Hanford Healthy Energy Workers: Healthcare Needs Assessment and Recommendations, June 1, 2021
- Issuer
- Congressional materials
- Document type
- 2021 Hanford Healthy Energy Workers Healthcare Needs Assessment And Recomme
- Case
- 2021 Hanford Healthy Energy Workers Healthcare Needs Assessment And Recomme
Summary
Hanford Healthy Energy Workers - Healthcare Needs Assessment and Recommendations is a Research Services report to the Legislature from the Washington State Department of Commerce, dated June 1, 2021, prepared pursuant to Engrossed Substitute Senate Bill 6168 Sec. 127(83), Chapter 415, Laws of 2020. It was prepared by the Hanford Healthy Energy Workers Board, which met from August 2020 through March 2021. Its findings report that more than 57% of current and former workers surveyed reported being in an exposure event and over 32% indicated long-term exposure to hazardous materials. The board recommends creating a Hanford Healthy Energy Workers Center, improving access to primary and specialty care, and improving healthcare quality and coordination. The report closes with workforce survey narrative responses about workers' compensation processes.
Summary drafted by a model from the document's text below and checked by script against that text before publication. It is a navigation aid, not a reading of what the document proves. Where AI is used
Cite this document
“Hanford Healthy Energy Workers: Healthcare Needs Assessment and Recommendations, June 1, 2021.”
Original at app.leg.wa.gov. Archived at Pandemic Darlings, https://pandemicdarlings.com/source-documents/2021-hanford-healthy-energy-workers-healthcare-needs-assessment-and-recomme/
, SHA-256 941acfc59157df90bd4ed146a388f389f4f1dcf9ff312d9be117dcad8678f83a.Full text
Hanford Healthy Energy
Workers - Healthcare Needs
Assessment and
Recommendations
Pursuant to Engrossed Substitute Senate Bill 6168 Sec. 127(83),
Chapter 415, Laws of 2020
June 1, 2021
RESEARCH SERVICES
REPORT TO THE LEGISLATURE
Lisa Brown, Director
2.5
Acknowledgments
Consultant Team
Avvento Consulting, Inc.
Hanford Healthy Energy Workers Board Members
Marty Cohen, ScD, CIH, CSP, Teaching Professor Jason Leung, Principal Consultant
University of Washington, Department of
Environmental and Occupational Health Sciences Kevin Leung, RN
(co-chair)
L.B. Sandy Rock MD MPH / Public Health Physician
Nick Bumpaous, President, Central Washington /Former Risk Communicator at Hanford
Building Trades Council (co-chair)
Steve Maki, SMS, CHST
Esi Nkyekyer, MD, MPH, Acting Assistant Professor, Washington State Department of Commerce
Medical Director OEM Clinic, Harborview Medical Sean Ardussi, Special Projects Manager,
Center sean.ardussi@commerce.wa.gov
Nicholas Reul, MD, MPH, FACOEM, Medical Officer Lisa Brown, Director
for Occupational Safety and Health, Washington
State Department of Labor and Industries Jasmine Vasavada, Legislative Director
Mark Riker, Executive Secretary, Washington State Mark Barkley, Assistant Director, Local
Building and Construction Trades Council Government Division
Jason Sprowl, Workforce Specialist Alice Zillah, Research Services Section Manager
Randi Walli, Business Manager, UA Local 598 RESEARCH SERVICES
Plumbers and Steamfitters 1011 Plum St. SE
P.O. Box 42525
Dianne Whitten, Recording Secretary, Hanford
Olympia, WA 98504-2525
Atomic Metal Trades Council (HAMTC)
www.commerce.wa.gov
Jill Wood, Director of the Office of Radiation
Protection, Environmental Public Health Division, For people with disabilities, this report is available on
Washington State Department of Health request in other formats. To submit a request please
call 360.725.4000 (TTY 360.586.0772)
Hanford Healthy Energy Workers Board-Alternates
Mike Means, Director, Office of Radiation
Protection, Washington State Department of Health
Earl Fordham, Certified Health Physicist, Deputy
Director of Office of Radiation Protection,
Environmental Public Health Division, Washington
State Department of Health
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND
RECOMMENDATIONS
Table of Contents
Executive Summary ..................................................................................................................................... 2
Introduction ................................................................................................................................................. 5
Findings ...................................................................................................................................................... 9
Recommendations Framework ................................................................................................................... 17
Hanford Healthy Energy Workers Center .................................................................................................... 18
Improve Access to Primary Care, Acute Specialty Care and Chronic Disease Management.......................... 22
Improve Healthcare Quality and Coordination of Services ........................................................................... 24
Conclusions............................................................................................................................................... 27
Appendix A: Assessments of Hanford Worker Protection and Key Indicators of Progress............................ 29
Appendix B: Medical Surveillance Systems Inventory ................................................................................. 44
Appendix C: Glossary ................................................................................................................................. 49
Appendix D: Workforce Survey Results ....................................................................................................... 53
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 1
RECOMMENDATIONS
Executive Summary
Overview
The Hanford nuclear site is a sprawling, 560-square mile area in Southcentral Washington where, for more than
four decades (1944-1987), the federal government produced plutonium for nuclear weapons and missile
warheads.
During the years of plutonium production, many highly radioactive byproducts and waste chemicals were
dumped directly into the ground or stored in subterranean multi-million-gallon underground storage areas
known as tank farms. Unique hazards of radioactive materials exist, including from metals used in uranium rod
cladding and processes (e.g., mercury; beryllium); building and protective materials (such as asbestos and
silica); and toxic chemicals used for extraction of plutonium from the raw mixture of highly radioactive material
that was the byproduct of controlled nuclear reactions.
Cleanup Mission
In the late 1980s, the Department of Energy's mission at the Hanford site shifted from production to cleanup.
In 1993, with the declassification and release of previously classified documents, the types and extent of
contamination and potential exposure became apparent—especially from various chemical vapors and,
uniquely, beryllium.
Today, about 8,000 Hanford employees are involved in the environmental cleanup project. Crews responsible
for site cleanup continue to deal with several different kinds of waste in a number of different forms, with
many of the wastes being potentially harmful to people and the environment. As reported by the Department of
Energy (DOE) in 2019, the federal government plans to have a presence at the Hanford Site well beyond 2095. 1
Increasing Concern over Beryllium and Tank Farm Vapor exposures
During the past 20 years, concerns of the Hanford workforce have primarily been related to:
Chemical vapor exposure at the tank farms
Beryllium exposure at various sites where beryllium-containing tools were used or beryllium-containing
products were used in ways that left behind beryllium dust or oxide
Due to the unique possible exposures at Hanford, potential health consequences can be atypical and difficult
to diagnose and treat, requiring specialized medical services and training. Health effects experienced by
Hanford workers are complex. They can present within minutes of exposure or over the course of several
years. Active and former Hanford workforce members consider their health still at risk from their work and
perceive that there is little that the healthcare system does or can do to remedy their disorders. 2
Hanford Healthy Energy Workers Board
To address requirements detailed in ESSB 6168 Sec.127(83) (2020), the Washington State Department of
Commerce (Commerce) convened the Hanford Healthy Energy Workers Board (board). Board members
represented a broad range of experience related to the unique work conducted at the Hanford site and the
health needs for those who have worked there in the past or are currently working there today. The board met
1 U.S. Department of Energy, 2019 Hanford Lifecycle Report, https://www.hanford.gov/files.cfm/2019_Hanford_Lifecycle_Report_w-
Transmittal_Letter.pdf
2 National Institute for Occupational Safety and Health Centers for Disease Control and Prevention U.S. Department of Health and
Human Service, Review of Hanford Tank Farm Worker Safety and Health Programs November 28, 2016
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 2
RECOMMENDATIONS
over eight months to prepare this report: reviewing existing research, identifying unmet Hanford worker
healthcare needs and developing recommendations for future efforts.
Key Findings
Short-term and Long-term Exposure Continue to be of Concern among the Hanford Workforce: The
workforce survey inquired about workers' short-term and long-term exposure to hazardous materials. More
than 57% of all current and former workers reported being in an exposure event. Over 32% of respondents
indicated long-term exposure to hazardous materials.
Health Effects due to Short-term and Long-term Exposure Continue to be of Concern: The workforce
survey asked current and former workers about the health effects that they are experiencing due to their
work at the Hanford site.
Gaps in Access to Healthcare Persist: The workforce survey and healthcare provider interviews highlighted
the complexity of managing long-term health effects for Hanford workers due in part to the often-delayed
onset of exposure-associated health conditions.
Concern Expressed by Current and Former Workers: Many narrative responses in the workforce survey
expressed deep concerns about workers’ compensation system processes and the healthcare system's
ability to meet workers' needs.
Care Coordination is of Particular Importance for the Hanford Workforce: This research identified
deficiencies in continued engagement with workers after an initial assessment or diagnosis as a common
obstacle for the Hanford workforce.
Emphasis on Workplace Hazards and Exposure Risks is Substantiated: The number of responses received
indicating exposures substantiates the Hanford Healthy Energy Worker Board's prioritized focus on these
workplace hazards and exposure risks. Their responses confirmed that health effects are both acute and
chronic in nature and warrant increased focus by the Legislature. A central finding is the vital role of care
coordination from initial assessment and diagnosis to long-term follow-up care. In light of these findings,
the Board makes the following recommendations:
Recommendations
The following recommendations were developed for the Hanford Healthy Energy Workers Board over the
course of an eight-month process for consideration by the Washington State Legislature and the Governor. Any
next steps to make progress based on these recommendations will require action on behalf of the Washington
State Legislature and the Governor.
Create a Hanford Healthy Energy Workers Center
The board proposes that the state should support a new Hanford Healthy Energy Workers Center that can
serve as a centralized clearinghouse for Hanford-specific health-related information that includes up-to-date
scientific knowledge, research on emergent topics, exposure data analysis, medical surveillance data analysis
and coordinated intergovernmental efforts for policy and advocacy.
Improve Access to Primary Care, Acute Specialty Care and Chronic Disease
Management
Steps should be taken to expand access to Hanford onsite healthcare services and primary and follow-up care
in the greater Tri-Cities area. Measures range from creating a local, specialized clinic co-housed at the Hanford
Healthy Energy Workers Center to exploring state regulatory and contractual mechanisms to increase access
to medical specialties such as pulmonology and oncology.
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 3
RECOMMENDATIONS
Improve Healthcare Quality and Coordination of Services
The board recommends improving the quality of care available to Hanford workers both at the Hanford site
and in the Tri-Cities area. This research identified that patients sometimes did not receive a diagnosis until
they visited and out-of-state or out-of-county clinic. Priorities for future consideration include improving
coordination of care between providers, aligning incentives for high quality, coordinated healthcare, and
convening the healthcare community to raise the overall standard of care that Hanford workers receive.
Implementation Approach
Reconvene Hanford Healthy Energy Workers Board: Since the Hanford Healthy Energy Workers Board
does not continue in an official capacity beyond the preparation of this report to the Legislature, the
Legislature and the Governor may wish to consider reconvening this group to steer the implementation of
the recommendations in this report. Members of this board remain committed to positive outcomes for the
Hanford workforce and could be a valuable resource to steer future efforts towards addressing the
healthcare needs of the Hanford workforce.
Implementation Roadmap: The Hanford Healthy Energy Workers Board recognizes that implementing the
recommendations outlined in this study will be a multi-year effort. A productive next step or priority for the
board will be to collaboratively develop an implementation plan with Legislative and Executive Branch
partners.
Convene Working Groups: The board also recognizes that to implement the recommendations outlined in
this report, an interdisciplinary, multi-agency effort may be needed. A natural next step for the board in is to
begin convening working groups based upon the recommendations framework to 1) developing high-level
scope and requirements to implement recommendations and 2) develop detailed stakeholder engagement
plans.
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 4
RECOMMENDATIONS
Introduction
Background
In November 2019, the Healthy Energy Workers Working Group released its report to the Legislature initiated by
SB 5627, An Act creating the healthy energy work group to develop the healthy energy workers board 3. The
report, facilitated by the University of Washington, made recommendations regarding the composition of a
future Healthy Energy Workers Board and identified priorities for its initial work program.
Following this effort, the 2020 supplemental operating budget, ESSB 6168 Sec.127(83) (2020), built upon the
priorities identified in the 2019 report and tasked Commerce with forming a Healthy Energy Workers Board to
provide recommendations and a report to the Legislature. The Legislature appropriated $250,000 for the state
fiscal year 2021 to do this work. The proviso identified the following key activities for the healthy energy
workers board:
Conduct an unmet health care needs assessment for Hanford workers and develop recommendations on
how these health care needs can be met.
Review studies on how to prevent worker exposure, summarize existing results and recommendations,
develop key indicators of progress in meeting unmet health care needs
Catalog the health surveillance systems in use at the Hanford site.
Submit a report to the Legislature by June 1, 2021, documenting recommendations on meeting health care
needs, progress on meeting key indicators and, if necessary, recommendations for the establishment of
new health surveillance systems at Hanford.
Membership
Commerce built upon the recommendations in the 2019 report to the Legislature as it convened a new Hanford
Healthy Energy Workers Board. Commerce extended invitations to previous members while reaching out to
representatives from areas of expertise that were recommended for inclusion in the future board, including:
A member with healthcare services evaluation expertise
A member familiar with high-level healthcare services in the region
A representative from the Hanford Worker Engagement Center (HWEC)
A representative from the United States Department of Energy
Commerce extended invitations to board candidates representing all of these interests, with the Department of
Energy declining to participate.
For the duration of the research covered in this report, the following individuals served on the Hanford Healthy
Energy Workers Board:
Co-Chair - Marty Cohen, ScD, CIH, CSP, Assistant Chair for Stakeholder Engagement, University of Washington
Department of Environmental and Occupational Health Sciences
Co-Chair - Nickolas Bumpaous, President, Central Washington Building Trades Council
3 Washington State Legislature, SB 5627, https://app.leg.wa.gov/billsummary?BillNumber=5627&Year=2019
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 5
RECOMMENDATIONS
Steve Maki, SMS, CHST
Mike Means, Director, Office of Radiation Protection, Washington State Department of Health
Esi Nkyekyer, Acting Assistant Professor, Medical Director OEM Clinic, Harborview Medical Center
Nicholas Reul, MD, MPH, Medical Officer for Occupational Safety and Health, Washington State Department of
Labor and Industries
Mark Riker, Executive Secretary, Washington State Building and Construction Trades Council
Jason Sprowl, Workforce Specialist
Randi Walli, Business Manager, UA Local 598 Plumbers and Steamfitters
Dianne Whitten, Recording Secretary, Hanford Atomic Metal Trades Council (HAMTC)
Jill Wood, Director of the Office of Radiation Protection, Environmental Public Health Division, Washington
State Department of Health
Hanford Healthy Energy Workers Board, Alternates
Mike Means, Director, Office of Radiation Protection, Washington State Department of Health
Earl Fordham, Certified Health Physicist, Deputy Director of Office of Radiation Protection, Environmental
Public Health Division, Washington State Department of Health
Role of Board Members
Board members contributing to this report served based on their particular subject-matter expertise and did
not necessarily represent any particular organization or agency's view or position. Members from executive
branch agencies (Washington State Labor and Industries and Washington State Department of Health)
provided guidance and consultation as subject-matter experts on the board with the knowledge that any
recommendations for future action with policy or fiscal implications for state agencies were not necessarily
the position of these agencies. Any recommendations with future policy or fiscal implications will be subject to
a future legislative process and the OFM budget review process.
Guiding Principles
The board developed and adopted the following guiding principles to help provide clarity and guidance
throughout the project.
Design survey and develop recommendations with objectivity and independence from prior studies,
remaining open to emerging innovations.
Be transparent with methods, results and findings.
Show empathy towards challenges and barriers experienced by Hanford workers.
Build broad stakeholder partnerships through iterative development.
Protect the privacy of Hanford workers.
Adhere to the mandate of the Legislative proviso.
Deliver a substantive product to the Legislature that draws upon a wide range of resources (training,
scientific, medical and community resources) that may be available; directly address the question of how
to make currently not present resources available.
Develop recommendations to enable address community need.
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 6
RECOMMENDATIONS
Hanford Healthy Energy Workers Board Process
The board met regularly from August 2020 through March 2021. Meetings were held virtually under the
Governor's emergency orders related to the COVID-19 pandemic and were subject to the Washington Open
Public Meetings Act (OPMA). Meetings were open to the public through both internet and call-in options.
Updates on the board's work were regularly posted to the project website.
To assist in conducting the unmet healthcare needs assessment and to conduct the necessary research to
prepare the report to the legislature, the board secured Avvento Consulting's services. Avvento Consulting
brought expertise in survey design and implementation, occupational health, and specific experience in the
unique issues for workers at the Hanford worksite
Healthcare Needs Assessment
The Healthcare Needs Assessment consisted of two parts: 1) a Hanford workforce Survey and 2) interviews
conducted with the healthcare provider community.
