MINUTES OF THE meeting
of the
ASSEMBLY Committee on Natural Resources, Agriculture, and Mining
Seventy-First Session
February 12, 2001
The Committee on Natural Resources, Agriculture, and Miningwas called to order at 1:00 p.m., on Monday, February 12, 2001. Chairman Marcia de Braga presided in Room 1214 of the Legislative Building, Carson City, Nevada. Exhibit A is the Agenda. Exhibit B is the Guest List. All exhibits are available and on file at the Research Library of the Legislative Counsel Bureau.
COMMITTEE MEMBERS PRESENT:
Mrs. Marcia de Braga, Chairman
Mr. Tom Collins, Vice Chairman
Mr. Douglas Bache
Mr. David Brown
Mr. John Carpenter
Mr. Jerry Claborn
Mr. David Humke
Mr. John J. Lee
Mr. John Marvel
Mr. Harry Mortenson
Mr. Roy Neighbors
COMMITTEE MEMBERS ABSENT:
Ms. Genie Ohrenschall (Excused)
GUEST LEGISLATORS PRESENT:
Assemblywoman Sharron Angle, District 29
Assemblywoman Merle Berman, District 2
Assemblywoman Vivian Freeman, District 24
Assemblywoman Dawn Gibbons, District 25
Assemblywoman Ellen Koivisto, District 14
Assemblywoman Sheila Leslie, District 27
Assemblywoman Mark Manendo, District 18
Assemblywoman Kathy McClain, District 15
Assemblywoman Bonnie Parnell, District 40
Assemblywoman Debbie Smith, District 30
Assemblywoman Sandy Tiffany, District 21
Assemblyman Wendell Williams, District 6
STAFF MEMBERS PRESENT:
Linda Eissmann, Committee Policy Analyst
Marla McDade Williams, Committee Policy Analyst
June Rigsby, Committee Secretary
OTHERS PRESENT:
Yvonne Sylva, Administrator, Nevada State Health Division
Dr. Mary Guinan, Nevada State Health Officer
Dr. Randall Todd, State Epidemiologist, Nevada State Health Division
Galen Denio, Manager, Public Health Engineering, Nevada State Health Division
Dr. Ronald Rosen, School of Medicine, University of Nevada, Reno
Dr. Carolyn Hastings, Oncologist, Childrens’ Hospital of Oakland
Dr. Vera Byers, Clinical Immunologist
Dr. Al Levin, Immunologist
Allan Biaggi, Administrator, Division of Environmental Protection
Paul Liebendorfer, Chief, Bureau of Federal Facilities
Dr. Bruce Macler, Regional Toxicologist, EPA, San Francisco
Chairman de Braga called the Assembly Natural Resources, Agriculture, and Mining Committee to order. Roll was called and a quorum was judged to be in place. All members were present except for Assemblywoman Ohrenschall who was noted as an excused absence.
Chairman de Braga welcomed as guests the Assembly Committee on Health and Human Services. Roll was called, and all members were present, except for Assemblyman Tiffany who was noted as an excused absence.
Chairman de Braga opened the meeting with a welcome to both committees and an acknowledgement of the research and support that contributed to the leukemia hearings. Chairman de Braga stated the purpose of the 3-day special hearings was to gather information about the recent Acute Lymphocytic Leukemia (ALL) cluster in Fallon and to explore possible environmental causes. The hearings had been designed to provide a forum for the pooling of research, data, experts, community leaders, agencies, government officials, health and environmental experts, and all other resources.
With the discovery of 11 cases of ALL in the Fallon area within a short number of years, it had become imperative to address the expected concerns of the residents as well as be aware of the welfare of the community as a whole. With the extensive media coverage, Chairman de Braga explained that publicity had served a positive purpose by bringing attention and resources to the community.
The format for the three days was described as a balance of expert testimony and public input. Following the testimony of witnesses, questions by the two committees were slated. Guests were encouraged to sign in and participate, and no questions would be judged as worthless. At the conclusion of the three days, a panel would assemble recommendations based on all of the testimony.
Chairman de Braga emphasized that, even if the specific cause of the cluster was never identified, public concerns would be addressed and environmental improvements made on behalf of the entire community.
Because of the pre-scheduled commitments of the two committees in attendance, Chairman de Braga stated that, if at any time, a quorum failed to be present, the hearings would continue uninterrupted under the status of a subcommittee.
Chairman de Braga introduced the opening expert testimony from the Nevada State Health Division. The committees received two handouts, which were as follows:
Yvonne Sylva, Administrator of the State Health Division, outlined their official action since being notified in July 2000 of the high number of ALL cases in Fallon. Their role as the first line of response was recognized. A complete investigation was initiated, with two employees assigned full time, Dr. Mary Guinan, State Health Officer, and Dr. Randall Todd, State Epidemiologist. By November 2000, it became apparent that additional resources would be required. The calls from the news media dictated the hiring of a full time media coordinator as well as a bilingual research assistant to Dr. Todd.
