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Part I - Environmental Impacts: State Dept. Of Health, Penn State Medical Webinars On Caring For Persons Living & Working In Communities With Oil & Natural Gas Extraction

The state Department of Health Bureau of Epidemiology and Penn State Medical Project ECHO hosted two webinars in January and February for medical professionals and the public on Caring for Persons Living and Working in Communities Involved in Oil and Natural Gas Extraction.

In April 2023, the state Department of Health the State Health Improvement Plan identified rising health issues related to natural resource extraction-- including oil and gas development-- as one of the top five threats affecting health outcomes of Pennsylvanians. Read more here.

In August 2023, the University of Pittsburgh School of Public Health released the results of several health studies funded by the Department of Health on unconventional shale gas development in Southwest Pennsylvania that found links to public health impacts like making asthma worse and increasing the risk of lymphoma in children. Read more here.

Later that month the second highest ranking official in the Department of Health took the extraordinary step of apologizing to residents for not listening to residents near shale gas operations about their health concerns. Read more here.

These webinars are part of an effort to follow-up on those studies to educate health providers and the public about the health impacts of oil and gas development impacts.

The objective of the webinars was to answer these questions--

-- What can providers do and say to alleviate patient fear and frustration in the face of chronic exposure to fracking?

-- What chronic health impacts should be monitored for based on these types of chemical exposures?

-- How can providers and health systems advocate for patients and communities when health and safety are threatened by the oil and gas industry?

The webinars--

-- Identify the potential health risks associated with oil and gas development exposure

-- Describe the impact of oil and gas development on the environment

-- Discuss techniques for addressing patient concerns

-- Identifying additional resources for addressing concerns

Part I - Agenda

The first webinar on January 9 discussed--

-- The process of unconventional oil and gas development

-- Identifies where oil and gas development occurs in Pennsylvania

-- Describes how oil and gas development can impact the environment

The webinar included discussion of a medical case study of an anonymous, but real worker in the oil and gas industry and concerns he expressed

Part II - Agenda

The second webinar on February 13 discussed--

--The potential health risks associated with oil and gas development

-- The techniques for addressing patient concerns

-- Identified additional resources to help answer patient questions about health impacts

The webinar discusses a medical case study of the real exposures a Washington County family had to hazardous air emissions from a shale gas pipeline facility. Read more here.

Opening Presentation

Dr. Julie Miller, a board-certified Public Health Toxicologist with the state Department of Health, gave the opening presentations at both webinars.

Dr. Miller's primary training and area of expertise includes analytical chemistry, toxicology study design, data analysis and interpretation and human health risk assessments.

Dr. Miller has also managed occupational health and safety projects and has received postdoctoral training at the U.S. Centers for Disease Control and Prevention – National Institute for Occupational Safety and Health.

Dr. Miller has over 50 published manuscripts, abstracts, and book chapters related to toxicology.

Part I Opening Presentation

Here is a transcript of Dr. Miller’s opening presentation to the first webinar.

Click Here for a copy of the presentation slides from the entire webinar. Dr. Miller’s slides begin on page 12.

My name is Julie Miller. I'm the state toxicologist with the Pennsylvania Department of Health, and I'm so excited to talk to you today as part of a two-part [Penn State Medical] ECHO series presentation.

And this was created as a resource for healthcare professionals covering the impact of unconventional oil and gas development on health.

This industry is commonly referred to by the term fracking and will likely be how your patients will refer to it.

However, we will use the term UOGD, which stands for unconventional oil and gas development for accuracy to avoid any confusion.

Today we will be discussing three main topics in the first part of our series.

First we'll go over the process of unconventional oil and gas development so you can better understand the risks associated with each stage.

Then we will identify what areas of Pennsylvania are the most impacted.

And finally, we will finish the first section with a discussion on how the environment is impacted by UOGD.

We encourage you to join next month as well, which is when we will cover the potential health risks associated with UOGD exposure, discuss concern, response, and share additional resources.

So the UOGD process, we're going to begin by discussing what unconventional oil and gas development is.

I'm sure you've heard the term fracking before, but that is actually only one step in the process.

A common misunderstanding is that fracking is the only stage with health risks.

As this is not accurate, we will begin by going over what all the stages are and some health considerations associated with each step.

Shale Gas Well Drilling Process

To begin, an unconventional well will go through five main phases throughout its lifetime. We will discuss in each and greater detail, but here is a quick timeline for overview.

First, the well pad must be prepared. This timeframe varies greatly by location and it typically lasts between one and five months.

Next, the well needs to be drilled. This takes roughly one to two months per well. Keep in mind that a well pad ordinarily has multiple wells per pad.

The third step is the hydraulic fracturing or fracking phase, this step usually takes less than a week per well.