Hanford Workforce Survey
The workforce survey was conducted online from January 4, 2021, through January 17, 2021. It garnered
voluntary responses from 1,661 current and former Hanford workers recruited through various local
advertising and media campaigns. Contacting the current and former workforce was a significant challenge;
both due to disaggregate nature of the workforce split between various contracting companies and U.S.
Department of Energy staff, as well as the fact that the U.S. Department of Energy chose not to participate in
this process. A process with U.S. Department of Energy engaged directly in the process would potentially be
able to establish participation of the current and former Hanford workforce more completely.
Survey participants were prompted to answer questions in the following areas, depending on whether
respondents indicated that they had been in a radiological/chemical/particulate exposure event or whether
they had experienced long-term exposure to hazardous materials:
Workplace Protection: Respondents were surveyed as to whether they thought that workplace protective
measures were sufficient.
Short-term Exposure: Respondents who indicated that they had been in a
radiological/chemical/particulate exposure event were asked additional questions about the timeliness of
healthcare after an exposure event, the medical evaluation process, their confidence that the evaluation
would be thorough and definitive and whether additional medical attention was needed.
Long-term Exposure: Respondents who indicated that they had long-term exposure to hazardous materials
were asked if they required additional medical attention.
Health Effects: Survey respondents were asked if they had experienced health effects due to a short-term
event or health effects due to long-term exposure.
Health Care Access: Respondents were asked a series of questions about the access and affordability of
health care. Questions included inquiries about access to transportation, the ability to pay for healthcare
and access to additional onsite healthcare services.
Health Care Quality: Respondents were asked about their assessment of the onsite medical staff
(occupational medical contractor) and the ability of health care professionals in the Tri-Cities to address
Hanford workers' unique healthcare needs.
Demographics: - The survey gathered demographic data such as race/ethnicity, gender and age.
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 7
RECOMMENDATIONS
Healthcare Provider Interviews
Healthcare provider interviews were conducted to augment the workforce survey on healthcare needs from the
perspective of local clinicians and those outside the region familiar with Hanford workers' health needs. Nine
individuals were interviewed, including primary care providers and specialists in hematology, oncology,
pulmonology and allergy. Interviews focused on the providers' experience in serving Hanford workers, barriers
to the treatment they encountered and recommendations to improve healthcare and Hanford workers'
experiences.
Review of Studies on How to Prevent Worker Exposure and Key
Indicators of Progress
The project team reviewed known studies on how to prevent worker exposure and health effects. Specifically,
the team reviewed studies and organized findings in the following manner:
Relevant Assessments: For the Chronic Beryllium Disease Prevention Program (CBDPP), tank farm vapors
and health effects studies, the team reviewed and provided citations to literature most relevant to worker
protection and health effects. All of the works cited are publicly available or made publicly available by
DOE.
Aggregated Findings/Recommendations/Corrective Actions: Upon analysis of relevant findings, the team
summarized findings, recommendations and corrective actions related to CBDPP and tank farm vapors.
Each finding, recommendation and corrective action is categorized according to the type of actions that
were recommended or agreed to by parties.
Key Indicators of Progress: The board and project team then reviewed these recommendations and
corrective actions as identified in the assessments for CBDPP and Tank Farm Vapors for any measurable
or identifiable indicators of progress.
The results of this effort are included in Appendix A: Assessments of Hanford Worker Protection and Key
Indicators of Progress.
Catalog of the Health Surveillance Systems
The board sought to develop an inventory of existing medical surveillance and worker protection programs to
reduce and monitor exposure risks. Specifically, the board and project team organized information gathered in
the following manner:
Current Hanford Medical Surveillance Components: Includes components of medical monitoring and
diagnostics, and potential current worker eligibility, based on known hazards to be present at the Hanford
site.
Additional Consideration: In addition to programs targeted toward current Hanford workers, the board and
project team have included additional medical surveillance programs available to former workers.
DOE has provided the updated medical surveillance programs employed by the onsite occupational medical
provider, HPM Corporation Occupational Medical Services (HPMC OMS) as of March 17, 2021 for inclusion in
this report. The results of this effort are included in Appendix B: Medical Surveillance Systems Inventory.
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 8
RECOMMENDATIONS
Findings
To learn more about the healthcare experience of the greater Hanford worker community, a survey was
conducted of more than 1600 past or current Hanford workers. Without direct access to past or current
Hanford workforce contact information, participation was recruited on a voluntary basis using a variety of
targeted outreach methods throughout the community. Respondents were nearly 70% male, more than 83%
Caucasian or white and split nearly evenly between those older than 65 and those younger. For complete
survey detail, review responses for each survey question in Appendix D.
Survey Design
Target Population - Current and former Hanford workers were invited to a publicly available website
(Hanfordsurvey.com) and then were directed to an online survey. At the outset of the survey, respondents were
asked to indicate whether they were a current Department of Energy (DOE) employee, a current contractor
employee, a former DOE employee or a former contractor employee. If a respondent indicated that they had
never worked at Hanford, no further survey responses were collected from that individual.
Survey Limitations - One constraint of the survey is that the true statistical significance of results could not be
determined because the total number of current and former members of the total Hanford workforce is
unknown. Additionally, the project team relied on convenience or opportunity sampling as a method for finding
respondents. Respondents were motivated to participate through word-of-mouth or in response to various
advertising methods and do not represent a true random sample of the current and former Hanford workforce.
Areas of Inquiry - As directed by the board, the survey focused on key areas of inquiry to answer key questions
about the unique healthcare needs of Hanford workers. Depending on whether respondents indicated that they
had been in a radiological/chemical/particulate exposure event or whether they had experienced long-term
exposure to hazardous materials, survey participants were prompted to answer questions in the following
areas:
Workplace protection - Respondents were surveyed as to whether they thought that workplace protective
measures were sufficient.
Short-term exposure - Respondents, depending on whether they indicated that they had been in a
radiological/chemical/particulate exposure event, were asked additional questions about the timelines of
healthcare after an exposure event, the medical evaluation process, their confidence that the evaluation
would be thorough and definitive and whether additional medical attention was needed.
Long-term exposure - Respondents, depending on whether they had indicated that they had long-term
exposure to hazardous materials, were asked if they required additional medical attention.
Health effects - Survey respondents were asked if they had experienced health effects due to a short-term
event or health effects due to long-term exposure.
Healthcare access - Respondents were asked a series of questions about the access and affordability of
health care. Questions included inquiries as to access to transportation, the ability to pay for healthcare
and access to additional onsite healthcare services.
Healthcare quality - Respondents were asked about their assessment of the onsite medical staff
(Occupational Medical Contractor) and the Tri-Cities area health care professionals' ability to address the
unique healthcare needs of Hanford workers.
Demographics - The survey gathered demographic data such as race/ethnicity, gender and age.
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 9
RECOMMENDATIONS
Data Gathering Tools - The survey was designed and approved by the board and was conducted using a
commercially available online survey platform. Key tool features included data encryption and mobile device
web browser compatibility.
Privacy Safeguards - To safeguard the privacy of Hanford workers responding to the survey, the respondents
remained anonymous and no Personally Identifying Information (PII) or Protected Health Information (PHI)
was gathered. Due to the anonymous nature of the survey, the board also consented to the recommendation
that an Institutional Review Board (IRB) was not required to study human subjects. With several questions in
the survey that permitted open-ended responses, there was a potential for respondents to included personally
identifiable information. A disclaimer at the beginning of the survey, as well as where there are questions that
have the potential for open-ended response was included.
Survey Communications and Outreach
The board did not have direct access to DOE employee or contractor email distribution, so the following were
the primary avenues utilized for outreach:
Labor Organizations - Outreach was conducted via union newsletter and email distribution lists to the labor
organizations represented by board members
Targeted communications materials for general distribution
Print/Local Media - Due to the large population of Hanford workers in the Tri-Cities area, Commerce engaged
with local print and radio media outlets to advertise and promote the Hanford workforce survey.
Tri-Cities Herald - print and digital advertising
KONA Radio - up to six daily radio advertisements with additional coverage in interviews for news
segments.
Social Media - Due to the online nature of the workforce survey, a natural outreach medium was social media
advertisements targeting the Tri-Cities area. Because of the two-week timeframe survey timeframe and
reduced in-person communications venues, this was an effective approach.
The following section describes the summary-level findings that were the impetus for developing
recommendations. More detailed information about each survey question can be found in Appendix D.
Short-term and Long-term Exposure Continue to be of Concern among the Hanford Workforce. The
workforce survey inquired about workers' short-term and long-term exposure to hazardous materials. The
number of responses received indicating exposures substantiates the Hanford Healthy Energy Worker
Board's continued focus on these workplace hazards and exposure risks. Figure 1 shows that at least 57%
of all current and former workers experienced acute exposure events, while Figure 2 demonstrates that at
least 32% of respondents reported long-term exposure to hazardous materials. Workers who responded
'not sure/do not know' could potentially have had either acute or chronic exposures.
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 10
RECOMMENDATIONS
I have been in a radiological /chemical/particulate (e.g. silica, asbestos,
beryllium) exposure event.
Not Sure/Do Not Know
No
Yes
0% 10% 20% 30% 40% 50% 60% 70%
Figure 1: Workforce Survey - Acute Hazard Exposure
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 11
RECOMMENDATIONS
I have had prolonged radiological/chemical/particulate (e.g., scilica,
asbestos, beryllium) exposure.
Not Sure/Do Not Know
No
Yes
0% 10% 20% 30% 40% 50% 60% 70%
Figure 2: Workforce Survey - Prolonged Hazard Exposure
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 12
RECOMMENDATIONS
Health Effects due to Short-term and Long-term Exposure Continue to be of Concern. The workforce
survey inquired about the health effects that current and former workers are experiencing due to their work
at the Hanford site. The survey responses received confirm that health effects are both acute and chronic
in nature (Figures 3, 4) and warrant increased focus by the Legislature.
I have had health effects due to short-term (acute) hazardous material
exposure from working at Hanford.
Not Sure/Do Not Know
No
Yes
0% 10% 20% 30% 40% 50% 60% 70%
Figure 3: Workforce Survey - Health Effects, Acute Hazard Exposure
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 13
RECOMMENDATIONS
I have or have had health effects due to hazardous materials exposure
over time from working at Hanford.
Not Sure/Do Not Know
No
Yes
0% 10% 20% 30% 40% 50% 60% 70%
Figure 4: Workforce Survey - Health Effects, Prolonged Hazard Exposure
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 14
RECOMMENDATIONS
Gaps in Access to Healthcare Persist. Survey respondents weighed in on several topics ranging from their
ability to pay for healthcare and attend medical appointments, and their desire for additional onsite
healthcare services that may improve their wellbeing. While access to health care can be impacted by
factors such as specific health conditions and socioeconomic variables, the survey painted a picture of
gaps in access to both primary care and specialized care. As shown in Figure 5: Workforce Survey -
Additional Onsite Medical Services the most desired additional onsite medical service was urgent care, a
primary care function.
Which of the following additional onsite medical services do you think
should be available?
Other
Tele-medicine Access
Short-term Pharmaceutical Dispensing
Specialty Care
Physical Therapy
Primary Care
Chronic Condition Management
Urgent Care
0% 10% 20% 30% 40% 50% 60% 70%
Figure 5: Workforce Survey - Additional Onsite Medical Services
Concern Expressed by Current and Former Workers. Many narrative responses provided in the workforce
survey expressed deep concerns about the fairness of workers’ compensation system processes and the
healthcare system's ability to meet workers' needs. Emotions of despair and distrust punctuated these
narrative responses.
Care Coordination and Quality. The workforce survey and provider interviews highlighted the complexity of
managing long-term health effects for Hanford workers due to the often-delayed onset of exposure-related
health conditions. A central finding is the important role of care coordination from initial
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 15
RECOMMENDATIONS
assessment/diagnosis to long-term follow-up care. Freeform responses to the workforce survey and
provider interviews pointed to deficiencies in continued engagement with the worker after an initial
assessment or diagnosis. The interviews with healthcare providers revealed the challenges coordinating
long-term care, in part because many workers experience adverse effects many years after the exposure
event. Workers indicated the presence of health problems long after initial diagnosis, sometimes more
than 20 years later.
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 16
RECOMMENDATIONS
Recommendations Framework
To effectively group similar recommendations for consideration, the Hanford Healthy Energy Workers Board
developed a recommendations framework (Figure 6) to improve current and former Hanford workers' health
care. The framework presents high-level groupings or themes for related recommendations. Each
recommendation is a separate action to be considered by the Washington State Legislature and the Governor.
The following sections describe the recommendation and provide additional discussion and assessment.
Figure 6: Recommendations Framework
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 17
RECOMMENDATIONS
Hanford Healthy Energy Workers Center
The state should support a new center (Hanford Healthy Energy Workers Center) to:
Establish an information clearinghouse for information promoting better access to healthcare,
Improve quality of medical knowledge and training, and
Improve transparency and effectiveness of information sharing.
In standing-up a new Hanford Healthy Energy Workers Center, the state should assign a standing advisory
board made up of workforce representation, institutions of academic medicine, industrial hygienists,
healthcare providers and the U.S. Department of Energy to ensure that all stakeholders' interests will be
represented.
Currently, an easily accessible clearinghouse for exposure data and best health practices for Hanford workers
does not exist. The lack of centralized information leaves room for uncertainty regarding the nature of
exposure events and how they are associated with medical problems found in Hanford workers. This
potentially slows down the process for treatment and ultimately delays patient care.
While individual healthcare information may currently be shared electronically and seamlessly between
providers, population-level healthcare data is needed about the Hanford workforce in the areas to facilitate
communication of best practices to inform treatment, additional research, and policy:
Exposure data
Medical surveillance trends
Aggregated claims-related data
A clearinghouse for sharing healthcare information while still protecting patient privacy would help make
healthcare delivery for Hanford workers more effective and efficient. Providers could go to one location to
retrieve population-level workplace exposure data, related diagnostic trends, and potentially associated health
conditions as well as individualized data. A centralized knowledge base could also increase the competency
and efficacy of local primary care providers. Real-time data reporting in the clearinghouse could help guide the
allocation of resources if certain communities were showing declines in follow-up care percentages.
The current and former workforce at Hanford is comprised of those who have worked for, or currently work
directly for the U.S. Department of Energy as well as those who have worked for, or currently work for the
numerous contractors that provide specialized services at the Hanford site. The disaggregated nature of this
workforce makes consistent communication a challenge. A centralized source for Hanford-related healthcare
information located within the Tri-Cities area, would go a long way towards building trust among a better-
informed current and former Hanford workforce, particularly should the U.S. Department of Energy decide to
participate as a partner.
Proposal - Centralize medical and scientific knowledge
The state should establish and fund the Hanford Healthy Energy Workers Center as an independent,
centralized entity to serve as a clearinghouse for disseminating peer-reviewed and accepted medical and
scientific literature. Important functions would also include the evaluation and communication of newly
available studies about Hanford-specific hazards and ongoing tracking of implemented healthcare practices.
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 18
RECOMMENDATIONS
Assessment
The current health system creates “information silos,” which keeps information departmentalized. Providers
must contact each other individually to share medical information and expertise. For incurable diseases such
as chronic beryllium disease, information sharing could be key to finding cures. Current testing and treatment
mainly target symptoms.
Centralized medical and scientific knowledge can also lead to improved practices beyond the medical
community. Links to health outcomes and current safety practices are often reviewed regularly by many
industries. DOE employees and contractors can also utilize the centralize medical and scientific knowledge
base to re-evaluate their own on-site safety practices, in turn adjusting protection protocols and work place
practices.
Centralized information sharing also helps ensure the credibility of knowledge through peer review. When
studies are readily available for review, resulting best practices easily follow. Evidence-based practice is the
leading cornerstone of current medical protocol. Having systems in place, which are updated quickly, is key to
ensuring good patient outcomes.
Findings from the workforce survey indicated that many patients did not feel that their local providers
effectively dealt with cases related to Hanford's health hazards. Many cases were referred to an outside
specialist. A centralized knowledge base would help increase overall provider confidence in diagnosing and
treating Hanford's acute cases.
Proposal - Promote research
Continued research into potential health effects due to exposures and resulting healthcare needs is critical.
The state should fund and promote research that influences the healthcare needs of current and former
Hanford workers. The Hanford Healthy Energy Workers Center would serve as a point of coordination and
priority setting for studies and initiatives help to address gaps in medical/scientific knowledge.
Assessment
Collaborative research has proven beneficial in the past. It allows for multidisciplinary perspectives to many
challenges in healthcare. Collaborative research also can create mentor relationships between specialties to
increase overall competencies.
One way to encourage collaborative research is to create an academic journal published quarterly, authored by
participating providers. Covered topics could include new incidence of disease related to Hanford exposure,
new diagnostic techniques and new treatment plans.
Yearly conferences within the region where providers and other representation can meet would facilitate
presentations of new research findings and create opportunities for training providers on diagnostics and
treatment.