Ms. Sylva summarized the multitude of state and federal government agencies that were engaged for the fact-finding phase of their investigation. These included the Center for Disease Control in Atlanta, the National Institute of Cancer, EPA, Department of Energy, the Nevada Department of Agriculture and Nevada Environmental Protection. In January, an additional employee was assigned to field requests from the public and the news media.
According to Ms. Sylva, the investigation had been designed as a partnership with the community of Fallon and was evidenced by a community presentation made to Fallon residents in January. A separate community forum at the Naval Air Station followed, with attendance estimated at 80 residents. A community meeting in early February provided additional opportunity for more than 250 citizens to ask questions and air their concerns. A community telephone hotline (1-888-608-4623) was established, with a reported 56 inquiries to date. Ms. Sylva welcomed additional recommendations for addressing public concerns.
Scrutiny of the Health Division’s investigative work had been openly solicited, with requests made to federal agencies across the country. This peer review was designed to be an analytical critique of the soundness of their investigative methods as well as their findings to date. Recommendations on improvements to their methodology were invited.
In response to Chairman de Braga’s question regarding the nature of hotline questions, Ms. Sylva replied that citizen concern centered on the safety of continuing to live in Fallon, the chances of other children developing leukemia, and the safety of drinking the water.
Assemblywoman Gibbons requested clarification of Fallon population figures, the percentage of ethnic minority citizens, history of residents who had requested testing of their private wells, and data on other cancer cases that were linked to arsenic in well water in the Fallon area. Ms. Sylva deferred to the upcoming testimony of Dr. Todd and Galen Denio. Chairman de Braga clarified that the population of Fallon was estimated at 8,300 within the city limits and 26,000 within the county.
Dr. Mary Guinan, State Health Officer, resumed testimony for the Nevada State Health Division. In July 2000 a call had been received from Chairman de Braga regarding the alarming number of leukemia cases at the Churchill Community Hospital. Following a review of the Nevada State Cancer Registry, it became readily apparent that the rate of current ALL cases in Fallon did represent a significant increase from what would be expected statistically.
Phase 1 of their investigative work commenced with consultation among experts from various schools of medicine and public health agencies. All agreed that phase 1 had to be a thorough interview with each of the affected families for purposes of determining common exposures. Questionnaires from previously conducted epidemiological studies were reviewed, which resulted in the development of a 32-page questionnaire customized for the Fallon cluster. The time to conduct each family interview was estimated at two-three hours. The participation by affected families, voluntary in nature, was 100 percent. Scientific methodology was closely followed in the gathering of the data. Interviews of nine families were completed by November. The results were analyzed and presented to the families in December by Dr. Todd.
In response to a question by Assemblywoman McClain regarding the place of diagnosis of the nine cases, Dr. Guinan clarified that the definitive diagnosis of leukemia was a bone marrow biopsy. This specialized test had to be done at the hospital where the treatment would occur.
Assemblywoman McClain requested clarification about the Health Division’s ability to track cases in other parts of the nation. Dr. Guinan reported that the publicity did result in the addition of two cases in individuals who were not residents of Fallon at the time of diagnosis. Word-of-mouth reports from the citizens of Fallon contributed to the identification of the first nine cases.
Assemblywoman Leslie inquired about whether the Health Division investigation included the comparison of physical evidence (e.g., blood test results) that might tie these cases together. Dr. Guinan explained that questions did focus on discovering common experiences with the goal of generating hypotheses that could be tested in the next phase of the investigation. Environmental exposures were a principal focus. Additionally, each family was invited to speculate about any theory they had about cause or commonality with other families.
In response to Assemblywoman Leslie’s request for clarification regarding testing of the children and environment, Dr. Guinan explained that no testing had been conducted. Phase one was descriptive in nature, and additional testing would be premature until possible causal agents could be identified. Testing of children (e.g., blood, hair analysis) dictated a judicious approach.
Assemblywoman Angle raised the issue of the number of phases of the investigation, any planned efforts to be proactive in uncovering new cases of leukemia, and a timeline of when the results of the study would be available.
Dr. Guinan explained that the number of phases of the investigation was unknown. There had been hundreds of investigations of clusters, with few resulting in identification of cause. The Woburn cluster, one of the few with an identified cause, took 18 years. The Health Division had planned to proceed step-wise. Assurance of public fears had to be the first matter of importance.
In response to Assemblyman Neighbors, Dr. Guinan clarified that an historic review of the health records had been conducted for purposes of comparing the current cancer rate with historic rates. The rate for Churchill County had been the same as the state average, with no increase evidenced prior to this cluster. An essential piece of information was described by Dr. Guinan as the population figures for children up to the age of nine years in the Fallon area.
Assemblyman Neighbors requested clarification on whether Fallon’s drinking water had been tested for substances besides arsenic. Dr. Guinan reported that tests had included radioactive substances and pesticide tests, with no evidence of significant levels. Jet fuel tests of water had been negative as well. It was further noted that some of the leukemia victims were served by the municipal water system while others were on private wells.
