-antibodies. She has also found that a relationship exists between auto-antibodies and the severity of asbestos-related disease and between the intensity of exposure to asbestos and to auto-antibody incidence. However, these relationships are not proof of causation, that is, the research does not prove that the auto-antibodies cause asbestos-related disease.

Audience Member Question - Are you studying people or just mice?
Answer - The subjects in the pilot study were people. I am continuing to attempt to expand the number of Libby people in my study.

CAG Member Question - How many other research labs are studying the effect of asbestos on cells?
Answer - Only CEHS and a research facility in Germany are studying asbestos and auto-immunity.

CAG Member Question - Would the presence of auto-antibodies be a possible biomarker of asbestos exposure and asbestos-related disease?
Answer - Yes, the presence is a possible biomarker.

Dr. Holian - Dr. Holian is studying macrophage cell receptors that recognize particulate and asbestos which triggers the death of macrophage cells. The death of the macrophage cells stimulates the immune system causing chronic inflammatory disease. The research has determined that the response to particulate and asbestos varies among individual people. Understanding the cause of this variability may lead to therapies capable of intervening in the disease process. The research has also found that tremolite asbestos has a longer lasting effect that other forms of asbestos or other particulate. In addition to identifying asbestos-related disease mechanisms, Dr. Holian's future goals include finding a long-term funding support for clinical research in Libby and for basic research by the CEHS.

CAG Member Question - You said that you are working with tremolite in some of your studies, but the tremolite is not from Libby. Why aren't you using Libby tremolite?
Answer - For our research, we must use well-characterized asbestos samples, and a well characterized sample of tremolite asbestos is not yet available. We are working with EPA and the United States Geological Service (USGS) to obtain such samples of Libby tremolite asbestos.
Comment by Jim Christiansen - The USGS has taken samples from the Libby mine, but has not yet provided EPA with a well-characterized sample. The lack of this sample is also delaying results of EPA's soil sampling.

CAG Member Question - What was the source of the tremolite asbestos used in your research?
Answer - We have obtained a well characterized sample of from the US National Bureau of Standards. The tremolite from the sample came from Korea

Audience Member Comment - You mentioned that your research has shown that tremolite asbestos has unique effects. We need you to contact Senator Baucus with this information to aid in his efforts to get a Libby exemption in the proposed asbestos legislation.
Answer - Scientifically, our results must be peer reviewed to be widely accepted. However, I will call Senator Baucus to tell him of CEHS's research results.

CAG Member Question - You mentioned that Dr. Pershouse has had particular success in inducing mesothelioma in mice using Libby tremolite asbestos, correct?
Answer - Yes. Dr. Pershouse has been able to produce visible scarring in lung tissue after one dose of Libby tremolite in mice lungs. Other labs have had a significantly more difficult time producing mesothelioma after higher dosages of other forms of asbestos.

CAG Member Question -Is your funding being cut?
Answer - No. Our funding situation is looking great now. NIH is moving to a five year Superfund grant which may help us.

CAG Member Question - Are the new federal medical privacy rules inhibiting your ability to get clinical data from Libby?
Answer - We are getting clinical data from Libby, but we must be careful to ensure patient confidentiality.

CAG Member Comment - Thank you for your work.

EPA Report

Jim Christiansen introduced Mike Cook, Director of the Office of Emergency Response and Remediation. Mr. Cook has the highest ranking non-political position in EPA and is in charge of the Superfund Program. Mr. Cook stated that Libby remains an extremely high priority within EPA because of the human health issues and because of the dedicated action by the community. It is not unusual at Superfund sites for people to want a buyout so they can leave the area which has not been Libby's response. The Superfund National Priority List now includes 650 sites at which construction has not been completed. Construction is underway at 400 of the sites. At most of the 400, the party responsible for the contamination is paying for the cleanup. At a small number of the sites, EPA is funding the cleanup itself. The current demands on the Superfund budget are unprecedented. President Bush has requested a significant increase in the budget, and EPA is hopeful that the Congress will provide the increase even in the face of a difficult funding environment. EPA is responding to the funding challenges in two ways. First, it is managing the cleanups more carefully than in the past so that the cleanup goals can be achieved at a lower cost. Jim Christiansen is leading the nation in this regard. Second, EPA is prioritizing the cleanups to focus first on sites with the greatest public health consequences. Lower priority is being afforded to sites with ecological rather than human health concerns. If it receives the budget increase requested by the President, EPA should be able to provide sufficient funding to Libby to maintain a cleanup pace in Libby of 250 to 300 residences per year. The residential cleanups will remain the highest priority at Libby because of the human health concerns associated with them.