Additionally, prior assessments of tank farm vapors and the Chronic Beryllium Disease Program at Hanford
have documented gaps and corrective actions regarding communications to the Hanford workers (Appendix A:
Assessments of Hanford Worker Protection and Key Indicators of Progress). To help address this ongoing gap,
the Hanford Healthy Energy Workers Center could serve in an outreach and educational function for workers
seeking to understand current developments in protection, testing and treatment.
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 19
RECOMMENDATIONS
Proposal - Centralize and coordinate health surveillance programs
and exposure data
The ability to conduct an epidemiological study of health effects is inhibited by the division of health
surveillance programs between the site's Occupational Medical Contractor for current workers and other
programs for former workers. The state should establish the Hanford Healthy Energy Workers Center to serve
as a point of data aggregation, coordination and evaluation of various health surveillance programs, including
Hanford site exposure data. The Hanford Healthy Energy Workers Center will independently report and expand
upon health surveillance information currently publicly available, such as annual Population Health Trending
Summaries4 provided by DOE.
Assessment
Exposure events can be entered into a database documenting time, type of occurrence and location of the
event. This information will be the first step in proper data aggregation. This information should be accessible
to not only healthcare workers but also labor leadership as well. This exposure data should be stored and
managed by the Healthy Energy Workers Center. Outlying medical providers will also have access to this data
to accurately diagnose work-related injury claims. This will also help reduce the risk of inaccurate reporting
and waste.
When exposure data is accurately reported, coordinating efforts for treatment has the potential to drastically
improve. The majority of current testing for beryllium disease-related incidents are diagnosed outside of local
treatment areas. This creates a delay in care. Better coordination can help the center recommend further
allocation of resources if a site or area experiences a greater number of exposure events.
After collecting data, it will be easier for either DOE or local labor leaders to suggest changes in areas that
experience high levels of exposure events. For example, large numbers of respiratory events in a certain site
could prompt leadership to push for stricter safety standards at that location. If greater events occur at a
specific site, stronger health surveillance or screenings can be put into place, such as more frequent
screenings or examinations.
Proposal - Advocate for coordinated efforts at all levels of
government
With support from the Washington State Legislature and the Governor, the Hanford Healthy Energy Workers
Center would serve to coordinate health and labor policy advocacy activities at the federal, state and local
level. An example of concurrent activities is the introduction of S.4363, the Toxic Exposure Safety Act of 2020 5,
which, if passed, would address the boundaries of what can be achieved alone at the state level. Additional
advocacy and coordination among stakeholders and policy-makers would allow for input and refinements to
this and other federal and state legislation.
Assessment
The Hanford Healthy Energy Workers Center would provide a central data point for local and state government.
Data from incidence reports, individual and population-level health effects and current safety practices would
4 HPMC Occupational Medical Services, 2020 Population Health Trending Summary, Tank Farm Hazardous Waste Worker,
https://hanfordvapors.com/wp-content/uploads/2020/10/TANK-FARM-Health-Trend-Summary-Report-2020-FINAL.pdf
5 Sen. Murray, Patty [D-WA] (Introduced 07/29/2020), https://www.congress.gov/bill/116th-congress/senate-bill/4363
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 20
RECOMMENDATIONS
be accessible for review. Local governments would be able to view incident data and potentially recommend
local clinics to increase access to medical care. State and federal government agencies would be able to view
data and help strengthen safety standards for practices that are producing high levels of health events.
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 21
RECOMMENDATIONS
Improve Access to Primary Care, Acute Specialty Care
and Chronic Disease Management
The state should expand access to Hanford onsite and Tri-Cities area healthcare services available to current
and former Hanford workers.
Proposal - Improve local access to specialized care
The state should provide expanded access to primary care, occupational medicine, pulmonology and chronic
disease management by supporting and expanding evidence-based practices by onsite and local healthcare
providers that are uniquely tailored to Hanford workers' health needs.
Assessment
Currently, workers need to go outside of the Hanford site to obtain comprehensive medical care. Even local
urgent care facilities are at least 10 miles or more away from the central Hanford site. Increasing timely
access would greatly improve overall health for Hanford workers. Local healthcare clinics will need to increase
their abilities to diagnose and treat common Hanford-related illnesses. Currently, patients are usually referred
to outside specialists who are not in the surrounding area. In particular, healthcare providers reported a need
for occupational medicine physicians and doctors willing to treat patients with beryllium-related health issues.
Half of survey respondents cited a need for onsite urgent care facilities (50%) and chronic condition
management (49%). A significant proportion (45%) indicated the need for primary care for injuries and
illnesses regardless of whether they were related to a worker's job.
Proposal - Increase independent oversight to mitigate provider
competing interests that impede healthcare delivery
Barriers continue to persist to workers effectively navigating both the workers' compensation health evaluation
process and accessing necessary care. One significant barrier citied by the workforce is that healthcare
providers often have to deal with competing interests and/or administrative barriers that may be at odds with
the quality of care. An example of a potential competing interest is that a provider has engaged in a contract
with DOE, to which it is solely accountable, to administer onsite healthcare services at Hanford. The state
should evaluate the feasibility of increasing independent oversight of healthcare providers serving Hanford
workers.
Assessment
Workforce Survey respondents voiced ongoing concern about whether healthcare providers were able to
deliver care in manner that was free of competing interests and whether providers were always allowed to act
in the best interest of Hanford workers. If left unaddressed, these concerns will continue to erode the trust in
the healthcare community and further endanger workers' willingness to engage with providers in their care. If
Hanford workers do not trust their providers and do not take an active role in their own care, the quality of care
ultimately suffers. 6 Low quality of care can then manifest itself in the form of poor treatment follow-up and the
absence of shared decision-making between the patient and the provider.
6 Coulter, Angela. "Patient engagement—what works?" The Journal of ambulatory care management 35.2 (2012): 80-89.
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 22
RECOMMENDATIONS
By providing independent oversight, providers who care for Hanford workers can work freely and
independently, in the best interests of Hanford workers.
Proposal - Improve onsite and local provider availability and capacity
The state should assess the feasibility of improving, through state-purchased healthcare in Benton and
Franklin County, the availability of specialty care such as pulmonology, occupational medicine, and oncology.
Assessment
Current local and regional health systems often refer Hanford workers' cases to outside specialists, some out
of state. Hanford workers expressed in the survey that local providers are not equipped to handle their needs,
thus possibly leaving the community underserved by the healthcare system.
Local specialty provider clinical availability should be targeted for improvement. Additionally, Washington State
should consider increasing capacity for computerized tomography (CT scan), magnetic resonance imaging
(MRI scan), bronchoscopy and disease-specific blood work should become available at local treatment sites.
Patients should not have to wait until they can see an out-of-state or out-of-county clinic to receive a diagnosis.
Diagnostic testing capacity for Hanford-related diseases can be cross-trained across the network.
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 23
RECOMMENDATIONS
Improve Healthcare Quality and Coordination of
Services
The state should support improved quality for the specialized healthcare services needed for the Hanford
workforce through improved care coordination.
Proposal - Provide care coordination technical assistance to
providers
With support from the Washington State Legislature and the Governor, the newly established Hanford Healthy
Energy Workers Center would provide technical and clinical practice assistance to local healthcare providers.
One of the Center's key responsibilities would be to implement evidence-based practices of coordination of
care for complex and chronic conditions, tailored to the Hanford workforce. Enhanced coordination
capabilities should include enhanced care and case management across multiple provider systems
Assessment
By offering technical assistance to providers, the Hanford Healthy Energy Workers Center can ultimately
improve the care coordination for Hanford workers who have health conditions that are difficult to manage
that may evolve over the course of several years. Coordinated case management does not currently exist for
Hanford workers. Proper case management has been proven in the past on multiple platforms to help expedite
and improve patient care and outcomes, particularly those with chronic conditions. 7
Proposal - Align provider incentives toward coordination
For state-purchased healthcare in Benton and Franklin Counties, the state should explore the alignment of
provider incentives towards greater coordination of care and chronic disease management, particularly for the
Hanford workforce and surrounding community. For example, the state can explore incentives in value-based
purchasing.
Assessment
Current coordination is limited to provider-to-provider phone calls, emails and faxes for shared communication
for mutual patients. There is no existing coordination program or incentives for providers taking care of
Hanford patients.
Incentives towards a percentage of reimbursement may help encourage participation in coordination
programs. Benchmarks include timely submitted reports, participation in collaboration consortiums and
attending yearly conferences for coordinated care for Hanford workers.
Proposal - Align providers towards a standard of care
With support from the Washington State Legislature and the Governor, the Hanford Healthy Energy Workers
Center should convene periodic conferences with the spectrum of providers that share in the care for Hanford
workers (onsite Occupational Medical Provider, Tri-Cities area providers and institutions of academic
7 Wagner, Edward H. "Chronic disease management: what will it take to improve care for chronic illness?." Effective clinical practice 1.1
(1998).
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 24
RECOMMENDATIONS
medicine). Such conferences will help to establish a consensus standard of care for acute and chronic
conditions related to work at Hanford.
Assessment
There are currently no conferences for doctors, specialists and patient advocates to meet yearly regarding the
care of Hanford workers. Annual conferences are commonly used in many different medical disciplines. Such
conferences would help promote improved specialized care, peer accountability and improve current
diagnostic techniques. This knowledge share for providers would complement the proposed data-sharing role
of the Hanford Healthy Energy Workers Center. Providers could use the provider knowledge share to compare
treatment practices while also pulling necessary data on exposure events, exposure materials and other data
from the Hanford Healthy Energy Workers Center.
As mentioned previously, financial incentives for those providers attending a joint conference could help
encourage participation. Topic and workshops covered during yearly conferences could also count toward
Continuing Education Points, which providers must fulfill to renew a medical license.
As coordinated care improves, conferences could include attendees from multiple states, regions and
countries. International collaboration focused on incurable diseases such as chronic beryllium disease could
help catalog exposure data since no current database exists. Annual conferences would facilitate the re-
evaluation of current standards for testing and treatment. The frequent yearly assessment would push to
constantly improve practices in treating Hanford workers.
Enhance the sustainability and availability of medical and legal
resources for Hanford workers
The state should explore enhancing the medical and legal advocacy resources currently available to Hanford
workers. This could include exploring the enhancement and augmentation of capabilities at the Hanford
Workforce Engagement Center (HWEC)8 and the exploration of independent and sustainable funding to
support additional medical and legal advocacy resources.
Assessment
Additional help is needed for potential claimants to navigate paperwork and legal issues. While HWEC
currently assists claimants with completing paperwork, the demand for legal assistance by claimants may
increase in the foreseeable future. In 2018, the Washington Legislature passed provisions for Hanford site
workers allowing for prima facie presumption of certain occupation diseases.9 Therefore, based on the law,
certain diseases will be, on face, accepted as having been caused by work at Hanford until proven otherwise.
The result is the removal of one of the most significant barriers faced by workers when establishing a workers'
compensation claim for injury or illnesses related to their work at Hanford.
If the increased demand for legal and workers' compensation claim assistance is not met, Hanford workers
will turn to private, personal injury legal practices who widely advertise their contingent-fee-based services. In
the interest of keeping workers' compensation award dollars in the direct hands of Hanford workers, the board
8 The Hanford Workforce Engagement Center (HWEC) is service center staffed with experienced representatives equipped to help
current and former Hanford employees and their families with their questions or concerns about occupational health issues.
Assistance includes the completion of paperwork required to file a workers’ compensation claim.
9 Revised Code of Washington, RCW 51.32.187
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 25
RECOMMENDATIONS
recommends increasing the capacity of cost-free and independent legal and process assistance available to
workers.
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 26
RECOMMENDATIONS
Conclusions
Washington State is Uniquely Positioned to Make a Difference
Based on the information gathered through the healthcare needs assessment, review of worker protection
studies and review of health surveillance programs at Hanford, the board concludes that gaps exist in the
healthcare system's ability to meet Hanford workers' needs. Based on these findings, the board encourages
the state to continue and expand its leading role in improving Hanford workers' health and safety.
Healthcare Needs Assessment. The workforce survey and provider interviews reinforced that Hanford
workers' health effects are complex and can present within a few hours or over the course of several years. By
funding the Hanford Healthy Energy Workers Center, the state can help address the issues with care continuity
and coordination, and the follow-up care that is needed for the unique exposures and resulting chronic health
conditions experienced by current and former Hanford workers.
Review of Worker Protection Studies. Several assessments over time have pointed toward the need for further
study to understand worker protection. These assessments have incrementally expanded the available
knowledge, but in aggregate actionable findings are not readily available in a single, consolidated source for
the public. The work to improve scientific knowledge and its availability will be a long-term effort. However,
Washington State is well positioned to invest in a resource such as the Healthy Hanford Energy Workers Center
to help serve the community with the best available resources and information.
Review of Health Surveillance Programs at Hanford. Health surveillance information is publicly reported as a
result of the settlement agreement between DOE and Washington River Protection Solutions (WRPS). 10
However, the state has an opportunity to improve transparency and trust amongst all parties by establishing
the Hanford Healthy Energy Workers Center as an independent clearinghouse for health surveillance
information.
Implementation Approach
Reconvene Hanford Healthy Energy Workers Board: Since the Hanford Healthy Energy Workers Board
does not continue in an official capacity beyond the preparation of this report to the Legislature, the
Legislature and the Governor may consider reconvening this group to steer the implementation of the
recommendations in this report. Members of this board remain committed to positive outcomes for the
Hanford workforce and could be a valuable resource to steer future efforts towards addressing the
healthcare needs of the Hanford workforce.
Implementation Roadmap: The Hanford Healthy Energy Workers Board recognizes that implementing the
recommendations outlined in this study will be a multi-year effort. A productive next step or priority for the
board will be to collaboratively develop an implementation plan with Legislative and Executive Branch
partners.
Convene Working Groups: The board also recognizes that to implement the recommendations outlined in
this report, an interdisciplinary, multi-agency effort may be needed. A natural next step for the board in is to
begin convening working groups based upon the recommendations framework to 1) developing high-level
10 In 2015, Hanford Challenge and the State of Washington filed separate citizen's suits against DOW and WRPS, alleging that vapors
from the underground tank farms presented an imminent and substantial endangerment. In 2016, WPRS and HAMTC agreed to a
settlement to implement a variety of corrective actions, including disclosure and reporting of health surveillance programs.
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 27
RECOMMENDATIONS
scope and requirements to implement recommendations and 2) develop detailed stakeholder engagement
plans.
Areas for Further Investigation
While the core mandate of the Healthcare Needs Assessment was to assess improved healthcare access and
coordination, the board noted a few areas that warrant continued investigation.
Hanford Site Safety Culture
Several respondents cited the fear of job loss or retribution as a potential barrier to utilizing the workers'
compensation system or reporting workplace hazardous materials exposure, although there were no questions
specifically addressing culture in the workforce survey. The board recommends that Washington State
consider an additional study to assess Hanford site safety culture, and particularly whether there are any
differences in the experiences of DOE and contractor employees.
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 28
RECOMMENDATIONS
Appendix A: Assessments of Hanford Worker Protection
and Key Indicators of Progress
Protection Programs Assessments
Increased attention on the part of the greater Hanford community has led to a broad desire to evaluate policies
and processes for the prevention of exposure in place at the Hanford worksite. Additionally, there is an
increasing desire to improve medical evaluations of those Hanford workers who were or may have been
exposed at the Hanford worksite.11
Since 1999, a number of workers were found to be sensitized to beryllium and some had been diagnosed with
chronic beryllium disease (CBD). Additionally, tank farm workers (TFWs) showed increasing awareness and
willingness to report “fugitive vapor emission” odors and/or symptoms. Together these trends contributed to
oversight agencies' intense focus on the programs and processes for preventing exposures and evaluation of
workers.12 Between 2010 and 2016, expert panels of evaluators from various independent agencies came to
Hanford and performed careful analyses of the programs in place intended to protect workers from the unique
hazards at the site: beryllium, beginning in 2010 and continuing into 2015 and tank farm vapors (TFV)
beginning in 2014 and continuing into 2016. These assessment activities are summarized below. In 2016, the
state of Washington, the Local 598 of the United Association of Plumbers and Steamfitters and the nonprofit
organization Hanford Challenge filed a lawsuit resulting in a signed settlement agreement in 2018 that
addressed many of the major remaining concerns of TFWs.13
Chronic Beryllium Disease Prevention Program (CBDPP)/Beryllium
Corrective Action Plan (BeCAP)
The Chronic Beryllium Disease Prevention Program (CBDPP) implements controls necessary to minimize the
exposure to beryllium of employees working at Hanford. It provides employer requirements for Hanford found
in 10 Code of Federal Regulations 850 (10 CFR 85014).
In response to concerns raised by external stakeholders regarding the adequacy of the 2009 implementation
of the Hanford Site Chronic Beryllium Disease Prevention Program (CBDPP), the initial independent inspection
was conducted during six visits over a period of five months in early 2010 by a team from the U.S. Department
of Energy (DOE) Office of Health, Safety and Security (HSS) at the request of the Assistant Secretary for
Environmental Management (EM). Follow-up evaluations took place annually, in 2011, 2012, 2013 and 2015.