In response to Assemblywoman Gibbons, Dr. Guinan outlined the expected rate of cancer versus actual rates of cancer in Fallon. Dr. Guinan reported that the same rate, 3 per 100,000 cases, would be expected throughout the state of Nevada. Multiple comparisons had been made with cancer registries across the nation, and the conclusion was that we had a definite increase in Fallon.
Dr. Todd, State Epidemiologist, resumed testimony for the Nevada State Health Division. Background information regarding communicable disease and cancer reporting practices for Nevada was presented. Dr. Todd referred the committees to his portfolio of handouts (Exhibit D). Nevada Revised Statutes (NRS) 441 was cited as the guideline for their tracking programs for 60 communicable diseases. NRS 457 contained the regulations for tracking cancer. Since 1979, all invasive cancer had been required to be reported by hospitals, with laboratories and physician offices being added to reporting requirements in the late 1990’s. It was noted that outpatient management of cancer had interfered with the completeness of data in the cancer registry. This had been compounded by an almost two year reporting lag in updating the data of the cancer registry, a common problem nationwide.
Dr. Todd elaborated on the three principal uses of the registry data, which included research, resource allocation, and program evaluation. The value of the registry data was illustrated by its application in cluster investigation.
The unusual number of ALL cases in a small community like Fallon within a short time frame grabbed the attention of the Nevada Health Division. Using population figures of Nevada communities, mathematical calculations of expected rates and actual rates were scrutinized. Regardless of how the data was sliced, the probability of the Fallon cluster being a random event was judged to be highly unlikely. For the years 1995 to 1999, Churchill County had expected to see only one case of childhood cancer. Statistical analyses were alarming and indicated high probability of a non-random event.
The expected rate in Nevada for residents up to age 10 was calculated at 2.78 cases of Acute Lymphocytic Leukemia (ALL) for a population of 100,000. Churchill County, with eight actual cases, was judged to be a statistically significant event given the expected 0.22 cases for its population of 7,850.
Dr. Todd elaborated on the epidemiological investigation, specifically the 32- page questionnaire. Residential history was examined starting with two years prior to the birth of each victim. Occupational history of both parents, medical history of the index child, prenatal history, environmental exposure data, types of pets, activities, and hobbies, household products, types of appliances in the home, and drinking water sources were all investigated.
A timeline was displayed which captured residency in the Fallon area for all of the affected families. Data was charted on bar graphs and then examined for overlapping of residency and other significant marker events. The preponderance of overlapping points was identified as November 1996 through June 1999. This became the time frame of interest and prompted research questions about coincidental environmental events in Churchill County.
Scrutiny of water analyses received priority attention, especially synthetic organic compounds (SOC) and volatile organic compounds (VOC). None were detected in the municipal water supply that served approximately half of the victim families. Data for private drinking water wells was not complete. Mercury, arsenic, gross alpha radiation, select components of jet fuel, benzene, and select pesticides and herbicides were tested, and all were at or below the allowable limits.
Occupational history data included specific questions about chemical, fume, and radiation exposures on the job. Although some incidents of exposure were discovered, this was judged not to be a common characteristic across all families. The medical history of each index child was reviewed and revealed no common denominator. Maternal pregnancy questions included many subjects such as alcohol and food consumption, medications consumed, occupational exposures, and breast-feeding habits. Questions related to family history of cancer revealed no pattern.
The most prominent question fielded by Dr. Todd during his investigation had been the possible link between leukemia and arsenic in the drinking water. Research did not reveal a preponderance of evidence that linked arsenic with leukemia. Arsenic had always been present in Fallon, which begged the question of why the recent cluster suddenly emerged. The pathway of exposure, as well as the biological mechanism through which a suspected agent caused leukemia, was described as essential elements of their epidemiological investigation.
Chairman de Braga requested clarification about the state cancer registry, specifically at what point in time the registry would have revealed a cluster of cancer. Dr. Todd explained that it would have taken several years before he would have been confident to draw conclusions about a cluster. The lag time between diagnosis and reporting was reported to be common for most cancer registries across the nation. Chairman de Braga urged the Nevada Health Division to submit recommendations about methods for expediting the cancer reporting process.
Assemblywoman Parnell inquired about substances tested in drinking water, specifically hydrocarbons and chemicals similar to those detected in Woburn. Dr. Todd explained that trichloroethylenes and tetrachloroethylenes were among the substances tested.
Assemblywoman Smith requested clarification on lag time, specifically whether it was a lag between the initial reporting of the cancer, the completeness, or both. Dr. Todd explained that lag time was a multifaceted problem, with the first component of lag described as the delay between diagnosis and compilation of the patient’s medical record. The second component of lag was related to the abstraction of the information from the medical records, a problem that was evident whether the abstraction was performed by the hospital or by a representative of the Nevada Health Division. Dr. Todd estimated the abstraction time for each medical record at 40 to 60 minutes. The addition of laboratory reporting was anticipated to be a means to expedite the process. By way of comparison, the Center for Disease Control (CDC) standard was reported to be 90 percent at the one-year mark.
