THE BOARD OF SUPERVISORS OF THE COUNTY OF STANISLAUS ACTION AGENDA SUMMARY

DE pT : ENVIRONMENTAL RESOURCE&~$&~J BOARD AGENDA # B-19

Urgen t Rou t ine X AGENDA DATE ~ ~ ~ i l 30. 2002

CEO Concurs w i t h Recommendation r@NO- 415 Vote Requi red YES- NO^ ( I n f o mation Attached)

SUBJECT: ACCEPTANCE OF THE UPDATE ON THE WESTLEY TIRE FIRE SITE

STAFF RECOMMEN- DATIONS: ACCEPT THE UPDATE ON THE WESTLEY TIRE FIRE SITE

FISCAL IMPACT: There is no fiscal impact.

BOARD ACTION

On motion of Supef'visorCaruso -__--------------------. , Seconded by Supe~isor_SMm ..................... 2-.

and approved by the following vote. Ayes: Su~ervisor~:Bl~m~sim~~~~a_r_u_s~~~PauL~a_n_d~~hairman~M_a~~!~ ............................................ Noes: Supervisors:_None_ _----------------------------------------------------------.---------------------.-- Excused or Absent: Supe~isorslNQIE _-------------------------.---------------------------------------------. Abstaining: S~perv isor~Nme --_--------------------------------.------------------------.-------.-----.-----

I) X Approved as recommended 2) Denied 3) Approved as amended MOTION:

ATTEST: CHRISTINE FERRARO TALLMAN, Clerk File No. 1 0 i W L

ACCEPTANCE OF THE UPDATE ON THE WESTLEY TIRE FIRE SITE Page 2

DISCUSSION: The Board requested staffto provide a quarterly update on the status of the Westley Tire Fire Site (WTFS). Information for this update is based on conversations and meetings with staff from the California State Department of Toxic Substances Control (DTSC), the Regional Water Quality Control Board (RWQCB), and the California Integrated Waste Management Board ( C W ) .

On September 22, 1999, lightning ignited the Filhin tire pile near Westley, California. The U. S. Environmental Protection Agency (USEPA) extinguished the fire in October of 1999. After the fire, a multi-agency team was formed, composed of the DTSC, CIWMB, and the RWQCB. These agencies are working together to determine the extent of the contamination ar~d facilitate the site remediation and clean-up.

This report is divided into six segments:

a General Information; a Remedial Investigation Activities; a Modesto Energy Limited Partnership; a Office of Environmental Health Hazard Assessment; a Air Quality; and, a Public Health Officer Update.

General Information

In April 2002, the final version of the Public Participation Plan for the WTFS was sent to the Patterson Library. The Public Participation Plan provides information on site specifics, lists and descriptions of technical milestones and site maps. The Public Participation Plan provides corresponding public participation activities, a schedule of activities, and previous community outreach efforts. The department has provided access to downloadable versions of the remediation plans and reports on the internet at www.co.stanislaus.ca.us/tirefire/reme.htm.

Remedial Investigation Activities

Debris Removal The contractor has completed the removal of Debris Piles 1, 4, and 7. Please see Attachment A for the location of Debris Piles. Attachment A is a site map from URS 2001, Remedial Investigation Report for Debris Pile 2 Characterization. In addition, the contractor has removed Debris Pile 6 with the exception of some unburned tires. Approximately 90,000 tons of waste material has been removed from the WTFS site. On February 6,

ACCEPTANCE OF THE UPDATE ON THE WESTLEY TIRE FIRE SITE Page 3

2002, the contractor began the removal of Debris Pile 2. DTSC determined that the first 15 feet of Debris Pile 2 was a California Hazardous Waste because of zinc levels, and was handled as such. This portion of Debris Pile 2 (20,000 tons) was transported to Kettleman Hills, a Class I hazardous waste landfill. The balance of the waste from Debris Pile 2 is being transported to Forward Landfill Inc., in San Joaquin County.

Groundwater Monitoring URS Corporation was hired by the State to assist in the site remediation including conducting groundwater monitoring. Samples from monitoring wells were last taken in July, 2001. The results of analyses of these samples were provided in URS Corporation's report issued in November. The following is a summary of the findings:

In both the down-canyon (GW-01) and mid-canyon (GW-02) wells, the level of benzene increased from the May to July sampling events. The volatile organic compound benzene was the only contaminate that exceeded the relevant water quality goals. The July results did not detect semi-volatile organic compounds in groundwater monitoring wells. Volatile organic compounds and semi-volatile organic compounds were not detected in background groundwater samples in the up- canyon groundwater monitoring wells (GW-03A and GW-03B). All groundwater samples, including samples collected from up- canyon monitoring wells (GW-03A and GW-03B), contained levels of arsenic and selenium above the relevant water quality goals. Concentrations reported were within the results of the up-canyon monitoring wells (GW-03A and GW-03B). What this means is the arsenic and selenium found in the down-canyon (GW-01) and mid- canyon (GW-02) wells is most likely naturally occurring. Other general water quality parameters and minerals exceeded relevant water quality standards. However, these results are within background concentrations reported in the samples collected from the monitoring wells.