Assessments and Studies
Department of Energy (DOE) Headquarters (HQ) Health, Safety and Security (HSS) Independent Oversight
(IO) Inspection 201015
11 Professional and personal knowledge and experience of former Hanford medical contractor Risk Communicator (2004-2019)
12 Professional and personal knowledge and experience of former Hanford medical contractor Risk Communicator (2004-2019)
13 Washington River Protection Solution, Settlement Agreement, https://hanfordvapors.com/wp-
content/uploads/2018/09/ENV_DEFENSE-853225-v1-Hanford_Vapors__Final_Signed_Settlement_Agreeme....pdf
14 U.S. Department of Energy, Beryllium Program, https://www.hanford.gov/page.cfm/Beryllium
15 Independent Oversight Inspection of the Hanford Site Chronic Beryllium Disease Prevention Program,
https://www.hanford.gov/files.cfm/2010_Hanford_Beryllium_Reportv3__final__June 20101.pdf
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 29
RECOMMENDATIONS
Hanford Corrective Action Plan in Response to HSS Beryllium Assessment Memo (BeCAP) (September
2010)16
Independent Oversight Follow-up Review, Hanford Site - June 201117
Independent Oversight Follow-up Review, Hanford Site – Report of February 2013 18
Independent Oversight Follow-up Review, Hanford Site – January 201419
Enterprise Assessments Follow-up Review of the Hanford Site Chronic Beryllium Disease Prevention
Program - June 201520
Findings/Corrective Actions / Recommendations
Area Finding/Recommendation Assessment
RL and ORP should identify actions to improve DOE HQ HSS Independent Oversight
communications with stakeholder organizations and use Inspection
Communication
their feedback and experience as a resource to improve the
Hanford site CBDPP.
RL should strengthen support mechanisms and DOE HQ HSS Independent Oversight
Communication
communications with beryllium-affected workers Inspection
RL, ORP and contractor organizations should identify DOE HQ HSS Independent Oversight
actions to raise awareness by site managers and Inspection
Communication
supervisors of the risks to workers associated with legacy
beryllium contamination and to build trust among workers.
Further defining the expectations for industrial hygiene Independent Oversight Follow-up
evaluations prior to intrusive work activities was needed to Review, Hanford Site – January 2014
ensure both a proper balance between production and
Industrial safety and alignment within the BeCAP team prior to
Hygiene implementation.
Recommendation: Define IH evaluation process for
intrusive work activities.
RL and ORP had not ensured that contractor baseline DOE HQ HSS Independent Oversight
beryllium inventory and hazard assessments had been Inspection
completed, as required by 10 CFR 850.20, 10 CFR 850.21
and the corresponding portions of the CBDPP.
Management
Recommendation: RL and ORP should require operating
contractors to develop and implement comprehensive
implementation plans
16 Corrective Action Plan in Response to Office of Health, Safety and Security (HHS) Beryllium Assessment,
https://www.hanford.gov/files.cfm/10-SED-0161_CAP_in_Response_to_HSS_BE_Assmt1.pdf
17 Office of Enterprise Assessments Independent Oversight Follow-up Review, Hanford Site - June 201,1
http://energy.gov/ea/downloads/independent-oversight-follow-review-hanford-site-june-2011
18 Independent Oversight Follow-up Review, Hanford Site - February 2013, http://energy.gov/ea/downloads/independent-oversight-
follow-review-hanford-site-february-2013
19 Independent Oversight Follow-up Review, Hanford Site – January 2014, http://energy.gov/ea/downloads/independent-oversight-
follow-review-hanford-site-january-2014
20 Enterprise Assessments Follow-up Review of the Hanford Site Chronic Beryllium Disease Prevention Program - June 2015,
http://energy.gov/ea/downloads/enterprise-assessments-follow-review-hanford-site-chronic-beryllium-disease-prevention
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 30
RECOMMENDATIONS
Area Finding/Recommendation Assessment
WRPS, CHPRC, MSA and WCH had not ensured that their DOE HQ HSS Independent Oversight
work planning and control processes and their Inspection
implementation of those processes in beryllium-controlled
facilities and areas were sufficient to fully ensure the
protection of workers, co-located employees and transient
personnel, as required by 10 CFR 850
Management
Recommendation: RL and ORP should promptly direct
operating contractors to identify and prioritize identified
deficiencies; RL and ORP should require operating
contractors to develop and implement comprehensive
implementation plans
On a priority and risk basis, RL and ORP should require DOE HQ HSS Independent Oversight
operating contractors to develop and implement Inspection
Management comprehensive implementation plans for completing
efforts to achieve full and effective implementation of the
site CBDPP.
RL, ORP and contractor organizations should determine DOE HQ HSS Independent Oversight
methods to strengthen assessment and issues Inspection
Management
management processes for beryllium processes and
activities.
RL, ORP and contractor organizations should identify DOE HQ HSS Independent Oversight
Management appropriate, timely actions to ensure that accurate Inspection
information about beryllium is available.
To ensure the long-term effectiveness of the CBDPP, RL DOE HQ HSS Independent Oversight
and ORP should consider further formalizing expectations Inspection
Management
and governance of the CBDPP (i.e., maintenance and
implementation).
DOE line management should ensure that adequate DOE HQ HSS Independent Oversight
Management
assessments of the CBDPP were performed. Inspection
EM should closely monitor site progress in implementing DOE HQ HSS Independent Oversight
Management and improving the CBDPP at the Hanford site and take an Inspection
active role in ensuring timely and effective implementation
Baseline beryllium inventory and hazard assessments; Hanford Corrective Action Plan in
develop a comprehensive improvement plan Response to HSS Beryllium
Management
Assessment Memo
Recommendation: implement interim actions (September 2010)
Site contractors not ensured that processes in beryllium- Hanford Corrective Action Plan in
controlled facilities and areas were sufficient to ensure Response to HSS Beryllium
protection completely. Assessment Memo
Management
(September 2010)
Recommendation: Develop a comprehensive improvement
plan
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 31
RECOMMENDATIONS
Area Finding/Recommendation Assessment
RL, ORP and the four major Hanford site prime contractors Independent Oversight Follow-up
were continuing to pursue the development of sitewide Review, Hanford Site – Report of
beryllium programs and processes to improve February 2013
identification and control of beryllium hazards and were
actively engaged in implementing the Hanford site BeCAP
Management
Recommendation: Ensure that valid assessments of
BeCAP product implementation through surveillances or
other assessment activities are conducted early to ensure
correct implementation.
A number of beryllium products had been reported as Independent Oversight Follow-up
completed, but the only beryllium products reported as Review, Hanford Site – Report of
being implemented in the field were various interim actions February 2013
as defined by RL, ORP and the beryllium work permit (BWP)
Management
Recommendation: Enhance mechanisms to ensure that
interim changes to beryllium procedures (e.g., BWP
Procedure), when required, are easily understood,
manageable and readily accessible by the workforce.
Four new associated procedures for beryllium posting, Independent Oversight Follow-up
facility assessment and characterization/verification and Review, Hanford Site – January 2014
beryllium sampling represent a significant accomplishment
in the continued evolution of the Hanford beryllium
Management program.
Recommendation: Continue with the implementation of
procedures.
Each of the contractors had begun some implementation
of these new procedures and practices. Appropriate
interim controls had been established to support
Management implementation.
Recommendation: Continue with the implementation of
procedures.
Significant progress in closing and implementing Enterprise Assessments Follow-up
numerous beryllium products, such that only 4 of the Review of the Hanford Site Chronic
original 74 beryllium [administrative] products remained to Beryllium Disease Prevention
be closed. Program - June 2015
Management
Recommendation Identify the remaining CBDPP program
activities needed to complete the implementation of all the
DOE CAP items from 2010.
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 32
RECOMMENDATIONS
Area Finding/Recommendation Assessment
The site had also begun to transition the CBDPP into the Enterprise Assessments Follow-up
Hanford Site Standards process and expected to complete Review of the Hanford Site Chronic
this transition by March 31, 2015. Beryllium Disease Prevention
Program - June 2015
Management Recommendation: RL and ORP should provide direction to
revise the Hanford Integrated Standards Management Plan
to ensure that the CBDPP processes are consistent with
other site-wide standards.
Considerable effort remains in completing and Enterprise Assessments Follow-up
implementing the remaining products and in fully Review of the Hanford Site Chronic
implementing each of the procedures across the Hanford Beryllium Disease Prevention
site. Program - June 2015
Occupational
Medical Recommendation: Expedite the request and evaluation of
Contractor cost impact proposals for the four primary Hanford site
contractors and the medical provider for the few remaining
beryllium products that have not been implemented due to
cost impact.
RL and ORP should consider ensuring that site contractors DOE HQ HSS Independent Oversight
strengthen their processes for baseline beryllium Inspection
Processes
inventories and hazards assessments.
AMH [now HPMC OMS] had not always analyzed medical, DOE HQ HSS Independent Oversight
job and exposure data for employees diagnosed as Inspection
sensitized or having CBD and thus was not collecting
information needed to identify workers at risk for exposure,
understand the beryllium health risks and identify
appropriate actions to improve the CBDPP, as required by
the CBDPP, 10 CFR 850.39 and 10 CFR 850.34.
Testing
Recommendation: RL should promptly direct AMH to
develop a comprehensive improvement plan
RL, ORP and contractor organizations should identify
appropriate, timely actions to ensure that accurate
information about beryllium is available
RL should promptly direct AMH to develop a DOE HQ HSS Independent Oversight
comprehensive improvement plan that addressed the Inspection
Testing
deficiencies and opportunities for improvement identified
in this report.
The medical contractor had not always analyzed medical, Hanford Corrective Action Plan in
job and exposure data for employees diagnosed as Response to HSS Beryllium
sensitized or having CBD Assessment Memo
Testing
(September 2010)
Recommendation: Develop a comprehensive improvement
plan
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 33
RECOMMENDATIONS
Area Finding/Recommendation Assessment
RL and ORP had not ensured that several categories of DOE HQ HSS Independent Oversight
workers at the Hanford site were receiving the minimum Inspection
beryllium-related training, as required by 10 CFR 850.37
and 10 CFR 851.25.
Training
Recommendation: RL, ORP and contractor organizations
should identify appropriate timely actions to ensure that
accurate information about beryllium is available
RL and ORP should promptly direct operating contractors DOE HQ HSS Independent Oversight
to identify and prioritize identified deficiencies (including Inspection
those identified in this report and others identified by other
Training
assessments or gap analyses) and, where warranted,
develop timely corrective actions and/or interim protective
measures.
Worker training related to beryllium Hanford Corrective Action Plan in
Response to HSS Beryllium
Training
Recommendation: Develop a comprehensive improvement Assessment Memo
plan (September 2010)
Much work remained to complete and implement the Independent Oversight Follow-up
various processes and products associated with the Review, Hanford Site – Report of
BeCAP, including the processes and training for several key February 2013
items, including building assessment and characterization
processes and posting; Take steps to ensure that the
beryllium sampling data communicated to workers through
the BWP and BHA is useful, accurate and consistent and
Training
that it is as clear as possible with respect to risk.
Provide clear and unambiguous training requirements in
beryllium procedures to ensure that workers, subject
matter experts, line managers and the training staff agree
on the minimum training and qualification requirements for
performing a beryllium work task
Key Indicators of Progress
Since the EA beryllium follow-up review in November 2013, there has been measurable progress in closing and
implementing numerous beryllium-related corrective actions, such that only four of the original 74 beryllium
recommendations remain unresolved. Based on limitations of more recent information that is publicly
available, additional collaboration with DOE would permit a full assessment as to whether remaining corrective
actions have been completed.
Additionally, according to the most recent EA beryllium review, each of the four Hanford site contractors has
implemented, to some degree, the following:
New CBDPP implementing procedures addressing BWPs and BHAs
Building assessment and characterization/verification
Beryllium posting/labeling
Assessment, characterization and verification of structures and Conex boxes
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 34
RECOMMENDATIONS
Evaluation of electrical equipment for beryllium.
Tank Farm Vapor Assessments
Assessments and Studies
Tank Vapors Assessment Team (TVAT) – 201421
Center for Toxicology and Environmental Health (CTEH) Assessment of Technical Basis of TF IH Program
– 201622
NIOSH Review TFW S&H Programs – 201623
OIG - Department of Energy’s Actions to Address Worker Concerns Regarding [retaliation for reporting]
Vapor Exposures at the Hanford Tank Farms – Nov 201624
Vapors Management Expert Panel (VMEP) – Evaluate Implementation of TVAT’s Report Recommendations
– 201625
DOE Office of Enterprise Assessment (EA-32) Follow-Up Assessment – 201726
Center for Toxicology and Environmental Health (CTEH) Re-Assessment of 2016 Assessment of Technical
Basis of TF Industrial Hygiene Program – 201827
Settlement Agreement – 201828
Findings/Corrective Actions / Recommendations
Area Finding/Recommendation Assessment
Human physiologic response to odor plays major role in Center for Toxicology and
perception of toxic chemical exposure. Environmental Health (CTEH)
Assessment of Technical Basis 29 of
Communication Recommendation: Education of workers concerning “basic TF IH Program – 2016
toxicological odor biology principles” to “put into proper
perspective [workers’] experiences with detected or ‘felt’
odors
21 Tank Vapors Assessment Team Final Report, 2014, https://srnl.doe.gov/documents/Hanford_TVAT_Report_2014-10-30-FINAL.pdf
22 Technical Basis Evaluation Report, https://hanfordvapors.com/wp-content/uploads/2017/03/CTEH-Tech-Basis-Eval-Report.pdf
23 Tank Farm Program Review, https://hanfordvapors.com/wp-
content/uploads/2016/12/NIOSH.Hanford.Tank_.Farm_.Program.Review.28.Nov_.2016.pdf
24 Office of Inspector General, Special Report, https://www.energy.gov/ig/downloads/special-report-oig-sr-17-01
25 Vapor Management Expert Panel, Independent Assessment, https://hanfordvapors.com/reference-materials/independent-
assessments/vapor-management-expert-panel-vmep/
26 Office of Enterprise Assessments Follow-up Assessment of Progress on Actions Taken to Address Tank Vapor Concerns at the
Hanford Site https://hanfordvapors.com/wp-content/uploads/2017/12/EA-32-Office-of-Enterprise-Assessments-January-2017.pdf
27 Re-assessment of the WRPS Industrial Hygiene Hanford Site Tank Vapor Program: Technical Basis and Implementation,
https://fsi1c2vb3k04dtil930vati1-wpengine.netdna-ssl.com/wp-content/uploads/2019/05/CTEH-Reassessment-Report-03042019-
64393-000-SUB-001-001.pdf
28 Washington River Protection Solution, Settlement Agreement, https://hanfordvapors.com/wp-
content/uploads/2018/09/ENV_DEFENSE-853225-v1-Hanford_Vapors__Final_Signed_Settlement_Agreeme....pdf
29 Industrial Hygiene (IH) Technical Basis document (Meacham et al., 2006a) along with other supporting technical documents provides
an overall summary of the WRPS IH program and includes reviews of the gas and vapor sources and dynamics, evaluation of head
space composition, measurement of gases and vapors in the workers breathing zone, toxicological evaluation of volatile chemicals in
tanks, prioritization of COPC and establishment of occupational exposure limits (OELs).
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 35
RECOMMENDATIONS
Area Finding/Recommendation Assessment
Some workers have experienced odors and symptoms that NIOSH Review TFW S&H Programs –
they attribute to exposure to tank farm chemicals and 2016
either do not believe the data that DOE presents or that the
data does not accurately characterize exposures.
Communication
Recommendation: Continue to build trust.
Acknowledge health concerns are legitimate.
Increase management-worker interaction.
Improve communication on return-to-work policy
Hazards associated with tank farm vapor exposures have OIG - Department of Energy’s Actions
been evaluated through multiple studies and evaluations to Address Worker Concerns
Regarding [retaliation for reporting]
Recommendation: Improvements in communication be Vapor Exposures at the Hanford Tank
Communication
made to inform workers about the status of actions and to Farms – Nov 2016
ameliorate continuing fear of retaliation on the part of
some workers.
Various recommendations and that actions were underway OIG - Department of Energy’s Actions
to address issues. to Address Worker Concerns
Regarding [retaliation for reporting]
Recommendation: Improvements in communication be Vapor Exposures at the Hanford Tank
Communication
made to inform workers about the status of actions and to Farms – Nov 2016
ameliorate continuing fear of retaliation on the part of
some workers.
Seven of the 52 workers interviewed indicated that they OIG - Department of Energy’s Actions
had concerns with reporting, communicating, reprisal or to Address Worker Concerns
fear of retaliation related to potential vapor exposures. Regarding [retaliation for reporting]
Vapor Exposures at the Hanford Tank
Communication Recommendation: Improvements in communication be Farms – Nov 2016
made to inform workers about the status of actions and to
ameliorate continuing fear of retaliation on the part of
some workers.
