LITTLE ROCK, Ark.—Is it too little, too late?
That's the question Mayflower residents are asking now that the state is finally offering them access to free health assessments five months after a ruptured ExxonMobil pipeline emptied 210,000 gallons of heavy crude into their city 25 miles northwest of Little Rock.
Since the March 29 spill, many people have continued to suffer from dizziness, headaches, nausea and vomiting—classic symptoms of short-term exposure to the chemicals found in crude oil.
While 22 homes in the Northwoods subdivision were evacuated on that Good Friday afternoon, people who lived nearby were allowed to remain in their homes. If the smells or symptoms were too overwhelming, they could leave their homes voluntarily, they were told.
"Five months out is a little late, but people are still sick," said Ann Jarrell, who wasn't evacuated and is still suffering from respiratory problems. "I'll continue to scream from the tallest tree that we need help."
Until Gov. Mike Beebe announced the assessments last Thursday, officials with the Arkansas Department of Health had said repeatedly that Mayflower residents shouldn't worry about lingering fumes. Those with symptoms were directed to call the Arkansas Poison and Drug Information Center and to attend public meetings the department organized.
The assessments began by appointment on Tuesday. After an initial screening by a public health nurse at the Faulkner County Health Unit in the nearby city of Conway, residents may be eligible for further evaluation or treatment from specialists with the Arkansas Department of Health and the University of Arkansas for Medical Sciences.
"We've been listening to people and trying to figure out what our role can be," Department of Health spokesman Ed Barham said about the decision to offer the health assessments. "It seems that we needed to do more. This is what we've come up with."
Arkansas isn't the first state to find itself trying to protect residential neighborhoods from health problems connected with an oil spill. Since 2010, health experts in Utah and Michigan have also been forced to cobble together their own guidelines, based on a patchwork of scientific and regulatory recommendations. Federal guidelines on oil spills don't clearly state when or if the public should be evacuated, or what should be done to assess public health in the weeks and months after a spill.
As a result, residents in different communities have received varying levels of protection. No houses were evacuated in Salt Lake City, Utah, when a ruptured pipeline leaked 33,000 gallons of medium grade crude oil before it was discovered on the morning of June 12, 2010. And in Marshall, Mich., officials agonized four days before calling for a voluntary evacuation after more than a million gallons of heavy Canadian crude spilled into the Kalamazoo River on July 25, 2010.
Much of the attention at an oil spill is focused on airborne levels of benzene, a known carcinogen that is toxic at very low doses. But crude oil also contains hundreds of other chemicals, and little is known about how some of them affect human health.
Given these gaps in scientific research, public health experts say it's difficult to determine what levels of exposure are safe.
Residents, public health advocates and environmental consultants tracking the Mayflower spill wonder if Arkansas's belated effort to conduct health assessments is enough.
"It is just that, a first step," said April Lane, a public health advocate in Arkansas who has pushed politicians to act on behalf of residents near the spill site. "Their answer is we need to pacify these people and give them what they are asking for in a way that won't overburden the state."
Wilma Subra is a Louisiana-based environmental consultant who has spent decades working with communities upended by chemical accidents, and she has been following news of the Arkansas spill. She is the recipient of a MacArthur "genius" grant and continues to work with people affected by the 2010 BP oil spill off the Gulf Coast.
Subra says that for the health assessments to be meaningful, special attention needs to be paid to what participants say about when their symptoms developed, how they have changed over time and how they are affected by rain, prevailing winds and digging up of soil by excavators—all activities that stir up the oil and its stew of chemicals, Subra said.
Not only must the treatments fit the symptoms, she said, but timeliness is also vital.
"You don't want to get two or three years down the line and you find out this whole process didn't work," Subra said. "Then, what do you have for people who have been sick all of this time? You've done something but it doesn't help the people and you won't know it for a couple of years."
Subra thinks the health department shouldn't merely invite residents to schedule an appointment for a health assessment. She thinks authorities should also conduct a community survey and interview as many people as possible, with the dual mission of collecting data and helping to solve people's health problems.