URS Corporation recommended continuing the groundwater monitoring for the following reasons:

To determine if contaminant migration is occurring; To determine the nature and extent of inorganic contaminants, as applicable;

ACCEPTANCE OF THE WDATE ON THE WESTLEY TIRE FIRE SITE Page 4

To determine if natural attenuation (if the concentrations are naturally decreasing) is occurring; To establish contaminant trends (for example, if there is a seasonal variation in contamination level); and,

r To determine remedial options.

On March 11, 2002, a sixth groundwater monitoring well was installed at the WTFS. This monitoring well is located approximately 600 feet down- canyon from the closest groundwater monitoring well. This groundwater monitoring well will act as a sentry well. The intent of the sentry well is to detect possible migration of contaminants downstream from the WTFS. In addition to the installation of the well, the contractor will be performing the quarterly groundwater sampling. The department has not received the report on the installation of the well or the results of the sampling that was conducted.

The RWQCB has recommended quarterly groundwater sampling until all the waste debris and contaminated soil has been removed from the site. In addition, the RWQCB is recommending on-going semi-annual sampling once the waste debris removal has been completed. The RWQCB has not determined how long the groundwater sampling will continue.

Modesto Energy Limited Partnership (MELP)

As of February 1 , 2002, Ed Filbin took possession of the tire incineration plant. This was a result of a condition of the lease agreement. The plant has not been disassembled or decommissioned.

Office of Environmental Health Hazard Assessment (OEHHA)

OEHHA was tasked with doing a literature review and preparing a report regarding health effects of smoke from burning tires. This report was to be submitted to the State Legislature in December of 2001. Currently the report is complete and has been submitted to other CALEPA agencies for comment. Once comments have been received, the final report will be submitted to the State Legislature. It is unclear as to when the report will be available for public review.

General Air Quality

The Board, at the last WTFS update on October 9, 2001, requested staf'ito provide information on the general quality of air in Stanislaus County. The San Joaquin Valley Air Pollution Control District (SJVAPCD) is divided

ACCEPTANCE OF THE UPDATE ON THE WESTLEY TIRE FIRE SITE Page 5

into the following regions: North (including San Joaquin, Stanislaus and Merced Counties); Central (including Madera, Fresno and Kings Counties); and, South (including Tulare and Kern Counties). General information on the valley's air quality may be found in Attachment B, which includes the following information:

A map showing the locations of both the SJVAPCD and California Air Resources Board air monitoring sites; Historical information from 1984 -2001, on both the one-hour ozone exceedances and the eight-hour ozone exceedances; A summary of the PMlO readings for 1988 -1997. This information is from the California Air Resources Control Board's website; Compiled information from the SWAPCD containing PMlO preliminary information for years 2000,2001 and through March 28,2002; and, SJVAPCD's Ambient Air Quality Standards and Valley Attainment Status. This information is from their website.

Public Health Officer Update

Dr. John Walker will present the results of the Health Screening Study. Attachment C is the report of the Screenin9 Studv of Clinic Visits for Respiratorv Illness: Before and After the Westlev Tire Fire.

POLICY ISSUE:

STAFFING IMPACT:

This item is informational in nature. Its purpose is to keep the Board informed on an issue related to the Board's priority of ensuring a safe, healthy community.

There is no staffing impact associated with this item.

mrr: "RS2WI. Rcm~lin"atigsti..l(monforDEbn,Pll~2C~,2m, Louaon of BMcd B d M.Im.b. SitcWidr SurTur~ Cbm-66, r n u o d ~ l s r ~ b m r v r v l t i ~ M I C B ~ M ~ / ~ b ~ u n p r i ~ wndgim~rn Sit% -pard f i r DTSC. A p l WO1

URs ~ ~ ~ r n o , ~ s r n ~ ~ ~

Figure 2

SITE LAYOUT WesUey Tire Fire Sie

Wesliey. California ... .~~ . . . .... . . .. . .. -

San Joaquin Valley Air Basin-PM10 Monitoring

EE ~ t . . . a a . m M P ~ & . ( n O

AIR RESOURCES BOARD

San Joaquin Valley Air Basin PMlO Air Quality Data

Select one of the following summaries of PMlO data for this air basin:

