The Former Workers Medical Exam Program for Los Alamos National Laboratory (LANL) began examinations in April of 2000 at the Española Program Office. The office is located in the Española Hospital Medical Arts Building, Suite B, and 1010 Spruce Street, Española, NM. Currently, we offer examinations at three locations: - The Española Program Office
- The LANL Occupational Medicine Clinic at the Los Alamos National Laboratory
- The Johns Hopkins University in Baltimore, Maryland
Kathy Garcia, RN, is the New Mexico Program Coordinator. Ms. Garcia manages the Española Program Office and does outreach for the program to recruit former workers and to present the program to community and union groups. Ms. Garcia will make appointments with former workers to answer their questions, explain their examination results, or to assist them as needed with obtaining records or forms needed for state and federal compensation programs. Joslyn Cordova is the administrative assistant in the office. Besides helping to manage the program office, Ms. Cordova assists former workers with appointments for their exposure and medical history questionnaires and appointments for exams done in Española or at the LANL Occupational Medicine Clinic. Two former workers from LANL, Rebecca Trujillo and Joe Borrego, conduct the exposure and medical history interviews, either in-person or over the telephone. This interview is the Exposure and Medical History Questionnaire (EQ2) and it takes about one to two hours to complete. The length of the interview depends on the number of different jobs a worker had at LANL and the number of years a former worker was employed at LANL. This questionnaire also gathers information from former workers about solvent exposure. No screening tests exist for solvent exposure that took place years before, so we do not do blood tests for past solvent exposure. The Española Program Office staff prepares the charts and paperwork for the examination session and assists the physicians from the Johns Hopkins Bloomberg School of Public Health and the University of New Mexico at the examination sessions. These exam sessions are held four to five times per year and they extend over five days. There have been 14 exam sessions over the past four years. One thousand six hundred and sixty-one exams (1,661) have been completed over this time. The examinations, blood tests, and breathing tests (spirometry) are done in the program office. If a former worker has worked around beryllium during their employment at the LANL site, we will draw three to four tablespoons full of blood for a beryllium sensitization test. This test is called a beryllium lymphocyte proliferation test (BeLPT). The chest x-ray and hearing test are performed at the Española Hospital. All charts, x-rays, and test results are shipped back to Baltimore where the program occupational medicine physicians review these results. The chest x-ray is sent to a certified B-reader who evaluates the film for possible occupational disease, such as asbestosis. If a former worker has at least one abnormal BeLPT, it is recommended that they apply to be part of the Energy Employees Occupational Illness Program Act (EEOIPA). A letter is sent to the former worker that outlines the findings and makes recommendations for further testing if needed. Any other significant findings are reported to the primary care physician as well. The program is not funded to perform any additional testing after the one-time free exam. The former worker's Primary Care Provider (PCP) is asked to see that these recommendations are carried out. All program records are kept in locked files. The LANL Occupational Medicine Clinic offers examinations for former workers twice a month. The physicians and health professionals at LANL perform the examinations and testing. Since June of 2000, the LANL Occupational Medicine Clinic has performed 280 examinations of former workers. This examination is the same as the one described above that is done in Española, NM. The results of the examination and testing are sent to Johns Hopkins. The Program Occupational Medicine physicians here at the School of Public Health review the results of the examination and testing. The occupational medicine physician writes a letter to the former worker that outlines the findings of the examination and testing and offers recommendations for further testing if needed. Once again, the former worker's PCP is asked to see that the recommendations are carried out. All program records are stored in locked files. The Center for Occupational and Environmental Health (COEH) is located at the Bayview Medical Center, part of the Johns Hopkins Health System. Examinations are offered once a month and a program occupational medicine physician performs the exam. All testing is done through the COEH except for the chest x-ray which is done at the Bayview Hospital. Fourteen examinations have been done at COEH. The occupational medicine physician writes a letter to the former worker that outlines the findings of the examination and testing and offers recommendations for further testing if needed. The former worker's PCP is asked to see that the recommendations are carried out. All program records are stored in locked files. Another option for former workers who are unable to travel to New Mexico or Maryland is a medical record review (MRR). In a MRR, the program letter asks the former worker to obtain selected tests, examination records, and a chest x-ray done in the last two years from their PCP or other medical facility. If the former worker had possible beryllium exposure during their employment at LANL, we arrange for a local laboratory to draw and ship the blood needed for a beryllium sensitization test. This test is called a beryllium lymphocyte proliferation test. One of the program occupational medicine physicians reviews the exposure and medical history, the reports and records sent by the PCP, the chest x-ray B-reading and gives their opinion about possible work-related disease.
Program Activities to June 2003. - Letters sent: 28,196
- Agreed to participate: 2,937
- Not interested in participating: 1,573
- Return to sender (bad address): 2,464
Total Exposure Questionnaire #1 (EQ1) returned [sent to former worker with unknown exposures by job title, e.g., staff member]: Total Exposure Questionnaire #2 (EQ2) completed [detailed exposure and medical history interview]: Total Former LANL Workers who did EQ1 and EQ2: Completed Examinations - Total 1,955 - Española, NM Program office = 1,661
- LANL Occupational Medicine Clinic = 280
- COEH, Baltimore, MD = 14
Medical Record Reviews - Totals = 83 Types and Numbers of Examinations Done - Asbestos exams = 1,305
- Beryllium exams = 1,887
- Lead Exams = 1,330
- Noise exams = 1,788
- Radiation exams = 1,858
Beryllium Lymphocyte Proliferation Tests (BeLPT - Beryllium sensitization test) - Total tests = 1,991 (includes repeat tests)
- Individual tests = 1,739
- Single positive LPTs = 26
- Double positive LPTs = 26
- Beryllium evaluations for double positive LPTs = 23
- Diagnosed Chronic Beryllium Disease = 2
Chest X-rays Done - Total chest x-rays (PA only) = 1,722
- Chest x-rays with B-reading showing changes suggestive of asbestos exposure or disease = 156
Spirometry (Breathing Test) Done - Total spirometry = 1,096
- Spirometry suggestive of possible work-related disease = 178
Audiograms (Hearing Test) Done - Total audiograms = 1,589
- Audiograms with hearing impairment = 703
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