Health and Safety: DOE's Implementation of a Comprehensive Health
Surveillance Program Is Slow (Letter Report, 12/16/93, GAO/RCED-94-47).

Workers in the Energy Department's (DOE) industrial complex are at risk
of exposure to ionizing radiation, potentially toxic chemicals, and
other health hazards.  A 1989 DOE panel recommended that the agency
implement a health surveillance program to systematically collect and
analyze data on workers' health and workplace conditions to detect
illnesses or health trends linked to workplace exposure.  In the 4 years
since, DOE has not fully implemented such a program.  DOE attributes the
delays to technical difficulties and staffing shortages, although GAO
believes that a lack of program planning has also been a contributing
factor.  DOE now projects full program implementation by 1998.  Until a
comprehensive program is developed, DOE will continue a program that
began at the University of Washington in 1983--one that is limited to
analyzing patterns of illnesses and injuries on the basis of information
provided by DOE sites.  A lack of complete reporting of illnesses and
injuries, however, limits the current program's ability to flag the
occupational diseases, injuries, and premature deaths that threaten
workers.  Expanding the program to additional sites without correcting
these problems will simply make a program with limited effectiveness
larger and will do little to improve the health of DOE workers.

--------------------------- Indexing Terms -----------------------------

 REPORTNUM:  RCED-94-47
     TITLE:  Health and Safety: DOE's Implementation of a Comprehensive 
             Health Surveillance Program Is Slow
      DATE:  12/16/93
   SUBJECT:  Nuclear facility safety
             Occupational health/safety programs
             Safety standards
             Health hazards
             Health research programs
             Environmental monitoring
             Working conditions
             Radiation exposure hazards
             Program evaluation
             Data collection operations

             
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Cover
================================================================ COVER


Report to the Chairman, Committee on Governmental Affairs, U.S. 
Senate

December 1993

HEALTH AND SAFETY - DOE'S
IMPLEMENTATION OF A COMPREHENSIVE
HEALTH SURVEILLANCE PROGRAM IS
SLOW

GAO/RCED-94-47

Health and Safety


Abbreviations
=============================================================== ABBREV

  DAS - Deputy Assistant Secretary
  DOE - Department of Energy
  GAO - General Accounting Office
  OEHS - Office of Epidemiology and Health Surveillance
  OSHA - Occupational Safety and Health Administration
  SPEERA - Secretarial Panel for the Evaluation of Epidemiologic
     Research Activities

Letter
=============================================================== LETTER


B-255212

December 16, 1993

The Honorable John Glenn
Chairman, Committee on
 Governmental Affairs
United States Senate

Dear Mr.  Chairman: 

Activities within the Department of Energy's (DOE) industrial complex
expose workers to ionizing radiation, potentially toxic chemicals,
and other health hazards.  In this environment, thousands of safety
and health incidents are reported at DOE facilities each year.  DOE
and its contractors manage occupational health programs throughout
the complex and conduct studies that evaluate the health effects of
its industrial activities.  Beginning in 1983, several external
reviews have questioned DOE's ability to credibly evaluate the
effects of its activities on workers' health. 

In response to these concerns, in 1989, the Secretary of Energy
established the Secretarial Panel for the Evaluation of Epidemiologic
Research Activities (SPEERA) to independently evaluate the overall
quality of DOE's occupational health activities.  SPEERA concluded
that, although DOE had operated health-related programs at its
facilities, it lacked a comprehensive occupational and environmental
health program designed to prevent occupationally related diseases,
injuries, and premature deaths.  SPEERA recommended, among other
things, that DOE implement a health surveillance program to
systematically collect and analyze data about workers' health and
workplace conditions in order to detect illnesses or health trends
that indicated possible adverse effects of workplace exposures.  In
March 1990, the Secretary directed that DOE establish a comprehensive
health surveillance program.  In February 1991, at your request, we
reported on the status of DOE's implementation of the SPEERA
recommendations.\1

Because of your continuing concern about the effects of DOE's
activities on workers' health, your office asked us (1) to determine
the status of DOE's efforts to implement a comprehensive health
surveillance program and (2) to assess the effectiveness of DOE's
current program. 