Basinwide summaries for the San Joaquin Valley Air Basin 1988-1997

Comparison of the San Joaquin Valley Air Basin with other California Air Basins for:

1994 -- 1995 1996 1997 ~ ~

County or monitoring site summaries from the map below or from the basin d i r e c t o e

San Joaquin Valley Air Basin

SAN JOAGlUlN COUNTY STANISLAUS COUNTY Stockton, Hazaiton St Modasto. 14th St

Stockton, Wagnsr-Halt Turlock, Minaret

MADERA COUNTY MERCED COUNTY Madera, Library

FRESNO COUNTY

Fresno, Drumrnond Fresno, I st Strest TULARE COUNTY

KINGS COUNTY KERN COUNTY

Hanford, West Lacey Blvd Hanford, South Irwin St

Corcoran, Pattarson Bakersfield, Celifarnia Corcoran,Van Darsten Bakersfisld. Golden

Bakersfinld, Chester St

. . . . . .

Please send questions or comments to:

a q M r b . c ~ g o v

This page last revised on March 8, 1999

Other Pollutants I PMlO I-Iome P a s I Ai r~as i~ l /%te ) Se l skn-Map

District/Si& Directow I C o _ w t y l S i t m I M o n i t a i m D i r e c t o r y _

ARB IJome~Eage 1 S e a r c h A R m r a ~ n s ! ~ o p i c s / Elnail ARB Help Attendant

ATTACHMENT B - PAGE 1 of 5 ?/38/701)7

wmation Provided by the San Joaquin Valley Air Pollution Control District

I Number of One-Hour Ozone Exceedances by(

1 Number of Eight-Hour Ozone Exceedances /

^Data for ZOO1 is based on preliminary data through 2-2602.

ATTACHMENT B - PAGE 2 of 5 ,il -.. ,,.

$il Exulanation of the terminology in the header above, as well as the sampling program and analytical methods used to collect the data, the PMlO air quality standards, and how to request air quality data.

Please sendquestions or comments to. aqd~veb@,arb. ca.gov

ATTACHMENT B - PAGE 3 of 5

San Joaquin Valley Air Pollution Control District Air Quality Results 2000

Unofficial Days Exceeding the Federal and State Standards

Forecast 12/28120 Federal Standards State Standards

Region AQl Pollutant Region 1-Hr03 8-Hr03 CO PMlO 03 CO PMIO

North 66 PMIO North 1 36 0 0 34 0 32 Central 78 PMIO Central 25 76 0 0 95 0 55 South 81 PMlO South 15 78 0 0 95 0 0

Valley 31 89 0 0 109 0 66

The information in this report is based o n preliminary data a n d is subject to change.

Air Quality Results 2001

03-8 =federal 8hour ozone standard, 03-1 =federal l-hour ozone standard, blanks = no data available

Forecast Unofficial Days Exceeding the Federal and State Standards

Federal Standards State Standards

Region AQl Pollutant Region 1-Hr03 8-Hr03 CO PMlO 03 CO PM10

North Central South

North 1 36 0 1 36 0 36 Central 17 87 0 2 101 0 90 South 17 90 0 3 94 0 9

Valley 29 104 0 3 118 0 96

The information in this report is based o n preliminary data a n d is subject to change.

Air Quality Results 01101102 To 04/17/02

03-8 =federal 8-hour ozone standard, 03-1 =federal l-hour ozone standard, blanks = no data available

Unofficial Days Exceeding the Federal and State Standards

Forecast 04/17/20 Federal Standards State Standards

Region AQl Pollutant Region l-Hr 03 8-Hr03 CO PMIO 03 CO PM10

North 43 03-8 North 0 0 0 0 0 0 0 Central 56 03-8 Central 0 3 0 0 6 0 2 South 49 PMIO South 0 3 0 0 5 0 0

Valley 0 6 0 0 6 0 2

The information in this report is based o n preliminary data and is subject to change.

ATTACHMENT B - PAGE 4 O F 5

ATTACHMENT B PAGE 5 o f 5

San Joaquin Valley Air Pollution Control District

... leading fke wory 60 a clemrfituw Home AQ!

