Saturday, August 24, 2013

NATURAL GAS: Marcellus Shale hospitals claw toward better data on gas field health issues

SAYRE, Pa. -- Two young engineers wanted to impress their boss. The crew had worked 17 days straight to produce a natural gas well in Wyoming that looked like a giant energy find on the front end of an emerging oil bust.
That night in 1982, as their boss celebrated over dinner 100 miles away, the enthusiastic 25-year-old engineers started dismantling the gas flares. A big job would already be done by the time their boss returned, they reasoned.
"We had no cellphones, no radio and no TV," said Theodore Them, at the time a 31-year-old chemist working in some of the nation's most remote gas fields.
Later, Them and dozens of others watched with horror as a miscalculation caused the flare's 65-foot tower to tip and fall, crushing and killing the men.
"That incident directed the rest of my life," said Them, who today heads up a team of occupational medicine specialists at Guthrie Health in northern Pennsylvania. "It was jarring and catastrophic and inspiring at the same time, because those kids didn't have a chance. They just didn't have a chance."
Within a couple of years, Them went off to medical school to start a career that he hoped could help prevent catastrophic workplace accidents in the oil and gas fields and in the factory towns of Pennsylvania and New York.
"Seeing those men die, I thought there was a better way," he said from his office at Guthrie in Sayre, a little town that straddles the New York border. "Every injury I've ever seen in any employee has been preventable. Every single one of them."
Them's Guthrie clinic is part of an expanding system of hospitals and clinics here in Pennsylvania's gas country. Business at Them's clinic has tripled since 2008, he said, primarily as a response to natural gas drilling in the region's Marcellus Shale formation. His clinic has grown to seven occupational medicine doctors and a support staff of more than 40 people who work with gas field workers across 14,000 square miles.
For the past five years, gas development has transformed this corner of the state -- the counties of Tioga, Lycoming, Bradford and Susquehanna. Truck traffic, housing prices, royalty checks and new kinds of industrial jobs have changed aspects of life in the once-secluded rural townships and bedroom communities. Before the drilling started, industrial jobs and pollution that put pressure on area health care providers were across the border in Corning, N.Y., and nearby Steuben and Broome counties.
Rural hospitals and clinics are building capacity to respond to gas field injuries and to partner with companies on safety programs. They're providing preventive care and drug screenings to a transient workforce of rig hands who live in the region for short periods before shipping off to new drilling sites in other states.
The energy industry has learned to be nimble. If the cost of producing gas in one area gets too high, rigs and manpower move to greener pastures. For the past year, that's meant a shift toward higher-priced oil and gas liquids in Ohio's Utica Shale basin and in Texas.
"They'll bounce to one area, and they'll bounce back here again," Them said in late June, as Pennsylvania's gas production figures held up against a backdrop of declining drilling rigs. From his vantage point, the churn of eastern Marcellus wells has kept his clinic busy with patients from Alabama, Louisiana, Texas and Arkansas.
"We just know the absolute number of cases we're treating is going up," Them said.
Gas field injuries today look the same today as they did in 2008, he said: muscular-skeletal injuries; sprains; injuries to the hands, feet and back. In rare cases, he noted, patients show up with chemical burns from cleaning up tanks used in the hydraulic fracturing process.
"What we don't know is whether there is an increase in the rate of injury, because we don't know the number of workers in the area."

Building a 'data warehouse'

