Department of Energy Presentation to The Advisory Board on Toxic Substances and Worker Health Patricia R. Worthington, PhD Director Office of Health and Safety Office of Environment, Health, Safety and Security April 26, 2016

Office of Environment, Health, Safety and Security DOE’s Office of Health and Safety Mission Establishes worker safety and health requirements and expectations for the Department to ensure protection of workers from the hazards associated with Department operations. Conducts health studies to determine worker and public health effects from exposure to hazardous materials associated with Department operations and supports international health studies and programs. Implements medical surveillance and screening programs for current and former workers and supports DOL in the implementation of EEOICPA. 2

Office of Environment, Health, Safety and Security Background The work of the DOE is critical to America’s safety and security. But that work wouldn’t be possible with our number one asset, the Department’s workforce. The Department embraces its responsibility for and commitment to the health and well-being of DOE’s current and former workers, both Federal and contractor employees. 3

Office of Environment, Health, Safety and Security Background (cont.) At the start of the Manhattan Project, General Leslie Groves chose Robert Oppenheimer to be the scientific lead. The site location was selected in Northern New Mexico at the site now called the Los Alamos National Laboratory. Facilities were built at Los Alamos, Oak Ridge, and Hanford and within a remarkably short time; there were thousands of workers at sites throughout the country gathered in hopes of achieving a remarkable scientific achievement. Their hard work, accomplishments, and tremendous sacrifice are why all Americans get to enjoy the freedoms we have today. 4

Office of Environment, Health, Safety and Security DOE’s EEOICPA Core Mandate Work on behalf of the program claimants to ensure that all available worker and facility records and data are provided to DOL, NIOSH, and the NIOSH Advisory Board. The program continues to be an extremely important activity not only within my office, but within the entire DOE complex. 5

Office of Environment, Health, Safety and Security DOE’s Responsibilities under EEOICPA Respond via the SERT system to DOL and NIOSH requests for information related to individual claims (employment verification, exposure records). Provide support and assistance to DOL, NIOSH, and the NIOSH Advisory Board on large-scale research and site characterization projects through records research and retrieval efforts at various DOE sites. Conduct research, in coordination with DOL and NIOSH, on issues related to covered facilities designations. 6

Office of Environment, Health, Safety and Security Records Fund and coordinate records retrieval activities at DOE sites in support of individual claims. Employment verifications for DOL Dose records for NIOSH Document Acquisition Requests (DAR) employee work history/exposures for DOL 7

Office of Environment, Health, Safety and Security DOE EEOICPA Site Contacts DOE EEOICPA Site POCs: – Coordinate all research activities with NIOSH, NIOSH Advisory Board, DOL and various contractors; – Set up site visits and tours for NIOSH, NIOSH Advisory Board, DOL, as well as other groups; – Work with both DOL and NIOSH to identify site subject matter experts and to facilitate interviews with current and former workers; – Manage site’s response to individual records requests. Ensure DOE responses are complete and timely; and – Provide onsite EEOICPA information to workers. 8

Office of Environment, Health, Safety and Security Site Exposure Matrix (SEM) SEM is a repository of DOE site-specific information gathered regarding toxic substances present. It is used as a tool to assist with compensation determinations under EEOICPA Part E for DOE contractors and subcontractors who have illnesses related to their work for DOE. Relational database linking the following: – Toxic chemicals; – Buildings/areas/facilities; – Processes/activities; – Illnesses/health effects; and – Job/labor categories. 9

Office of Environment, Health, Safety and Security SEM (cont.) Put together from 2006 to 2008: – Teams from DOL went to every DOE site; – DOE site helped with search process; – DOL teams reviewed thousands of boxes; and – DOE sites copied and reviewed hundreds of documents at each site. The SEM was reviewed for classification in 2009 and released to the public. – New information is held and reviewed by DOE every 6 months before inclusion in SEM. 10

Office of Environment, Health, Safety and Security Facilities Research and maintain the Covered Facilities Database Database of over 300 facilities covered under EEOICPA. This includes DOE facilities, AWEs, and Beryllium Vendors whose employees are eligible for benefits under EEOICP. Full listing can be found at: 11

Office of Environment, Health, Safety and Security Outreach Continued to participate in all Joint Outreach Task Group meetings that include DOE, DOL, and NIOSH, along with the DOL Ombudsman and the DOE Former Worker Medical Screening Programs. 12

