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Libby Community Advisory Group

Meeting Summary
September 11, 2003

EPA Libby Home

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:

EPA Report

Jim Christiansen reported on behalf of EPA on the following topics.

Boat Ramp Cleanup - A sampling and cleanup plan has been developed, and sampling at the site began yesterday. Based on the sampling, the cleanup plan will be refined. Cleanup will begin on September 22. An addendum to the plan will set out the cleanup boundary.

Audience Member Question - At the last CAG meeting you said that the cleanup plan would be presented to the City Council meeting at its September meeting. Did you do so?
Answer - Earlier this week, I briefed the entire City Council regarding the plan, and they did not have any questions. The plan is public, and a copy is available at the EPA Information Center.

Audience Member Question - The time of the meeting at which you presented the plan was changed. Who changed the time?
Answer - I don't know. I asked the City to put it on a Council meeting agenda and advertise it the normal way.

Audience Member Comment - The plan was not presented to the public. I have sent EPA comments regarding the cleanup plan, and I ask that they be included with the summary of this meeting. I am aware of contamination issues on this site because I conducted a petroleum remediation on it for W.R. Grace. Vermiculite is boiling up through the asphalt on the access road to the site. (A copy of comments provided by D.C. Orr is included below as Appendix 2.) (PDF file, About PDF files)

Response - I wrote you a letter today responding to your comments. Included in the letter is a cleanup plan for the access road. Mr. Orr was invited to a pre-construction meeting regarding the boat ramp cleanup.

Audience Member Question - Did you address the ditches?
Answer - I did not address the ditches in my letter today. I will, however, discuss the ditches with Paul Peronard.

Comment Alan Stringer - The petroleum cleanup referenced by Mr. Orr was completed as required in the summer of 2000.

Audience Member Question - What about the illegal sewer system on the site?
Answer - I will look into this issue and get an answer.

BN Railroad Yard - Cleanup of the rail yard has stopped because the vacuuming of the track ballast was not working. The clearance sampling detected asbestos fibers. A new cleanup method is therefore under consideration. One alternative is physical excavation of the ballast. BN and EPA will decide on a cleanup method this winter, and cleanup will resume in the spring.

Flyway Cleanup - The administrative order for the cleanup has been signed and accepted by the bankruptcy court. EPA is negotiating a cleanup work plan with W.R. Grace. Cleanup will likely begin in the spring.

Residential Cleanups - About 130 residential cleanups have been finished to date, and the target number for this year is 200. The present pace will be maintained into the fall when it will be ramped down.

Long-Term Cleanup Issues - EPA has asked the Healthy Community Initiative to spearhead forming a work group to address the operation and maintenance issues that will remain after the Superfund cleanup is completed in several years. The work group will identify issues and develop a work plan for addressing them. Examples of the issues include the cleanup letter that will be provided to building owners after the cleanup is finished as well as how to respond to contamination left behind. Members of the work group will include representatives of EPA, the state, the CAG, the TAG, the business community, realtors, and people affected by asbestos contamination.

CAG Member Skramstad Comment - The cleanup at my house conducted by E.R. has been excellent. We are still discussing one area of contamination beneath the house.

Audience Member Lerah Parker Comment - The public has not been tuned into the cleanup of our property. There were differences in the cleanups conducted at Millwork West, Seifke, and Parker properties. Some equipment was cleaned and some was destroyed.
Response - Cleanup plans are public. We try to talk with everyone and to make the process as transparent as possible. The TAG is asking similar questions about cleanup consistency, and answers are being provided. Not every past action was documented. When the emergency response work began, guidelines were not available, and every decision was not documented. The situation is different between the cleanup of two properties versus 1,200 properties. EPA is improving its protocol as the cleanup progresses.

CAG Member Question - What group did you say you will be working with regarding the operation and maintenance plan for the period after the Superfund cleanup?
Answer - The Health Communities Initiative was asked to help EPA put together a work group.

CAG Member Comment - Two or three people whose homes were contaminated should be included in this group.
Answer - I agree.

CAG Member Comment - People with asbestosis should also be included.
Answer - I agree. People who have had to live with the contamination should be included.

ATSDR Report

Dan Strausbaugh reported that Myrna Lundy who acted as the coordinator for NORC in the medical screening has a serious brain disease and is in a rest home in Miles City. He stated that Ms. Lundy was always compassionate and respectful to people from Libby participating in the medical screening. He then passed out a sympathy card for CAG members to sign that would be sent to the Lundy family.

