The Veterans Administration's Asbestos Abatement Program

Our plain-English summary of The Veterans Administration's Asbestos Abatement Program, by G.W. Schepers (Annals of the New York Academy of Sciences, 1991).

The study

• Author: G.W. Schepers
• Journal: Annals of the New York Academy of Sciences
• Published: 1991;643:597-608
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 004483).

Abstract

1. The Veterans Administration has developed a program of asbestos abatement for its more than 1000 buildings, where health care personnel from 173 hospitals and 238 ambulatory care clinics are likely to encounter respirable asbestos. 2. This is a costly program, which has averaged about $25 million annually for the past ten years. 3. The VA has banned the use of new asbestos products containing more than 1% of asbestos in building construction or renovation projects. 4. Industrial hygiene engineering programs have been ordered instituted at all VA medical centers to monitor dust levels in compliance with OSHA and EPA requirements. 5. Health surveillance programs, managed by an environmental health physician at each medical center, have been instituted for all personnel who have been identified to have breathed asbestos fibers in excess of OSHA-EPA threshold limit values. 6. The health care program focuses on the identification of asbestosis and asbestos-related cancer through periodic X-ray films, lung function tests, and electrocardiographic and physical examination screening. 7. The program also stresses cessation of smoking.

In plain English

This paper, by an author who had worked in the Veterans Administration (VA), described its program for managing and removing asbestos in VA buildings. It was not a study of disease rates. The VA system included 173 medical centers and 238 ambulatory care clinics. The problem surfaced while the author was looking into an unusually high incidence of lung cancer at the Dallas, Texas medical center, a former Navy hospital, where an employee photographed decaying asbestos insulation. A systematic asbestos identification program followed, and all reports came back positive for asbestos. An Administrator's Circular barred building products with more than 1% asbestos, made fiber type the basis for removal priorities, and required medical surveillance for exposed staff. The surveillance plan stressed the need for smoking cessation by exposed personnel. Its stated cost was about $25 million a year, excluding hidden costs such as existing staff time. At one small medical center, 100 employees were listed as exposed. The author reported that most centers had ignored 1984 surveillance guidance. By the author's 1989 retirement, more than 80% had sent satisfactory plans. The program was still far from its goal of removing all asbestos.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Descriptive account of an administrative asbestos abatement and medical surveillance program, largely based on the author's own experience working in the VA; not an epidemiological study
• Who was studied: Veterans Administration buildings, staff, patients and visitors: 173 medical centers and 238 ambulatory care clinics (well over 1000 buildings, staff over 170,000), United States, roughly the 1970s to 1989
• Exposure: Asbestos-containing materials in place in VA buildings, such as pipe and boiler insulation, ceiling tiles and wall boards. The former Navy hospital at Dallas contained amosite and crocidolite as well as chrysotile products.
• Main results:
  • The author became aware of an unusually high incidence of lung cancer at the VA medical center in Dallas, Texas, and tried to find a reason for it
  • While the author was looking into this, an engineering service employee at the Dallas center produced photographs of decaying asbestos-containing materials there
  • After a systematic asbestos identification program was launched across VA medical centers, all reports came back positive for asbestos
  • The program's stated price tag was about $25 million annually; the author said this figure did not include hidden costs
  • The Circular barred use of products in building construction whose asbestos content exceeds 1%
  • Mineral fiber identification was the basis for setting removal priorities
  • The majority of VA medical centers ignored the 1984 medical surveillance guidance
  • At one of the smaller VA hospitals, 100 employees in various job titles were identified as exposed to asbestos dust
  • The need for smoking cessation by personnel exposed to asbestos was woven into the medical surveillance plan
  • Several asbestos victims were identified among long-term VA employees (no number given)
  • By the author's retirement in August 1989, more than 80% of VA medical centers had submitted satisfactory medical surveillance plans
• The authors' conclusion: The author reported that the program was still far from its goal of removing asbestos from all VA medical centers, and hoped others would continue to guide the VA to full completion of the task
• Limitations the authors state:
  • The roughly $25 million annual cost figure leaves out hidden costs such as the time of existing staff
  • The list of exposed staff covered only those under the Chief Engineer's supervision; in centrally air-conditioned buildings almost anyone could be exposed

Topics

Medical terms in this study, explained in our Lexicon: Abatement, Industrial Hygiene, OSHA, Threshold Limit Value (TLV).

Related studies

• Personal airborne asbestos exposure levels associated with various types of abatement — J.H. Lange, K.W. Thomulka, et al. (2006)
• Airborne exposure during asbestos abatement of floor tile, wall plaster, and pipe insulation — J.H. Lange (2005)
• Airborne exposure concentrations during asbestos abatement of ceiling and wall plaster — J.H. Lange, K.W. Thomulka (2002)
• Asbestos abatement of pipe and floor tile/mastic and comparison of critical plastic barrier controls — J.H. Lange (2004)
• Personal exposure during abatement of various asbestos-containing materials in the same work area — J.H. Lange, K.W. Thomulka, et al. (2005)
• Air sampling during asbestos abatement of floor tile and mastic — J.H. Lange, K.W. Thomulka (2000)

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