Human Biomonitoring (HBM) and Geospatial Mapping Applied to Determining Imminent and Proximate Threat to Human Safety at a Federal Superfund System

The World Wide Leaders in Healthcare -Ahimsa Porter Sumchai, MD -Stanford Fellowship Board Certified in Emergency Medicine -Inductee International Association of Emergency Medicine 2011–2012 Publication

The term emergency can can be applied to any situation where urgent and immediate action is required to mitigate or prevent an adverse situation that threatens public health, property and the environment. California abides by two sets of laws governing the decision to declare or proclaim a public health emergency in order to exercise extraordinary powers to respond to an emergency.

https://www.nationalacademies.org/our-work/human-biomonitoring-for-environmental-toxicants

Biomonitoring detects pollution in people. As a method for measuring toxic chemicals in human tissues, HBM is a proven tool for studying harmful environmental chemicals to confirm exposures and validate public health policies. Population biomonitoring was first applied to environmental public health in the U.S. Environmental Protection Agency’s regulatory reduction of lead in gasoline on January 1, 1986.

“HBM is the only way to identify and quantify human exposure and risk, elucidate the mechanism of toxic effects and ultimately decide if measures have to be taken to reduce exposure. Risk assessment and risk management without HBM leads to wrong estimates and inadequate measures.” Human Biomonitoring: State of the Art, Jurgen Angerer et al. Int J Hyg Environ Health May 2007

Historical timeline human biomonitoring in the U.S. — the 1993 NHEXAS research opened the door to a modern era of human biomonitoring for an aggregate of chemicals being detected by the Hunters Point Community Biomonitoring Program in 2021

Biomonitoring for measuring and detecting toxic chemicals in human tissue was enacted by the EPA in 1967 when the National Human Monitoring Program (NHMP) used an exposure based assessment to detect pesticides in fatty tissue.

HBM was used to reduce human exposures to lead, PCB’s and the pesticide DDT. The modern era of HBM began in 1993 when the National Human Exposure Assessment Survey addressed human exposures to multiple chemicals including metals, pesticides and volatile organic compounds using aggregate analysis. An Overview of the National Human Exposure Assessment Survey — https://cfpub.epa.tov/si/si_public_record_report.cfm?dirEntryld=61422&Lab=NERL

The National Research Council 1991 report, Human Exposure Assessment for Airborne Pollutants concludes “monitoring the environment by identifying and measuring concentrations of chemicals in media (e.g. air, water and soil )is not -by itself- an adequate basis for assessing human exposures. HBM offers an improved understanding of potential health risks through the detection of “biomarkers” of exposure that indicate the progressive response to exposures in the human body that lead to disease… before disease occurs.”

Human Exposure Assessment for Airborne Pollutants — https://www.nap.edu/catalog/1544/human-exposure-assessment-for-airborne-pollutants-advances-and-opportunies

The Radium Girls…they paid with their lives…their fight was for justice!

“If it hadn’t been for these dial painters thousands of workers might well have been in great danger.” US Atomic Bomb Commission

The earliest example of workplace medical monitoring is the tragic story of the Radium Girls — female factory workers who contracted radiation poisoning from painting watch dials with luminous paint that contained radium in the early 1920's. Over 30 deaths were documented in women as young as 20 after the Radium Dial Company faced an increased military demand for watches during the World War I era.

To maximize profit they hired girls as young as 11 to paint numbers onto watch faces in assembly line fashion, instructing them to “lip-dip” the paint brushes to speed up the process. The “ghost girls” glowed in the dark as radium accumulated in their bones and teeth.

By 1926 it became obvious radium was causing a spectrum of disease— including necrosis of the jaw, fractures, hemorrhage and stillbirths. Cancer rates skyrocketed and by 1936 over $90,000 in medical settlements had been paid by the U.S. Radium Corp.

Xrays of the women showed their jaws and bones “riddled with holes like honeycombs.”As they began to die, doctors paid by U.S. Radium Co, defamed them by publicly announcing their deaths were due to syphilis.