Managing Tank Farm vapor issues is a challenge because DOE Office of Enterprise Assessment
of longstanding, complex issues in vapor characterization (EA-32) Follow-Up Assessment –
and the identification and control of fugitive releases and 2017
potential exposures to personnel.
Recommendation: Improve communications and trust
Communication building.
Increase worker involvement.
Improve industrial hygiene and tank headspace sampling
programs.
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 36
RECOMMENDATIONS
Area Finding/Recommendation Assessment
The CVST has contributed to development and DOE Office of Enterprise Assessment
implementation of some of the actions to address the (EA-32) Follow-Up Assessment –
TVAT supporting recommendations. 2017
Communication
Recommendation: Continue Chemical Vapors Solutions
Team meetings and support.
WRPS will post on a publicly available website the AOP-15 Settlement Agreement – 2018
Communication
procedure.
WRPS will post on a publicly available website all AOP-15 Settlement Agreement – 2018
Communication
Event Investigation Reports
WRPS will post on a publicly available website the Settlement Agreement – 2018
following documents as effective on December 31, 2017:
(1) procedures for determining appropriate PPE; (2)
procedures for alternative respiratory protection
Communication
assessments (“ARPAs”); (3) procedures for assessing
worker hazards (including vapor risks); and (4) tank vapor
information sheets (“TVISs”) for the COPCs in the tank
farms.
DOE and WRPS will make reasonable efforts to post on a Settlement Agreement – 2018
Communication publicly available website a monthly list of Problem
Evaluation Requests (“PERs”) regarding AOP-15 events.
DOE and WRPS will post on a publicly available website the Settlement Agreement – 2018
Communication
Health Trending Summaries for tank farm workers.
DOE and WRPS will post on a publicly available website a Settlement Agreement – 2018
thorough explanation of the tank farm waste worker
Communication
medical surveillance program (routine occupational tests
and their purpose).
DOE and WRPS will post on a publicly available website a Settlement Agreement – 2018
thorough explanation of the current policy concerning
Communication
return to work following a reported exposure and before
the results of all medical tests are available.
DOE will provide Hanford workers with information on a Settlement Agreement – 2018
publicly available website regarding their potential ability
Communication
to participate in the DOE Former Worker Medical Screening
Program.
DOE and WRPS promptly will post on a publicly available Settlement Agreement – 2018
Communication website the Health Process Plan entitled “PNNL-25791,
Hanford Tank Farm Exposure and Risk Assessment Plan.”
DOE and WRPS promptly will post on a publicly available Settlement Agreement – 2018
Communication website the Chronic Occupational Exposure Limits (OELs)
With Regulatory Basis, PNNL-26777.
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 37
RECOMMENDATIONS
Area Finding/Recommendation Assessment
Many different areas of improvement such as new Vapors Management Expert Panel
technologies, new requirements and procedures, new (VMEP) – Evaluate Implementation of
information and the introduction of new personnel with TVAT’s Report Recommendations –
limited tank farm experience. 2016
Engineering
Controls Recommendation: An updated integrated control strategy
should be documented incorporating the results of the new
hazard understandings, abatement technologies,
engineering controls, administrative controls and PPE
examined or implemented.
DOE and WRPS will post on a publicly available website the Settlement Agreement – 2018
Exposure
results of the Phase Two testing of a NUCON Thermal
Monitoring
Oxidation System
DOE and WRPS will complete design for the optimal Settlement Agreement – 2018
Exposure
components and configuration of the Vapors Monitoring
Monitoring
and Detection System (VMDS) for stack monitoring.
DOE and WRPS will institute a process by which they will Settlement Agreement – 2018
Exposure
timely provide applicable TVISs and the worker’s personal
Monitoring
exposure data.
DOE will direct the Hanford occupational medical services Settlement Agreement – 2018
Health
provider that, upon request from a tank farm worker, the
Information
provider will timely provide its medical data related to the
Sharing
worker.
TVAT developed a hypothesis that vapors coming out of Tank Vapors Assessment Team
tanks in high concentration (bolus) plumes sporadically (TVAT) – 2014
intersected with the breathing zones of workers.
Recommendation: Sample proactively the head space of
Industrial tanks.
Hygiene
Accelerate development and implementation of a revised
industrial hygiene exposure assessment strategy.
Utilize real time personal detection and protective
equipment technologies
Industrial Utilize real time personal detection and protective WRPS – Tank Vapor Assessment
Hygiene equipment technologies Team Implementation Plan
Technical Basis is sound from both a toxicological and Center for Toxicology and
industrial hygiene standpoint. Environmental Health (CTEH)
Industrial Assessment of Technical Basis of TF
Hygiene Recommendation: Create a set of Acceptable IH Program – 2016
Occupational Exposure Limits (AOELs)
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 38
RECOMMENDATIONS
Area Finding/Recommendation Assessment
WRPS and the DOE have taken positive steps to help NIOSH Review TFW S&H Programs –
resolve concerns regarding exposure to tank farm vapors 2016
and gases.
Industrial
Hygiene
Recommendation: Increase focus on engineering controls.
Acknowledge health concerns are legitimate.
DOE and WRPS have also collected a significant amount of NIOSH Review TFW S&H Programs –
data they believe demonstrates worker exposures are very 2016
low.
Industrial
Hygiene Recommendation: Develop an evidence-based rationale for
the tank farm perimeter.
Reduce reliance on respiratory protection.
Progress was being made to inform workers and Vapors Management Expert Panel
interested parties about the facts and challenges related to (VMEP) – Evaluate Implementation of
vapors and the strategies and activities related to worker TVAT’s Report Recommendations –
safety. 2016
Industrial Recommendation: Development of a formalized vapors
Hygiene communication strategy.
Engage in efforts to improve monitoring the atmosphere in
and around the tank farms and tank farm workers on a
continuous basis and/or right when workers smell
something.
WRPS has made progress in implementing actions to DOE Office of Enterprise Assessment
address the TVAT recommendations. The respirator (EA-32) Follow-Up Assessment –
cartridge testing station has the potential to provide more 2017
confidence in the adequacy of lower levels of respiratory
protection.
Industrial
Hygiene
Recommendation: Continue progress. Improve industrial
hygiene and tank headspace sampling programs.
Improve communications and trust building.
Several new types of personnel monitoring and vapor DOE Office of Enterprise Assessment
detection equipment are being prototyped. (EA-32) Follow-Up Assessment –
2017
Industrial
Recommendation: Improve industrial hygiene and tank
Hygiene
headspace sampling programs.
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 39
RECOMMENDATIONS
Area Finding/Recommendation Assessment
The IH program has been strengthened. DOE Office of Enterprise Assessment
(EA-32) Follow-Up Assessment –
Industrial
Recommendation Continue improving industrial hygiene 2017
Hygiene
and tank headspace sampling programs.
WRPS has achieved measurable progress in evaluating DOE Office of Enterprise Assessment
and deploying new detector technologies to better detect, (EA-32) Follow-Up Assessment –
characterize and report the results of potential acute vapor 2017
exposures on a real-time basis.
Industrial
Hygiene
Recommendation: Continue improving industrial hygiene
and tank headspace sampling programs.
WRPS had taken to improve the defense-in-depth strategy Center for Toxicology and
for tank farm worker health protection increased Environmental Health (CTEH) Re-
confidence in the level of worker protection. Assessment of 2016 Assessment of
Industrial Technical Basis of TF Industrial
Hygiene Recommendation: The intervals between review of new Hygiene Program – 2018
headspace and source sampling and analysis data to
update the tank vapor chemical list should be better
defined.
Identified opportunities for improving the way technical Center for Toxicology and
and procedural information is conveyed to and received Environmental Health (CTEH) Re-
from the workforce Assessment of 2016 Assessment of
Industrial Technical Basis of TF Industrial
Hygiene Recommendation: A program for effective communication Hygiene Program – 2018
of IH data analyses should parallel updates of tank vapor
inventories, toxicological assessments and COPC and COC
determinations
Chemical Worker training had been implemented for tank Center for Toxicology and
farm workers, including IHTs. Environmental Health (CTEH) Re-
Assessment of 2016 Assessment of
Industrial
Recommendation: A program for effective communication Technical Basis of TF Industrial
Hygiene
of IH data analyses should parallel updates of tank vapor Hygiene Program – 2018
inventories, toxicological assessments and COPC and COC
determinations.
IHTs had received specific training in risk communication Center for Toxicology and
and conversing during high-stress situations. Environmental Health (CTEH) Re-
Assessment of 2016 Assessment of
Industrial
Recommendation: A program for effective communication Technical Basis of TF Industrial
Hygiene
of IH data analyses should parallel updates of tank vapor Hygiene Program – 2018
inventories, toxicological assessments and COPC and COC
determinations.
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 40
RECOMMENDATIONS
Area Finding/Recommendation Assessment
TVAT determined that the most likely scenario was that Tank Vapors Assessment Team
characterization methods (e.g., use of 8-hour time- (TVAT) – 2014
weighted averages) were inadequate.
Recommendation: Site contractor and DOE management
Management
actively demonstrate commitment to improve the current
program.
Implement measurable benchmarks.
After the Hanford occupational medical services provider Settlement Agreement – 2018
informs DOE of the anticipated completion date for the
Management (HPMC OMS) Medical Data Study, DOE will inform
Plaintiffs of that date.
WRPS had implemented many of the TVAT Vapors Management Expert Panel
recommendations and other improvements while (VMEP) – Evaluate Implementation of
continuing to explore additional improvements. TVAT’s Report Recommendations –
Medical 2016
Evaluation Recommendation: Development of better tools for
tracking, integrating and aggregating data which would be
extremely useful for informing health decisions and
providing the best care for workers.
Occupational medical services (OMS) provider will inform Settlement Agreement – 2018
workers of their rights to seek medical diagnoses from a
Medical qualified medical provider when workers report to the
Evaluation Hanford occupational medical services provider for
symptoms possibly related to vapor exposure.
Analysis using Hill’s criteria 30 strongly suggests a causal Tank Vapors Assessment Team
link between chemical vapor releases and subsequent (TVAT) – 2014
health effects, particularly upper respiratory irritation,
experienced by tank farm workers.
Medical
Evaluation Recommendation: Modify the medical case evaluation
process and reporting procedures.
Investigate and pursue external research opportunities and
partnerships.
Testing and eventual installation of a “Strobic Air” high- Settlement Agreement – 2018
Testing
velocity fan.
30 Hill's criteria for causation are a group of nine principles that can be useful in establishing epidemiologic evidence of a causal
relationship between a presumed cause and an observed effect and have been widely used in public health research.
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 41
RECOMMENDATIONS
Area Finding/Recommendation Assessment
WRPS and HAMTC had entered into a memorandum of Settlement Agreement – 2018
agreement (MOA) regarding respiratory protection of
TFWs
Testing
Recommendation: Respirator mask cartridge testing to be
carried out.
Key Indicators of Progress
In September 2018, the Department of Energy (DOE) and Washington River Protection Solutions, LCC (WRPS)
signed a settlement agreement regarding lawsuits brought by Washington State and by Hanford Challenge and
Local 598 of the United Association of Plumbers and Steamfitters. Washington State, Hanford Challenge and
Local 598 filed lawsuits alleging that vapors from underground tanks, arranged in tank “farms” at the Hanford
Nuclear Reservation (“Hanford”) in southeast Washington, “may present an imminent and substantial
endangerment.”31
The agreement included deadlines and specifics for certain administrative, engineering and personal
protective equipment (PPE) objectives. Administrative controls, engineering controls and PPE make up the trio
of industrial hygiene principles of worker protection. Some objectives were in process or even completed by
the time of the signing of the Agreement; others were met over the ensuing months before the pandemic
intervened. (The settlement agreement included a “Force Majeure” clause, which allowed delays in meeting
objectives in the event of an unforeseeable circumstance—something occurring that is beyond control of any
or all parties.)
Health Effects Studies
Various evaluations of exposures to and possible health effects from vapor emissions from underground
storage tanks at the tank farms in the central portion of the Hanford nuclear site have taken place over the
years. These evaluations have been documented and made publicly available, more so in recent years than
prior to 2005. Many, if not all, evaluations, assessments and studies are now available through portals on the
website of the primary contractor in charge of cleanup activities at the tank farms: Washington River
Protection Solutions (WRPS). This is, in part, due to the requirements of the settlement agreement of 2018 of
the lawsuit brought by Hanford Challenge, Local 598 and Washington State against USDOE and WRPS.
While many hazards—some unique to the Hanford site—pose threats (risks) to the Hanford workforce, the
most frequently reported and studied are those of vapor exposures (odors) at the tank farms. Internal policy
and procedure evaluations have been undertaken at other locations on the site after discovered or recognized
potential hazard exposures occurred (e.g. radioactive materials; asbestos) and extensive evaluation and re-
evaluation of protection from and health effects caused by the unique hazard, beryllium, have been required by
external oversight bodies such as the DOE’s Office of the Inspector General, Office of Enforcement and
Oversight and Office of Enterprise Assessments (EA-32).
31 Washington River Protection Solution, Settlement Agreement, https://hanfordvapors.com/wp-
content/uploads/2018/09/ENV_DEFENSE-853225-v1-Hanford_Vapors__Final_Signed_Settlement_Agreeme....pdf
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 42
RECOMMENDATIONS
The following is a listing of publicly available evaluations of tank farm vapor exposures and health effects with
references and implications32. This review summarizes the existing literature and other available sources
regarding occupational exposure to vapors from nuclear waste stored in underground storage tanks at
Hanford Nuclear Reservation and the potential impact of these vapors on the health of workers. This
encompasses self-reported symptoms from over 90 tank farm workers documented in a variety of
assessments and the media; 20 years of surveillance data from over 5,000 tank farm workers; DOE former
worker screening results; and a cohort mortality study of over 34,000 former Hanford workers, including tank
farm workers.
Assessments and Studies
The following synopses of reports and studies include the title of report or study; exposure era;
population/occupation; report type; study population; and finding(s):
HPMC OMS, Annual Report 2018 (2012-2017 covered) compared Tank Farm Workers lab results to other
site workers in routine medical surveillance. Found among 4,415 workers that TFW was not a risk factor for
abnormal blood, urine or lung tests33
Eberlein SJ, Mandel JS, Harber PI et al. (2006) Health effects panel evaluation of pulmonary function and
liver enzyme levels among Hanford tank farm, a case-control study of 5,000+ workers and found that TFW
was not a risk factor for lung obstruction or elevated liver enzymes.34
DOE, 2018 from 2014-2016 TFW total recordable cases (TRC), days away or restricted (DART) that of
2,000+ workers TRC, DART the rates for TF contractor were about 80% lower than comparable industries.
ORISE, (Vicary and Ellis, 2009) from 2004-2008 compared TFW plus other workers in terms of absence and
diagnosis, DOE (IISP) database compared 2,160 TFW to 18,642 not TFW and found that TFW had higher
absence rates due to musculoskeletal and other diagnoses, not vapor linked.
DOE, 2017 Period of potential exposure: 1943-2017 Exams carried out from 1997 to 2017. All DOE former
workers underwent screening exam—a total of 89,081 workers (no control group). Noted asbestosis,
pulmonary obstruction, beryllium sensitization and hearing loss. No other findings.
Schubauer-Berigan, 2015 reviewed all radiation exposure data between 1944–1978 at five DOE sites.
Cohort mortality 34,278 from Hanford; 119,196 overall Standardized Mortality Rate (SMR) 0.85. Only cause
of death with SMR> 1 was mesothelioma/pleural disease (asbestos).
Schubauer-Berigan MK, Daniels RD, Bertke SJ. (2015) Cancer mortality through 2005 among a pooled
cohort of U.S. nuclear workers exposed to external ionizing radiation. Radiation Research 183(6): 620–
631.35
Key Indicators of Progress
Based on the review of publicly available studies, no additional recommended actions beyond those identified
for the Beryllium or Tank Farm Vapors programs were identified. Additional collaboration with DOE and joint
evaluation of the HPMC OMS annual report is needed in order to assess additional indicators of progress.
32 Cherry et al 2021; "The legacy of weapons grade plutonium production: Health status of Hanford complex workers who manage the
waste," in press, Toxicology and Industrial Health
33 HPMC Occupation Medical Services, Population Health Trending Summary, Tank Farm Hazardous Waste Worker
https://hanfordvapors.com/wp-content/uploads/2018/04/18-HPMC-OMS-PM-038_Attachment-2017-Report-TRAC-1654.pdf
34 U.S. Department of Energy, Health Effect Panel Evaluation of Pulmonary Function and Liver Enzyme Levels among Hanford Tank
Farm Workers, https://www.hanford.gov/files.cfm/FOI_2019-00537_Response.pdf
35 Schubauer-Berigan, Mary K., et al. "Cancer mortality through 2005 among a pooled cohort of US nuclear workers exposed to external
ionizing radiation." Radiation research 183.6 (2015): 620-631.
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 43
RECOMMENDATIONS
Appendix B: Medical Surveillance Systems Inventory
For the purposes of developing the content and analysis for the inventory of medical surveillance, the project
team utilized information released to Commerce from DOE after a Freedom of Information Act request and
publicly available information. The information provided in this appendix reflects programs managed by the
Occupational Medical Contactor as of March 18, 202136.