Lately, hospitals here have been operating under a microscope that's unfamiliar to most other rural systems. Since the documentary "Gasland" set its sights on the public health risks of shale gas drilling in Pennsylvania and the Delaware River Basin, questions about implications for populations around drilling sites have landed on the doorstep of the region's century-old hospitals and new clinics.
Guthrie's Them and cadres of public health researchers inside and outside the region are turning to electronic medical records. The plan is to build a sprawling database that pools anonymous medical and social data and matches them with information about the region's industrial footprint and environmental problems.
They're calling it a "data warehouse," said Laura Fitzgerald, director of research and clinical information at Guthrie. It's a computing term, really, not a term that's bandied about in the medical field.
"If you don't do that, you're not going to be able to prove or disprove anything," she said.
The data warehouse would open the door to data-driven research that attempts to connect dots through medical histories and job histories and people's proximity to gas drilling, industrial sites, and higher concentrations of water and air pollutants. It will attempt to use data in rural areas in a similar way as researchers use data in urban industrial zones to understand cancer clusters, asthma or the effect of social inequities.
For the region's health care establishment, it came down to "subjective and objective observations," Them explained, "that really were challenging and posed very good questions that we couldn't answer, nor could anybody else. Yet it was surmised that the largest health care institutions in the region had such data, and if we had it, why weren't we mining it?"
Geisinger, a Danville-based hospital system that serves nearly 3 million people inside and outside the Marcellus gas basin, spearheaded the project and pulled in Guthrie and Susquehanna Health, a hospital and clinic based in Williamsport. EnergyWire recently interviewed researchers and doctors about the data project and the rural hospital systems' growth as a result of the region's absorption of gas drillers and businesses supporting them.
Culling data to create a central repository is an attempt to get a handle on fragmented strands of information about the health effects of people working in the gas fields and living nearby, David Carey, a research director at Geisinger, said in an interview earlier this year.
"Geo-coding" well locations and patient homes and apartments will help create a surrogate for exposure to contaminants. What's missing, he noted, is actual data for chemical exposure.

Filter toward 'legitimate science'

Capturing gas field workers could be among the most challenging pieces of the project, Them said. The health group plans to work with industry to get data about employees to help inform the research. "That's going to be a fleeting, elusive set of people to track," he said.
It's early in the process, but bringing area companies on board with the project has been a slow process, he acknowledged. "If I were in their shoes, I would be a little gun-shy."
Politics has already been injected into the project, even as doctors at Guthrie, Geisinger and Susquehanna emphasize impartiality. In February, New York's Department of Environmental Conservation said it would extend a review process put in place by Gov. Andrew Cuomo (D) -- a de facto ban on shale gas drilling -- so that ongoing public health studies of unconventional gas drilling can be completed.
The short list of those reviews included a planned Geisinger study of asthma and respiratory diseases, alongside a Pennsylvania State University health study and a longer-term U.S. EPA study of the impact of hydraulic fracturing on water and health.
The fear that data could be misused to smear the industry colors discussions with industry.
"There will be a filtering mechanism to ensure it is legitimate science," Them said.
"The intent would be to query the data and see if there is that connection," he added, "statistical probability that there is some result that could be related to gas field presence or drilling. Only at that point would we allow people to take that information and move forward with the data."
A scientific advisory board, including top environmental and public health researchers at Johns Hopkins University and Brown University, will be tasked with providing a scientific review of the merit of proposed research studies using the database.
"We really see this as an opportunity to do a broad-based repository of information for studying rural health," Guthrie's Fitzgerald said.

Talking to each other

Still, the data warehouse isn't set to be rolled out for years, she said. Logistical and financial pieces are still coming together.
Other hurdles exist, including the integration of electronic health records across health care systems. Together, the three hospital systems include populations across much of central and eastern Pennsylvania and into New York, and they're in the process of investing millions of dollars in upgrading their electronic health records.
"Those systems don't necessarily talk with each other," said Lisa Davis, director of the Pennsylvania Office of Rural Health.
This comes as more sweeping changes in the health care arena take hold around the Affordable Care Act, President Obama's health care reform plan. As Pennsylvania's rural health systems build capacity, they're also adjusting to changes in Medicaid designed to increase access for the underinsured.
Davis said she supports the effort by the hospital systems to build a large research database on potential health effects.
"The challenge is that the state has not created a registry of impacts," she said.
That's also been mired in state politics. In 2012, Pennsylvania lawmakers scratched out a $2 million funding proposal for a statewide registry that would track respiratory issues and skin and stomach problems potentially tied to gas drilling.