Pierre & Marie Curie — their remains are so radioactive they are interred in one inch thick lead coffins to prevent radium 226 exposures from harming visitors to the Pantheon.

In 1934 the lethal effects of radiation were sensationalized when Madame Marie Curie, the Nobel Prize winning scientist who discovered radium, died of aplastic anemia. The first “Radium Girl”, 87 years after her death Madame Curies’ remains are dangerously radioactive… and are expected to remain so for the 1,500 half life of radium 226.

Amelia “Mollie” Maggia and The Radium Girls — the exhumed bodies of factory workers exposed to radium glowed in their coffins.

Human biomonitoring was used to seek justice for the wrongful deaths of the Radium Girls that included xrays and autopsy examination. Amelia “Mollie” Maggia was the first to die. She was 24 years old. Mollie suffered from jaw pain and tooth loss before a dentist pulled out a decayed segment of her jaw. On October 15, 1927 her body was exhumed.

“At 3:30pm, Berry walked up to the grave with Dr. Matland and a cohort of New York doctors who would lead in conducting the autopsy. There were thirteen officials gathered to witness “Mollie’s” exhumation. Mollie’s body could provide corroborative evidence for the dial painters fight in court. Despite the dim fall day, the coffin seemed to glow with an unnatural light— the inside of the coffin was aglow with the soft luminescence of radium.” Burning Bones helped prove that women were poisoned by glowing paint — https://www.popsci.com/autopsy-dying-radium-poisoning/

History repeats itself and the September 2018 the discovery of a radium dial in a newly developed residential neighborhood on a federal Superfund site in southeast San Francisco prompted the second collaborative effort in a decade to institute a human biomonitoring program at the Hunters Point Naval Shipyard.

Gamma scanning conducted by the California Department of Public Health detected over 200 above background gamma emitting soil anomalies on Parcel A of the Hunters Point Naval Shipyard.

In March of 2009, a research collaboration led by community scientists and academic researchers submitted a proposal to the National Institute of Environmental Health Sciences for $2.5 million in community exposure funds to conduct human biomonitoring and simultaneous air monitoring in Bayview Hunters Point. While the proposal was not funded, the team persisted and ultimately paved the way for the January 2019 launch of the Hunters Point Community Biomonitoring Program and it’s public benefit non-profit.

HP Biomonitoring conducts urinary screenings on residents and workers within the one mile perimeter of the shipyard that detail dangerous clusters of toxic exposures and associated diseases. Using a urinary screening test capable of detecting up to 35 chemical “toxicants, HP Biomonitoring is detecting patterns of exposure specific to the shipyards known contaminants including radioactive agents of disease. Additionally, HP Biomonitorings’ trailblazing work is establishing cause and effect relationships between toxic chemicals and diseases.

The HP Biomonitoring “ROC” cluster (radionuclides of concern) combines the findings of urinary screenings with geospatial mapping of radioactive biomarkers detected at the residence and/or worksite. The cluster of radioactive biomarkers in the mapping tracks eastward along the historic entrance at 3rd & Palou toward the chemical and radiation contaminated Parcel E shoreline.

HP Biomonitorings’ South Basin Cluster maps the statistically unlikely detection of four elements found in toxic concentrations in “neighbors” centered around the shipyards contaminated South Basin region and Palou street entry. The four elements detected are arsenic, gadolinium, manganese and vanadium. In 16 screenings three or four of the elements have been detected in concentrations above allowable levels.

Manganese has been detected with 100% frequency in screenings conducted on residents of both Hunters Point and Treasure Island. Manganese has a 100% detection frequency in shipyard soils owing to its use in steel production and its natural presence in the serpentinite bedrock of the region. 90% of manganese used globally is in the conversion of iron to steel.