Office of Environment, Health, Safety and Security Former Worker Medical Screening Program (FWP) History: Established following the issuance of the FY 1993 Defense Authorization Act (P.L ), authorizing DOE to: “…establish and carry out a program for the identification and on- going medical evaluation of…former DOE employees who are subject to significant health risks as a result of the exposure of such employees to hazardous or radioactive substances during such employment….” Mission: To identify and notify former workers at risk for occupational disease and offer them medical screening that can lead to treatment. First former worker projects initiated in

Office of Environment, Health, Safety and Security FWP (cont.) Program now serves all former workers from all DOE sites in locations close to their residences. Identify and notify former workers at risk for occupational disease. Offer medical screening that can lead to treatment. Provide information and assistance about medical followup and compensation. As of September 30, 2015, a total of 117,449 medical exams have been conducted through the FWP; 80,780 initial screening exams; and 36,669 re-screen exams. 14

Office of Environment, Health, Safety and Security Service Providers The FWP infrastructure consists of four designated regional projects located near major DOE sites, as well as two nationwide projects. 15

Office of Environment, Health, Safety and Security Service Providers (cont.) The regional FWP projects include: Pantex Former Worker Medical Surveillance Program, conducted by Drexel University School of Public Health in conjunction with the University of Texas Health Science Center at Tyler and West Texas A&M Partners Clinic. Medical Exam Program for Former Workers at Los Alamos and Sandia (New Mexico) National Laboratories, conducted by Johns Hopkins Bloomberg School of Public Health in conjunction with the University of New Mexico. Worker Health Protection Program (WHPP), conducted jointly by Queens College of the City University of New York, United Steelworkers, the Atomic Trades and Labor Council in Oak Ridge, and the former Fernald Atomic Trades and Labor Council. Former Burlington AEC Plant and Ames Laboratory Workers Medical Screening Program, conducted by The University of Iowa College of Public Health. 16

Office of Environment, Health, Safety and Security Service Providers (cont.) The two nationwide FWP projects include: National Supplemental Screening Program (NSSP), conducted by Oak Ridge Associated Universities (ORAU) in conjunction with Axion Health, Comprehensive Health Services, National Jewish Health, and the University of Colorado Denver. Building Trades National Medical Screening Program (BTMed), conducted by CPWR – The Center for Construction Research and Training (CPWR) in conjunction with Duke University Medical Center, the University of Cincinnati Medical Center, and Zenith- American Solutions. 17

Office of Environment, Health, Safety and Security Medical Examination A listing of exposures and medical examinations offered through the FWP is available in the medical protocol posted on the FWP Web site ( worker-program-medical-protocol). worker-program-medical-protocol 18

Office of Environment, Health, Safety and Security FWP Early Lung Cancer Detection (ELCD) Program Since 2000, DOE has made screening with low-dose helical computed tomography (CT) scans available to former workers who are at risk for occupational lung cancer as a result of their work for DOE to detect lung cancers at an earlier, more treatable stage. Since 2000, the FWP’s ELCD program has screened 14,961 participants and provided 45,097 CT scans. In FY 2015, 671 participants were screened and a total of 3,822 CT scans were performed; this includes baseline, followup, and annual scans. 19

Office of Environment, Health, Safety and Security FWP ELCD Program (cont.) The FWP projects currently offering low-dose CT scans for ELCD include: –WHPP, administered by Queens College of the City University of New York and the United Steelworkers, along with their partners; –BTMed, conducted by CPWR in conjunction with their partners; and –NSSP, administered by ORAU and their partners. Other FWP projects are either exploring how to incorporate CT scanning into their current protocols or in the planning phases for initiating this component. More information regarding the ELCD program can be found at

Office of Environment, Health, Safety and Security Protect PII/PHI All medical information collected as part of this program is treated as confidential and is used only as allowed by the Privacy Act of 1974 and the Health Insurance Portability and Accountability Act (HIPAA). All FWP activities are conducted with procedures that are consistent with DOE's ethical guidelines and the "Common Rule.” All protocols are approved by the Institutional Review Boards or Human Subjects Committees of DOE and involved universities. All individuals sign an informed consent and HIPAA authorization prior to participation. In addition, all program staff are required to take annual privacy awareness training, and all FWP projects have security procedures in place for the safe transmittal and storage of PII. 21

Office of Environment, Health, Safety and Security Resources for FWP Information FWP Web site: safety/former-worker-medical-screening-program safety/former-worker-medical-screening-program FWP brochure: medical-screening-program-brochure medical-screening-program-brochure 22

Office of Environment, Health, Safety and Security Dr. Patricia R. Worthington Director Office of Health and Safety Contact Information 23

Office of Environment, Health, Safety and Security Thank you! 24