Assemblywoman Smith resumed questioning with a request for clarification of dates of water testing, specifically the inconsistency in the testing schedule and the reported two-year gap. Dr. Todd deferred to Galen Denio’s upcoming testimony.
In response to Assemblywoman Smith’s question about private well testing, Dr. Todd clarified that private well testing had most often occurred when the property changed ownership. The mortgage companies, not the state, were the requestors of the water test and reportedly did not routinely order detection of the more complex chemical substances.
Assemblywoman Smith inquired about the possibility of school commonality. Dr. Todd reported no clustering or connection to any school site.
Assemblywoman Koivisto pursued the issue of the amounts of synthetic organic compounds (SOC) and volatile organic compounds (VOC) detected in the water. Dr. Todd clarified that water analyses revealed zero detection.
In response to Assemblywoman Leslie’s question regarding high levels of other diseases in the Fallon area, Dr. Todd explained that his review of the cancer registry data through 1999 revealed only the childhood ALL cases in Fallon.
Assemblywoman Gibbons inquired about the probability that the Fallon cluster could be a statistical anomaly. Dr. Todd replied that it was impossible to state with absolute certainty that it was not a fluke. Despite the fact that most cluster investigations failed to conclusively identify a causal link, public concerns dictated the need to continue the investigation.
Assemblyman Mortenson shared his personal experience with recent water testing and cited a line in his water report which stated that radioactive substances were not included in the analysis. In response to Assemblyman Mortenson’s request for clarification, Dr. Todd added that the municipal water data presented were historical in nature and not connected to his current investigation.
Assemblyman Mortenson inquired about possible medical procedures and diagnostic x-ray exposure that the leukemia victims may have experienced. Dr. Todd clarified that those were precisely the types of questions asked of the victims. No pattern of exposure, including prenatal ultrasound testing, was revealed. In response to a question of statistical probability, Dr. Todd stated that the projected statewide probability rate of 0.84 per 100,000 residents had not held up in Churchill County. Assemblyman Mortenson next requested if the improbability of such events had been calculated, to which Dr. Todd replied that it had not been determined.
Assemblywoman Berman cited an upcoming bill dealing with the comprehensive cancer plan in Nevada. She specifically inquired whether her bill should be amended to address the need for expeditious identification and response to cancer clusters. Dr. Todd replied that this would require additional thought and that his written response would follow after consultation with his colleagues.
In response to Assemblyman Bache’s question regarding the possible connection with the 1997 flood, Dr. Todd explained that the flood had been one of the most prominent events identified for the time period of interest. Initial investigation had not revealed any evidence of contamination of municipal water supplies. Aquifer contamination would need further study.
Assemblyman Brown inquired about the geographic boundaries of the investigation. Dr. Todd reported that the cases were distributed throughout the city and surrounding area. Chairman de Braga called the committees’ attention to their information packets and to a copy of the published map which pinpointed the 11 cases.
Galen Denio, Manager of Public Health Engineering, Bureau of Health Protection Services resumed testimony for the Nevada State Health Division. A handout (Exhibit E), which outlined the procedures for protection of public water systems, was distributed. Mr. Denio presented an overview of the principal functions of the Bureau, the focus of which was ensuring compliance with drinking water regulations.
In response to earlier questions regarding water testing, Mr. Denio clarified that the maximum contaminant levels (MCL) had been set by the Environmental Protection Agency (EPA) and adopted by the state of Nevada. The contaminant list was described as extensive. In regard to private well water, Mr. Denio reported that the bureau did not test these drinking water sources. In regard to the non-detects referenced by Dr. Todd, current methodology did not allow for detection.
Chairman de Braga cautioned the committees of the need to maintain open minds on the issues, especially given the extensive media coverage and speculation about arsenic as a possible cause. Chairman de Braga requested clarification about the policy and procedure for alerting the public in cases of high level of contaminants in the drinking water. She cited the recent case of private well contamination at Soda Lake and inquired about the follow-up procedure.
Mr. Denio explained that, because it was not a public water system, the Nevada Health Division had not been advised through formal channels. Chairman de Braga emphasized that, although not a public water supply covered by law, it was nonetheless a health threat to residents in that area. She expressed concerns over the lack of a system to alert the residents of the danger.
Mr. Denio clarified that the federal mortgage lending agencies had required well water testing when the property changed ownership. The state did not have the responsibility with regard to private wells. Chairman de Braga restated her concern that the quality of the drinking water should be disclosed as part of the real estate transactions. This breakdown in communication could be addressed in the final report of recommendations.