By contrast, manganese was detected only 19% of the time in 357 urinary screenings conducted by Biomonitoring California:

HP Biomonitoring is incorporating the advanced EPA screening tool EJSCREEN in it’s mapping and environmental analysis to increase the power of interpreting individual urinary screenings.

EJSCREEN: Environmental Justice Screening and Mapping Tool/US EPA

By typing the location into the search bar, EJSCREEN colorfully displays eleven environmental indicators. Risk of exposure to diesel particulates, ozone, lead based paint and proximity to Superfund sites and hazardous waste are mapped. Air toxics cancer risk and respiratory hazard index are calculated along with the EJ Index that incorporates social factors including population size, income levels and percent people of color, under age five and over 65.

EJSCREEN mapping of air toxics cancer risk identifies Bayview district risks in the 87th to 100th percentile. The Hunters Point Shipyard is off line to mapping but the EJSCREEN Standard Report identifies an 87th percentile ranking for NATA cancer risk for the federal Superfund site and neighboring Yosemite Slough.
EJSCREEN Standard Report for the Hunters Point Naval Shipyard and South Basin Region. The majority of variables exceed the 90th percentile for the US population.
HP Biomonitoring conducted a urinary screening on a doctor diagnosed with multiple brain, lung and auditory nerve tumors mapped in the South Basin Cluster. Arsenic, gadolinium and manganese are detected in toxic levels. Rubidium, thallium and copper are detected in high normal to potentially toxic concentrations.

HP Biomonitoring has mapped a cluster of cancers linked to airborne radiation and chemical exposures by the Atomic Bomb Survivor Data Base, the VA Environmental Health Registry and the World Trade Center Health Program.

Eight types of cancers detected in shipyard residents and workers are assigned a pin color mapping the residence and/or work site. The color code for pin assignments is red — breast cancer, green — thyroid cancer, yellow — brain/nervous system, blue — cancer of the airways and lung, white — leukemia/lymphoma. The black pin is reserved for deaths in dogs due to radiation induced canine fibrosarcoma. The mapping closely corresponds to the HP Biomonitoring ROC cluster.

Cancer is the leading cause of death of atomic bomb survivors
Bar graph comparisons of emergency department visits and hospitalizations shows the disproportional impacts the 94124 zip code faces for a range of cardiopulmonary diseases linked to air pollution that include congestive heart failure, adult and childhood asthma, COPD and pneumonia.
EJSCREEN mapping of fine particulate exposure documents the entire southeast region to be blanked in PM 2.5 in the 90th percentile of exposure compared to the US population.
Hunters Point Shipyard hilltop homeowner for 20 years underwent urinary screening during an asthma attack triggered when she “sees dust” in her environment. Soil elements documented to be present in Parcel A soils are detected in high normal to toxic concentrations including cadmium, cesium, nickel, rubidium, thallium, tungsten, copper, lithium, manganese, vanadium, zinc and potassium.
All elements detected on urinary screening of a hilltop resident during an asthma attack are listed by the EPA or HRA as chemicals or radionuclides used at the shipyard except tungsten and lithium. Tungsten is used in heavy metal alloys such as high speed steel from which cutting tools are manufactured. Tungsten is also used in superalloys to for wear wear resistant coatings. Lithium is an element present in trace amount in virtually all rocks and it’s detection in a urinary screening conducted on a resident who is not prescribed lithium salts for psychiatric illness is proof of exposure to airborne soil elements.

Shipyard soil elements documented to be present by the U.S. Navy and EPA are being detected in a remarkably similar profile in urinary screenings conducted on Hunters Point residents and workers independent of age, gender, race, ethnicity and education level. The common pattern of elements being detected combined with geospatial mapping identify the Hunters Point Naval Shipyard to be the source of exposure and airborne transmission to be the route of exposure.

