The Elk River, West Virginia chemical spill of Jan. 9, 2014 has been one of the most challenging environmental health emergencies to occur within the United States over the past decade, and it has garnered significant national attention over the course of the past three months. The event occurred when the Freedom Industries spill poured 10,000 gallons of toxic 4-methylcyclohexane methanol (MCHM), and significant quantities of polyglycol ether into one of West Virginia’s most important sources of public drinking water, leaving 300,000 people in nine counties (roughly 16 percent of the state’s total population) without drinking water.
Dr. Rahul Gupta, Health Officer and Executive Director of the Kanawha-Charleston Health Department, is one public health official who has been at the forefront of recovery efforts across the state. In the following interview, Dr. Gupta discusses his experiences over the course of the past few months with Justin Snair, Senior Program Analyst for Critical Infrastructure and Environmental Security at NACCHO.
Q: Can you please describe your experience coordinating with other agencies over the course of your community’s recovery from this spill, and who were your partners?
A: Thanks for your continued interest in, and support of, our ongoing efforts to help our community recover from what has been a very trying ordeal.
The Elk River Chemical Spill was a major environmental health emergency, it impacted hundreds of thousands of people and had a wide ranging impact across my local community and state. Such a large-scale drinking water contamination event is virtually unheard of in this nation’s history. In attempting to recover from this crisis, we have worked with a very wide list of local, state, federal, and private agencies and organizations to coordinate our response. These include the Kanawha-Charleston Board of Health, Kanawha County Commission, Kanawha County Emergency Management, the Mayor of Charleston, the City of Charleston Emergency Management, leaderships of several other townships, other local public health departments, the West Virginia Department of Health & Human Resources, the National Guard, the Governor’s office, the West Virginia Secretary of State’s Office, our state legislature, the West Virginia Poison Control Center, our local, national, and international media, the offices of both of our U.S. Senators (Joe Manchin and Jay Rockefeller), as well as our U.S. Representatives (Shelly More Capito and Nick Joe Rahall) and numerous other organizations.
Hopefully, the length of this list provides some scope for just how large of an effort the response and recovery process from this spill has been, and how many organizations and public officials across the state and federal government have had to work together to help us move our community forward.
Q: Which of these partners did you rely upon the most, and what gaps in your collaborative efforts did you notice?
A: Since these kinds of massive emergencies happen very rarely, many of my closest partnerships were developed out of necessity over the course of our response. In an unprecedented measure, Governor Tomblin ordered the National Guard to assist the Kanawha-Charleston Health Department to respond to this public health emergency. As a result, I worked closely with Adjutant General James Hoyer of the West Virginia National Guard to support 40-50 National Guard troops at the Kanawha-Charleston Health Department. These troops have been from up to six different states. For a period of days, these men and women of the National Guard have assisted our staff in reopening schools, businesses, and other establishments across the county. Based on the results of our excellent working relationship and highly effective partnership, a rapid response team has been formulated consisting of health department sanitarians, the National Guard, and community school officials. The purpose of this rapid response team is to investigate, respond to, and take action towards any school complaints across the county for a period of several weeks going forward.
The Kanawha-Charleston Health Department has also actively worked with Metro 911 to provide technical and subject matter assistance for the various local emergency management agencies, as well as to assist in water distribution. The Health Department served as a water distribution site, an organizer for such events, and played a critical role in ensuring the delivery of the water to special needs populations.
As for the second part of your question—gaps which we noticed? It was clear from the very beginning of our response that we need to dramatically re-think our communication protocols going forward. We first learned of the chemical spill from media reports and widespread public complaints. This is obviously problematic for any number of reasons, but it is especially difficult to provide accurate and timely information to our constituents when we are learning of an event for the first time through the same sources and channels that they are.
I spoke at length about these challenges over the course of several official testimonies which I provided to the state legislature, and multiple provisions have been since added to Senate Bill 373 (SB 373), a bill recently signed into law by Governor Tomblin which aims at rectifying problems identified by the Freedom Industries spill.