Ambient Air Quality Standards & Valley Attainment Status

Pollutant

Ozone - One hour

Ozone - Eight hour

Pollutant

Ozone - One hour

Ozone - Eight hour

DesignationlCIassification

PM-10

PM-2.5

Joaquin

Nitrogen Dioxide I' UnclassifiedlAttainment 1 Attainment

Sulfur Dioxide - Kern County (SJVAB portion) Attainment Attainment

Sulfur Dioxide -All Other Counties lUnclassified1 Attainment

Lead (Particulate) *No Designation* Attainment

Hydrogen Sulfide *No Federal Standard* Unclassified

Sulfates 'No Federal Standard* Attainment ] [visibility Reducing Particles 'No Federal Standard* Unclassified

Nonattainmentlsevere

Designation To Be

DesignationlClas:

I 1 CO - Fresno Urbanized Area

CO - Remainder of Fresno County

CO - Merced, Madera and Kings Counties

CO - Kern (SJVAB portion), Tulare, Stanislaus, Sari

Maps & Tables of the Area Designations for the State and National Ambient Air Quality Standards and Expected Peak Day Concentrations and Designation Values. Air Resources Board, January 1998; Classification letter, ARE Staff, March 16, 1993; ARB Action, November 9, 1994; ARB Action. November 21,1996; CO: (1) 40 CFR Parts 52 and 81 -- Fresno Urbanized Area, Bakersfield Metropolitan Area, Stockton Urbanized Area and Modesto Urbanized Area redesignated on March 31, 1998, effective June 1. 1998 (2) Area has reachec attainment status. The request for redesignation was approved by the Air Resources Board on September 24. 1998. The re-designation became final upon action by the California Office of Administrative Law on August 26. 1999.

State Standard3 - Nonattainrnenffsevere

*No State Standard

~ e d e r a l 3 G i G q -II~onattainrnenff~evere

Designation To Be Determined

INonattainment/Serious Designation To Be

ATTACHMENT B - PAGE 5 of 5

F i t a t e Standard3 I

L

INO State Standard ~etermined

UnclassifiedlAttainment - ~nclassifiedl~ttainment' - ~nclassifiedl~ttainment'

L

Attainment

Unclassified

Attainment

Screenina Studv of Clinic Visits for Respiratory Illness: Beforeand Afierthe Westlev Tire Fire

Kyle Luman MPH, John Walker MD, and Crystal Watson MS Stanislaus County, Health Services Agency

Summary:

This study presents the results of a retrospective analysis of 318,000 visits at two sets of clin-

ics during a four-year period -- two years prior to, and two years after the tire fire. The first

set of clinics, Golden Valley Health Centers (GVHC), are on the west side of the county near

the fire. The comparison clinics, operated by the Health Services Agency (HSA), are located

away from the fire in mid-county. Two hypotheses were tested:

1. Has there been an increase in resuiratow visits followina the tire fire? Results suggest

that there was no significant up trend in overall visits for upper and lower respiratory

illness following the tire fire. However, a sub-study of asthma shows an increase in the

absolute number of visits at all of the clinics and a proportionate increase at three. It is

premature to conclude that the increases were specifically related to the tire fire.

2. I s there a relationship between uroximitv of the clinic to the tire fire and urouortion of

res~iratorv visits since the tire fire? The results were inconclusive. For all respiratory

illness, only the Newman clinic had a significant increase. For asthma, the Westley and

Newman clinics had a significant increase. There was not a clear gradient of respiratory

visits related to proximity of the clinic to the tire fire; in fact, the highest proportion of

asthma visits were at the comparison HSA clinics.

Background

On September 22, 1999, lightning ignited a pile of approximately six million tires near Westley

that burned for five weeks until the fire was put out by extraordinary means on October 27,

1999. State and federal officials participated in the response. A professional oil fire crew from

Texas were contracted to put out the fire.

The smoke and fumes from the fire alarmed residents of the communities residing closest to

the piles of tires as well as county officials. Consequently, there have been a series of public

health interventions and assessments as a result of the fire.

Phase I: 1999

During the acute phase of the tire fire during 1999, the Health Services Agency provided a

number of services including:

1. Preparation and dissemination of health advisories in English and Spanish.

2. Telephone consultations to concerned citizens staffed by Public Health Nurses.

3. A series of onsite clinics in Patterson and Westley that provided free examinations.

4. A notice in the county Medical Society's bulletin requesting physicians to report any ill-

nesses related to the fire. There were no reports.

5. A statistical analysis of the telephone consultations and physical examinations. It was

our assessment that there was a peak of calls and clinic activity soon after the fire,

which tapered during October. There was one additional peak in late October, which

may have been related to heavy environmental smoke from the distant Colusa forest

fires in Northern California.

Phase 11: 2000

Following the fire, the county Chief Executive Officer wrote state health officials requesting a

prospective study to determine the possible long-term health effects of the tire fire.

The state health officials said that a prospective health study was not feasible because:

A. The number of individuals exposed was relatively small.

B. The exposure was slightly over a month in duration, which also is relatively short.

C. The levels of air-borne pollutants measured during the fire were assessed by California

Environmental Protection Agency (EPA) officials as not posing an imminent toxic threat.