The Navy conducted biomonitoring on tissue samples of clams and fish collected along the sediments and shoreline of the base and published the findings in the Parcel F Feasibility Study. The Navy used toxins detected in it’s biomonitoring to guide remediation of the contaminated shoreline. The contaminants detected by the Navy using biomonitoring were copper, lead, mercury and PCBs. Radionuclides of concern were not tested for even though cesium-137, radium -226, cobalt-60 and strontium- 90 are documented to be present in Parcel E-2 soils that drain into South Basin Area X.

The Hunters Point Community Biomonitoring Program has mounting evidence supported by urinary screenings and geospatial mappings of a community wide toxic exposure caused by airborne shipyard soil and landfill hazards.

Proximity of shipyard soil excavations to Hunters Point residences. Photo credit: SF Chronicle Liz Hafalia 2007

“The Navy denies the findings of advanced human biomonitoring capable of detecting 35 chemical toxins conducted by a licensed medical professional and analyzed by a certified laboratory using mass spectrometry… yet expects the public to accept the Navy’s restricted biomonitoring research conducted on fish and shellfish that relied on sample sizes as small as six , excluded radionuclides documented to be present in shoreline soils and limited the number of chemicals analyzed to four!” Ahimsa Porter Sumchai, MD PD — Medical Director and Principal Investigator Hunters Point Community Biomonitoring Program

Imminent and Proximate Threat Supporting the Declaration of a Local Emergency — California Health & Safety Code Section 101080.

“In reality, contamination levels are three times higher than the Navy reported and 60% higher than the Navy’s own safety guidelines. [Principle plaintiff] Andre Patterson has been diagnosed with three tumors on his back, he has rashes and has lost several of his teeth.” Attorney Stanley Goff — Courthousenews.com Residents of Treasure Island File Class Action Over Radiation Pollution

On April 2, 2021, HP Biomonitoring conducted a comprehensive medical, historical and site evaluation along with urinary toxicology screening on a 12 year resident of Treasure Island Naval Station who presented in the immediate aftermath of exposure to a solid waste disposal area (SWDA) located on the western shoreline of the island.

The resident is a disabled senior who lives in subsidized housing with her daughter and small dog. In late March she walked - with cane assistance -along the island perimeter approaching the Westside SWDA where she experienced eye itching, watering, particle sensations and redness that spread to include her face and neck and caused her lips to swell.

.Solid Waste Disposal Area or SWDA on Treasure Island is an acronym for a military burn pit. The VA Airborne Hazards and Open Burn Pit Registry describes symptoms of exposure that are the same as the TI resident reported when seeking biomonitoring evaluation and screening.

These are symptoms the Veterans Administration Airborne Hazards and Open Burn Pit Registry describe as burn pit exposures. Burn pits are open-air uncontrolled areas used by the military as a means to dispose of metal, rubber, chemicals, munitions, unexploded ordinance and medical waste.

Military burn pit at Halyburton Court Treasure Island. Over 163 radiation anomalies were announced by the Navy on September 17, 2019. Photo: US Navy RAB Presentation courtesy Carol Harvey

Treasure Island is the site of military burn pits used to incinerate radioactive and chemical waste. A California Department of Public Health website documents the existence of two burn pits on Treasure Island in the region where the resident was exposed.

At least two Solid Waste Disposal Areas are located on Treasure Island. One was an incinerator located on the eastern perimeter of the island. In 2019 4,000 cubic yards of toxic soil was excavated from the Northpoint SWDA. The most dangerous region of the island is Halyburton Court designated a SWDA by the Navy and fenced off from the remainder of the island. Radioactive burn pit found near Treasure Island home — Carol Harvey SF Bayview Newspaper 2014

Urinary screening on 20 year TI resident exposed to military burn pit at Westside SWDA detects elevations in heavy metals and radioactive biomarkers including aluminum, cadmium, cesium, gadolinium, nickel, rubidium, thallium and manganese.

https://hunterspointcommunitylawsuit.com

“We are fighting this toxic genocide all the way to the top of the government ladder.”