During public health emergencies, local health departments in West Virginia are required to submit reports and requests through two separate incident command structures. We have one set of reports that must be sent to the county emergency operations center (EOC)/incident command, who will then submit this information to the State EOC. We have another set of reports which we are required to send to the West Virginia Department of Health & Human Resources Center for Threat Preparedness, Public Health Incident Command. This information is also processed and sent off to the State EOC. The kinds of repetitive processes consume our already limited resources which are especially important to conserve during times of emergencies.
Q: You mentioned that you provided a number of recommendations to the West Virginia State Legislature which were subsequently adopted and implemented in SB 373. Are there any recommendations of particular importance which you were happy to see included in the final legislation?
A: I was asked to provide several testimonies, as well as written documentation, and other guidance to the West Virginia State Legislature which was very interested in developing a strong legislative response to the Freedom Industries spill. On a very broad level, the majority of my testimony focused on issues which I have already mentioned here—I specifically advocated for more effective inter- and intra-agency communications, a larger role for local health departments in water safety, and the inclusion of long-term medical monitoring. Unfortunately, there is a significant lack of critical public health infrastructure in West Virginia and altering this dynamic is a long term goal which I hope my testimony will begin to get the ball rolling on. SB 373 has been signed into law recently by Governor Tomblin with many of my recommendations implemented in the final bill, so I believe that things are slowly progressing in a positive direction.
Q: What other important corrections do you feel need to be in place in order to mitigate/ better manage a similar crisis in the future?
A: SB 373 was a good start here at the state level, but West Virginia still needs to adopt the 2008 recommendations made by the US Chemical Safety Board following the Bayer CropScience explosion in which two people were killed. I am also working as a member of a Federal Advisory Panel convened by Senator Manchin to help introduce new legislative solutions at the federal level in the United States Congress. This process is ongoing. However, it is important to emphasize that this particular event has brought forth two important national issues of public health significance which are not only limited to West Virginia: Drinking water protections and reform of the Toxic Substances Control Act. Public health agencies and organizations need to better understand and assist in shaping legislation and policies on both of these fronts.
Q: We have discussed a large number of obstacles and procedural roadblocks/gaps which you have dealt with over the past several months in attempting to respond to this crisis. In your mind, what were the three challenges that stand out the most to you over the course of this crisis?
A: I would start with the difficulties which we had in obtaining accurate and timely information from state and federal level stakeholders. As the level of government most proximate to the people, we enjoy a deep level of trust and faith with our communities and as a result they expected us to be aware of and immediately communicate any developments in an open and transparent manner. We were also in the uncomfortable position of explaining to the community a number of conflicting statements from the various entities involved in the recovery efforts regarding the safety of the water for drinking and general usage at different points along the way. For example, there were times when the water was declared safe for everyone yet two days later guidance was changed for pregnant women. Furthermore, once water was declared safe, water distribution was terminated. A few days later, water distribution was resumed while simultaneously claiming that the tap water was safe to drink. We also had numerous challenges in encouraging state and federal agencies to actually develop the science to support our own assertions along the way, which often served to compound this issue of trying to explain conflicting reports to a generally confused and increasingly frustrated public.
Q: Transitioning away from our conversation of the broader legislative and regulatory issues, can you share what you have personally learned from this crisis which will help you to better serve your community as a local public health official in the future?
A: This crisis has made it even more apparent that it is crucial to continuously earn and maintain the public’s trust and confidence. We at the Kanawha-Charleston Health Department have been fortunate to be considered one of the most trusted public agencies during this crisis, and our constituents have had a significant amount of faith and trust in the information and guidance which we have provided them with.
As a general take away I would add that local public health must always make its decisions based on good science, and not be afraid to be upfront and honest when adequate science is unavailable. I also believe that additional staff training and education are needed in several areas including the psychological aspects of emergency response, and the use of social media, including, but not necessarily limited to, best practices in times of an emergency.
Q: I think you bring up an important point in your last response: To this point we have primarily focused on the challenges which you have faced as a local public health official trying to respond to this crisis. I think it’s also important to understand this event from the perspective of your affected community members—what has their experience been like over the course of this ordeal, and what major challenges have they faced in adapting to this disaster? What has been the biggest challenge which your community has faced as a result of the spill?