Asbestos Related Health Care Project Report
LeRoy Thom reported on behalf of the Asbestos Related Health Care Project (ARHCP). The ARHCP is a non-profit corporation established to administer the $2.75 million provided by W.R. Grace pursuant to the consent decree in the mine access litigation brought by EPA against W.R. Grace. The ARHCP must administer these funds consistent with this decree to supplement the W.R. Grace Medical Plan. The Board of Directors of ARHCP includes: LeRoy Thom, President; Diana Rewerts, Vice President; John Johanson, Treasure; Marcia Fantozzi, Secretary; Carlyn Alsbury, Member; Jim Myers, Member; and Jeff Regh, Member. ARHCP reached agreement with W.R. Grace in January 2003. The ARHCP program is called the Libby Asbestos Medical Plan (LAMP). ARHCP has selected Montana Benefits and Health Connections (MBHC) to be the third party administrator of LAMP. This firm will administer the funds at or below its cost of doing so. Mr. Thom stated that three documents are available, a summary of LAMP, an explanation of LAMP benefits, and application forms. He then introduced personnel from Montana Benefits and Health Connections, include Jimmy Senterfitt, Chief Operations Officer, Tim Sizemore, Director of Provider Relations, and KaiEllen Bucher, Special Project Coordinator for LAMP. Mr. Senterfitt, stated that MBHC will administer the funds but will not be an insurer. His goal is to make the $2.75 million go as far as possible. Enrollment in LAMP began with a mass mailing by the W.R. Grace medical plan administrator to all W.R. Grace plan participants. LAMP is meant to be the payer of last resort. It will coordinate benefits with those of other providers. People are eligible for LAMP if they are eligible for the W.R. Grace Medical Plan.

CAG Member Comment - Mr. Thom and the Board of the ARHCP are to be commended for their work in establishing this program. I can confirm that MBHC has not recovered all of its costs in setting up LAMP.

Audience Member Question - Will the $2.75 million earn interest?
Answer - Yes.

Audience Member Question - How are these funds invested?
Answer - The $2.75 million has been deposited in Glacier Bank. The fund we chose has a low interest rate because we could not accept restrictions on access to the money and could not take any risks of loss.

CAG Member Question - The $2.75 million provided by the consent decree must supplement the W.R. Grace medical plan?
Answer - Yes. To receive funding, one must be eligible for the W.R. Grace Medical Plan. Not everyone, therefore, can receive benefits from LAMP.

Audience Member Question - Will LAMP pay for treatments denied by the W.R. Grace plan, or for bills which the W.R. Grace plan does not pay?
Answer - No. LAMP does not provide gap coverage.

Audience Member Question - Will ARHCP provide a public report on its finances on an annual or semi-annual basis?
Answer - The consent decree requires that W.R. Grace report quarterly to EPA. ARHCP must report to W.R. Grace on the same basis.

Audience Member Question - Is the LAMP eligibility period limited? What if my children become sick five or ten years from now?
Answer - Although $2.75 million may seem like a lot of money, when it comes to medical expenses it is not. Because of the limited amount of funds, I would be surprised if the fund still exists five or ten years from now.

Audience Member Question - So the LAMP program will not help people with the 20% co-payment requirement in the W.R. Grace plan or people not eligible for the W.R. Grace plan?
Answer - It is best to review the eligibility requirements, but LAMP does not provide gap coverage, i.e. it does not pay all costs not born by the W.R. Grace Medical Plan.

CAG Member Question - Is it correct that W.R. Grace recently cut back from paying the full costs of medical treatment of asbestos-related disease to only 80% of the costs?
Answer by Alan Stringer - The payments have not changed, but have been the same for the last three years. The plan pays 100% of the usual, reasonable, and customary charges. However, there are no usual, reasonable, and customary charges for hospital bills, so in-patient hospital charges have been reimbursed at an 80% rate.

Comment by Rick Palagi - SJLH bills the patient's insurers, including W.R. Grace, Medicare, Medicaid, or others. We also work out payment plans with individuals for any bills not covered by insurance. We do not, however, turn people away because they cannot pay. We are unable to collect about 30% of all charges that we bill.

CAG Member Question - Has the Hospital turned over anyone to collection agencies?
Answer by Rick Palagi - I do not know, but I will find out.