Bonner & Bonner — Attorneys and Mediators at Law -Hunters Point Community Lawsuit — Fight for Justice

Wrongful death clause from Kevin Abbey, et al. Plaintiffs v United States of America Department of the Navy — Class Action Demand for Jury Trial filed September 14, 2020 by Walkup, Melodia, Kelly & Schoenberger

A federal lawsuit filed by 400 police officers stationed in Building 606 beginning in 1996 on the Hunters Point Shipyard radiation and chemical contaminated Parcel E alleges exposure to hazardous materials led to chronic disabling health conditions and wrongful deaths.

Declaration of Local Public Health Emergency — Hunters Point Naval Shipyard and Treasure Island Naval Station

EPA EJSCREEN Standard Report mapped at 5021 3rd Street location of the Hunters Point Community Biomonitoring Program
EPA EJSCREEN Standard Report Mapped at residence of TI resident exposed to SWDA.

Comparing EPA EJSCREEN environmental indicators for Hunters Point and Treasure Island reveals the majority of variables for both sites exceed the 90th percentile for the US population. Treasure Island’s dangerously high EJ variables approach the 100th percentile for PM 2.5, Diesel PM, Air Toxics Cancer Risk, Respiratory Hazard Index, lead paint exposure and Superfund proximity.

The State of California Emergency Plan (SEP) authorized by the Emergency Services Act defines a series of Emergency Support Functions, one of which is the Public Health and Medical Emergency Support Function. (CA-ESF 8)

California has two sets of laws that support a political declaration or proclamation in order to exercise extraordinary powers to respond to imminent and proximate threats to human health and safety. The most comprehensive is the Emergency Services Ac that can be applied to any circumstance in which conditions of extreme peril to the safety of persons and property exist that are beyond the control of the services, personnel, equipment and facilities of the locale and require the combined forces of the region to respond.

Gloria Berry — D10 Resident, Candidate for Supervisor and elected member of the Democratic Central Committee Assembly District 17 sponsored a broadly sponsored and near unanimous Resolution adopted by the DCCC in 2020 calling for full moratorium, medical monitoring and reparations for Hunters Point residents.

The second set of laws is contained in the California Health & Safety Code. This regulation was enacted to facilitate immediate response to hazardous materials and spills and was expanded to include any “imminent and proximate threat of the introduction of any contagious, infectious or communicable disease, chemical agent, noncommunicable biologic agent, toxin or radioactive agent.”

Dr. Aude Bouagnon speaks at the April 22, 2021 City Hall rally calling for Moratorium and Declaration of a Public Health Emergency for Hunters Point and Treasure Island Naval Bases. Bouagnon is a second year UCSF medical student and scientist with a PhD who assisted the launch of HP Biomonitoring. Dr. Bouagnon was introduced by Arieann Harrison — daughter and scion of Marie Harrison — Mother of the Environmental Justice Movement in Bayview Hunters Point

Under such circumstances the local health officer or designee may declare a local health emergency under Section 101080 of the Health & Safety Code.

Therefore, as a licensed medical practitioner operating a medical facility within the jurisdiction facing imminent and proximate threat, as a former physician with the San Francisco Department of Public Health, as a former Attending Physician for the Veterans Administration Environmental Registry, Stanford Fellowship trained and Board Certified in Emergency Medicine.

And in the absence of principled, compassionate and independent leadership exercised by the local health officer — As designee, I hereby declare a Local Health Emergency Under Section 101080 of the California Health & Safety Code at Naval Stations Hunters Point and Treasure Island.

“Because I think I know an emergency situation when I see one!” Stanford Life Flight 1986–1988

Ahimsa Porter Sumchai MD, PD - Medical Director & PI. Founding Chair- Radiological Committee Hunters Point Shipyard RAB Attending MD VA Toxic Registry and SFDPH

Ahimsa Porter Sumchai MD, PD - Medical Director & PI. Founding Chair- Radiological Committee Hunters Point Shipyard RAB Attending MD VA Toxic Registry and SFDPH