The fourth step is the flowback and waste management step. The length of this phase varies by site and commonly is one to four month long process. This is the last step of the construction or pre-production activities.

And then finally, we have the production phase, which is the longest phase that a well will be in. It generally spends 25 to 40 years producing oil and/or gas before it needs to be plugged. That is the industry equivalent of calling it closed.

So let's expand a bit on these phases, beginning with well pad preparation.

Well pad preparation includes tasks such as cutting down trees, creating access roads, and leveling the area if needed.

This phase is known to be associated with significant truck traffic leading to poor air quality conditions. This is due to vehicle exhaust and dust from the maintenance roads, which are often unpaved.

I want to draw your attention to the photo on the right [in the slides] where you can see dozens of red vehicles inside of the well pad.

Just for a proper understanding of size and noise levels. All of the red vehicles are the size of semi-trucks.

It is estimated that heavily fracked well pads have over 4,000 one-way trips from heavy trucks alone during the well production phase.

And due to these activities, poor air quality, noise and increased traffic crashes are the main concerns during this time.

Once the well pad has been constructed drilling of the well bore begins. This consists of creating vertical holes approximately 5 to 9,000 feet deep, followed by horizontal sections that can run several thousand feet.

Casings are then installed along the length of the hole that is drilled. That casing is what protects soil and water sources from contamination.

The main health considerations during the drilling phase include poor air quality exposure to drill cuttings as well as effects from constant noise and light pollution.

Drill cuttings are the waste that comes off of the drill and often contains toxic metals and naturally occurring radioactive materials such as lead, radium and uranium.

In 2020, Pennsylvania's oil and gas industry sent over 244,000 tons of drill cuttings to landfills.

There is the potential for this waste to contaminate water sources or create poor air quality in communities near these landfills.

Noise is a concern during all phases of oil and gas development and regularly exceeds the World Health Organization, or WHO, community noise guideline of 50 decibels.

It is not uncommon for noise to reach 90 decibels. That range is the range which noise can cause harm.

Light pollution is also a health consideration as lights are often on all night leading to poor sleep quality.

Next is the hydraulic fracturing phase.

During this step, water is mixed with sand and other chemicals and other chemicals are injected into the shale layer at high pressure.

This action fractures the shale, which helps to release some of the oil or gas trapped within. This is where the term fracking originates.

The fluid that is used during the process is known as fracking fluid, and the composition varies by location and operator.

The main health considerations during hydraulic fracturing include potential well water contamination, poor air quality, noise pollution, as well as seismic vibrations.

Fracking Chemicals

Before we continue, I want to discuss fracking fluid a little bit more.

Fracking fluid includes water and many other chemicals. The image on the right illustrates the typical breakdown of fracking fluid used in the United States.

While water is the main ingredient in fracking fluid, some of the chemical additives used are carcinogenic to humans.

Each well uses millions of gallons of fracking fluid. So while low in concentration, these chemicals are high on the absolute scale and have the potential to cause significant health impacts if they leak into water sources.

And here is a non-exhaustive list of the various types of chemicals that may be added to fracking fluid.

For example, commonly known substances such as lead, mercury, cyanide, and chloroform can all be used during the fracking process.

Less commonly known, but still high-risk compounds such as bronopol are used by some operators.

Bronopol is shown to cause reproductive toxicity in animals and can be absorbed through the skin, inhalation and ingestion routes.

Additionally, as bronopol degrades, it produces formaldehyde and nitrosamines, which are known and likely human carcinogens respectively.

This is just one example of the types of chemicals that can be found in fracking fluid.

Continuing with the phases of development, once wells have been fractured, the direction of the fracking fluid reverses and returns to the surface.

When it returns to the surface, it is then referred to as produced water or flowback, and may contain fracking fluid chemicals naturally occurring in the formation and the products of chemical reactions.

Flowback may be treated and reused or brought to a separate location for disposal.

Flowback is disposed of by either being injected into the earth or placed in an evaporation pit. The image here is of an evaporation pit.

This waste may be left at landfills that may or may not be qualified to handle this type of waste.

The main health considerations here are continued poor air, quality water and soil contamination and exposure to waste.

Production is the final phase we will discuss.

This is when the well is fully functional and is producing oil and/or gas. Wells spend the majority of their life in this phase.

The main considerations during production include poor air quality and flaring.

Flaring is the controlled burning of excess or unwanted petroleum products. This process releases a considerable amount of noise and light pollution as well as methane.

Finally, many epidemiologic studies have identified health impacts due to living near producing wells. However, the exact magnitude of the impact and cause is not fully understood yet.

Where Is Oil & Gas Development?

So what about UOGD in Pennsylvania and how this may impact Pennsylvania residents?

There have been over 12,800 unconventional wells drilled to date in Pennsylvania. Currently, 36 of our 67 counties have active unconventional wells.