--------------------
\1 Nuclear Health and Safety:  Efforts to Strengthen DOE's Health and
Epidemiology Programs (GAO/RCED-91-57, Feb.  5, 1991). 


   RESULTS IN BRIEF
------------------------------------------------------------ Letter :1

Although almost 4 years have passed since the Secretary directed the
establishment of a comprehensive health surveillance program, DOE has
not fully implemented such a program.  For example, DOE is still
unable to determine if exposures to hazardous substances at DOE sites
cause workers' illnesses or injuries because DOE does not routinely
analyze workplace exposure data.  DOE now projects full program
implementation, including analyses of workers' occupational
exposures, by 1998.  According to Office of Health officials,
technical difficulties and a continuing staffing shortage within the
Office of Health have contributed to delays in implementing a
comprehensive program.  However, a lack of program planning has also
contributed to delays in implementation.  Recently, to facilitate
program implementation, the Deputy Assistant Secretary reorganized
management responsibility for the program within the Office of
Health. 

Until a comprehensive program is developed and implemented, DOE will
continue to operate a program that began as a pilot at the University
of Washington in 1983 and is limited to analyzing patterns of
illnesses and injuries based on workers' information provided by the
sites.  However, the current program covers only about 40 percent of
DOE's workforce, and the reports provided back to the sites by the
program are not always timely and useful.  Because workers' injuries
and illnesses are not always reported, the current program may not
provide the early warning of potential workplace hazards needed to
protect workers from occupationally related diseases, injuries, and
premature deaths.  The Office of Health is in the process of
improving the timing and organization of the current program's
reports and plans to expand the current program to additional sites
in 1994. 


   BACKGROUND
------------------------------------------------------------ Letter :2

Beginning in the 1980s, several external reviews identified problems
with DOE's management of its health-related programs.\2 Among other
things, these reviews pointed out that DOE was not effectively
overseeing its health programs and lacked credibility in its research
activities on the health effects of workers' exposures to radiation
and hazardous materials. 

Acknowledging that problems existed within DOE's health-related
programs, in August 1989, the Secretary of Energy established SPEERA
to make recommendations on the management, organization, and
reporting structure of the various DOE programs involved in
epidemiologic research activities.  In March 1990, SPEERA concluded
that the majority of DOE's epidemiologic research had focused on
long-term studies related to workers' deaths and was not being
optimally used to monitor the day-to-day health of workers or to
understand the incidence of disease associated with DOE's activities. 
SPEERA made 55 specific recommendations to improve the credibility
and management of DOE's epidemiology and health surveillance
programs.\3 In addition to recommending that DOE turn over the
management of long-term epidemiologic research to the Department of
Health and Human Services, SPEERA recommended that DOE establish a
comprehensive health surveillance program to identify health risks
within the weapons complex as early as possible. 

On March 27, 1990, in response to SPEERA's recommendations, the
Secretary created the Office of Health under the Assistant Secretary
for Environment, Safety and Health to consolidate DOE's health
activities.  In addition, the Secretary directed the establishment of
a comprehensive health surveillance program to meet the health and
safety needs of workers throughout DOE's industrial complex.  On May
18, 1990, the Acting Assistant Secretary of Environment, Safety and
Health submitted an implementation plan for the Office of Health to
the Secretary.  Included in the plan was an implementation schedule
for DOE's epidemiology program.  The plan projected full
implementation of the health surveillance program by March 31, 1992. 


--------------------
\2 DOE's Safety and Health Oversight Program at Nuclear Facilities
Could Be Strengthened (GAO/RCED-84-50, Nov.  30, 1983).

Safety Issues at the Defense Production Reactors, National Research
Council, National Academy Press (1987).

The Nuclear Weapons Complex:  Management for Health, Safety, and the
Environment, National Research Council, National Academy Press
(1989).

Complex Cleanup:  The Environmental Legacy of Nuclear Weapons
Production, Office of Technology Assessment, OTA-O-484 (Feb.  1991).

Hazards Ahead:  Managing Cleanup Worker Health and Safety at the
Nuclear Weapons Complex, Office of Technology Assessment, OTA-BP-O-85
(Feb.  1993). 