Dr. Ronald Rosen, School of Medicine, University of Nevada, Reno commenced testimony. Two handouts, a pamphlet entitled “Epidemiology of Childhood Leukemia” and a one-page summary of comments (Exhibit F), were distributed. Dr. Rosen reviewed the remarkable progress made during the last 50 years in the diagnosis and treatment of leukemia, with an estimated 85 percent survival rate. Children had accounted for only 1 to 2 percent of all cancers, with Acute Lymphocytic Leukemia (ALL) the most common malignancy. The projected ALL rate was described as 3 per 100,000. At the point of diagnosis, ALL peaked at two to five years of age. Gender and race had been discovered as significant, with a male dominance of ALL and a prevalence in affluent white children.
Dr. Rosen explained the differences between the various forms of leukemia. The childhood ALL had been classified as a heterogeneous group of diseases, with varying immuno-phenotypes. He further emphasized the point that 80 percent of all ALL revealed a genetic link. These actual genetic abnormalities within the cells had the promise of enabling scientists to understand how the genetic and environmental factors linked together.
The trend, as described by Dr. Rosen, was one of increasing rates. Trends also included striking differences in the international statistics of cancer in children. Possible explanations were offered by Dr. Rosen and included access to higher quality medical care, a finer ability to diagnose cancer, and better cancer reporting systems.
Dr. Rosen summarized the risk to develop cancer as a complex interplay of inherited predisposition, exogenous exposure to agents with leukemogenic potential, and chance events. Despite impressive advancements in the treatment of ALL, cause had evaded science and, when discovered, was predicted to be complex. Dr. Rosen elaborated by stating that ALL was a genetic disease, but rarely inherited as a genetic syndrome. Of interest was the leukemia rate for children with genetically based Down’s Syndrome, where the rate was 20 to 30 times greater than the general population.
Dr. Rosen restated that little was known about epidemiology and etiologic patterns in childhood cancers compared to adults. A strong causal relationship had been established with prenatal radiation exposure, albeit connected to a small percentage of ALL cases. Through the decades, documentation from atomic bomb events had been thorough and included occupational exposure of workers and their subsequent deaths from cancer. The data for ionizing radiation, overall, had been conflicting. High dose exposure had been correlated to the high incidence of leukemia among survivors of atomic blasts, while age was strongly correlated to the type of leukemia.
Non-ionizing radiation research had been extensive but inconclusive. Finding a control, non-exposed population would be almost impossible. EMF (electromagnetic fields) research had been largely inconclusive and remained controversial. Research on chemical exposures to herbicides and pesticides had been associated with certain forms of leukemia.
Dr. Rosen described the unique population of interest, specifically young children between the ages of two to five in developed countries. Epidemiological evidence supported the view that childhood ALL occurred in this age group due to a rare abnormal response brought on by unusual timing in combination with individual genetic susceptibility to a common infection.
This indirect evidence had been judged to be very compelling. The etiologic role in this infection was described in the context of population mixing. On the subject of population mixing and herd immunity (e.g., polio virus), Dr. Rosen described an increased risk of infection after population mixing and movement. Leukemia clusters occurred when herd immunity was deregulated by population mixing.
In summary, Dr. Rosen highlighted that in the unique population with ALL it was a delayed first exposure that had been considered to contribute to pathogenesis of several diseases associated with socio-economic affluence. Decreased breast-feeding practices in affluent populations had been suggested as a factor and would need analysis in the Fallon group. An abnormal immunologic response was emphasized as a probable factor in the development of childhood leukemia.
Dr. Rosen highlighted the distinction between descriptive and analytical statistics that resulted from epidemiological studies of leukemia. Interpretation of data had been challenging, with conflicting results between studies. A lack of prevalence of pediatric malignancies plus confounding circumstances contributed to the chance of bias in studies.
In closing, Dr. Rosen reiterated that the Fallon cases had great significance and could contribute to the eventual link of environmental-genetic interactions to the pathogenesis of the various types and subtypes of childhood leukemia. Prevention would follow as a realistic goal.
Chairman de Braga expressed her appreciation to Dr. Rosen. She inquired as to whether the recommendations to which he alluded were in the handouts. Dr. Rosen clarified that recommendations were not included, however he would be happy to contribute input.
Dr. Carolyn Hastings, Pediatric Hematologist and Oncologist at the Children’s Hospital in Oakland, commenced testimony. Dr. Hastings had practiced medicine for more than ten years in northern Nevada and had firsthand experience with the Fallon cluster. It was noted that, because of the relative rareness of childhood leukemia (i.e., 3,000 cases per year), pediatric oncologists across the nation networked for purposes of sharing knowledge and experience.
The pooling of knowledge allowed for expansion of research and hypothesis generation. Genetic mutation had been determined to be a significant piece of the puzzle. One mutation that had developed in-utero was thought to be complicated by a second mutation in early childhood, probably due to some environmental exposure (e.g., infection). Establishment of the type and subtype of leukemia was described by Dr. Hastings as essential to scientific comparisons.
Demographics were highlighted as the second essential component of the research. Correlations with age, race, and gender had been established. Children under the age of five years and Hispanic children had been cited as having a higher incidence.