She also worries about how quickly the assessments can be turned around, whether the nurse and medical specialists have enough expertise to ask the right questions and identify symptoms affiliated with oil spills, who will pay if people have to travel out-of-state to see a specialist, and if the information collected will be presented to the public in a transparent manner.
"A large number of people are very ill," she said. "The downside is that (the state) waited so long to start this. It's important to turn it around quickly so people in the community understand they are not alone and that they can see others are also suffering."
Nurse Not a Chemical Spill Specialist
Liz Bush, the public health nurse who will be handling the initial screenings, is employed by the Arkansas Department of Health. As part of the assessment she'll use a questionnaire based on information gathered after oil spills in the Gulf of Mexico and the Kalamazoo River in Michigan and chemical spills in Arkansas. Dr. William Mason, a pulmonologist who is the department's chief of emergency response, helped compile the questionnaire. When Mason was in private practice, he treated many people who were exposed to chemicals in the workplace.
Bush is a registered nurse but doesn't have a background with oil refineries or chemical spills, said Cathy Flannigan, a health department spokeswoman.
"We don't have nurses in Arkansas who specialize in oil spills," Flannigan said. "And we don't think that background is critical to get the basic information we will be getting. What's vital is that she be able to connect residents to specialized doctors."
Depending on the results of that initial screening, participants would be able to connect with specialists at Little Rock's University of Arkansas for Medical Sciences via "telemedicine" provided through a high-quality video connection, Barham said. Initial assessments and follow-up sessions via telemedicine will be free. Private insurance, Medicaid or Exxon would cover more advanced treatments, Barham said.
Health department officials are counting on daily newspapers, television broadcasts, the Mayflower mayor and local doctors to publicize the health assessments.
"We want to make sure everybody knows about it," Barham said, adding that posting notices on homes in Mayflower is "as of today not something we have planned but it's definitely possible."
Barham said he has no idea how many Mayflower residents might sign up for the assessments. His records show that the Poison Control Center received 37 calls from 19 individuals between March 29 and Aug. 1.
Some Residents Find Homes Unlivable
Ann Jarrell will likely be among the first Mayflower resident to make an appointment with Bush. She has been badgering local politicians and officials for months to respond to her concerns.
Jarrell has suffered from breathing issues, migraine-like headaches, severe stomach problems, blurry vision and fatigue since the Pegasus ruptured just three-and-a-half football fields from her home off Suggs Circle, which is not part of the subdivision where homeowners were evacuated.
The 54-year-old said she opted to stay put on March 29 after she called the Mayflower Police Department and was told she didn't need to leave unless she spotted oil in her yard. Her 23-year-old daughter and infant grandson stayed put, too.
Jarrell said she didn't learn how toxic the oil fumes were until she attended an April 22 public meeting. Afterward, she told her daughter that she and the baby needed to move out. The baby still hasn't fully recovered from breathing troubles he experienced after the spill, she said.
"My headaches were so bad that I was crying," she said, adding that her doctor put her on an inhaler to ease her respiratory distress.
Jarrell noticed that her symptoms improved whenever she left town on trips for her job as a computer software trainer.
On Aug. 20, Jarrell said her doctor told her that she needed to get out of Mayflower, so she moved in with friends in North Little Rock. Her doctor even advised her to send somebody else to pick up her belongings, she said.
Jarrell doubts that a majority of her neighbors will to travel to Conway for the free health screenings because they will find it too intimidating. Many don't have health insurance, she said, and haven't seen a doctor since their initial emergency room visits, which were paid for by Exxon.
"That means we won't get a true sampling of how many people are sick," she said. "For the longest time, nobody was even acknowledging that there were sick people. We couldn't get calls back from the health department."
Jarrell still feels sick, but said her symptoms have tapered off since she left Mayflower. She is beginning to doubt that her house will ever be her home again.
"I don't know when I'll be able to go home because they are still digging," Jarrell said, adding that several of her neighbors have left permanently and others are trying to exit. "I see it as getting worse and worse, not better."
This story is part of a joint investigative project by InsideClimate News and the Arkansas Times. Funding for the project comes from readers who donated to an ioby.org crowdfunding campaign that raised nearly $27,000 and from the Fund for Investigative Journalism.