\3 Epidemiology deals with the incidence, distribution, and control
of disease in a population.  Analyzing information about exposures
and illnesses among groups of people allows inferences to be made
about the causes of disease, and programs can be developed for
disease prevention and control.  Health surveillance, one of the
activities within DOE's epidemiology program, is the continual
evaluation of workers' exposures and illnesses. 


   IMPLEMENTATION OF A
   COMPREHENSIVE HEALTH
   SURVEILLANCE PROGRAM IS STILL 5
   YEARS AWAY
------------------------------------------------------------ Letter :3

Although almost 4 years have passed since the Secretary directed the
establishment of a comprehensive health surveillance program, DOE is
still at least 5 years away from such a program.  Without a
comprehensive program, DOE is unable to determine if workers'
illnesses and injuries are related to hazardous workplace exposures
at DOE sites.  Until July 1993, the Office of Epidemiology and Health
Surveillance (OEHS), one of three suboffices of the Office of Health,
had been responsible for developing and managing DOE's health
surveillance program.  According to DOE health officials, technical
problems and understaffing within the Office of Health have
contributed to delays in implementing a comprehensive health
surveillance program as planned.  However, a lack of program planning
has also contributed to delays in implementation. 


      DOE IS STILL DEVELOPING
      PROGRAM FUNCTIONS
---------------------------------------------------------- Letter :3.1

According to the OEHS Director, DOE is testing and implementing
functions for the comprehensive health surveillance program on a
modular basis.  The program consists of four modules, each of which
collects specific data from DOE sites.  The four modules are the
Health Events Module, the Demographic Module, the Exposure Module,
and the Clinical Module.  At the time of our review, the Health
Events and Demographic Modules were functioning, while DOE was still
developing the Exposure and Clinical Modules.  The Health Events
Module contains data on workers' illnesses and injuries, while the
Demographic Module contains descriptive and occupational information
about each worker, such as a coded identification number, birth date,
sex, race, job title, and work location.\4 Currently, these modules
analyze the workers' health and descriptive data to determine the
observed and expected rates of adverse health events that occur in
the workforce. 

To determine potential causes of observed illnesses and injuries and
to identify emerging health problems before disease is evident, DOE
plans to analyze information on workers submitted by DOE sites in the
Exposure and Clinical Modules.  The Exposure Module will contain
health physics and industrial hygiene exposure data for each worker. 
At DOE sites, health physics programs collect and maintain
information on workers' radiation exposures, and industrial hygiene
programs collect information on workers' exposures to other
industrial hazards--for example, exposures to chemicals, gases,
metals, and noise.  The Clinical Module will contain information from
workers' physical examinations and laboratory tests.  By eventually
combining and analyzing data from all of the modules, DOE will be
able to relate adverse changes in workers' health to workplace
hazards and, when necessary, initiate corrective actions to protect
workers' health. 

Each of the new modules is now being developed and must be tested and
refined at DOE sites before implementation.  According to the OEHS
Director, DOE plans to test the Clinical Module at four sites during
1994 and 1995, using workers' physical examination data currently
available at the sites' occupational medical departments.  Under this
same schedule, the Exposure Module will be tested using workers'
health physics data from several sites.  If the tests are successful,
the Clinical Module and health physics data will be incorporated into
the comprehensive health surveillance program by 1997.  However, DOE
does not expect to incorporate industrial hygiene exposure data into
the program until 1998 because the Office of Health must first work
with the Offices of Environmental Restoration and Defense Programs to
define the essential industrial hygiene hazards that workers are
exposed to and then define the types of measurements required for
workers.  According to the OEHS Director, many sites lack industrial
hygiene data that can be linked to individual workers.  Instead of
individual data, most sites collect data on chemicals, gases, and
other potential toxins through area sampling methods to determine
compliance with Occupational Safety and Health Administration (OSHA)
contaminant exposure standards.  Because the health surveillance
program requires exposure data for individual workers, most
industrial hygiene data that currently exist throughout the DOE
complex are not useful to the program. 


--------------------
\4 Each site assigns every worker a unique, permanent, coded
identification number to protect the confidentiality of workers
included in the program. 