Audience Member Question - You said that the residential cleanups will have the highest priority. Does a residential cleanup include the yard or only the inside of the house?
Answer - The residential cleanups include both inside and outside of the house.

Audience Member Question - Will the budget for Libby be cut for this year?
Answer - No. Libby has a budget this year of $17.6 million.

CAG Member Question - How many houses have been cleaned this year?
Answer - So far this year, we have completed about 80 houses. We may not hit the targeted amount of 250-300 residences this year.

CAG Member Question - What is the total amount of money EPA has spent cleaning up Libby so far?
Answer - About $80 million.

CAG Member Question - So because of the human health concerns in Libby, we have no concerns about continued funding for the cleanup?
Answer - If EPA receives the requested budget increase, we should be able to maintain the 250 to 300 residential cleanups per year. If the increase is not forthcoming, Libby will remain a high priority, but I am sure of the amount of funding EPA will be able to provide.

Audience Member Question - Will EPA just be cleaning up houses?
Answer - Residential cleanups will be the highest priority, but we recognize that other cleanups are also necessary, including the mine, Rainy Creek Road, the Flyway, the bluffs across the river, Troy, and other land parcels.

Audience Member Question - If one divides the $17.6 million by 250 to 300 residential cleanups, one gets a large number. Why is the per house cleanup cost so high?
Answer - The $17.6 million includes more that just the actual residential cleanup cost. It also includes sampling, design work prior to cleanups, investigation to determine which houses need cleaning, and a staff in Libby of over 100 people. The largest share of the funding does go to the actual cleanups, however.

CAG Member Question - What is the total number of houses that will be cleaned?
Answer - Last year we investigated some 3,500 properties and identified 1,200 that need cleaning. We expect to investigate another 1,000 homes this year, including revisiting some homes as well as 400 to 500 homes not previously visited. The soil sampling has not yet been completed, and it may identify more houses needing outside cleanups.

CAG Member Question - How many companies are working on the cleanup now, and how many of those had to bid for their jobs?
Answer - Two contractors are now working. Environmental Restoration, which has a contract with EPA Region 8, is continuing work begun under the emergency cleanup time and materials contract. Solute, which is partnered with MARCOR, is working under a cost plus contract. We are currently in the process of contracting with three additional firms, two small and one disadvantaged contractor. When all five firms are under contract, they will compete with each other to do work in Libby. This competition should help keep costs down.

Comment and Question by Commissioner Rita Windom - Commissioner Windom thanked Mike Cook on behalf of the County Commission for coming to Libby and providing the assurance about continued funding for the Libby cleanup. She then asked about the status of the cleanup of the Stimson mill site which because of its economic potential is one of the most important pieces of property in the community. She asked specifically whether the buildings would be torn down or cleaned, about cleanup of the old nursery site, and whether EPA has conducted a more general investigation of contamination other than asbestos.
Answer by Jim Christiansen - Cleanup of the mill is in the 2004 budget, but EPA will need feedback from the property owner about whether the buildings should be torn down or cleaned. EPA has sampled dust and air in all of the buildings. Contamination was found in two of them, the central maintenance building and the plywood building. The central maintenance building is leaking vermiculite insulation. The plywood building appears to be contaminated with secondary dust and should not be a major problem to clean. Detailed cost investigation indicates that the cost of cleaning or tearing down the central maintenance building would be similar. Rebuilding the maintenance building would probably triple the cleanup cost, and is not in EPA's plans. The nursery site is not causing harm now and is a lower priority. Cleaning it may be a winter time job. Dirt will be excavated and hauled either to the mine or to the asbestos cell at the Lincoln County landfill. Soil sampling of the entire mill property has not been done. Stimson has conducted a phase one investigation of the property which is standard industry practice. Whoever purchases the property will probably also want to do its own analysis. The new owner may want to contact Sandy Olson with the Montana Department of Environmental Quality which takes the lead in other, non-asbestos hazardous waste contamination investigations. The state may also have information about other programs such as the Brownfield Program.