During 2000 there were persisting concerns regarding the health effects of the fire. The

county CEO requested the California Department of Health Services to consider longitudinal

health studies. The reply indicated that such a study would be unfeasible. The greatest

concern of the Public Health Officer was the issue of CARCINOGENS. Several meetings and

consultations with toxicologists and environmental health physicians, both at California EPA

and the California Department of Health Services allayed concerns.

Phase 111: 2001-2002

Appendix #I is a chronology of Public Health activities regarding the tire fire during 2001 and

2002.

2 ATTACHMENT C - PAGE 2 OF 16

1. Comparison with the Tracy Tire Fire. The investigators inquired with San Joaquin County of-

ficials regarding the health effects of the nearby tire fire during 1998-99 in Tracy, which

burned for eighteen months. There were no reports of increased acute emergency room vis-

its.

2. Community Meeting. During March 2001, the Public Health Officer presented the findings of

public health studies during the tire fire to the community. The community expressed contin-

ued concerns regarding sub-acute effects of the tire fire.

3. Meeting with State Health Officials. During May 2001 there was a meeting in response to

the community's concerns. Attendees included county government, community representa-

tives, State Health officials, and providers of healthcare on the west side of the county. The current studv was ~rouosed at this meet in^. There were two hypotheses that were proposed.

First, is there a temporal association between clinic visits and the fire (i.e. is there a higher

percentage of clinic visits for respiratory illness after the fire)? Second, is there a spatial asso-

ciation between clinic visits and the fire (i.e. is there a higher percentage of visits due to respi-

ratory illness at the clinics that are closest to the fire)?

Methods

A. Studv Locations

Six clinics were chosen for the study primarily because of geographical location. Figure 1

shows the geographical location of the clinics in relation to the site of the tire fire. Three of

Golden Valley Health Center's (GVHC) clinics were selected because they are located on the

west side of the county near fire. The Westley clinic is located closest to the fire followed by

the Patterson and then the Newman clinic. These three clinics are located along Highway 33,

near the 1-5 corridor. As a comparison, three county-operated health clinics along the Hwy 99

corridor were chosen: Ceres, Hughson, and Turlock.

B. Studv Period and Data Collection

A four-year period bracketing the tire fire dates was chosen. The study period began with July

1997 and ended in June 2001. Figure 2 is a time line of the study period which shows that the

tire fire began approximately in the middle of the study. Data from GVHC was collected from

their Information Services department. The information gathered from GVHC was Date of Ser-

ATTACHMENT C - P m 3 OF 16

Figure 2: Timeline of the Respiratory Illness Clinic Visits Study. - 0

I. 0 cn '3 cn T. 0- -

Sept 22, Westley Tire Fire '3 7 al h - 5 3 3 7 7

I I I I I I I I

1997 1998 1999 2000 2001

4 ATTACHMENT C - PAGE 4 OF 16

vice, Date of Birth, Gender, Clinic, and up to two diagnosis codes. All information was anony-

mous; that is, no personal identifying information was obtained. Since the three com-

parison clinics are within the same agency as the individuals conducting this study, the same

clinic visit information was available for the HSA clinics as well.

C. Studv Parameters

The total number of clinic visits in which a diagnosis code was given per month was calculated

for each clinic. This total number of visits was used as the denominator for all subsequent

percentage estimations. The number of respiratory illness visits per month (the numerator es-

timate) was calculated several ways. First, we looked at three different well-defined illnesses

that have a possibility of being exacerbated by the fire. These illnesses were asthma (IcD-9:

493), emphysema (ICD-9: 492), and chronic bronchitis (ICD-9: 491.) The percentage of all clinic

visits that were due to these respiratory illnesses each month was then calculated by dividing

the number of respiratory illness visits by the total number of clinic visits. The respiratory ill-

ness visit percentage was then compared between all six clinics.

To eliminate some of the wide month-to-month variation that was observed at some of the

smaller clinics, we collapsed the monthly percentage estimates into seasonal (winter, spring,

summer and fall) estimates to look at the four-year trends.

D. Tests of Statistical Siqnificance

We also calculated an overall percentage of clinic visits before (July 1997-Sept 21, 1999) and

after (Sept 22, 1999-June 2001) the tire fire in order to perform a statistical test to determine

if observed changes in the percentage were significant statistically. 95% confidence intervals

were calculated around each of the pre-fire (pre) and post-fire (post) point estimates for each

clinic.

Results

A. Population and Clinic Demoara~hics

Figure 3 shows the number of clinic visits during the four year study period at each clinic. The

three HSA clinics have a higher number of overall clinic visits, which is not surprising since

they are located in the more densely populated central county area.

ATTACHMENT C - PAGE 5 OF 16

Tables 1 and 2 contain the demographic information about the patients at the clinics as well as

the cities in which the clinics are located.