Most of the active wells are located in the northeast and southwestern parts of the state. Washington and Susquehanna Counties have the greatest number of active unconventional wells.

If you are interested, the Pennsylvania Department of Environmental Protection, or DEP, publishes multiple interactive resources. These share information such as well locations, operator of the well inspection and violation history and more.

[Editor’s Note: the Department of Health Environmental Health Indicators Map and DEP’s Oil and Gas Mapping application are good tools to local oil and gas threats near you.]

Setback Distances Not Sufficient

Interestingly, there is no national regulation in place for how close wells can be built to residential structures or schools. This is known as a setback distance and is commonly regulated at the state level.

Pennsylvania last updated its setback distances in 2012.

As of the state, the closest a well site can be drilled is 300 feet from any solid blue-lined stream, spring, body of water or wetland greater than one acre.

Regarding structures such as schools, shopping centers, residential facilities, and private water wells, oil and gas wells cannot be located closer than 500 feet.

Currently, the greatest setback distance is related to public water supply. If there is an extraction point used by a water purveyor, a well bore must be located at least 1,000 feet from that site.

Many studies suggest this distance is not sufficient to protect the public from potential health impacts.

The current highest recommended setback distance in the nation is 3,200 feet, in California.

Many setback distances to homes and other structures in top producing states are much closer than the current literature would advise.

For example, in Texas, the highest producing state and produces over a quarter of the nation's natural gas, their setback distance is slightly less than Pennsylvania's, at 467 feet.

Louisiana is the third highest producing state and has a setback distance of only 300 feet.

For comparison, I have included two of the most conservative setback distances. This includes 2,000 feet in Colorado and 3,200 feet in California.

While knowing the distance that a well is legally allowed to be placed from a school or residence is helpful, knowing how many Pennsylvanians are exposed daily is even more critical.

Current data has found that more than 950 schools are located within a half mile of oil and gas activity.

This includes oil and gas wells, compressors and processors.

This equates to over 200,000 students exposed daily by attending schools in the area.

This number continues to rise as additional wells are drilled.

Furthermore, 1.5 million or 1 in 10 Pennsylvanians are potentially exposed at their residences.

How many patients do you believe you see each day that may be part of this exposed cohort?

Communities around the state have voiced their concerns of UOGD over the last decade.

Issues Of Concern

Here's a list of some of the topics community concerns you may hear about.

A few of them include the contamination of water and soil with radioactive materials from UOGD, how many abandoned wells are leaking in their communities, various questions related to the chemicals used in fracking and many more.

[Other issues noted in Dr. Miller’s slides are--

-- Oil and Gas wastewater injections wells and groundwater safety

-- Chemicals in the fracking fluid that maybe harmful to health like PFAS ‘forever chemicals’ and trade secret chemicals

-- How to protect from other known hazards

-- Increases in certain cancer types]

Abandoned Conventional Wells

I wanted to quickly touch on abandoned wells in Pennsylvania and when a well is no longer producing oil or gas it is closed with a process known as being plugged or plugging.

Plugging a well involves removing all of the remaining debris and filling the well with cement.

Unfortunately, not all wells are plugged correctly.

DEP is aware of over 30,000 orphaned and abandoned wells, but the Shapiro administration estimates that there are more than 300,000 abandoned wells.

Abandoned wells can leak oil and gas into the air, water sources, soil, and nearby properties.

Although these are typically not unconventional wells, they're still worth keeping in mind as they're abundant in our state.

You can learn more about DEP's effort to plug abandoned wells at the DEP's Abandoned and Orphaned Wells program page.

Potential Patient Exposures

So we talked about the UOGD process earlier in this presentation. And as these impacts are potential exposure sources for your patients, we're going to discuss next these in a little bit more detail so that you are confident in your ability to determine if your patient may have been exposed.

Air Quality

So the first one I wanted to touch on is air quality. UOGD has a potential to impact air quality throughout the entire lifetime of the well.

The pre-production stages lead to a higher level of particulate matter. This includes dust and smoke from dirt roads and vehicles as well as silica, which is often used in the hydraulic fracturing phase.

Organic gases can be released at any phase.

Volatile organic compounds such as benzene and toluene, as well as light hydrocarbons such as methane and ethane are a few examples.

This often occurs due to leaking or broken equipment. And waste impoundments.

Methane is one of the key contributors to the United States' failure to meet agreed upon global emissions targets and contributed to around 40% of all global warming to date.

Nitrogen oxides, which can cause damage to the respiratory pathways as well as the burning of eyes and skin, are byproducts of high temperature combustion.

Flaring, which is shown here, as well as venting, can be a significant source of both nitrogen oxides and greenhouse gas emissions such as methane.

Water Quality

Next is water quality. Drinking, surface and groundwater can also be impacted by UOGD.