Audience Member Comment - At the nursery site, raw vermiculite was brought from the mine and deposited on a 100 foot by 100 foot area. This is the only area on which vermiculite was placed.
Response by Jim Christiansen - We don't know the extent of the vermiculite contamination as the site has not yet been characterized. I have walked the nursery site and seen raw tremolite and vermiculite.

CAG Member Question - Aren't you required to remove asbestos before tearing a building down?

Answer - Under the Superfund law, EPA may tear down buildings without first removing the asbestos but all material from the demolition must then be deposited in an approved asbestos disposal site.

CAG Member Question - The assets at the Stimson mill are currently being auctioned. If the dryers are sold will they be cleaned before they are moved? The dryers were covered with vermiculite insulation and then encased in concrete. Over the years the concrete has cracked.
Answer - EPA monitors dust where it is likely to be disturbed. Equipment generally does not harbor dust. We have not discussed the dryers with Stimson, but we will do so.

Audience Member Question - Does EPA have a written policy about what equipment must be cleaned and what destroyed. The Rainy Creek Nursery equipment was all destroyed.
Answer - The level of contamination at the nursery was particularly high, and the emergency cleanup was just beginning when the nursery equipment was addressed. While we are developing criteria to guide the cleanups, we do not have written policy addressing all equipment. Judgement has been and will continue to be required. We have been learning as we go. We have not always been consistent.

Comment by George Keck - Mr. Keck read the statement adopted by the Libby Area Technical Assistance Group, Inc. regarding EPA funding and Mr. Christiansen's budgets. The statement is included below as Appendix 2.

CAG Member Comment - When the decision was made to include Libby on the National Priority List, we were promised that the Libby town operable unit would be cleaned and would receive a clean bill of health in three years.
Response - When Paul Peronard made the referenced statement, we only had estimates of how many homes would need cleaned and of how complicated the cleaning would be. Mr. Peronard estimated that 800 homes would need cleaning. We are able to clean about 250 homes per year regardless of funding. I can't say how many years the cleanup will require because we don't know the number of homes that must be cleaned or how complicated the cleaning will be. The Libby situation is unique. I don't know of another case in which more than 150 homes have been cleaned in a single year during a longer construction season than in Libby.

Audience Member Question - Is tearing down older homes needing cleanup an option if the owner does not ask to have the home rebuilt?
Answer - Yes tear-down with payment of fair market value but no rebuild is an option that can be considered.

Audience Member Question - How is fair market value determined?
Answer - EPA uses certified public appraisers for structures and personal property. We also urge property owners to obtain their own appraisal values to better inform negotiations.

EPA Web Site Libby Fact Sheet - As Wendy Thomi explained at the May CAG meeting, EPA intends to post on its web site a fact sheet summarizing its cleanup activities in Libby since 1990. The fact sheet will include names of people who can be contacted concerning the activities. Gayla Benefield volunteered to be the designated contact person for the fact sheet on behalf of the CAG.

Presentation by Jenny Bland

Jenny Bland reported on activities by the Libby School District funded by an environmental justice grant from EPA. The School District is attempting to track and include in a registry all of the children who have passed through the schools since the mine began operating. Work has begun on current enrollees. Brochures have been mailed to the 1,696 current school children. Some 98% of the brochures were successfully delivered by the US Postal Service. We had hoped for an 80% return of the completed forms in the brochures, but to date only 21% have been returned. The good news is that 90% of those returning the brochure forms have agreed to share their information with ATSDR and the CARD Clinic. We will shortly begin working on the Libby School enrollees during1990 through 2002, which we estimate includes 2,500 to 3,000 former students. If anyone knows of someone who has received a brochure, please urge them to fill out and return the form.

