The TVA Fly Ash Spill: Community Medical Screenings Greg Nichols, MPH, CPH March 17, 2014

Overview

• December 22, 2008, sometime after midnight, a coal ash impoundment retention wall failed at the TVA Kingston Fossil Plant in Roane County, TN

• Over 5 million cubic yards of coal ash covered almost 400 acres of land and water

• From 2009-2010, ORAU and Vanderbilt University Medical Center provided medical examinations for community residents

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Background on TVA

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Largest public utility in the US Provides electricity to more than 9 million people in 7 states 11 coal-fired generating facilities Uses 29 million tons of coal per year

Kingston Fossil Plant (KIF)

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Completed in 1955 Has 9 coal-fired units that generate 8 billion kWh of electricity a year Burns 14,000 tons of coal per day at full capacity Creates 1,000 tons of fly ash in one day

How a Coal Plant Works

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What is Coal Fly Ash?

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One of the by-products of burning coal Good structural qualities Contains heavy metals, volatile organic compounds, and radioactive solids Currently, not considered hazardous by EPA (subject to change)

The Disaster

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The Disaster (Cont.)

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NASA’s Landsat 5 satellite image (November 20, 2008)

NASA’s Landsat 5 satellite image (December 22, 2008)

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Aerial of Ash Spill

Public Health Concerns • No previous data on human health effects of fly ash in

this context

• Looked at Department of Health, TDEC and EPA data to determine risks – Heavy Metals – Ash dust – Gravel dust – Mental Health

• Contaminant Affected organs of systems Medical tests to measure health Medical examination protocol

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Risk Assessment

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Evaluation of Risk in: •General public • Special populations

Based on: •Hazard identification •Dose response-

exposure assessment •Risk characterization •Risk management •Risk communication

Using: •Dose measurements •Modeling •Assumptions •Monitoring •Known data

Protocol

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Coal Ash Constituent Residential Property Ash Concentration (mean, range, mg/kg) [TDEC, Jan 6-7, 2009]

Regional Soil Background Concentration (mean, range, mg/kg) [EPA Jan 2, 2009]

Aluminum 14,109 (1000 – 22,000) 4308 (2170 - 6190) Arsenic 75 (26 – 100) 8 (1 – 16) Barium 357 (180 – 1100) 47 (25 -95) Beryllium 3 (1.5 – 7.9) 0.8 (0.2 – 2.5) Cadmium 0 (0 – 0.2) 0.17 (0.04 – 0.36) Chromium 25 (16 – 43) 16 (4 – 31) Cobalt 13 (6.7 – 29) 5.5 (3.2 – 8.0) Copper 46 (25 – 76) 9.9 (4.3 – 23) Iron 13,000 (10,000 – 21,000) 12,875 (4880 – 23,100) Lead 19 (9.8 – 29) 16.7 (6.6 – 27.2) Manganese 102 (56 – 260) 389 (61 – 1230) Mercury 0 (0 – 0) 0.13 (0.12 – 0.14) Nickel 23 (13 – 37) 6.1 (<4.9 – 8.5) Selenium* 0.2 (0 – 2.2) 1.9 (1.0 – 2.0) Thallium* 0.16 (0 – 1.8) < 5.5 Uranium 2.89 < 9 Vanadium 77 (42 – 150) 17 (5 -36) Zinc 40 (25 – 67) 33(18 – 69)

*Not higher than background but included due to potential toxic effects

Protocol (Cont.)

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Those living within 2 miles from spill considered at greatest risk of exposure

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• Medical history questionnaire • Physical exam by a medical toxicologist • Blood/serum tests for aluminum, chromium, cobalt, copper,

nickel, selenium • Urine tests for arsenic, barium, beryllium, thallium, vanadium • Basic metabolic markers

– Complete blood count – Comprehensive Metabolic Profile (Chemistry Panel) – Urinalysis

• Chest x-ray • Spirometry (Breathing test)

Protocol (Cont.)

Findings - Demographics

• 214 participants from 112 households

• Sample fairly representative of the Roane County population

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Findings – Exam and Questionnaire • No individual exhibited signs of toxicity

• Abnormalities on physical exam due to preexisting conditions

• Biggest change after spill was HEENT and respiratory symptoms

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Medical problems related to:

Pre-spill Post-spill

Head, eye, ear, nose, and throat (HEENT)

48 (23%0 133 (65%)

Pulmonary (Lung) 77 (38%) 106 (52%)

Findings – Heavy Metals

• Acceptable laboratory values for most metals • Elevated blood values observed for aluminum,

copper and selenium, which are micronutrients and influenced by diet, dietary supplements, and medications

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Findings – Spirometry/Chest X-rays

• 194 people completed breathing tests – 75% with normal results – Over half of the abnormal tests were found in

smokers

• 208 people had chest x-rays – 2 people with lung mass (unrelated to fly ash) – Most x-rays were normal with a variety of

unrelated findings

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Findings – General Laboratory Results

• Anemia in 43% of individuals

• Blood sugar elevated in 18% of our sample (not fasting)

• Liver function tests elevated in almost 2% of the participants

• Kidney function tests elevated in 1% of participants

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Conclusions/Limitations

• Findings were compatible with conclusions of the Public Health Assessment prepared by the Tennessee Department of health in 2009

• A repeat evaluation could determine whether there has been any change in health in the future that may be related to the fly ash spill

• This was not a true epidemiologic study – Community benefit – Volunteer population

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Photos after the Spill

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Kingston’s Legacy

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Debate still looms over whether or not to classify coal ash as hazardous waste Shortly after the disaster, EPA conducted hazard assessment on all fossil plants in the US that used wet storage TVA has converted all wet storage operations to dry storage or gypsum Community changed forever EPA announced final ruling on classification of coal ash by December 18, 2014

October 29, 2013

Public Health and Politics

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Political Cartoon from the Knoxville News-Sentinel August 20, 2010

Questions?

• ORAU’s Report and Resources: www.orau.org/kingstonproject

• Department of Health’s Public Health Assessment: http://health.state.tn.us/coalashspill.htm

• EPA’s Kingston Clean-up website: www.epakingstontva.com

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