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Appendix B: Summary of the Committee's Town Halls
Pages 185-214

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From page 185...
... population, speakers suggested that exposed communities and vulnerable populations should be prioritized for PFAS blood testing, using equity as a guide to design testing protocols. Continued Assessment of Health Effects Many speakers highlighted the lack of studies detailing health outcomes related to PFAS exposures, citing this as a glaring and troubling data gap, given the long list of health concerns and trends identified by and in exposed communities.
From page 186...
... Allen also stated that the community sees patterns of disease and illness related to source proximity that are not currently acknowledged or understood by health care practitioners. Given the documented link between PFAS and specific health effects, including immune function and endocrine health, blood testing is vital for matched, relevant health care based on exposure history.
From page 187...
... This unawareness has led to previous practices that caused undue PFAS exposure, such as using AFFF to clean vehicles or allowing children to play in AFFF. Khan emphasized the importance of medical monitoring and PFAS bloodwork for firefighters and other PFAS-exposed communities.
From page 188...
... For example, Mello said, blood testing could facilitate identification of communities more likely to be immunocompromised due to PFAS exposure when designing COVID-19 intervention or protocols. Even in the absence of information framing PFAS exposure levels in relation to specific health outcomes, however, Mello said exposure assessment is critical for affected communities.
From page 189...
... She described legacy and emerging PFAS contamination originating from Solvay, an industrial user of PFAS located in West Deptford. Industrial activities by the company were found to contaminate the drinking water of 50,000 residents of the surrounding area with legacy PFNA,4 first identified in 2013.
From page 190...
... This fact-finding process took up valuable time that could have helped mitigate exposure-related effects in the community. Hackett indicated that state and local regulatory agencies are now taking PFAS contamination more seriously, with the state setting more protective drinking water MCLs and continued community blood testing.
From page 191...
... Working in this context, Hackett stated, the study design has shifted to include more tests beyond liver, kidney, and thyroid function, as immune suppression, endocrine disruption, neurological effects, reproductive issues, and breast cancer become increasingly salient community concerns. Hackett also detailed ongoing contamination concerns in her community due to continued stack emissions and exposure to unregulated, short-chain compounds designed to replace PFOA that studies show to be as toxic as long-chain, legacy PFAAs.6 As a result of regrettable substitution, Hackett advised that bioaccumulation and total body burden of numerous PFAS has to be considered for those requesting medical direction through continued blood testing beyond the limited number of PFAS currently under scrutiny.
From page 192...
... Grosse mentioned she lacked such information and agency raising her own children and would have greatly valued the knowledge and associated opportunity to switch to filtered water or bottle-feed her children to reduce their early-life exposures. Grosse also emphasized that blood testing remains imperative to characterize exposure and changes in PFAS blood levels over time.
From page 193...
... She stated that blood testing for PFAS should be made available and accessible to these and all demographic groups, with a critical need for exposure assessment over time. Furthermore, Whittington stressed, it is important to have updated clinical guidance about PFAS blood testing, health concerns, and standards of care for health care professionals.
From page 194...
... Watters also stressed the value to the community of baseline exposure assessment and the importance of tracking exposure over time through continued blood testing given evolving exposure scenarios. This work is currently being done through the North Carolina State University GenX (PFAS)
From page 195...
... She detailed a litany of regional health concerns, including pediatric bone cancers, osteosarcoma and brain tumors, pediatric kidney cancers and diseases, bladder cancer, gallbladder dysfunction, testicular cancer, pancreatic cancer, liver cancer, nonalcoholic fatty liver disease, leukemia, blood cancers, colon cancer, thyroid cancer and dysfunction, autoimmune diseases, digestive issues, multiple sclerosis, skin disorders, infertility, premature births, developmental delays, learning disabilities, autism, breast cancer, and nonHodgkin's lymphoma. Donovan stated that the currently available data indicate increased risk of negative health effects, including birth defects, kidney disease, and increased cholesterol related to PFOA exposure.
From page 196...
... Cail noted that right before the COVID-19 pandemic more state agencies began mobilizing to address the issue within her community and across the state, but this was only after years of inaction. She noted that she had seen this before, as institutions prioritize "wealth before health." With more information about regional PFAS exposures, Cail and her family started trying to find answers from the medical community regarding how to get PFAS blood testing and how to get treatment for their exposure and related health effects.
From page 197...
... Since learning about the PFAS problem in tandem with regional medical resources encouraging care, Bailey provided multiple examples of early interventions across the community that served to detect or treat cancer or other health problems before severe disease. Bailey concluded by outlining specific community needs from health care providers, including physician education, medical monitoring, PFAS blood testing, preventive health screening and assessments, documentation on medical records of PFAS exposure and environmental health attributes, and recognized guidance that ensures insurance coverage.
From page 198...
... The majority of community members have been denied covered testing through state agencies and insurance providers. Rich said that the committee's recommendations have the potential to improve care and community health outcomes by making sought-after care accessible and affordable, and she urged the committee to recommend blood testing and medical monitoring for residents in exposed communities, ensuring those exposed through complex pathways are included.