Presentation by Tracy Velazquez

Tracy Velazquez, one of the grant writers retained by Lincoln County, reported on progress in implementing the Rural Health Outreach Grant obtained from the Health Resources and Services Administration (HRSA). The Asbestos Related Disease (ARD) Network, the group which will govern implementation of the grant, met today. The grant anticipates that a CAG member would serve on this group to represent asbestos victims. The CAG will be asked at its July meeting to designate a representative. Appendix 3 below includes a summary of the Rural Outreach Grant to Create an Asbestos Related Disease Care Network Project. The next meeting of the ARD Network will be Thursday, June 26, at noon. For more information contact Karol Spas.

Presentation by Coleen Lux

Coleen Lux, a graduate student at the University of Montana, introduced herself to the CAG. Ms. Lux has been attending CAG meetings since October 2002. She is writing her masters thesis on how the community of Libby has come together to talk about and identify solutions to the asbestos contamination and specifically on the CAG and how well it has served its members. Ms. Lux will be seeking interviews with CAG members about their experiences over the coming months.

Public & CAG Member Comment

There was no additional comment.

Next Meeting

The next regular CAG meeting is scheduled for 7:00 to 9:00 p.m. on Thursday, July 10, 2003 in the Ponderosa Room of Libby City Hall.

Appendix 1

CAG Member & Guest Attendance List
June 12, 2003

Members

Group/Organization Represented

Sandy Wagner

Community Health Center/TAG

George Keck

Technical Advisory Group

K.W. Maki

Libby Schools

Craig French

Montana Department of Environmental Quality

Don Wilkins

Lumber & Sawmill Workers

George Bauer

City of Libby

Jim Christiansen

EPA

David F. Latham

The Montanian Newspaper

Ken Hays

Senior Citizens

Bob Dedrick

Asbestos Victim

Clinton Maynard

Area Asbestos Research Group

Les Skramstad

Asbestos Victim (alternate for Norita Skramstad)

Gordon Sullivan

TAG

Wendy Thomi

US EPA

Rick Flesher

Former W.R. Grace Employee

Gayla Benefield

Lincoln County Asbestos Victims Relief Organization

Gary Swenson

Libby Volunteer Fire Department

Brad Black

CARD Clinic/County Health Officer

Visitors

Group/Organization Represented

Dr. Andrij Holian

UM Center for Environmental Health Sciences

Dr. Jean Pfau

UM Center for Environmental Health Sciences

Mike Cook

Director of the Office of Emergency Response and Remediation

Appendix 2

LIBBY AREA TECHNICAL ASSISTANCE GROUP INC.

Statement for release/record at CAG meeting 12 June 2003

Since November 1999, EPA Region 8 has worked diligently to design and develop a comprehensive and cost effective remedial program to address the catastrophic asbestos issues at the Libby operational sites. To make absolutely certain this program meets the goals and objectives of the EPA work plan and ensures the safety of all persons and properties within the designated sites, funding must be as outlined in the budget prepared by the onsite EPA Project Manager, Jim Christiansen. Libby will set the pattern and serve as a model for clean-up programs across the nation. It is paramount that the EPA perform their work in a timely fashion and to the highest of standards, ensuring the health and safety of each citizen and the economic viability of each community.

Appendix 3

Rural Health Outreach Grant to Create an
Asbestos Related Disease Care Network Project

Project Summary

What is the overarching Goal of the Grant?

Improve medical and social service care and delivery for ARD patients, and reduce the cost of care to both providers and patients.

How is this Goal to be Achieved?

- Create coordinated system of ARD care: integrated system providing patients with case management, patient education, referrals, some direct services
- Give healthcare providers better information about asbestos patients and their needs
- Create a "hierarchy of payers" (local, state, federal) to reduce incidence of unpaid medical care that could swamp Libby's providers.

What Will the Grant Pay For?

Year One

Year Two

Year Three

Half-time Project Director

Half-time Project Director

Half-time Project Director

Half-time Case Manager

Half-time Case Manager

Full-time Case Manager

Second ½ time Case Mgr

Second ½ time Case Mgr

Local travel expenses for community outreach/direct service provision and travel to conference in DC

Local travel expenses & required conference

Local travel expenses & required conference

Laptop computer & database development

Computer & database maintenance

Computer & database maintenance

Printing brochures for patients & postage to send

Printing/mailing updated brochures

Printing/mailing updated brochures

Project Evaluation (process and outcome): $4,000

Evaluation: $4,000

Evaluation- to include written final survey and report: $6,000

Rent ($465/mo.)