CAG Member Question - To be sure that we are understanding what is being said, let's use an example. Suppose the hospital bill is $5,000, and the W.R. Grace plan pays 80% or $4,000. Will the LAMP program pay the other $1,000?
Answer - No. The ARHCP Board decided that because the fund is limited, it would not provide gap coverage. We understood that in many cases the cost of administering the gap payment would exceed the payment, and we did not want administration costs eating up the fund. We did not understand that the W.R. Grace Medical Plan only paid 80% of hospital bills. The Board will revisit this issue.

CAG Member Comment - W.R. Grace should pay 100% of the medical costs of people it poisoned.
CAG Member Comment - Compensation for W.R. Grace executives should be reduced and more money made available to pay for Libby medical bills.

CAG Member Comment - In its medical plan, W.R. Grace defines asbestos-related disease. W.R. Grace should not be dictating to us what asbestos-related disease is, the federal government should define the disease based on the best available science, and W.R. Grace should then reimburse all medical costs.

CAG Member Comment - The Congress is considering language that would include a definition of asbestos-related disease that would not be acceptable in Libby, so we have been fighting a federal definition.

Audience Member Comment - My doctor is Dr. Whitehouse, a Spokane doctor. The LAMP payment should not be limited only to Libby or Montana medical charges.
Response - LAMP is not limited to covering the medical costs for qualified people in Libby or Montana.

Audience Member Comment - If W.R. Grace agrees to pay 100% of medical costs, what will prevent doctors from raising their prices?

Audience Member Question - Would W.R. Grace agree to set the co-payment on a sliding scale depending on the ability to pay?
Answer by Alan Stringer - I will take this question to W.R. Grace management.

CAG Member Comment - Please take back to your management that W.R. Grace should pay 100% of eligible medical costs. People have been coming to us concerned that their wives will be left in debt for burial costs thinking that W.R. Grace will pay 100% of their medical bills.

CAG Member Comment - The asbestos exposure was not an accident. It was deliberately done to us. W.R. Grace should pay every penny of medical and burial costs.

CAG Action - The CAG agreed to David Latham's offer to draft a letter to W.R. Grace stating that W.R. Grace should pay 100% of the cost of medical care arising from asbestos-related disease. Mr. Latham will provide a draft to Mr. Mueller who will circulate it to CAG members before the October CAG meeting. The CAG will act on the letter at the October meeting.

Environmental Justice Grant Letter

LeRoy Thom passed out a list of goals developed by the CARD Outreach for Recovery Assistance (CORA) environmental justice proposal (see Appendix 3 (PDF file included with Appendix 2, scroll down, About PDF files).

CAG Action - The CAG agreed unanimously to send the draft letter that was included as Appendix 3 (PDF file) of the August 14 CAG meeting summary to Linda K. Smith, Project Officer U.S. Environmental Protection Agency, in support of CORA's environmental justice proposal. A signature page for the letter was passed around for CAG member signatures.

ARD Net Report

Karol Spas, Program Director for the Asbestos-Related Disease (ARD) Network, passed out a brochure explaining her program. She reminded the CAG that Lincoln County has received a three-year grant from the Health Resources and Services Administration of the US Department of Health and Human Services to support the program. The grant includes $133,000 for 2003, $162,000 for 2004, and $190,000 for 2005. The program will assist people in applying for available asbestos-related health services from Social Security, SSI, Medicaid, and Medicare, as well as drug assistance and other programs. It will also include money for direct services such as personal care and house keeping. Eligibility criteria for the direct services are being developed. Ms. Spas requested comments from the community about needed services. She also asked for a CAG member to serve on the ARD Board of Directors, and Gayla Benefield volunteered to do so. Finally, she also asked for volunteers to work with the program and provide services to people impacted by asbestos-related diseases.

TAG Report

George Keck passed out copies of a September 9, 2003 letter Jim Christiansen responding to the list of action items in Mr. Keck's August 8, 2003 letter, which was included as Appendix 4 (PDF file)to the August 14, 2003 CAG meeting summary. A copy of Mr. Christiansen's letter is included below as Appendix 4. (PDF file About PDF files) Mr. Keck stated that EPA has either responded by providing requested documents or by referencing documents that still being written or reviewed.

Public Comment

Audience Member Comment - A recent story in the Missoulian stated that Libby was a safe place to live. This is not true. While Libby may be cleaner and safer, it is not clean or safe. The CAG and/or EPA should be providing information stating this fact. People should not be moving here and buying homes thinking that it is safe to do so.