From page 199...
... PFAS blood testing helps baseline exposures and raises awareness so people can take steps in reducing exposures. Baseline testing could help answer health questions in the future and help secure health studies in communities at risk "Given all these barriers [to PFAS exposure information]
From page 200...
... This widespread contamination has resulted in historical and ongoing PFAS exposure for service and community members, as well as the area's fish and wildlife. Wusterbarth's remarks focused on several primary community needs: PFAS blood testing, improved guidance for health care practitioners, exposure assessment in the environment, and exposure mitigation.
From page 201...
... Shortly thereafter, the Michigan Department of Environment, Great Lakes, and Energy tested her drinking water, and Wynn-Stelt learned the well water she and her husband had drank for more than 20 years was contaminated with PFAS at levels up to 80,000 ppt. On learning about her exposure, Wynn-Stelt sought blood testing.
From page 202...
... Wynn-Stelt labeled the assertion that PFAS levels in blood cannot be definitively linked to health effects, and therefore should not be monitored as circular logic, stating if testing is not occurring at various scales, links cannot be identified, further and erroneously justifying a lack of testing. Wynn-Stelt closed her remarks by stating explicitly her community's needs, including accessible PFAS blood testing for people in various exposed communities.
From page 203...
... Military firefighters are now eligible for PFAS blood testing, but retired military firefighters and civilians are not. Quint related concerns from the fire service community regarding the ramifications of blood testing results and options to lower PFAS levels in blood.
From page 204...
... This water is also used to cultivate silage vegetation and other crops. PFAS-contaminated groundwater has resulted in PFAS contamination of regional livestock, leading to sundry economic and health questions and concerns unrelated to drinking water exposure.
From page 205...
... This lack of health care facilities exacerbates contamination issues because there is no capacity to monitor health outcomes, as families seek health care in the northern part of the county where doctors may not be able to identify localized health outcome patterns. Rosenbaum emphasized the immediate need for blood testing to establish a baseline that serves as evidence of contamination and an indicator of potential health effects.
From page 206...
... Favors indicated that despite these levels, the state of Colorado has not provided expansive PFAS blood testing to all residents, even knowing the inherent value of blood testing as an indicator of exposure and potential health effects. Favors emphasized the particular importance of transparent information and access to testing when considering the transitory lifestyles of military members and other community residents.
From page 207...
... Ventura went on to elaborate about specific actions and concerns in California, describing the recent position of the state to implement phased drinking water monitoring and site investigation. She added the caveat that this phased approach has failed to assess small water systems and private wells: this is a key data gap considering health care practitioners need detailed information about exposure to adequately consider environmental health concerns during care.
From page 208...
... Shosie explained that her community is affected by PFAS contamination from military sites and airport activities, resulting in PFAS concentrations in drinking water up to 13,000 ppt. This high level of PFAS exposure is plaguing a majority-Latino community across a 3-mile contamination plume; Shosie provided a number of maps providing geospatial context about the extent of contamination.
From page 209...
... Maruzzo echoed other participants by pointing out that highly exposed and vulnerable populations should be prioritized for PFAS blood testing, using equity as a guide to design testing protocols. He further suggested that inclusion in these categories should be constrained by occupation, location, and biosocial vulnerabilities.
From page 210...
... Only a handful of the 33 communities relying on water likely contaminated by AFFF or other PFAS sources have been able to access drinking water testing, contributing to widespread unawareness of the problem across the state. Miller stated that limited assessment of drinking water and other environmental factors is matched by a lack of health assessments probing the effects of PFAS in exposed communities; only two health assessments have been conducted.
From page 211...
... This study is a multicity, long-term national research effort focused on assessing cancer in firefighters across the nation. Participation in this study provided Krause and several other department members access to PFAS blood testing.
From page 212...
... "We pay lip service to scientific evidence over here, but very often in Yakima Valley science is suppressed." Jean Mendoza Rebecca Patterson (Vietnam Veterans of America) Rebecca Patterson presented commentary as a Navy veteran and veteran advocate, highlighting the importance of PFAS blood testing for veteran's health care.
From page 213...
... PFAS blood testing can provide evidence of exposure that enables veterans to access vital health care. Patterson also asserted that PFAS blood testing can lead to more informed health care, allowing service members and veterans to screen for and potentially prevent health conditions specifically associated with PFAS exposure.
From page 214...
... 214 Guidance on PFAS Exposure, Testing, and Clinical Follow-Up "It was joy for me to learn some of the things the scientific study found out." "I hope we can all acknowledge that we need to move in the same direction at the same time and not point fingers and not fight and not quarrel but find out what we can do to stop this from happening because it is going to cost us our lives." Bucky Bailey One other person at the Western Town Hall provided public testimony, which is available on YouTube16: Gina Solomon. 16 See https://www.youtube.com/watch?


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