      TECHNICAL PROBLEMS AND
      UNDERSTAFFING DELAY PROGRAM
      IMPLEMENTATION
---------------------------------------------------------- Letter :3.2

According to the OEHS Director, DOE's diverse activities and multiple
contractors complicate the effort to collect useful industrial
hygiene exposure data.  Because multiple contractors manage and
operate the sites, different methods are used to track and maintain
employee information.  Contractors' automated data processing
resources vary, which also affects contractors' ability to collect
and store records.  The Office of Health is currently funding a
project at the Lawrence Livermore National Laboratory to develop
better indicators of individual exposures to chemicals and other
potential toxins to support the Exposure Module.  However, the
results of the project are not expected until September 1994. 

According to the Deputy Assistant Secretary (DAS) of the Office of
Health, implementation of a comprehensive health surveillance program
has been slow because the Office of Health has not had sufficient
staff.  According to the OEHS Director, until January 1992, the
Office of Health had no occupational medical director, which hampered
efforts of headquarters staff to communicate with site medical
directors about requirements for a comprehensive health surveillance
program.  In addition, in 1990, the Office of Health proposed a staff
level of 86 by fiscal year 1992 to implement its plan.  According to
the OEHS director, he expected that 5 of the 86 would carry out the
development and management of the program.  In mid-1992, however, the
staff level was frozen at 65, and, through mid-1993, only one
full-time epidemiologist worked on the program.  According to the
OEHS Director, additional staffing is unlikely.  As a result, a
comprehensive program will not be fully implemented until 1998. 

In addition to limited staff resources, competing priorities within
the Office of Health have contributed to delaying program
implementation, according to the OEHS director.  Among the competing
priorities were the expansion of the monitoring program for beryllium
workers to the Y-12 population at Oak Ridge and the development of
DOE's comprehensive epidemiologic data resource. 

Moreover, lack of program planning within the Office of Health has
contributed to the delays in the program's implementation.  For
example, the most recent Health Surveillance Program Plan, dated
September 1993, does not contain an implementation strategy that
outlines the specific tasks to be accomplished or establishes
milestones for their completion.  According to the DAS, the Office of
Health has no written plan for completing the remaining tasks of the
comprehensive program because he views the development of the program
as an evolving process. 

In July 1993, the DAS assigned specific responsibility for developing
the health surveillance program to all three Office of Health
suboffices.  Before that, only one suboffice, OEHS, had managed the
program.  According to the DAS, this change was made to better
utilize the unique expertise of each suboffice in developing the
program's modules.  With this change, OEHS will retain responsibility
for the Health Events and Demographic Modules, the Office of Health
Physics and Industrial Hygiene will assume responsibility for the
Exposure Module, and the Office of Occupational Medicine will be
responsible for the Clinical Module.  According to the DAS, his
office is responsible for overall management of the program's
development, including coordination of the modules from each
suboffice. 


   CURRENT PROGRAM'S EFFECTIVENESS
   IS LIMITED
------------------------------------------------------------ Letter :4

Without a comprehensive health surveillance program, DOE is operating
a program that began as a pilot at the University of Washington in
Seattle in 1983.  The current program is limited to evaluating
patterns of illness at DOE facilities based on demographic
information provided by the sites (the Demographic Module) and
information on workers' injuries and illnesses (the Health Events
Module).  However, the coverage provided under this program is
limited, the reports generated are not timely, and it is questionable
whether the current program provides an early warning of health
problems because health data are not provided for all employees.\5


--------------------
\5 During fiscal year 1993, the Office of Health budgeted $4.5
million for its health surveillance program activities. 


      PROGRAM COVERAGE IS LIMITED
---------------------------------------------------------- Letter :4.1

As of September 1993, 7 of DOE's 33 facilities are participating in
the current program.  The seven facilities, the dates participation
began, and the approximate number of workers covered are shown in
table 1. 



                           Table 1
           
           DOE Contractor Workers Covered Under the
             Current Health Surveillance Program

Facility                                      Date   Workers
----------------------------------------  --------  --------
Hanford Site                                  1983    15,560
Idaho Falls                                   1983     5,150
Brookhaven Laboratory                         1989     3,460
Rocky Flats                                   1991     6,965
Savannah River                                1992    17,030
Fernald                                       1993     2,000
Sandia                                        1993     8,590
============================================================
Total                                                 58,755
------------------------------------------------------------
Although the seven facilities are among the largest DOE facilities,
about 60 percent of DOE's 150,000 contract workers still are not
included in the current health surveillance program.  The Office of
Health is testing the current program at selected cleanup sites,
production facilities, and national laboratories and plans to expand
the program to six more sites in 1994.  The DAS said that new sites
will be included in the program on the basis of the cleanup priority
given to sites by the Office of Environmental Restoration and Waste
Management, since the cleanup sites are where the hazardous exposure
risk is greatest for workers. 