1. AGE (Table 1). The first table compares population and average age of the six cities and

six clinics. At four of the six clinics, the average age of clinic patients is younger than the

average city population age. The notable exception is Hughson where the average clinic

patient is six years older tha

average patient age, 17

years old and 19 years

old, respectively.

2. RACE (Table 2). All six

clinics have a hiqher propor- - . . [ion of Hispan~c patients com- I 65,341 I I pared with the city popula-

tion. The clinics with the high-

est percentage of Hispanics

were the three GVHC clinics:

Newman 72%, Patterson

85%, and Westley 96%.

B. All U ~ p e r and Lower Res-

piratorv Illness

Figure 4 and 5 display the

seasonal variation in visits for

respiratory illness at the six

Ceres

Turlock 81 I

o 20,000 40,000 60,000 80,ooo 100,ooa

Table 1: Total Number and Average Age for the Population and the Selected Clinics in Stanislaus County, 2000.

The analysis that in- Source: U.S. Census Bureau, Census 2000 Summary File 1; HSA &

cluded the broader group of Golden Valley Clinic Data

respiratory disease codes

shows a basic seasonal fluctuation. The highest percentage of respiratory illness occurs in the

winter months and the lowest percentage occurs in the summer months. Another observation

is that the two most rural clinics, Westley (GVHC clinic) and Hughson (HSA clinic), have the

highest percentage of visits due to respiratory visits.

ATTACHMENT C - PAGE 6 OF 16

The secondary analysis seeks to

determine if there is a statisti-

cally significant difference in

man was not seen at the other

GVHC clinics, nor any of the

ties that might underlie in-

creases in clinic visits. There

could be an increase in clinic

visits after the tire fire due to

an increased awareness and

crease in symptoms or illness.

While the smoke and thus the

biological impact of the tire fire

7

ATTACHMENT C - PAGE 7 OF 16

was very limited in

Newman (if present at

all), the psychological

impact (due to media

coverage) certainly

was quite strong. This

could partly explain

the increase that was

seen at Newman, but

one would then have

to question the lack of

increase at any of the

other clinics though.

C. Chronic Res~ira-

torv Illness

During four years,

there were only 47

clinic visits for emphy-

sema at the three HSA

clinics and 5 visits at

the GVHC clinics.

There were 215 clinic

visits for chronic bron-

chitis at the three HSA

clinics and 44 visits at

the GVHC clinics. The

number of clinic visits

due to these two con-

ditions was deemed to be too sparse to analyze as separate conditions. They were included in

the broader respiratory illness analysis.

ATTA- C - PAGE 8 OF 16

D. Asthma Figure 8: Percentage of Clinic Visits Due to Asthma at Stanislaus

There was a sufficient County Health Services by Season.

number of clinic visits

to evaluate asthma.

Figures 7 and 8 show

the four-year seasonal

trends in the propor-

tion of visits due to

asthma at the six clin-

ics. Figure 7 shows

that there is an up-

ward trend at the

Westley and Newman

GVHC clinics while the

other four clinics

(Patterson in Figure 7

and the others in Fig-

ure 8) remained rather

steady. There did not

appear to be much as-

sociation between the

percentage of clinic

visits due to asthma

diagnosis and the sea-

sons of the year.

Figure 9 shows the

95% confidence inter- I

Sum Wlin Sum Wlin Sum Win Sum Win Sum 1997 1998 1999 2000 2001

Fiqure 9: Percentaqe with 95% Confidence Intervals of all Clinic Vis- itsfor Asthma re-Fire and Post-Fire, HSA and GVHC Clinics.

Pre Pos t Pre Pos t Pre Pos t Pre Pos t Pre Pos t Pre Post Westley Patteison Newman Hughson Ceres Turlock I

vals for the pre and post fire asthma clinic visit percentages. The statistical tests show that

the Westley and Newman clinics did have a significant increase in the percentage of clinic vis-

its that were due to asthma. In addition, the percentage decreased significantly at the Turlock

and Hughson clinics.

ATTACHMENT C - PAGE '3 OF 16

Figure 10 was suggested

Figure 10: Number of Asthma Visits at the HSA Clinics and GVHC Clinics Combined by Season.

by our secondary reviewer

who recommended that

we graphically compare

the absolute number of

visits for asthma for the

GVHC and HSA clinics.