Workplace exposures at Hanford can vary by job function, which is evaluated as part of an Employee Job Task
Analysis (EJTA). The EJTA is an electronic document which is completed by every worker with their supervisor
at Hanford and which describes and delineates many known or possible work hazards to which each employee
might be exposed (and to what degree), depending on job title, location and hazard analysis. "The EJTA is an
evaluation of current job hazards. The EJTA does not document historical exposures or represent potential
exposures in case of an accident, incident or abnormal event. It is not an exhaustive list of all chemical or
physical exposures that may have been encountered. The EJTA is not designed to evaluate or provide medical
exams for potential past historical exposures on DOE sites. This information is shared with the occupational
medical contractor and determines into which medical surveillance/monitoring programs the worker is placed.
The content of the medical evaluation varies from program to program. Some examples of Medical Programs
are “Asbestos Worker,” “Tank Farm Worker,” “Tank Farm Entry,” “Lead Worker,” and many others, which are
based on the assigned work for which the worker is qualified. Most programs include basic laboratory
evaluation (complete blood count; chemistry panel; urinalysis) and chest x-ray. Additional blood and/or urine
tests are included depending on specifics of the potential on-the-job exposures (e.g., lead; mercury).
Exposure protocol testing components are based on best practices/best medical science available. The
medical contractor also uses the current list of chemicals of potential concern (COPCs) at the tank farms or
similar data as one basis for exposure protocols.
While there are no specific biomarkers for most chemicals of concern, the medical contractor performs
tests/exams to evaluate changes in target organ function that could indicate chemical exposure effects.
There are two beryllium programs: Beryllium Worker Program (for workers assigned to work in areas known or
thought to have had beryllium contamination) or Beryllium Voluntary Program (for workers who know or think
they were exposed to beryllium in previous work). The procedures for those programs are defined in the
CBDPP, discussed in Appendix A. The complete procedure for beryllium disease testing can be found in the
Beryllium Information Booklet. The essentials are listed in Table 1 below.
In Table 1: Hanford Medical Surveillance Components reflects hazards and programs as of 2018 utilized for
the Hanford workforce.
Pulmon
Enrollment ary Electro- Vision
Method/ Eligibility Questio Chest X- Functio cardiogr Audiogr Screeni Physical
Surveillance Program Requirement nnaire Lab(s) Ray n am am ng Exam Other
EJTA X X X X X Vacci
Animal Handler
ne
36 HPMC, List of Surveillance Program Managed by the Occupational Medical Contractor (HPMC), 3/18/2021
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 44
RECOMMENDATIONS
Pulmon
Enrollment ary Electro- Vision
Method/ Eligibility Questio Chest X- Functio cardiogr Audiogr Screeni Physical
Surveillance Program Requirement nnaire Lab(s) Ray n am am ng Exam Other
De-enrollment X X X X
from worker
program OR
Worker answer
on DOE Historic
Health
Exposure
Asbestos Historical
Questionnaire
OR
Med provider
order OR
Employer
request
Asbestos Worker EJTA X X X X
Benzene EJTA X X X X
Beryllium Worker X X X X X
Voluntary Request
Beryllium EJTA with X X X X X
Voluntary- worker request
WASTREN
Beryllium Worker EJTA X X X X X
Bloodborne EJTA Vacci
Pathogen ne
Cadmium Worker EJTA X X X X X
Med provider X X X Fecal
Carcinogen order OR Test
Historical employer
request
EJTA X X Fecal
Carcinogen Worker
Test
Chromium EJTA X X X X
(hexavalent)
Worker
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 45
RECOMMENDATIONS
Pulmon
Enrollment ary Electro- Vision
Method/ Eligibility Questio Chest X- Functio cardiogr Audiogr Screeni Physical
Surveillance Program Requirement nnaire Lab(s) Ray n am am ng Exam Other
De-enrollment X X X X
from worker
program OR
Worker answer
on DOE Historic
Health
Chromium Exposure
Historical Questionnaire
OR
Med provider
order OR
Employer
request
Communicable EJTA X X
Disease
Corrosives EJTA X X X
Formaldehyde EJTA X X X
Hazardous EJTA X X X X X X
Material-Waste
Worker
Worker answer X X X X X X X
on DOE Historic
Health
Exposure
HME for Historical
Questionnaire
Exposure
OR
Med provider
order
Hearing EJTA X X X
Conservation
Program
Laser Vision EJTA X X X
Lead Programs EJTA X X X
Mercury EJTA X X X X X
Methylene EJTA X X X X X
Chloride
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 46
RECOMMENDATIONS
Pulmon
Enrollment ary Electro- Vision
Method/ Eligibility Questio Chest X- Functio cardiogr Audiogr Screeni Physical
Surveillance Program Requirement nnaire Lab(s) Ray n am am ng Exam Other
Pesticides and EJTA X X X X
Organophosphates
Polychlorinated EJTA X X X
Biphenyl Handler
Silica-Chrystalline- EJTA X X X X X
Worker
Silica-Crystalline- EJTA X X X X X
Historical
Synthetic Vitreous EJTA X X X X
Fibers
Tank Farm EJTA X X X X X X X
Hazardous Waste
Worker
Welding Fumes EJTA X X X X X
Table 1: Hanford Medical Surveillance Components
Table 2: Associated Onsite Medical Services describes routine and post-exposure onsite services that may
also gather clinical data such as bloodwork or chest x-rays used in monitoring.
Onsite Medical Service Description
Medical exam protocol is used to medically qualify
individuals to perform specific types of work or work in
Pre-employment Physical Exams / Qualification specific environments. An example is the "respirator user"
exam used to pre-qualify personnel to use respiratory
protection.
Medical Monitoring Bloodwork, chest x-rays, spirometry, audiograms
Post-Exposure Lab Workup CBC and differential
Table 2: Associated Onsite Medical Services
Additional Considerations
Other non-Hanford-based worker medical screening programs:
Radiation Protection at Hanford. Since 1942, when the Hanford Site was just beginning to be developed for
production of plutonium, the management team and scientists knew that a program was needed to protect
workers from and train them about the hazards of radiation. Thus developed the Radiation Protection
Program, also called the Radiation Control Program, which was implemented in the earliest months of the
Hanford Engineering Works activities and continues to this day. The essence of the program is to assure
that workers are knowledgeable about and protected from radiation exposure, as well as being monitored
for possible external exposures or internal uptake of radioactive material. Extensive information is
available concerning the technical elements of the program [footnotes here]. The Pacific Northwest
Laboratory provides services for the US Department of Energy Richland Operations Office and Hanford
contractors that include “external dosimetry measurements and evaluations, internal dosimetry
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 47
RECOMMENDATIONS
measurements and evaluations, in vivo measurements, radiological record keeping, radiation source
calibration, and instrument calibration and evaluation".
The National Supplemental Screening Program, conducted by Oak Ridge Associated Universities in
conjunction with National Jewish Health, Comprehensive Health Services, Axion Health and the University
of Colorado Denver. Its mission is to evaluate the health of former DOE workers who may have been
exposed to hazardous substances at work. It provides free medical screenings to DOE workers who may
have been exposed to hazards in the workplace. The NSSP collects data to help identify if these former
workers have developed any health conditions related to workplace exposures, as well as any health
conditions that arise as these workers age. DOE, through its Office of Health, has sponsored beryllium
screening for former workers from many sites; a surveillance program for Rocky Flats radiation workers
and several former workers, site-specific, health-screening programs. 37
The Building Trades National Medical Screening Program, conducted by CPWR - The Center for
Construction Research and Training in conjunction with the University of Cincinnati Medical Center, Duke
University Medical Center and Zenith American Solutions, Inc., provides free medical screening services to
construction workers formerly employed at Department of Energy (DOE) nuclear weapons sites, who may
be at risk for occupational illness. 38 39
Worker Health and Safety of EHSS of DOE:
Energy Employees Occupational Illness Compensation Program -- provides compensation and medical
benefits to employees who worked at certain Department of Energy (DOE) facilities
Former Worker Medical Screening Program -- provides ongoing medical screening examinations, at no
cost, to all former DOE federal, contractor and subcontractor workers who may be at risk for occupational
diseases. The FWP is supported by DOE's corporate health and safety program within the Office of
Environment, Health, Safety and Security (EHSS) and reflects our commitment to the health and safety of
all DOE workers - past and present - who have served the nation in its national security and other missions.
Domestic Health Studies and Activities --conducts and supports health studies and other research
activities to determine if DOE workers and people living in communities near DOE sites are adversely
affected by exposures to hazardous materials from DOE operations
International Health Studies and Activities -- support the health and safety mission of DOE and increased
knowledge concerning the health effects of ionizing radiation
37 National Supplemental Screening Program (NSSP), https://www.orau.org/nssp/
38 Building Trades National Medical Screening program, https://www.btmed.org/
39 Building Trades National Medical Screening Program, https://www.cpwr.com/service/medical-screening/
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 48
RECOMMENDATIONS
Appendix C: Glossary
ACGIH American Conference of Governmental Industrial Hygienists
AIHA American Industrial Hygiene Association
ALARA As Low As Reasonably Achievable
AMH – AdvanceMed Hanford -- the Hanford occupational medical contractor from 2004 to 2011 (Prior to that
was HEHF—Hanford Environmental Health Foundation)
AOELs -- Acceptable Occupational Exposure Limits
AOP Abnormal Operating Procedure
BeLPT – Beryllium Lymphocyte Proliferation Test—a biological test carried out on a person’s blood to
determine whether sensitization to beryllium has developed. The test measures the response of certain white
blood cells (lymphocytes) in the presence of varying dilutions of a beryllium sulfate solution. The more readily
and rapidly the increase (proliferation) of these white cells, the more likely sensitization has occurred.
Beryllium – a metal that is used in many industries because of its lightness, malleability, conductivity and
strength. It is often alloyed with copper and was used in materials in which uranium was clad during
production of plutonium at various Department of Energy sites including Hanford.
Beryllium sensitization – an immunologic (“allergic”) reaction to beryllium caused by previous exposure, which
can lead to chronic beryllium (lung) disease.
BHA – beryllium hazard area
BWP – beryllium work permit
CBDPP – chronic beryllium disease prevention program
CHAT Chemical Hazard Awareness Training
CHPRC -- CHPRC is now CPCC – CH2MHill Plateau Remediation Company
Chronic Beryllium Disease – a lung disease caused by inhalation of and resultant sensitization to beryllium
dust and/or beryllium oxidation products. It is similar to other chronic obstructive pulmonary diseases (COPD),
particularly sarcoidosis. Sensitization can also occur from skin contact with beryllium.
Conex boxes – “Container Express” - large metal boxes used for storage and transport of materials by train or
boat; typically, 6’x6’x8’ they can range up to 40’ long and more
COPC Chemicals of Potential Concern
CTEH Center for Toxicology and Environmental Health
CVST Chemical Vapor Solutions Team
CWBT Central Washington Building and Construction Trade Council
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 49
RECOMMENDATIONS
DOE ORP -- Department of Energy, Office of River Protection
DOE RL – Department of Energy, Richland Office
DST Double-Shell Tank
EA Office of Enterprise Assessments
Fugitive vapor releases -- vapor sources that are not associated with known emission points, such as
ventilation stacks or breather filters.
HAMTC – Hanford Atomic Metal Trades Council – is the sole bargaining unit for the 14 unions that represent
production and maintenance employees of the Hanford facility contractors. HAMTC represents approximately
2,700 workers.
HPMC - HPM Corporation
HPMC OMS -- the Hanford occupational medical contractor from 2012 to present
HWEC – Hanford Workforce Engagement Center – a service center staffed with experienced representatives
equipped to help current and former Hanford employees and their families with their questions or concerns
about occupational health issues.
IH - Industrial Hygiene
IHT - Industrial Hygiene Technician
IPT - Integrated Project Team
ISM -Integrated Safety Management
LDCT - low dose computerized tomography (of lungs)
MSA --MSA is now HMIS – Mission Support Alliance
NIOSH National Institute of Occupational Safety and Health
OEL – Occupational Exposure Limit – the highest level of exposure to a toxic substance that has been
established by knowledgeable and trusted authorities not to be harmful to human health.
OEL- Occupational Exposure Limit
OEL-C Occupational Exposure Limit – Ceiling Limit
OJT -On-the-Job Training
ORP -Office of River Protection
OSHA -Occupational Safety and Health Administration
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 50
RECOMMENDATIONS
PBI- Performance Based Incentive PID Photon Ionization Detector
PNNL -Pacific Northwest National Laboratory
PTR-MS -Proton Transfer Reaction Mass Spectrometry
RL - Richland Operations Office. The Richland office oversees work performed by contractors, as well as site
infrastructure needs and many other programs that are necessary to ensure the safety of Hanford cleanup
Risk Communication – a set of principles describing effective communication in situations of high concern
and low trust.
SCBA -Self-Contained Breathing Apparatus
SEA -Special Emphasis Area
SRNL -Savannah River National Laboratory
SST -Single-Shell Tank
Tank Farm – site of buried underground storage tanks (USTs) in which millions of gallons of highly radioactive
and mixed toxic chemical waste are buried at the Hanford site. There are 18 tank farms at Hanford with a total
of 177 USTs.
Technical Basis -- reviews of the gas and vapor sources and dynamics, evaluation of head space composition,
measurement of gases and vapors in the workers breathing zone, toxicological evaluation of volatile
chemicals in tanks, prioritization of COPC and establishment of occupational exposure limits (OELs).
TFW – tank farm worker
TVAT Tank Vapor Assessment Team
TVIS – Tank Vapor Information Sheet
TWA -Time-Weighted Average
VMEP -Vapor Management Expert Panel
VOC -Volatile Organic Compound
WCH – Washington Closure Hanford
White Card - Those who apply for the Energy Employees Program (EEOICPA) and are awarded medical
benefits will be issued a white card (Medical Benefits Identification Card) with their accepted illnesses listed
on the front. Similar to a standard insurance card, whenever you receive medical care related to an accepted
illness, you will show this card to have the costs covered under EEOICPA. The card can cover a wide variety of
medical services including home nursing care.
WRPS – Washington River Protection Solutions
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 51
RECOMMENDATIONS
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 52
RECOMMENDATIONS
Appendix D: Workforce Survey Results
The following appendix is an aggregation of results by question for the workforce survey. Additionally, for
questions where respondents were asked to provide a free-form response, those raw responses have also
been included.
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 53
RECOMMENDATIONS
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 54
RECOMMENDATIONS
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 55
RECOMMENDATIONS
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 56
RECOMMENDATIONS
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 57
RECOMMENDATIONS
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 58
RECOMMENDATIONS
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 59
RECOMMENDATIONS
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 60
RECOMMENDATIONS
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 61
RECOMMENDATIONS
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 62
RECOMMENDATIONS
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 63
RECOMMENDATIONS
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 64
RECOMMENDATIONS
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 65
RECOMMENDATIONS
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 66
RECOMMENDATIONS
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 67
RECOMMENDATIONS
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 68
RECOMMENDATIONS
Free Form Responses:
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 69
RECOMMENDATIONS
More Specialists in diagnosing and treating chemical expposures are needed.
Need better qualified non biased medical staff.
Too many times in the past management and health services would perform feeble
testing with no follow up. Most incidents would be conveniently explained away with
some BS.
Access to someone other than a contact nurse. I had a very high exposure to Nox at
the PUREX stack. The nurse had no idea what that meant and I had to insist that it be
anotated in my medical records.
Tracking cancer care
Chronic lung - breathing problems
The services are fine
epi pen, oxygen, other emergency response medicine
tax payers money...should see their own Doctor like everyone else
Some exposures are immediately unknown. More training in labs of such possibilities.
Even the radon gas in the air affects health.
Mental Health
I do not trust any onsite medical services that are over seen by the US Goverment
Independent Health Advocate
Better communication and directions of nextcstep care
Mental health issues
IMMEDIATE ACCESS TO PROPER/CORRECT AND ACCREDITED WARRANTED
MEDICAL ATTENTION, DIAGNOSIS AND PROPER CORRECT LIFESAVING TREATMENT
AND PROCEDURES. END HARM. STOP INTENTIONAL MISDIAGNOSIS
Advice, referral
On the job injuries, yearly physicals
There is no trust with on site anything
All these are provided!
Good as is.
They had HEHF offsite where we went for medical care.
Putting safety before the schedule for all, including requiring subcontractors
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 70
RECOMMENDATIONS
X
not sure of any onsite med
Employed by staff that know what proper medical treatment is needed.
Medical Advocates for staff when they feel unwell/ill. Staff need someone that can
help staff through the medical system, because sometimes doctors don’t make the
right or complete diagnosis and when ill people aren’t able to advocate for themselves
or give up on being able to get help.
Physiological care (mental health is important too)
none. should be performed by a professional, off site with no ties to the Hanford site.
a site setup like the veterans and neurotoxocity experts-Tim Jarvis-EEOICPA overlap
Workers compensation claims
Off site only.