Assemblywoman Gibbons requested clarification of the role of socio-economic factors and the possibility of the development of another type of cancer. Dr. Hastings explained that it was impossible to determine with certainty when the leukemia developed in a child.
In response to Assemblyman Carpenter’s question regarding the existence of a diagnostic blood test, Dr. Hastings explained that there was no screening test available to predict the disease. The complete blood count (CBC) was described as the most common screening tool. There would be no predictive quality to the test, only diagnostic value. A bone marrow test, described as highly invasive, would alert the physician in advance of active symptoms. Acknowledged as the most conclusive of all laboratory tests, Dr. Hastings added that bone marrow testing would be done only after reasonable suspicion.
Chairman de Braga requested a comparison between suspected environmental causes of lymphoma and leukemia. Dr. Hastings confirmed the similarity. She elaborated on the two major hypotheses, genetics and environmental exposures. Chairman de Braga expressed her gratitude to Dr. Hastings and requested any recommendations.
Following a break, Chairman de Braga called the meeting to order and stated that, because a quorum was not present, the hearings would continue as a sub-committee. An introduction of Dr. Vera Byers and Dr. Al Levin was made. An outline of their presentation (Exhibit G) was distributed.
Dr. Vera Byers, a physician with a specialty in clinical immunology, commenced testimony and described with her experiences with the Woburn, Massachusetts cancer cluster case. Woburn was judged to be the prototype for cluster investigation. Dr. Al Levin, a physician and scientist, interjected with his description of the role he played in the Woburn case.
Dr. Levin stated with certainty that he believed the Fallon case would be a very easy case. There had been signature genetic lesions evident in these diseases that could be connected to etiologic agents. Examination of the siblings, parents and neighbors promised to be revealing of any common environmental exposure. Dr. Levin expressed confidence at discovering the disease process, the causal agent, and perhaps the pathway.
Dr. Byers resumed testimony with an overview of the Woburn cancer cluster. Woburn, a town with a significant industrial presence, saw the development of 12 cases between the years 1969 to 1979. The cause was determined to be well water contamination by trichloroethylene (TCE) and perchloroethylene (PCE).
One of the outstanding features of the Woburn cluster was that the community itself identified the increased number of cases (as did Fallon) as well as the suspected source of contamination. The close proximity of the affected homes was significant. Since 70 percent of all cancers had been known to have a carcinogenic cause (as opposed to genetic), water, soil and air sources were tested for chemicals.
Dr. Byers highlighted the value of testing family members and neighbors to uncover similar abnormalities. In Woburn, immune abnormalities were evident and correlated strongly with TCE contamination. Sources of domestic exposure were scrutinized because it was known that, increasingly, industrial chemicals were invading households in alarming amounts. The significance was described as being directly related to continuous low dose exposures within the contained atmosphere in a home.
Dr. Byers reiterated the need to empower the community of Fallon. Historically, it had been the community (e.g., Woburn) that not only uncovered the cluster but the source of the environmental contamination. The prolonged investigation over almost two decades was attributed to the failure of the scientific and medical communities’ to believe the residents of Woburn.
Assemblyman Carpenter requested clarification of the map displaying the location of cases in Woburn. Not all of the dots were included in the Woburn cluster, highlighting the difficulty of cluster identification. In terms of the genetic link, a prenatal exposure compounded by a secondary environmental insult had been the leading theory.
Dr. Levin interjected with an explanation of the role of genetics in the development of all diseases. Disease was described as a function of the individual as he responded to an etiologic agent.
Chairman de Braga asked if the findings in Woburn had been conclusive. Dr. Byers replied that the findings were highly conclusive and included the confirmation of autoimmune abnormalities among family members of the leukemia victims. In response to a question regarding the 20-year timeframe, Dr. Byers clarified that once the active investigation was instigated and publicized, the answers were apparent within 3 years. Woburn demonstrated conclusively that it was in-utero exposure and that when the suspect water wells were closed, new cases ceased within ten years (i.e., latency period).
Chairman de Braga acknowledged the contribution of Dr. Byers and Dr. Levin and requested submission of their recommendations for future action.
Assemblywoman Gibbons summarized the factors that were known to be correlated with leukemia, for example a virus. She also requested clarification on the socio-economic status of the families in Woburn and the role that Dr. Byers and Dr. Levin would play in the Fallon investigation. Had they been invited to participate? Both responded “no” to the question of invitation.
Dr. Byers expanded her explanation of viral etiology by stating that interaction with a chemical carcinogen was required to trigger the cancer. In terms of socioeconomic class, Dr. Levin stated that all of the Woburn families had great similarity as well as stability (i.e., long term residence in the area).
In response to Assemblyman Carpenter’s question about the known causes of up to 70 percent of cancers, Dr. Byers stated that triggers such as smoking and trichloroethylene exposure had been well established and documented. Assemblyman Carpenter observed that there appeared to be more cases of cancer, despite the recent medical discoveries. Dr. Byers shared her theory on the movement of industrial chemicals into households and the significant increase in exposure. Dr. Levin added his observation that pancreatic and brain cancers, once rare, had become much more common today. Breast cancer appeared to be epidemic.