      CURRENT PROGRAM'S REPORTS DO
      NOT MEET USERS' NEEDS
---------------------------------------------------------- Letter :4.2

At the participating sites, medical directors were concerned about
the reports received from the health surveillance program.  At the
time of our review, Savannah River, Fernald, and Sandia, relatively
new participants, had not yet received reports from the program
because of the time required to both train personnel on program
requirements and submit required data to the University of
Washington.  As a result, our review focused on the four sites that
had submitted data and received reports from the university.  While
the medical director at Brookhaven Laboratory was generally satisfied
with the current program, the directors at Hanford, Idaho Falls, and
Rocky Flats, as well as the contractor at the University of
Washington, had the following concerns: 


         TIMELINESS AND USEFULNESS
         OF REPORTS
-------------------------------------------------------- Letter :4.2.1

  The health surveillance program provides three regular reports to
     participating sites.  On a monthly or quarterly basis (the
     timing is based on each site's wishes), the program provides a
     report that summarizes the information on workers' illnesses and
     injuries received from the site.  On a semiannual basis, the
     program provides a more comprehensive analysis of workers'
     injuries and illnesses, reporting, by occupation, the observed
     and expected number of cases and the calculated risk for each
     type of illness or injury at the site.  Annually, the program
     reports to each site demographic analyses of its workforce--for
     example, the percentage of the workforce represented by each
     occupational group, by age and sex. 

  Three medical directors said that these reports add little value to
     the occupational health program at their sites.  Two medical
     directors said that by the time they receive the semiannual
     analysis from the program, they have already recognized and
     acted on any medical problems at their sites.  Two medical
     directors also told us that the report that summarizes illness
     and injury data has little utility because it simply lists the
     workers' medical incidents submitted by the sites.  One medical
     director said that physicians at his site typically see 15 to 30
     patients a day and have little time to analyze extensive data. 

  Office of Health officials agree that the reports have been a
     problem.  The officials told us that they have recently revised
     both the data submission requirements and report formats.  The
     program now requires sites to submit health data on a monthly
     basis, no later than 15 days after the end of the month.  DOE
     also has revised the reports to provide more comprehensive
     analyses, including illness trends at the sites.  These
     comprehensive reports will be returned to the sites at the end
     of each quarter, rather than on a semiannual basis. 


         USE OF JOB TITLES AS
         SURROGATE FOR WORKERS'
         EXPOSURES
-------------------------------------------------------- Letter :4.2.2

  Because the Exposure Module is not yet functioning, the current
     program uses job titles as an indication of the type of hazards
     to which a worker might be exposed.  According to the university
     contractor, without specific exposure data, knowledge of a
     person's job provides a first estimate of exposure to an
     occupational hazard; for example, nuclear reactor operators
     could be exposed to ionizing radiation.  However, both the
     contractor and one of the medical directors said that the broad
     job classifications, that are often used at sites, such as
     "Specialist," "Experienced," "Non-Exempt," and "Professional,"
     provide few specifics about potential exposures. 

  Broad job titles affect the program's ability to efficiently
     investigate occupational hazards and protect workers' health. 
     As the program currently operates, if a greater than expected
     number of health events are observed at a site, such as an
     unexpectedly high number of respiratory problems, an
     investigation is carried out, using the job titles as the first
     step toward determining a potential occupational hazard. 
     According to the university contractor, investigation of
     respiratory problems could proceed more efficiently if the job
     titles better reflected more specific information about the type
     of work performed and, thus, about potential hazards. 

  Office of Health officials told us that the use of job titles will
     be replaced when the Exposure Module is incorporated into the
     program.  Until the Exposure Module is functioning, however,
     separate analyses will be provided for workers in occupations
     for which known hazards exist in the work environment.  For
     example, the program will provide separate analyses of injuries
     and illnesses for asbestos, beryllium, or lead workers. 