A: Because we are part of our community, the health department’s frustrations and the community’s frustrations were very similar. There has been a general lack of trust in the water supply. At one point “safe” became a four letter word. There are innumerable problems associated with simply not having a clear understanding whether or not the local water supply is safe—this effects general hygiene, nutrition, it causes economic disruptions as the community is forced to expend additional resources in securing non-contaminated sources of water, etc. Schools and local government agencies can also experience disruptions in service—the challenges run the gambit. When this is all compounded by a lack of good scientific information/ conflicting scientific information from the experts, and varying levels of action and response from the state and federal government in attempting to respond to this widespread crisis, there is a natural increase in frustration with governmental agencies and a loss of public trust in general.
Q: Can you provide any further clarification or examples of what you mean by “explaining to the community conflicting statements from these entities?” How did you address these?
A: The spill occurred on Jan. 9. On Jan.13, it was announced by state and federal partners that the water was safe to consume after the flushing process. In the late evening of Jan. 15, information was released from the CDC cautioning pregnant women to continue to use bottle water. There were a number of well-regarded experts that publicly disagreed with the methodology that was being used to test the overall safety of our water supply, and some also challenged the CDC’s screening levels for MCHM. On Feb. 5, in a press conference, CDC officials stated that the water was ‘appropriate’ to drink. The use of the word ‘appropriate’ frustrated my community and the media which was already growing increasingly dissatisfied by the state and federal response to the spill, and so there was a growing sense of unrest regarding whether or not it made sense to trust what was being said at any level of government regarding the actual safety of our water. While this press conference was ongoing, children were being taken to hospital from schools in ambulance due to ‘odor’ related issues in the water. The optics of the events that day was just terrifying to the public and it triggered a cascade of events where we began to receive multiple school complaints of water contamination issues each day. Then, five days later, several expert witnesses could not state conclusively that our water was in fact safe in official testimony before a Congressional committee. Also during this time, another locally-based West Virginia scientist declared that he had found significant quantities of formaldehyde in the water and some state officials publicly disagreed with him triggering another public controversy.
As the only unit of governmental public health people trusted at this time, it became our responsibility to try to explain each and all of the statements. This has often been challenging while we have simultaneously attempted to preserve the rapidly eroding trust of the people in their government.
Q: How is your recovery progressing? Are the challenges which you are facing at your local level the same challenges the state and region is facing?
A: Because of the level of mistrust, the public is slow to return to using the water. Survey data from the time of the spill until March 1 shows that less than five percent of the population are drinking or cooking with our local water, and approximately 20 percent are not using the water for any purpose. There has been a secondary wave of health impacts after the flushing which has further exacerbated the frustrations of a very anxious and suspicious community. There has been little in the way of funding support by outside organizations to evaluate the population health effects of the spill. Even the regulatory fixes that have been passed in SB 373 are problematic in that they do not come with additional funding for monitoring the health effects. All of this means that we are finding ourselves in a never-ending response mode.
Complaints related to the water have progressively decreased. However, there is seemingly another mini-crisis each day in either the schools, or with foam in the river, etc. It seems as though every day we have been in a state of constant crisis since Jan. 9, and we are unsure of when things will return back to ‘normal.’ For example, the group of independent scientists hired by the Governor through the West Virginia Tap Assessment Project recently reported that their screening level recommendations for the chemical MCHM was 8 times more stringent that recommended by the CDC. Additionally, they reported that the ten homes they conducted tests on found to still contain <6 parts per billion of the chemical in the tap water. Most recently, the water treatment company stated that as late as on March 21–22, their sampling demonstrated non-detectable levels of MCHM at the water intake (river), however, the water after treatment leaving the plant to go into people’s homes had a very small amount of the chemical. The water treatment company is currently changing all of its filters which will take eight weeks.
Dr. Gupta will be joined by Martha A. McElfresh from the West Virginia Department of Health and Human Resources, and Dr. Elizabeth Scharman from the West Virginia Poison Control Center for a joint webinar on April 22 to discuss the roles of local public health, poison control, and public health laboratory officials in the response; to reflect on the challenges, systems, and practices that led to the incident; and discuss ways to improve upon future responses and prevent similar incidents from occurring. Register for the webinar now.