Although safety measures such as cement casings are put in place to protect water sources from contamination, there are still many well-researched instances of water quality contamination.

For example, in 2016, the US EPA concluded that fracking had impacted drinking surface and groundwater resources throughout the country.

Contamination of water sources most frequently occurs during pre-production activities and can be due to various situations such as broken casings, accidental spills, gas migration, and improper disposal techniques.

Some key contaminants of concern include heavy metals, inorganic substances, methane, the chemicals used in fracking fluid, as well as radium 226 and 228.

As radium 226 decays it creates radon as a byproduct. Radon can sit on the surface of water or evaporate into the air.

And I also wanted to flag that January is Radon Awareness Month, so that's something that we should all be thinking about.

Other Impacts

There are other environmental impacts that can occur due to oil and gas development.

This is not an exhaustive list and research is still ongoing.

Earthquakes can be induced by either hydraulic fracturing or injection of flowback fluid at waste sites.

In the United States, the largest known earthquake from fracking was a 4.0 earthquake in Texas.

As we mentioned earlier, noise and light pollution can have a large impact on human and animal life.

Studies have found noise to exceed 90 decibels during all phases of development.

That is the equivalent of about being 25 feet away from a motorcycle.

Lights can be utilized 24/7 during development, severely altering the environment and sleep patterns.

New well sites also mean an increase in traffic. It is estimated that around 4,000 large trucks make a one-way trip from a well pad just during the fracturing phase alone. Along with this traffic comes increased risk of traffic crashes.

Lastly, water scarcity is a huge issue with UOGD. While Pennsylvania is not in a drought, there are still reports of local fishing ponds being entirely drained for UOGD use.

In just one year hundreds of billions of gallons of water are used in this industry and most is not able to be recycled or reused in any way.

[Editor’s Note: DEP reported that in Pennsylvania, 88% of shale gas production wastewater is recycled and reused. Read more here.]

Private Drinking Water Wells

And what about some regulatory considerations?

Something to keep in mind when discussing health concerns with your patients is that over 3.5 million Pennsylvanians primarily use well water as their main water source.

Pennsylvania does not regulate the water quality of private well water.

It is the responsibility of the owner to maintain, inspect, and test their well water to ensure potability.

Furthermore, the Energy Act of 2005 excludes hydraulic fracturing activities from regulation under the Safe Water Drinking Act. This is commonly referred to as the Halliburton loophole.

Please remind any patient that mentions that they use private wall water at home to test their water annually.

Importance of Education

Education is probably at the forefront of all that we do in public health.

I mean, if you can't get the information to the general population as to the importance of why they should care about something and then how they can protect themselves and their family from various environmental health hazards, I mean, that's probably the most important thing for us as a Department of Health.

And so we try and do a lot of education. We have a lot of resources on our website for if you get your water tested, how you can interpret those water results.

I think just like probably clinicians encounter, when you get a lab result back, you don't really know what it means to a lay person.

And it's the same thing with water test results.

And so number one, we're always available for someone to call and be like, "I want to talk about my water results and what that means for my health."

But then also we have a resource compiled for different levels of concern. So if you get a water test result and you get a level of 10 for a certain contaminant, what does that mean?

And when should I be concerned? And so we've provided that.

But yes, education is probably the most important thing that I think we could do for public health.

Conclusion

So I hope that wasn't too much information, but I greatly appreciate having the opportunity to share the first part of our presentation with you.

Please join us next month where we will cover the potential health impacts identified in current scientific literature, suggestions on addressing environmental health concerns that your patients may have, as well as additional resources for providers and patients.

If you have any additional questions or comments, please feel free to reach out to the Division of Environmental Health Epidemiology with the Pennsylvania Department of Health.

We manage the Oil and Natural Gas Production Health Information [webpage] where statewide health concern information is gathered to help better understand what individuals living near oil and gas are experiencing.

Additionally, [or go to the Report an Environmental Health Concern webpage] if you would like to refer your patients to us [or report an environmental health concern].

And I'll end with a list of our environmental health physician partners that helped with reviewing this resource. I think some of you are on the line today.

So again, thank you so much and feel free to contact us at DEHE@pa.gov with any questions.

And I also have a list of some resources that I could just leave up on the screen while we take some questions.

[Resources and study references for Dr. Miller’s presentation begin on page 40.]

Resource Links From Presentation:

-- Dept. Of Health Oil & Natural Gas Production Health Concerns

-- Dept. Of Health PA Health Alert Network

-- FracFocus Chemical Disclosure Registry

-- DEP Office of Oil & Gas Management

-- DEP Oil and Gas Reports

-- Penn State Marcellus Center for Outreach and Research [Oil & Gas Graphics]

Additional Resource Links:

-- Environmental Health Project - Shale Gas Health Impacts