The numbers displayed

600

are not percentages;

rather, they are the actual

number of visits by sea-

fire. There was a notable rise in actual number of clinic visits at both sets of clinics during

500 -

400

300

200 --

son. These data show that

there is an up trend in ac-

While there was a significant increase in the percentage of asthrna clinic visits at Westley after

the tire fire, there was an equal increase seen a t the Newman clinic. If the increase was due

to the effects of the tire fire, we would have expected to see a gradient of increase, highest at

Westley, then Patterson and finally, a slight increase or no increase at Newman. Since this is

not what was observed, it is not clear what exactly is causing the increase in percentage of

clinic visits due to asthma. It is worth pointing out, that even after the significant increase at

these two GVHC clinics after the tire fire, they both still have a lower percentage of asthrna

clinic visits than the HSA Hughson clinic does. The Hughson clinic is also a rural clinic not

unlike the three GVHC clinics. There was a significant decrease in the percentage of clinic vis-

its due to asthrna at the Hughson clinic during the post tire fire time period, but it was still

higher than any of the other 5 clinics in the study. In summary, we did see an increase in the

percentage of clinic visits due to asthma at the Westley clinic; however, we also saw the same

increase at the Newman clinic and these increased percentages of clinic visits due to asthma is

not out of line with other rural clinics in the area.

I

1 L. -.. -... rn . . , -. . ...- - . . . .I

. '. I- - L. . :

,- '-= . . . . . . . . i . '

Y k.

100 -

0 Fall Spr Fall Spr Fall Spr Fall Spr 1997 1998 1999 2000 2001

I - --4

0 = - tual number of asthrna visits at both sets of clinics, and that the up trend preceded the tire

The current study appears to be unprecedented, at least from a review of the literature. As of

March 2002, a search of the international literature through the National Library of Medicine

revealed the following citations. Tire fire: 0 citations. Petroleum fires: 71 citations. Forest

fires: 106 citations

The fire chemically closest to the tire fire is a petroleum fire. Citations referenced such things

as oil refineries and the Gulf War in Kuwait. Massive tire fires have potential health effects;

however, there is a dearth of published studies regarding the health effects. We accessed

memoranda regarding four tire fires (refs 1, 2, and 4):

Everett, Washington - 1984

El Paso, Texas - 1997

Tracy, California - 1998

The Everett fire burned for two months. The study is primarily a risk assessment for lung can-

cer. The risk to the nearby communities, including Seattle, was assessed as minimal.

The major finding of this study was the increase in total visits for asthma at the six clinics

studied. Asthma is a syndrome rather than a specific disease. The known intrinsic risk factors

are age, gender, family history of asthma and premature birth. The extrinsic risk factors are

cigarette smoke, dust mites, cockroaches, household pets, pollens, indoor mold, and air pollu-

tion (ref. 5). The air pollution that has been studied as a cause of asthma (see refs. 6-8), has

been a CHRONIC environmental exposure rather than short-term. There has not been a study

specific to tire fires. Moreover, there is not a specific biologic marker for tire fire by-products,

such as is used epidemiologically and medically for environmental lead poisoning. Last, there

were other significant environmental insults occurring at the same time as the Westley tire

fire. There were forest fires burning in northern California that were contributing significant

amounts of smoke to our air during the month that the tire fire was burning.

ATTACHMENT C - PAGS 11 OF 16

Critique and Limitations of Study

This is a screening study, which used electronic data. There was no chart review.

This study has all of the problems associated with studies that rely on the use of ICD-9 codes.

Such coding can vary by physicians and clinic system, which could create artificial variation.

Demographic data confirms a sample bias with over-representation of the Hispanic population

due to the clinics selected.

There is an assumption that residents of these communities attended the clinic closest to their

home so that if there was a gradient of illness, then the there would also be a gradient of res-

piratory illness visits to the clinics. This assumption might not be true. Some individuals near

the fire could have seen a doctor for an illness related to the fire at a clinic quite removed from

the fire.

This was not a population-based study. Data was analyzed from two clinic systems and from

just three clinics within each system. It did not include information from other physicians who

may have treated patients with illnesses related to the fire. Not all residents in the six commu-

nities in this study use the six clinics included in this study.

We were unable to obtain unduplicated patient visits. It is likely that patients with respiratory

illness had multiple clinic visits, before and/or after the tire fire.

This study is an ecological study. We do not have unique exposure measurements on indi-

viduals. We are assuming that everyone that lived in Westley was exposed. We also are as-

suming that the individuals living elsewhere (Turlock) were not exposed. This lack of informa-

tion about the individual's exposure severely limits our ability to discuss causality.

There are potential problems with confounding factors in this study. We do not have informa-

tion on other exposures that individuals in this study might have had independent of the tire

fire. I n fact, there are possible respiratory visits after the fire of persons not exposed -- for ex-

ample, newborn and migrant families.

ATTAC3DENT C - PAGE 12 OF 16

Conclusions

Hvpothesis #I: I s there a higher percentage of clinic visits for respiratory illness after the tire

fire? For all respiratorv illness, there was not an increase after the fire. The main pattern was

seasonal. The only increase was seen in Newman, away from the fire and there was a relative

downtrend in two HSA clinics. For asthma, there probably was an increase after the fire.