         NO AGGREGATE ANALYSIS OF
         WORKERS' DATA
-------------------------------------------------------- Letter :4.2.3

  Medical directors at two sites were concerned about the limitations
     of the current site-by-site analysis of the medical data.  In
     addition to site-specific reporting, the directors said that the
     medical data from all the sites should be aggregated and
     analyzed.  Both directors considered the amount of individual
     site population data too small to provide statistically precise
     estimates of health risks within the complex.  Furthermore, the
     directors noted that by pooling the data, each site could
     compare its own experience to the DOE complex as a whole.  The
     chairperson of the SPEERA panel told us that aggregate analysis
     would provide more powerful statistical analysis because the
     number of illnesses at any one site may not be enough to detect
     trends.  She also noted that providing participating medical
     directors with DOE-wide analysis of workers' medical data would
     allow them to compare workers' experiences at their site with
     the DOE experience as a whole. 

  According to the OEHS Director, aggregate analysis of data will be
     provided to participating sites in 1995.  The director also said
     that the program has not conducted this type of analysis to date
     because of the small amount of data on workers available under
     the current program. 


      CURRENT PROGRAM MAY NOT
      PROVIDE EARLY WARNING OF
      HEALTH PROBLEMS
---------------------------------------------------------- Letter :4.3

The current health surveillance program's ability to provide early
warnings of potential hazards at DOE sites is questionable because
health events data are not provided for all workers.  DOE depends on
return-to-work medical clearances as the primary source of data on
injuries and illnesses for the Health Events Module.  A physician in
the site's occupational medical department completes the
return-to-work form, certifying that an employee is physically able
to return to work.  The form reports identification information, the
number of days absent, and, most importantly, the type of illness or
injury. 

Although required by DOE's Occupational Medical Order (DOE Order
5480.8A), workers' compliance in obtaining these medical clearances
is limited, particularly among salaried staff.  DOE's Savannah River
Site medical administrator told us, for example, that only 60 to 70
percent of salaried employees are cleared by the medical department
after an absence.  A 1989 study at the Hanford Site found that only
60 percent of the salaried workers were cleared by the medical
department while 87 percent of the hourly workers were cleared. 
Information on salaried workers is important because these employees
usually have had long experience on the shop floor prior to becoming
salaried employees.  Because many occupationally induced diseases,
from cancer to mercury intoxication, can have long induction and
latent periods, some illnesses may only become apparent long after a
worker is exposed. 

Moreover, employees with major illnesses or injuries who do not
return to their jobs are not issued the return-to-work clearances. 
Thus, major illnesses are not reported in the Health Events Module. 
For example, in 1991, the university contractor compared Hanford's
cancer data in the Health Events Module with national cancer data
over the period 1985 to 1990.  Among Hanford's 60 to 64 age group, he
found 39 percent of the cases he expected when he compared Hanford's
data with the national cancer data.  For the 65 to 69 age group at
Hanford, he found only 28 percent of the cases expected.  The most
plausible explanation, according to the contractor, is that people
who become sick and have cancer diagnosed often simply retire. 
However, these elderly workers are the very group that will suffer
from any cancers induced by occupational exposure 10 or 20 years
earlier. 

Because not all injuries and illnesses are reported, DOE's current
health surveillance program may not be an effective early warning
system.  The university contractor told us that the program has no
way of knowing the completeness of workers' health data sent by the
sites.  According to the contractor, no verification procedures are
used; the program simply accepts the submitted data.  The contractor
also told us that limited compliance with DOE orders, such as the
return-to-work clearance procedures, results from DOE's general lack
of control over the site contractors. 

According to the OEHS Director, the office is taking steps to
determine the extent of incomplete reporting of injuries and
illnesses by the participating sites.  For example, the office is
exploring alternative sources, including state cancer registries, for
identifying any additional cases of cancer occurring in the work
force.  In addition, a comparison of return-to-work clearance records
with payroll information is being conducted at Rocky Flats to
identify workers with absences due to illness who did not clear
through the medical department.  DOE also intends to follow this
method at all participating sites and develop incentives for sites to
increase their compliance rates when necessary. 