Assemblyman Carpenter probed for a theory on the increase in cancers. Dr. Levin explained that brain cancer had been tied conclusively to maternal cigarette smoking and exposure to certain pesticides.
Assemblywoman McClain requested a comparison between Fallon and Woburn, specifically the compact number of years in the Fallon cluster. Dr. Levin stated emphatically that the circumstances in Fallon suggested an ideal case and great opportunity to learn. Chairman de Braga expressed her hope of the continued involvement of Dr. Byers and Dr. Levin.
Testimony resumed with Al Biaggi, Administrator of the Division of Environmental Protection. A report entitled “Environmental Conditions Summary of the Fallon, Nevada Area” (Exhibit H) was distributed to the committees. Mr. Biaggi introduced his staff and then presented an overview of the agency’s principal activities.
Water quality issues received highest priority with Nevada Environmental Protection. Issuance of permits, followed by quarterly compliance reports were, reported to be the key elements of their water monitoring programs. Periodic inspections had been conducted by the agency to further ensure compliance with regulations. Mr. Biaggi referred the committees to the handout, which contained summary tables of caseload data.
In terms of Fallon, Mr. Biaggi described the area as not being a heavily industrialized area. Fallon had a total of 64 permits, with 14 connected to industrial storm water and 19 assigned on a temporary basis for cleanup of site contaminations. Waste management covered solid waste (i.e., landfills), waste generation of hazardous waste, and the oversight of facilities using highly hazardous materials. Mr. Biaggi added that there were four facilities in Fallon designated as hazardous waste facilities, one being a chrome-plating operation and the remaining three being geothermal power plant operations. In regard to solid waste management, there had been a steady decrease in the number of landfills, with only one remaining in the Churchill area.
Mr. Biaggi outlined the air quality programs which operated in concert with the permitting processes described above. For Fallon, only two companies at three facilities had been subjected to reporting under the EPA TRI – Toxic Release Regulations. Statistics for the two companies had been unremarkable.
Strong inspection and enforcement programs ensured compliance with regulations. In Fallon, there were permits issued for six geothermal plants, six mineral processing facilities, eight sand and gravel operations, two industrial permits, four surface area disturbance permits, and two NAS permits (e.g., boilers and power generators).
Data for spills and accidents revealed 86 sites in the Fallon area, with 76 cases involving petroleum products. Ten cases were reported to be still active.
Mr. Biaggi introduced Paul Liebendorfer, Chief of the Bureau of Federal Facilities, who presented an overview of the Fallon Naval Air Station activity. Mr. Liebendorfer stated that 26 sites were known at the base and under current scrutiny. Principal contaminants included fuel oil, paints, solvents, and industrial refuse materials. The upper aquifer had been contaminated to a depth of 20 feet, however no contaminant had migrated off the base. General ground water flow was known to be to the southwest direction and away from the Fallon area.
Chairman de Braga requested clarification on the testing of soil and air in addition to water testing. Mr. Liebendorfer explained that all of the contamination had been determined as subsurface, therefore no air tests were warranted. Chairman de Braga questioned the follow-up procedures for fuel dumping. Mr. Biaggi interjected to explain that fuel dumping in the air was considered a distinct activity and not related to their responsibility to address soil and ground water contamination.
In reply to Chairman de Braga’s question about well contamination with JP8 jet fuel, Mr. Biaggi acknowledged a problem with groundwater contamination at the site with JP8.
Assemblywoman Gibbons asked for clarification on the scope of the authority and the ability of the State Environmental Protection Division to govern environmental events at the Fallon NAS. Mr. Biaggi characterized the relationship as a cooperative agreement with the federal government.
In response to Assemblyman Carpenter’s question regarding detection of jet fuel in well water, Mr. Biaggi stated that there had been no indication of hydrocarbon contamination. Assemblyman Carpenter next asked Mr. Biaggi if other tests had been conducted which might provide insight to cancer. Mr. Biaggi reiterated that municipal wells were tested frequently and that hydrocarbons had not been detected.
Chairman de Braga stated that it would be helpful to get a list of recommendations which included what could go wrong. Mr. Biaggi explained that there had to be an exposure pathway and that the mere presence of a chemical contaminant would not be enough to cause harm. Water would be suspected as a likely pathway, however there had been no proof to date.
In response to a question about agricultural activities by Assemblyman Carpenter, Mr. Biaggi acknowledged the testing of water for agricultural contaminants. He referred the committees to the Nevada Department of Agriculture.
Mr. Biaggi reintroduced Mr. Liebendorfer and the topic of the Shoal Project, an underground nuclear detonation near Fallon in 1963. Through the years, testing and remedial efforts were implemented, and Mr. Liebendorfer described the site as contained today. Ground water wells had been monitored through the years, with one well revealing traces of a radionuclide. Any movement of ground water would be away from the Fallon area.