CAG Member Question - Can you give us an update on ambient air sampling in Libby?
Answer by Jim Christiansen - Ambient air sampling is not detecting any asbestos. Health risks remain here, otherwise EPA would not be planning to spend $20 million per year for the next five years. This risk should be put in a balanced context, however.

Audience Member Question - I have heard that the administrator of the W.R. Grace health plan has sent out a letter requesting that plan members sign up for a free autopsy, but the information from it would stay with W.R. Grace. Is this correct?
Answer by Alan Stringer - The request that the plan pay for autopsy came from plan members, so W.R. Grace has agreed to pay for it. The information distribution is subject to the federal HYPPA regulations.

CAG Member Question - Can the information be provided directly to the deceased family?
Answer by Alan Stringer - That is a fair question.

CAG Member Comment - Families should be willing to share the actual cause of death in the obituary.
Response by David Latham - While I agree, doing so is at the family's discretion.

CAG Member Comment - Something is wrong with this picture. W.R. Grace is willing to pay 100% of autopsy costs, but not 100% of medical costs.

CAG Member Comment - During the July CAG meeting, I asked Dan Strausbaugh to answer two questions regarding Dr. Gerderding's June 20, 2003 letter to me (Clinton Maynard). First, what information did she rely upon to reach her decision that CERCLA connects the declaration of a public health emergency to critical short-term healthcare needs? Second, I asked that Dr. Gerberding define the "appropriate" public health services in Libby. Apparently, Mr. Strausbaugh has not passed on my questions to Dr. Gerberding.
Response by Dan Strausbaugh - I answered your first question during the July CAG meeting, and I did not agree to search government transcripts and records from the 1982 Congressional Hearings for specific reference to "critical short-termed health care needs." I explained that Dr. Gerberding's interpretation was likely her own. Regarding your second question, I also stated that I assumed that "appropriate" referenced ATSDR's mission, identifying and preventing exposure to toxic chemicals. I stated that ATSDR has been doing this in Libby.

CAG Member Comment - People in Libby will die at an early age without appropriate medical care.
Response - Congress sets the rules and the appropriate funding for agency activity. Picking apart the letter will not change the agency's response.

CAG Member Question - What is our legal recourse concerning ATSDR's failure to declare a public health emergency?

Audience Member Question - Writing another letter will not go to any rule or law or interpretation of law supporting Dr. Gerberding's decision. We apparently have no recourse. Can you tell me what the next step might be?
Answer by Dan Strausbaugh - I don't know of any appeal process for Dr. Gerberding's decision.

CAG Member Comment - Dr. Gerberding's letter puts ATSDR on record as declining to declare a public health emergency because the Department of Health and Human Services lacks resources and statutory authority. Maybe we should write a letter to our Congressional delegation asking for their assistance and include a copy of Dr. Gerberding's letter.

Audience Member Comment - Homeowners do not have recourse to ask questions about how safe we are. People don't have the health care we need. EPA is not resolving issues. It has moved from cleanup of asbestos contamination to containment. After four years of cleanup, the Parker property is still not clean. An EPA report during the 1980's stated that the area within 22 miles of the expansion plant was contaminated. I hear about surveys of Libby people regarding the cleanup. I have not been surveyed. Has anyone here?

Next Meeting

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

Appendix 1

CAG Member & Guest Attendance List
September 11, 2003

Members/ Group/Organization Represented
George Keck/ Technical Advisory Group (TAG)
Sandy Wagner/ Community Health Center/TAG
Clinton Maynard/ Area Asbestos Research Group
W.K. Maki/ Libby Schools
Bob Dedrick/ Asbestos Victim
George Bauer/ City of Libby
Ken Hays/ Senior Citizens
David F. Latham/ The Montanian Newspaper
Wendy Thomi/ EPA Community Involvement
Jim Christiansen/ EPA Project Manager
Dan Strausbaugh/ ATSDR/Region 8/Montana
Leroy Thom/ Former Grace Employee
Gayla Benefield/ Lincoln County Asbestos Victims Relief Organization
Les Skramstad/ Asbestos Victim
Gary D. Swenson/ Libby Volunteer Fire Department
Kerry Beasley/ St. John's Lutheran Hospital (SJLH)
Rick Palagi/ SJLH

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