The Medical profession in the Tri-Cities refuse the take any stance against the
Hanford Companies. I found out the hard way that local physicans are frightened and
intimidated.
All other should be off site doctors. .
risk communication briefings both internal and external
Endocronology
Need independent UW Occupational Health physician access on site
Followup services are conditioned on specific events.
Don’t know
They don't even have urgent care. HPMC is good for nothing- emergency care is a long
way from site- HPMC is a joke- They'll send you home and tell you ifthe conditoin
persists to folow up with your primary care provider.
Continued assessment over time (even if symptoms aren't there)
I think a place to work out to reduce the risk of health problems
G
NA
Heavy metal detoxing
Something different than what we currently have. I feel like the on site medical
provider is only there to document for the company and not with the best intention of
the sick or injured worker.
testing
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 71
RECOMMENDATIONS
GB none
Be Honest With Exposure To Workers ... Quit Twisting What Happened To Me !!!
None
nothing more
Low exposures over long period of time
No needed help
Any On-site care will be bias. That’s how Hanford works.
NONE
radiological and chemical exposure wound care.
Qualified Independent and unaffiliated Occupational Medicine doctor.
N
Dermatologist
Chemical vapor exposure medical experts
Long term evaluation for illness that is latent to materialize such as berylium,
asbestos or radiation exposures.
Kadlec employees
Management Needs ER Training - Seriousness is lacking
None
Medical service for all no matter who the contractor is (outside the fence)
Blood draw within an hour of exposure not the 2-3 hours that is occurring
Long term (multi year) followup of former, as well as, current emplyes who had
exposure.
Mental health services
Cancer studies/detection
Home health
Follow up care and monitoring
exposure amount was lost at Hanford Dosimetry
I do not believe the tax payers should pay for any additional medical service for
Hanford employees. It is not the employer’s responsibility to address the employee’s
medical conditions that are not due to an exposure.
Epidemiologist
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 72
RECOMMENDATIONS
Cancer screening
Pulmonologist
Nothing else
follow-up care
O additional
first aid. is this what is meant by urgent care?
Home Live-In 24 Hour Care
None needed. Just keep onsite staff reduced to reduce traffic
referrals to offsite providers
Don't trust
Physical fitness and nutritional training should be available to all that want it
Check periodically
Gym
MRI for lung check up
Message
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 73
RECOMMENDATIONS
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 74
RECOMMENDATIONS
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 75
RECOMMENDATIONS
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 76
RECOMMENDATIONS
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 77
RECOMMENDATIONS
Freeform Responses
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 78
RECOMMENDATIONS
Too damned many obstacles are thrown up to a get successful claim.
faster
Need things taken care of instead of having to wait for help
I have a condition caused by my desk job with Hand ford Contractor and they caught it
all the way instead of getting me help when I could have regained employment! I am
now permanently disabled! Radiation isn't the only deadly issue employees have to
worry about
Prefer not to answer
Wasn't sure what the condition is, doctors have not seen anything like it.
Claim hasn't been approved.
They don’t believe what you tell them
Cancer showed up years after exposure
It was easier
Because part of it due to the health problems and the other part is just regular health
needs and so two separate billing is too complicated and assist easier to use my
regular insurance because you jump through too many hoops and trying to find out
what’s going to get paid and what’s not through the government
Got laid off. Then had ear problems
To not miss work and put the crew in a bad spot
Much easier
Didnt hav a test for beryllium wasnt aware
The company won't support some my health care needs.
Denied benefits!!!
Did not think at the time my tumor was work related.
So contractor doesn’t hold it against me
the time it takes to get in to see someone for work is ridiculous
newly dianosed
It only covers specific items.
Didn’t know I could since retired
Takes too long to get approval
Other insurances were not available to me as I was working under sub contractors.
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 79
RECOMMENDATIONS
It’s not worth fighting with them to get the coverage
Don't want the employer to get rid of me
Because my condition was just recently accepted as being caused by my years at
Hanford.
Because I didn't want to be penalized by the company or have an investigation about
why and how it happened. Easier to pay for it and be done without any questions.
Because I didn't know that muscle/skeletal could be considered workman's comp
Employer was self insured couldn’t stand pain while waiting for them to decide.
could not prove cause was work related.
still in claims process after 25 years since disability
Didn't know if caused by onsite exposure.
My claims have been continually denied because mywprk history has lost or
misplaced in safe keeping at w.s.u.
Easier
Had no other choice.
Cannot get approved for medical assistance through DOL.
easier and quicker.
Billing gets confusing at doctors offices. Hard to separate each appointment and
which conditions I’m being seen for.
Not covered
Age
.
Good coverage
no white card
only choice.
covered by the VA
skin cancer on my left leg; didn't know if it was work related or not. unfamiliar with
compensation process.
Most efficient health source for me is my doctor
Easier, don't have to prove work cause.
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 80
RECOMMENDATIONS
Easier.
Red tape involved when using DOL card
do not have worker's comp.
workers comp system is working against the workers bet interests. They are focused
on denying claims.
I am not familiar with the Worker's Compensation program
Hanford drags their feet and tries to delay and not pay
Less paperwork, fewer questions and opinions from supervision
I have used my white care for my breathing and skin medical problems only.
Wasn't 100% sure if my hernia was from work.
Provider miss billed, difficult to get them to reverse filing.
Medicare and supplemental insurance covered the issue
ignorance
I'm not certain that my health issues are Hanford related.
I have Tri care
Easier, won't be sued by the state .
My management did not want to report an accident or incident. It would reflect poorly
on them.
In the process of getting diagnosed with several conditions..
Hanford Health system is politically lead. A negative Covid test still means you must
take weeks off of work with no pay.
Less hoops to jump through and pressure from bosses not wanting mark on their
record.
Was injured while at work and had to do a 3rd party evaluation, as required by Penser.
During the evaluation they decided my injury wasn't work related. Since that time I
have been to different doctors all at my cost.
Because the system is a joke, especially if you are from yakima, I have used both, and
when I had to come back from workers comp, nobody knew what they were doing.
Penser takes too long to approve: medical care, testing, labs etc
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 81
RECOMMENDATIONS
My health issues are extremely rare for someone in my age group. The medical
personnel think that it is related to my work at Hanford but it can't be proven.
Because it was not diagnosed at work. My healthcare provider urged me to open a
claim for my condition. I don’t want to jeopardize my employment.
Had private insurance. Didn’t know how to get helped pay for caregivers.
I am getting older
No clear link between my tumor and the site.
You would lose your job.
Because I have it.
Less hassle
The workers comp system is not user friendly, timely or fair.
Paid my own bill prior tocompensation program
Not available where located.
Reporting incidents at work damages safety statistics and could have negative effect
on personal job security.
diagnosing and treating numerous skin cancers.
They would not accept the evidence that I had
My health care provider is a Naturopathic Doctor.
they refused to cover the prescriptions for my covered condition
I did not want to have to argue with them that it happened on the job. While they make
you fill out paper work and still deny that it happened .
I haven't got hurt at work to be able to use it
Easier
Loss of hearing, skin rashes
Unaware workers compensation was available
workers comp system is a joke
This is what I have access to
Claim was denied
Don't live close
Easier
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 82
RECOMMENDATIONS
Don’t know if work related
It was diagnosed many years after I worked there.
L & I won't cover it
Due to the fact that our workers compensation denies any affects are due to work
exposers.
workers' compensation ran out
RCW 51.04.130 Industrial insurance coverage for Hanford workers—Special
agreements. Penser 3rd party insurance company hired legal counsel to deny claims
as used RCW 51.04.130 to state did not have to disclose what employee was exposed
to. EEOICPA stepped in which President Clinton put in place.
clam denied
Wasn't recognized as a current accepted condition by DOL.
We earned a bonus if we did not have a work related injury
Because local doctors refuse to deal with worker claims.
I have never filed a worker’s compensation claim.
To big of hassle to prove that it happened from Hanford
Haven't had a work related issue.
Wasn't sure if i qualified
Retired at time of diagnosis
unclear if covered due to work status since was not direct employee Hanford
Using onsite facilities and the hassle they present is not worth it
Afraid of workplace retaliation
Was not told that my cancers might be covered by work related health care
Not sure what causes the cancer and hert problems very hard to breathe
I didn't want to get laid off or lose my job
Problems getting care
Do to DOL money off set
Too many issues are denied by worker’s comp...as not related.
The Washington State workers comp system is a convaluted mess- excet for the
Hanford Presumption law, which has helped. Howver, even with a claim that is
apporived local doctors do not want to take L&I claims because of the state
Stigma
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 83
RECOMMENDATIONS
Too difficult filing a claim
Because events were denied by contractor and symptoms took 20 years to show on
tests.
It’s easier
Tried DOL for previous event from more than 25 years ago, it was denied
Because the hospital codes are different than the government codes. So I have to pay
the bill.
Easier to use
Wasn't sure it was work related or aging over the years
Because MSA makes it so difficult to file a claim.
No doctors take L&I cases and many health issues are not recognized/diagnosed as a
direct result to exposures at hanford. Neurological, heavy metal poisoning, heart
damage due to heavy metals, lung damage due to radiation exposure.
Too much hassle with WC
Fear of the company
Because that’s all I knew was available at the time.
Because of the red tape and bureaucracy involved in L&I (Penser).
Worker comp is to hard to us
Doctors and hospitals is Out of network
Cancer - Got jerked Around by DOE and Threw My Case in the trash but I'm not done
✅
Because the doctors preferred insurance vs l and I, and for $1k out of pocket, it was
easier to go through private insurance.
DOE deemed that my health condition was not their responsibility.
Process for worker’s compensation is slow and many doctors will not treat you under
workers compensation
Worker compensation frowned upon by company
They usually let you go if pose a threat
Hanford work claimed as not contributory to the Cancer.
My access too doctor easier and do not need to be explained,
Fear of reprisal.
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 84
RECOMMENDATIONS
Lack of trust due to denied claims, the run-around due to red tape, pressure to return
to work before physically ready.
Too much of a hassle trying to access worker’s compensation, being questioned
about things again and again, etc. I reported a work related issue many years ago
while working at Hanford and initially I was treated fine about it (by my manager and
the company workers comp folks). When the same type of problem flared up again
later (with a different work group and manager) I was almost berated for saying the
condition was work related - even though it was already documented from the first
occurrence and treatments). And overall the whole process and paperwork for
something being work related was a pain.
My treatment was not covered by workers' comp.
Easier. Doctor don’t want to do the paper work related to workers comp.
Because if you file a claim and there are issues you cannot get private Ins to help you
until you sign off on the L&I claim. Sadly there are thing L&I will pay for that private
win’t also.
It was easier because I didn't have to fill out tons of paperwork that was hard to
understand.
My claim was denied
The workers comp system at Hanford is too difficult to manage
I am a disabled veteran @ 70% which covers all cost along with Medicare and private
insurance
Forced to due to D.O.L. jerking us around.
Because they take so long to pay. I pay the provider myself and seek reimbursement.
It has taken up to 4 years to receive my compensation. They are awful....
They would not pay.
My diagnosis was considered a "common" health problem and therefore not covered
by worker's comp
Easier.
Better care and response. Panzer is a joke.
It takes weeks, sometime months to straighten out an L&I claim and sometimes you
wind up paying all the bills out of your own pocket.
I have no insurance anymore I pay for everything out of pocket I can't go to doctor
even if I want to. And I'm unemployed now
Hanford fought me for 7 years to accept my conditions caused by a severe chemical
exposure.
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 85
RECOMMENDATIONS
Because of privacy
Workers compensation was not approved prior to treatments.
Faster results
When I came back from covid (5-1/2) I was put in a very active, strenuous job. My
shoulder became very sore. I thought it was cause I was off so long. So I didn’t think it
was a issue. But now I have constant pain in my shoulder. But people get written up
when they speak up after the event.
Panzer makes processing claims nearly impossible. Was easier to use ptb time then
deal with them.
Doctors refuse to say the problem could have been a result of working at hanford.
Concerned of company retaliation/loss of employment.
Needed faster care
The uncaring hassles
For a couple of minor injuries it was just easier to use my health insurance than go
through the workman’s comp paperwork.
I have recurring medical evaluations under the Cold War Patriots program, that
medically evalustes my health every 3 years. I hope it continues in case I develop
illnesses for asbestos, berylium, or radiation exposures when I worked in the Hanford
area and other DOE areas. So far I have not had any complications the require
compensation, but what if they develop in the future? A compensation program needs
to continue for all current and past employees working in the Hanford site where
exposures occurred due to radiation, materials and chemicals there on the sites.
It was less stressful than proving my injury was related to the walking and working
surfaces at WTCC
Not as difficult to complete
I was told they could not tie it to work.
Back problems couldn’t wait and fight it out
DOE and Pender fight every exposure with unlimited funding to do so. I was taken to
L&I court over an exposure claim myself and the state provided proof it happened and
DOE and PENSER fought it for almost a year and a half so you have to drop out due to
not affording a lawyer plus you loose all the vacation time as they purposely plan
meetings and appointments on company time so it's vacation time for us hourly folks.
I fought it but they cleaned me out financially and vacation time from work due to their
unlimited budget to do so. Then MSA our contractor turns away when you need their
help promoting the chilling effect widely seen at hanford these days. They hold the
money so they have ultimate control on the claims.
I’ve never put in for claims
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 86
RECOMMENDATIONS
Because since 1989 I have been trying to locate my work history from Hanford and
have been denied benefits as fast as I apply for them.
Because they said there was nothing wrong with me and I went to my doctor and had
stage two tears in my back (MRI)
Don’t trust them
I had Prostate Cancer. Might have been caused by radiation or chemical exposure at
Hanford. I couldn't prove it si I took care of it.
Was retired when problem became apparent
I was not and am not aware of any other options
As not many doctors take the DOL white card
Due to denial of treatment, even after L&I appeal upheld claim, from DOE/self insurer
to approve treatment needed.
Easier to deal with
Penser the L&I people draws every thing out or refuses the doctor recommendations
like for MRI
DOE fights every claim. They have attorneys that do nothing but fight hanford claims.
Not sure if I am dealing with work related issues.
Didn’t have workers comp.
Ventilation system created a "sick" building. I was repeatedly sick with respiratory
issues until I retired.
Can’t prove it was work related
My claim with the DOL was approved only recently, eight years after I retired.
did not know about or understand procedures
Need to treat symptoms asap.
My claim was originally turned down it was around 1994
Company WC refused to pay.
Penzer is ridiculous, to file a claim and get approval is worse then dealing with L&I. So
took ptb and had surgery.
No info on where or how about workmans comp
DOE highly scrutinizes medical providers' ability to make a work-related exposure
causality determination. Getting employers to admit culpability after a Mercury
exposure is almost impossible. My symptoms are "age related". Getting a CBD
diagnosis is also farsical. My pulmonary issues are due to simple "asthma" or " acid
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 87
RECOMMENDATIONS
reflux". Even though I was diagnosed Beryllium sensitive from an exposure years ago.
It's ridiculous.
Easier and more convenient
Waited you long to report
Health effects show up later
Had to
Injuries sometimes arise at the EOS or symptoms show themselves after shift ends.
It was used by mistake
They wont do anything
Physicians in the area are so poorly trained in chronic exposures at Hanford that they
don’t want to take the time to evaluate patients to determine if Hanford exposures
contributed to the illness. Without a physician backing your claim it is a waste of time.
Because I didn’t want to fight with L&I anymore and be told we’re ! Had to go
easier, less hassle
I was told (point blank) by contractor L & I liaison, that my claim would automatically
be denied by the third party L & I administer.
big hassle to reopen case
Disagreements with management over when health issue happened
employer continues to question claim have been told it is okay to use claim but that i
could be held liable if court finds in employers favor
Because workers comp claims are denied and if it’s not reported immediately it’s
denied. Getting hurt at work and not knowing it’s work related gets you in trouble.
Worker's compensation is slow progress in injuries diagnosis process
Tired of all the questions interrogating me whether it was work related or not.
I want to get help instead of going through red tape.
Penser makes it way to difficult
Contractors are excluded from decent care
Easier
Faster
Was retired at the time of cancer diagnosis.
Fell at work, hurt my shoulder right before I retired and didn’t report it.
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 88
RECOMMENDATIONS
Easier access.
Didn't think about doing anything different.
Didn't want to deal with LI they are a pain in the ass
Just got approved for L&i after 3 years
On-site medical staff lack the ability to diagnose chronic health problems such as
back, shoulder or hip pain. The medical staff and management spend alot of time
trying to absolve themselves of responsibility for poor working conditions.
Most won't take it.
To much hassle to deal with, if you open a claim they do their best to cost it quickly
And you still have to use your insurance
PTSD from work in a hostile environment, sleep terrors.
Worried about not letting me do my job
My diagnosis is not listed as part of the program to help.