   CONCLUSIONS
------------------------------------------------------------ Letter :5

DOE has not implemented the comprehensive health surveillance program
SPEERA envisioned in 1990.  Resource constraints, competing
priorities, and most importantly, the lack of a clear approach for
completing the program's remaining components means that a
comprehensive program will not exist until 1998, if then.  Recently,
the Deputy Assistant Secretary of the Office of Health assigned
responsibility for developing the program modules to the offices
possessing the right expertise.  However, unless a plan is developed
that establishes an implementation strategy, identifies specific
milestones for completing the remaining tasks, and assigns adequate
resources, the 1998 goal may not be met. 

While DOE is improving the timing and organization of reports
provided to the sites participating in the current program, the lack
of complete reporting of illnesses and injuries limits the current
program's ability to provide the early warning of health hazards
needed to protect workers from occupationally related diseases,
injuries, and premature deaths.  Expanding the current program to
additional sites before correcting the problems already identified
will simply make a program with limited effectiveness larger and will
not contribute to improving the health of DOE's workers. 


   RECOMMENDATIONS
------------------------------------------------------------ Letter :6

We recommend that the Secretary of Energy direct the Assistant
Secretary of Environment, Safety and Health to

  develop an implementation plan for a comprehensive health
     surveillance program that outlines the tasks to be performed, as
     well as specific milestones based on the priority and resources
     assigned and

  correct the data collection problems in the current program before
     expanding it to additional DOE sites. 


---------------------------------------------------------- Letter :6.1

We performed our review between July 1992 and October 1993 in
accordance with generally accepted government auditing standards.  We
interviewed DOE headquarters officials and the DOE contractor who
operates the current health surveillance program at the University of
Washington in Seattle.  We also interviewed the occupational medical
directors at Hanford, Idaho Falls, Rocky Flats, Brookhaven
Laboratory, and Savannah River, as well as the chairperson of the
SPEERA panel.  (See app.  I for details on our objectives, scope, and
methodology.)

We discussed the facts presented in the report with DOE program
officials, including the Deputy Assistant Secretary, Office of
Health.  In general, they agreed the information was both factual and
presented from a balanced perspective.  However, the officials
provided additional information about both the planned completion
date of 1992 for the comprehensive program and the responsibilities
of the Office of Health suboffices before the July 1993
reorganization.  We made changes in the report where appropriate.  As
requested by your office, we did not obtain written agency comments
on a draft of this report. 

As arranged with your office, unless you publicly announce its
contents earlier, we plan no further distribution of this report
until 30 days after the date of this letter.  At that time, we will
send copies to DOE and other interested parties.  We will make the
report available to others on request. 

This work was performed under the direction of Victor S.  Rezendes,
Director, Energy and Science Issues, who may be reached at (202)
512-3841.  Major contributors to this report are listed in appendix
II. 

Sincerely yours,

J.  Dexter Peach
Assistant Comptroller General


OBJECTIVES, SCOPE, AND METHODOLOGY
=========================================================== Appendix I

Concerned about the health effects of the Department of Energy's
(DOE) industrial activities on workers, the Chairman, Senate
Committee on Governmental Affairs, asked us to determine the status
of DOE's efforts to implement a comprehensive health surveillance
program and to assess the effectiveness of DOE's current program.  To
determine the status of the program, we (1) reviewed recommendations
to DOE from external organizations regarding DOE's health and safety
programs; (2) interviewed DOE headquarters officials about the
program's implementation; (3) reviewed relevant DOE directives,
orders, and program plans; and (4) interviewed the chairperson of
DOE's Secretarial Panel for the Evaluation of Epidemiologic Research
Activities. 

To assess the effectiveness of the current health surveillance
program, we interviewed (1) DOE headquarters officials regarding the
program's procedures and reports and (2) the program contractor at
the University of Washington and occupational medical directors at
five DOE sites regarding their views of the program.  We selected the
five DOE sites that had participated in the current health
surveillance program for at least 1 year. 


MAJOR CONTRIBUTORS TO THIS REPORT
========================================================== Appendix II

RESOURCES, COMMUNITY, AND ECONOMIC
DEVELOPMENT DIVISION, WASHINGTON,
D.C. 

Jim Wells, Associate Director
James Noï¿½l, Assistant Director
Edward E.  Young, Jr., Assignment Manager
Anne McCaffrey, Evaluator-in-Charge

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