Rent ($479/mo.)

Rent ($493/mo.)

Health Education classes ($4,000)

Health Education classes

Health Education classes

Direct Patient Services: $50,000

Direct Patient Services: $60,000

Direct Patient Services: $70,000

Administration ($6,369)

Administration ($7,727)

Administration ($9,070)

How Will the Project be Managed?

The grant application sets the network itself as the governing body for the project, while the Project Director is the day-to-day manager. While Lincoln County is the fiscal agent for the grant, their decision-making authority over the project is delegated to the Project Director, who is responsible to the Network. Per the application, the network is comprised of the institutions listed below:

Lincoln County Board of Health
Center for Asbestos Related Disease
Libby Clinic
St. John's Lutheran Hospital
Lincoln County Community Health Center
Asbestos Related Health Care Project, Inc.

In addition, the Community Advisory Group can appoint one member, and the Lincoln County Commission can appoint one member each from Libby and from an area outside of Libby. There is nothing in the grant to say that more groups cannot become a part of the network, provided that all network members named in the grant are in agreement on their inclusion. However, it should be noted that the grant review committee expressed concern that the network might become unwieldy even with the current number of network members.

Decisions for the network will be made by consensus, and authority for making project decisions will be delegated to the network representatives of each member group.

It is therefore up to the Network itself to determine:

  • what services will be offered and how they will be offered
  • the scope of the project, and
• the level of integration and coordination of ARD care by the Network members.

What We Said We Were Going to Do in Year One

Goals

Strategies

Activities

Milestones

1. Improve coor-dination of ARD care in County

Create network of ARD service providers

hire project director
create electronic web based communications
hold regular meetings of partners and affiliates

Project director hired by 7/03
Website to be created by 10/03
First meeting of network in 9/03

2. Improve utilization of services and resources by ARD patients

Create integrated case manage-ment for ARD patients

hire case manager to assist patients with applications
Create care plans for ARD patients
hold community trainings explaining programs and procedures
work with state to improve coverage
Collaborate with CHC on education and information about means-tested primary care and other services

Case manager hired by 07/03
First community training 8/03
Begin case management services 9/03
Increased enrollment in federal programs by 3/04

3. Meet unmet medical and psycho-social needs of ARD patients

Create a system that will assess and develop resources to help ARD patients

needs assessment of ARD population
increase delivery of health education to ARD patients and community
coordinate community efforts to serve ARD patients
recruit faith and community based organizations to provide non medical services

Second needs assessment done 5/04
First health education class begins 9/03, and quarterly thereafter
Database of services/resources for patients and providers developed by 9/1/03
Outreach to volunteer orgs. Beginning 8/03
Development of service directory (both on-line and hard copy) by 10/03
Creation of direct service funding mechanism by November 2003
Begin direct service funding by end of 2003

Provide funding for direct services when no other funding sources are available

Develop, with project partners, criteria for providing medical and psycho-social services to patients
Disburse funds for direct services

4. Increase community and patient understanding and utilization of program

Outreach to community

media campaign to educate public
project staff visits to medical and social service providers throughout county
disseminate information on program at provider offices, via the Internet and in the community

Media plan developed by 9/03
Development of brochure by 10/03
Outreach to Troy and northcountry beginning 10/03
Poll of general public in 5/04
Creation of website by 11/03

5. Improved access to care for ARD patients

Improve affordability and availability of medical and related services

coordinate access to low-cost pharmaceuticals
increase outreach case management to Troy and Eureka
improve referrals to CHC and other subsidized health care services
patient advocacy around third party payer systems
develop improved transportation to specialist services

Case management in Troy and north Lincoln County beginning 10/03
Transportation plan to be created by 10/03 and initiated by 11/03
Survey ARD patients in 5/04

6. Sustainability

Coordinated funding effort

continue Governor's study group on long-term health care in Libby
continue W.R. Grace funding
Continue to seek grant funding

Apply for three grants

Timeline for Year One Activities per RHOG Grant Application

Photos courtesy of Dudley Dana, Dana Gallery