Easier
Can't say. Specific health diagnosis.
not sure what is covered by work related
too much employer harrassement
Less hassle
The system is too complicated. It’d take too long to get the workers comp claim
started and I need the attention now
Workers comp was denied
Because of the third party admin. It’s a absolute pain in the ass to use. Their favorite
word is No
My word against theirs
Fear of retaliation or being laid off due to using the Workers Comp
Its easier that way for minor things
Not knowing what caused my symptoms at the time.
Pain in the but!
Was injured but wasnt fully aware of how bad at first. Over time injury required surgery
but i hadnt reported it initially.
Paperwork, not worth hassle. Symptoms not present until later...
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 89
RECOMMENDATIONS
The process with workers compensation/Penser NA is slow and difficult. They deny
legitimate claims that should be covered.
Easier
Takes to long to get approval. In my case skin cancer.
Easier
It’s easy and great coverage.
I was denied my EEOIPCA claim
Because doctors in our community refuse to deal with L&I because of the ridiculous
amount of paperwork. Therefore, they won’t take you as a patient or perform surgery if
you are using L&I.
Immediate care was needed...could not wait for a claim to provide payment to medical
provider at the time of need.
Local Medical Professionals lack the knowledge to link exposure to illness.
Sitting at a computer all day has caused my health problems that my job doesn't
acknowledge.
Have not been accepted into the Hanford workers medical program
Cant get a claim thru
When you go they look at you quick and say oh your ok and can go back to work.
That's all they care about.
I didn’t want to fight with wc
System is too slow. Penser is/has been denying claims or parts of claims when they
are not qualified medical professionals to do so.
Doc did not take workers comp.
i am a veteran and it is easier and less of a hassle as they dont need justification of
my condition. they just treat me
Said too much time had past since injury. So l and I declined it.
Inadequate and long process for care. Fearfull of upper management.
At first the doctors didn’t believe it was work related.
Because they would rather claim age as the problem than the incident
Because it pays me closer to my full wages.
The hassle of proving I got hurt at work.
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 90
RECOMMENDATIONS
It is such a hassle dealing with the company (employer) and the contractor the
manages workers compensation. I would lose a limb and not want go through that
crap again! I have hurt myself at work n not reported it because you are treated so
badly!
easier
Easier to get treatment
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 91
RECOMMENDATIONS
Freeform Responses:
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 92
RECOMMENDATIONS
Its stacked against the worker
I have three conditions from Hanford
Claims Manager for L&I who handles all of WTCC Claims does not report the proper
wages or medical benefits when he has a claim from a worker who is working for
WTCC. This causes many workers to lose out on Time Loss Monies they are owed
Don’t trust them, seems to be more for the company
worked at hanford years ago. had cancer years after exposure.
They terminate you before you can use
Claim denied. I could not produce enough documentation from 1976
Again, biased and not specifically trained in the process of EEOICPA
They act like it’s their money you are using.
Because too many workers are denied and appeal process is a very short timeframe
Takes too long and sometimes confusing
Doctors that I went to on the Hanford project made a sexual Advance towards me
Way to cumbersome and frustrating
Didn't hav a test
They didn't want to know what the problem was, just when you can get back to work
DOE has hidden the truth in medical records and exposure to it's workers.
It's like walking in a minefield.
See above
time the process takes and possible denial after waiting 4ever
Hanford tryed to make my incident my fault and took NO responsibility.
You can wait months to get an appointment with a doctor that takes Penser, after you
wait months to find out if you are going to be covered
It took 16 months to receive my white card and compensation for my CBD.
Bladder cancer associated with Hanford workers is likely bit my claim was denied.
They are more worried about there safety rating and numbers then taking care of the
problem
Tested positive beryllium sensitivity, but have not had follow up exam for several
years. Not sure where to go.
Never had an issue.
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 93
RECOMMENDATIONS
still in process. two years since i filed
Claim denied twice for skin cancers
They use delaying actions. I have been working the process for 27 months. They keep
asking for doctor signatures. Doctors are tired of playing the games too.
Takes too long, hard to get all documentation required, they don't offer any assistance
So many hoops to jump through to get necessary equipment that’s used daily.
Separating which one of my conditions is covered or not.
Heard of many delays and claims rejected.
Hard to get claims approved
Originally denied and they didn’t inform about exposure for over a year
THEIR SYSTEM ONLY TRIES TO GET RID OF YOU
Your kidding right?
Not sure if the referral made by workers comp. was unbiased.
They sent me to a doctor of their choice and he totally had a preconceived idea of my
situation and would not even listen to me. He was a total prima donna.
The L&I claims at Hanford -- people try to do her best to make sure workers with
ligament claims get support for their claims. Sadly DOE is over this contract and not a
independent qualified organization who has the authority to champion these hurt/sick
workers needs stronger over sight by independent non government organization
Can't afford the loss in wages and long wait for compensation
There should be an independent separate agency for exposures and chronic care.
Unresponsive to my questions and understanding personal work history.
They lie harass your private doctor with so much paperwork and fight you all the way if
IME sides with you they do not finalize the report
They do not act as an advocate for the injured worker.
Don't have any idea how to use or if it applies to me
I haven't heard of such services.
Army veterans are being denied the health care offered to other retired employees.
I went through 2 separate IME exams. Both sided with me but the company still did
not allow the benefits. Instead, after 3 approvals by Washington State, they appealed
the decision at every turn even after 5 specialists, 2 IME’s, an Environmental and
Occupational Health and retaining legal representation.
Doe has bad record keeping, working at n reactor doing ball channel repair in hindsite
was insanity. Looking into the core of the reactor
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 94
RECOMMENDATIONS
administrators in the past have been more focused on saving money and not on
ensuring patient's health and return to work
Too sloq
DENIED BY HR @ PNNL
Because they will delay care if you claim but if you just make it a medical claim it is
better/faster
I did not informed I could receive compensation before my case was closed. I was told
by a coworker after the fact
Hassles, make you feel like being judged. Would not let me come back to work as an
operator but yet said I could come back as an HPT
Penser was difficult to deal with. My claims processor was always hard to
communicate with. Multiple times I would call and not hear back for days and on
occasion greater then a week.
When returning to work it seems it is not the same for everyone.. and get contradicting
answers for questions that are asked or how to return to work
Have to fight to get care or prescription
No experience with that process
Retired
I don’t know the current conditions.
Time frame for getting compensation, the amount of time and effort to enroll in
compensation.
See above, treated disgracefuly by three levels of L&I management (Washington state)
Does not cover all testing procedures or treatment therapies.
It's a constant fight to get them approve and cover claims.
I don't feel like my illness is taken seriously
Claims that were paid to folks i work around me didn't make sense
Claim was handled with bias
Hard to get claims approved and navigate system
Workers comp does not work very well. Too much red tape.
Can't get the help you need
Our worker compensation denies claims or responsibility. they work for the employers.
the claims people are biased to the system not the patient
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 95
RECOMMENDATIONS
Poor ability to share information/records between or among various parties involved
in assessing exposure and potential health effects
There not given all information what employees are exposed to and employees do not
know all the hazards to best represent themselves as well as physicians do not ask
the questions pertinent to hazards of a job. EEOICPA would not have come into place
if there was adequate coverage for nuclear employees. University of Washington did
studies on workers too but lack of information of what employees work with is not
able to help them. As well as legal counsel are not given full disclosure of exposures -
again RCW 51.04.130 comes into place. Under freedom of information act if you
request records they are blacked out as well as there are margin of error on data
collected. Example- receive a 1 everyday on dosimeter, margin of error allows a 2
range. So a 1 is canceled out even though everyday you receive a 1 your dose for a
month is '0'. Unless you understand the reporting process this is an item overlooked
as well as MSDS are for 1 chemical which employees use multiple chemicals such as
the tankfarms/labs.
I believe it is inadequate and unequal
Because most retired or even current employees feel that most local doctors depend
on Hanford. Being that's Hanford is their main source of income.
Little or no oversight of workers comp
claim denied
THE DOL MAKES IT TOO HARD TO QUALIFY FOR HELP.
we had officers let go because they could not r we turn to full duity
Retired
DOE controlled and employer overseen.
It's criminal the way it treats injured empl
I provided hundreds of pages of my medical records. The workmans' comp folks
ignore everything, they simply don't have the workers (their excuse).
Not worth it putting job on the line
Over complicated, you get the runaround
Not enough long term care/follow up.
Will not make a determination without a biopsis
Penser is the administrator for the DOE for worker's comp claims. They are a joke.
They have been caught on more than one occasion messing with claims and
claimants. , even by internal DOE reports, yet they are retained. Even withthe
presumption law DOE and Penser continue to violate the rules and make the claims as
difficult as possible.rts
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 96
RECOMMENDATIONS
My husband's illness was handled well in Richland, but calls from higher up were very
stressful.
I’ve been over a year and a half without medical treatment for a work injury due to
Penser/L and I prolonging the process.
Frustrating & long term documentation process. Also it was hard to find contacts for
as st DOL & Fed DOL.
The contractors do not make it easy for the employee
Penser is still not being held accountable for injured workers at hanford.
Lots of cheaters inWC
Never used
PENSOR is the worse. They are very negative to the customer- ie the workers
states system is biased
Twist EVERYTHING !!! Be Honest I Was The Contaminated One !!!
See above #21
They are trained to deny you, not to provide you with care
They are company focused
No Doctors want to take L & I claims
See previous comments. Independent medical examiners can be biased towards
company. Claim authorization denied or delayed.
Too many hoops you have to jump thru for a claim to get ok'd.
I started having issues when I was working on N reactor in 83 or 84. I started urinating
blood while working on the shut down. Even though in ended up with bladder later
everyone said they didn’t know.
I think I had to go for two or more “independent” evaluations and was questioned
about the same things again and again even though it seemed pretty obvious that the
issues were due to my work activities. It was a real pain, having to take a lot of time
off from work, although it was paid time, special time card coding, the manager not
sympathetic to my issues, etc.
Because even after having two internal depositions and having problems and a couple
surgeries with us I was told they can’t prove that it was cards from the internal
depositions so they pretty much ignored me
Did not cover my treatment.
Ever time you turn in a claim it gets turned downed. You have to appeal everything.
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 97
RECOMMENDATIONS
I am in one now for 2+ years. They have every right to shut down settling my case until
my time runs out. So they do unless I hire and attorney.
I was unhappy with how I was treated. My claim was over 20 years ago. I had two
claims for exposure to Vapors and they decided to combine them to one claim which I
didn't think that was right. My respiratory system was compromised and also am I feet
went numb and I couldn't walk for a Time. My feet are still numb to this day I have
peripheral neuropathy in my feet. My claim was denied and I'm bitter about it. My
blood oxygen is low and it shouldn't be that way.
I did not obtain any useful help from claims administration, which is geared towards
non-manual employees.
Dd.O.L. seems to change the "rules" when ever they see fit.
claims take forever, they do not have a comprehensive list of requirements...but
continually send correspondence requesting additional information. It is maddening.
This process is horrific.
Because I was accepted but they dont always pay even though dol has sent letters
saying I dont need to pay. After several calls I just paid the bill.
Much harder process that just using my own insurance. CHPRC strongly discouraged
use of Workers Comp. Offered little help to educate on the process and filling out
paperwork in order to use mistakes to prevent use of Workers Comp. also implied
threat of retaliation for raising associated issues with their discouragement.
Useless
The process makes you feel like you’ve done something wrong and have to prove you
deserve their help.
I know nothing about this process
They did not protect my right to keep my job while on a work accommodation plan.
The DOL is constantly changing the rules to make the process far more cumbersome
than it needs to be. They try and act like an insurance company but have very
draconian rules that are inconsistent with industry practice.
too slow
Process is complicated.
Takes to long , and poor care.
Panzer makes processing claims nearly impossible. They are supposed to follow the
same process as L&I, I have dealt with them and are much easier to deal with.
Too much red tape! & rejection
Currently the Hanford Site through Pensor fights and tries to deny any and all claims
Takes too long checking off boxes on a form instead of care
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 98
RECOMMENDATIONS
Same as above
In one case, the case was closed by the contract doctor when I felt it should not have
been.
The doctors here said lung plursey
You’re guilty of working unsafe
It’s an uphill battle to get any help from them
My claim was rejected
I'll let you know
Calls are never returned and the help I was promised never happened since 1989 to
date.
Even though I was diagnosed with serious illness and treated the primary concern
seems to be to protect the government not take care of my problems
Haven' t looked into it.
When I had claim they put onus on me.
Dealing with the state is just plain terrible
contractors onsite turn over full control of claim to DOE/self insurer for administration
and approval. Contractors do not have contract with self insurer but depend on DOE
and their umbrella and the employees of the contractors are at the mercy of DOE/self
insurer
It’s for the employees it’s about saving money
They fight every claim. They leave people hanging out there for years sometimes with
no closure or resolution or surgery if needed.
DOE controlling the process for claim acceptance
There is no trust with Pensor North America at all.
The IMEs are not for the workers best interest.
Company is in denial about building issues.
Too cumbersome to apply. The process takes too long. It is next to impossible to get
the medical records from the Hanford contractors.
Post exposure should be compensated from day 1 and not be subject to first 3 days of
missed work while being evaaluation or recovering from an (vapor) exposure.
It is not fairly administered and it fails to approve claims from actual affected workers
Could be faster
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 99
RECOMMENDATIONS
Case management sucks. Doesn’t help employee
Took 5 years to get approved. Company delayed approving so wouldn't have to.
Figured I would give up and they wouldn't have to pay.s
You are treated different
Penzer is HORRIBLE to deal with. Trying to get on the job injuries taken care of should
not be so hard.
However with my experiences needing workers compensation was with obvious
issues (broken bones).
Penser is not looking out for workers
Doctors encouraged to close cases
Waiting for me to die
Claims are denied and undue stress is placed on the injured workers
Whether at Hanford or elsewhere in the State the Workers Comp program is overly
beauracratic and focused towards CYA and assumes the worker is trying to scam the
system.
To slow and medical check is with old retired doctors that didn't seems to be all there.
Unless it is an injury or illness a supervisor witnessed they don’t believe the worker
Read the above answer that is all I have to say
too many hoops, always feel that I was being judged
See above.
Always deny claim. Always have to retain attorney to deal with workers comp
ime are useless they dont even examine you for the issue at hand
Because you have to fight for benefits every step of the way even when it’s diagnosed
as work related.
It should be handled by L&I and not a private company
I had a lower back injury that required surgery. Have been pain free since surgery.
Workers comp would not allow me to get the service I needed to live a healthy happy
lifestyle
na
Currently retired
Prostate cancer not included in comp
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 100
RECOMMENDATIONS
They say you have to work 50% of your career in order to qualify. It only takes 1
exposure to have health issues. I received a couple of severe exposures but was
denied help.
Too much tape
Workers' comp wasn't part of the process back in the late 80s's
Too much bullshit
Process makes it difficult to obtain and keep treatment
My diagnosis came years after my 30-year career and I filed DOL claims, but was
denied.
Never used workers comp.
Too complicated
Too much automated answering and run around.
Again third party admin. Makes it impossible to have any success
Process not explained very well. Hard to get a hold of claim person to ask questions.
Checks didn’t always arrive on time. Difficult to submit weekly claims.
Penser is very frustrating, bad communication, denying previously approved coverage.
Because they fight you the whole way
Ever since the third party administrator took over disapprove more claims and fight
the people along the way. The DOE is Totally mismanaged anymore with the latest
manager I have never seen it in the history of the Hanford site as it is today there
needs to be a major change in DOE management
Had a bad experience with an individual examiner.
Paper
The process with workers compensation/Penser NA is slow and difficult. They deny
legitimate claims that should be covered.
The current workers comp is a joke. Everyone has a story about getting screwed over!
Explained to me that EEOICPA purpose is to disprove claims and to work towards
denying claims rather than helping former employees with their medical aid.
Penser, third party system needs to go
Process to slow
A large part of my health problems are from the sedentary work environment.
See above
Third party administration making go to IME until they get the answer they want
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 101
RECOMMENDATIONS
Explained above.
The independent medical exam Dr.s make you feel like you are lying about what is
going on with you. They disagree with what your personal Dr. says
Slow process and Inadequate coverage
Not enough medical staff is familiar with the EEOICPA program.
It is not an easy process.
It has to many hoops to jump through. And knowing that I will be less compensated is
a stressor.
Penzer was a extremely difficult to work with
Administration of process is inefficient. Staff I dealt were very slow to process things.
Hard to get treatment. Dr. Is working to deny claim or quickly close it out
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 102
RECOMMENDATIONS
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 103
RECOMMENDATIONS
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 104
RECOMMENDATIONS
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 105
RECOMMENDATIONS
HANFORD HEALTHY ENERGY WORKERS - HEALTH CARE NEEDS ASSESSMENT AND 106
RECOMMENDATIONS
File and source
- File
- 2021_hanford-healthy-energy-workers-healthcare-needs-assessment-and-recomme.pdf
- Size
- 2,718,376 bytes
- SHA-256
- 941acfc59157df90bd4ed146a388f389f4f1dcf9ff312d9be117dcad8678f83a
- Original
- app.leg.wa.gov