There was a lack of a seasonal pattern, unlike with the total respiratory illness graph. The

highest percentages of asthma visits were in the central county HSA clinics. The Newman and

Westley GVHC clinics increased after the fire to the level of the HSA Ceres clinic. The HSA

Hughson clinic had a higher percentage of asthma visits than the other five clinics.

Hvoothesis #2: I s there a higher percentage of visits due to respiratory illness at the clinics

closest to the fire? For all respiratorv illness, there was no pattern associated with the fire.

For asthma, there possibly was a pattern of clinic visits associated with the fire. There was an

increase in the percentage of clinic visits at the Westley clinic (the clinic closest to the fire), but

there was an equal increase at the Newman clinic.

I n summary, the study findings are suggestive but not conclusive because the secondary elec-

tronic data could not control for confounding factors. In addition, the findings show an abso-

lute increase in the number of clinic visits for asthma during the four-year study period. It is

premature to assess a cause-effect relationship between the tire fire and the increases, espe-

cially since the up trend pre-dated the fire at several clinics studied.

Recommendations

1. Refrain from assigning cause-effect conclusions from the current screening study.

2. The findings will be presented in at least three forums for review. They will be presented at

the State Environmental Health Committee (CCLHO/CCDEH joint committee), the Stanislaus

County Board of Supervisors, and the Golden Valley Health Clinics Board of Directors.

3. Participate in the statewide asthma projects sponsored by the Department of Health Ser-

vices.

4. Create a county asthma coalition for prevention, education, and treatment. HSA will focus

on educational and prevention programs to address the up trend in asthma cases.

5. No further research at the local level. The issues are too complex. I f further research is

warranted, it should be done by expert researchers within the field of environmental health

epidemiology, such as a university-based program, or a school of Public Health.

Acknowledgments:

This study was financed by the Stanislaus County Department of Environmental Resources. We would like to acknowledge the partnership that was formed with GVHC and the tremendous cooperation that was shown. I n particular, David Campa, MD, MPH was very helpful with comments on the study and review of ICD-9 diagnosis codes. We also received help in our re- view of ICD-9 codes from Kathy Passanisi at the Stanislaus County, Health Services Agency. Also, we appreciate the secondary data review by Richard Kreutzer MD, Chief of the Environ- mental Health Investigations Branch, CA Department of Health Services.

ATTACXMENT C - PAGE 1 4 OF 16

References:

A. Tire Fires

1. U.S. Environmental Protection Agency (Region 10) Seattle, Washington. "An Assessment of Lung Cancer from the 1984 Tire Fire in Everett, Washington." October 1986.

2. U.S. Environmental Protection Agency, Office of Research and Development, Washington, D.C. 'Air Emissions from Scrap Tire Combustion." EPA-6001R-97-115, October 1997.

3. CA Integrated Waste Management Board. 'Evaluation of Employee Health Risk from Open Tire Burning." LEA Advisory #46, Publication No. 232-97-019, November 6, 1997.

4. CA Air Resources Board. "Tracy Tire Fire Emergency Response." September 3, 1998.

B. Asthma and Environment

5. Gergen PJ, and Weiss KB: "Epidemiology of Asthmar' in Asthma and Rhinitis (Busse and Holgate, eds), Blackwell Science, chapter 3, pp 15-31, 1995.

6. Perera FP, et. al. : "The challenge of preventing environmentally related disease in young children; community-based research in New York City", llO(2): 197-204, 2002.

7. Gurkan F, et. al. : "Asthmatic children and risk factors at a province in the southeast of Turkey", Allercl Immuno~ath , 30(1), 25-29, 2002.

8. Pandya RJ, et. al. : "Diesel exhaust and asthma: hypotheses and molecular mechanisms of action", Environ Health Perspect, llO(suppl 1): 103-112, 2002.

AmACHMENT C - PAGE 15 OF 16

Appendix A

February 27

March 21

May 11

June -July

Aug - Sept

September 22

October 9

November 30

January

Januarv 23

February 27

Westley Tire Fire: Public Health Evaluation

2001

Presentation to the Board of Supervisors

Wesley/Grayson Community Meeting

Meeting of State Health/Environmental consultants and com- munity representatives (study questions posed)

Meeting &site visits to Golden Valley Health Centers

Data received

Second Anniversary of the tire fire

Second Presentation to the Board of Supervisors

Review of preliminary analysis with GVHC

Secondary Analysis

Presentation to the state CCLHO/ CCDEH Environmental Health Commit- tee

Third meeting with Golden Valley & Conference call with state health of- ficials

ATTACHMENT C - PACE 16 OF 16