In response to Chairman de Braga, Mr. Liebendorfer clarified that the wells had been tested within the last six months. The Department of Energy had hired the Desert Research Institute to conduct a full-scale study of the groundwater movement at the site of Project Shoal.
Mr. Biaggi concluded his presentation with mention of Nevada’s only superfund site, the Carson River. With known high levels of mercury, the Carson River had long flowed through the Fallon area, however, links between mercury and cancer had not been established.
Assemblywoman Gibbons requested clarification of the flow of groundwater to the east. Mr. Biaggi reiterated that the flow and any potential contaminants from the navy base would be away from the Fallon community. Mr. Biaggi expressed his appreciation for the opportunity to participate and assist in the investigation.
Chairman de Braga introduced Dr. Bruce Macler, Regional Toxicologist, EPA, San Francisco. Dr. Macler shared a handout of his presentation (Exhibit I). Dr. Macler stated that the focus of his testimony was arsenic and its possible relation to the Fallon cluster. Exposure routes to arsenic were described as varied. Dr. Macler emphatically labeled arsenic a poison, regardless of ingestion route. Arsenic had been conclusively linked to lung, bladder, skin, liver, kidney, and prostate cancers, as well as diabetes and neurological complications. Like other cancers, leukemia occurred when damaged genes caused cells to reproduce uncontrollably.
Dr. Macler elaborated on the quantification of disease rates and associated arsenic levels. Extrapolation downward from certainty to uncertainty was voiced as a concern. Some cancer risks had been quantified with confidence; however, information was not abundant on the association with childhood leukemia. International studies (e.g., Bangladesh) did not reveal an increase in childhood leukemia cases. The mechanism of arsenic damage appeared to be related to the repair mechanisms of chromosomes. Acute Lymphocytic Leukemia (ALL) had been linked to genetic damage in earlier testimony. Dr. Macler speculated that arsenic did not initiate the leukemia but rather established a toxic background so that the actual causal agent could trigger the leukemia. Whatever agent triggered the leukemia was amplified by this toxic background, asserted Dr. Macler.
The question persisted in scientific circles about why Fallon had not witnessed increases in other cancers. Over a lifetime, with an estimated 10,000 residents in Fallon, 100 people would be expected to get cancers of all types from exposure to arsenic.
Detoxification of arsenic was described as a methylation process in the human body and was said to offer some protection to the human. Thinking had changed drastically in recent years, and the distinction between safe and unsafe forms of arsenic was obliterated. In moving from the known to the unknown in calculating risk, regulations interfered with risk assessment. Dr. Macler emphasized that toxicology and epidemiology and risk assessment were described as different processes, but interrelated fields. Risk assessment was depicted as a process that had been driven by regulatory needs.
Dr. Macler emphasized that there was no known threshold for arsenic and corresponding adverse effects. It had the status of a nonthreshold carcinogen. In summary, Dr. Macler stated that arsenic posed health risks and regulatory challenges, however the risks could not be used to link arsenic to the childhood leukemia cases. He further stated that arsenic had the potential of being a contributing factor.
Chairman de Braga asked if 10 parts per billion was an unrealistic level or excessively low. Dr. Macler replied that he did not agree, and added that 10 was feasible and a good place to be. Costs were predicted to go down for methods to treat arsenic in drinking water.
Assemblyman Carpenter referred back to an earlier comment made by Dr. Macler and requested that he elaborate on any issues that caused him concern during the day’s testimony. Dr. Macler explained that the nature of childhood leukemia and the associated chromosomal damage caused him concern. The immunological steps employed by the body to clean up damaged genes and systems needed more research to fully understand the relationships, especially in relation to arsenic health effects.
Assemblywoman Gibbons asked for clarification about the data that indicated that methylated arsenic compounds were as toxic as inorganic arsenic. Dr. Macler explained that the source of the data would be found in the federal register, in the literature, and on their Web site. Dr. Macler reiterated that because arsenic had long been present in Fallon, it was likely to be a background amplifier rather than the primary cause of the ALL.
In response to Assemblywoman Gibbons question regarding the role of individual genetics and impaired immunity, Dr. Macler agreed that there was a possibility of that association. He did not, however, agree that it could be a fluke. He cautioned the committee members to remember that everyone had been exposed to arsenic in Fallon water, but not everyone got sick. Everyone could have been exposed to something else in Fallon might have initiated childhood leukemia. Testimony did not indicate compact exposure among these 11 children in Fallon. Variability in susceptibility had to be factored into the investigation.
Assemblywoman Koivisto requested clarification about the calculation of risk, for adults or for children or for both. Dr. Macler stated that the risks were calculated for adults and therefore biased. Risks were seldom quantified for childhood cancer.
Chairman de Braga expressed her appreciation for the testimony. The meeting was adjourned at 5:19 p.m.
RESPECTFULLY SUBMITTED:
June Rigsby
Committee Secretary
APPROVED BY:
Assemblywoman Marcia de Braga, Chairman
DATE: