October 4, 2012

Dear Governor Cuomo,

We in the medical and scientific community in New York State are pleased that our efforts to bring the public health impacts of the largest land use decision in New York State's history to the attention of the Department of Environmental Conservation (DEC) and Department of Health (DOH) and to the forefront of the SGEIS process have been heard. We were heartened that in DECs September 20, 2012 announcement regarding a health review, Commissioner Martens wrote: Only after this evaluation is completed will a decision be made about whether to permit high volume hydraulic fracturing in New York. Obviously if there was a public health concern that could not be addressed we would not proceed. However, a DOH review of work already prepared by DEC on this topic is not enough to answer the question of whether there is a public health concern that cannot be addressed. New York must commission a full Health Impact Assessment to better understand the impacts of fracking (meaning the whole process of gas extraction, from site development to delivery) on public health and the measures needed to protect our communities. DEC Commissioner Joseph Martens September 20th press release rejecting our request for a Health Impact Assessment and announcing DOHs review of DECs work brings several concerns and questions to mind, including: What is the health impact analysis document currently under DOHs review and who will have access to it? Will the questions we've been asking--about the health effects of air and water pollution, soil contamination, radon, community impacts, worker safety, psychosocial stress, developmental toxicants and endocrine disruptors, and social justicebe addressed in this review? Will there be transparency and how will that be achieved? Will it be inclusive of all stakeholders? Will the DOH which previously had expressed that health impacts were adequately addressed in the 2011 draft of the SGEIS now be able to do an objective review, and if so, what has changed? What is the process for this review? What expertise does DEC have to conduct a health analysis in the first instance?

Our foremost concern is that the review proposed by Commissioner Martens differs significantly from the Health Impact Assessment (HIA) we requested. A comprehensive Health Impact Assessment, is a process designed by the World Health Organization and the Centers for Disease Control, and outlined in a guidance document by the National Academies of Science,

http://www.nap.edu/catalog.php?record_id=13229, for precisely the kind of decision which DEC is currently weighing. An HIA is: Transparent; Inclusive of all stakeholders; A recognized process which includes several public health tools; Conducted by an entity with public health expertise; and Includes public participation throughout the process. We have received no indication that DOHs proposed review will meet these standards. There also seems to be a misconception about the Health Impact Assessment process, alluded to by Commissioner Martens in his statement that the decision-making will remain a governmental responsibility. A Health Impact Assessment informs and provides recommendations to the decision-makers, and does not, in any way, take away the decision from the decision-makers. In closing, we would like to offer the following observation for your consideration. Commissioner Martens rightly refers to the need to establish the legitimacy of the regulatory process if the controversy that has engulfed shale gas fracking in New York is ever to be resolved. We suggest that you consider, in the face of the overwhelming recommendation of the medical communities of New York State that a Health Impact Assessment be undertaken, what the consequences would be if a credible one is not undertaken and fracking proves to be a health disaster. It will be impossible to contain the damage to the States credibility and authority in this area. Your Administration seems to have recognized that fact in responding to the demand for some health review, but to do so in this halfhearted and questionable way is to once again ensure your well-meaning efforts will be counterproductive. The only way to create the basis for public trust that fracking can be done without major threat to public health is to do a truly independent, truly comprehensive, truly transparent assessment, one done with all stakeholders and relevant experts at the table that demonstrates that is the case. We urge your most careful consideration of these concerns. Governor Cuomo, we ask that you join us in advocating on behalf of the most vulnerable, assuring that social justice is achieved, and that the relevant scientific information is in the hands of the decisionmakers--yours as well as DECs. We request that a copy of the DEC-generated health impact analysis referenced in the Commissioners press release be made available to the public and that you re-consider the proposed DOH review, and instead commission a full and transparent Health Impact Assessment.

Sincerely,

Michelle Bamberger MS DVM, private practice Veterinarian, Ithaca, NY Delores Bennett RN, Unadilla, NY Sharon Berger RN, Trumansburg, NY Paul C. Bermanzohn MD, Rosendale, NY Ronald E. Bishop PhD CHO, SUNY Oneonta Kelly K. Branigan RN, Middlefield, NY Michael P. Branigan CRNA MS, Middlefield, NY Broome County Medical Society Sheila Bushkin-Bedient MD MPH, Public Health and Preventive Medicine Consultant, Waterford, NY Marybeth Carlberg MD, Physician Advisory Board for Onondaga County Health Dept., SUNY Upstate Teaching Faculty, Syracuse, NY Jeffrey Carlberg MD, SUNY Upstate Teaching Faculty, Syracuse, NY David O Carpenter MD, Director, Institute for Health and the Environment University at Albany, Rensselaer, NY Andrew D Coates MD FACP, Assistant Professor of Medicine and Psychiatry, Albany Medical College D. Barry Crittenden MD, Instructor of Medicine, Division of Rheumatology, NYU School of Medicine Christine K Durbak, PhD, World Information Transfer, NY, NY Larysa Dyrszka MD, Pediatrician (retired), Bethel, NY Donna Flayhan PhD, Director, The Lower Manhattan Public Health Project, New Paltz, NY Michael Fox PhD, NYC, NY Amy Freeth MD, Department of Endocrinology, Diabetes and Metabolism, Cooperstown, NY Cindy Gordon MD, Town of Dryden, NY David Gould MD MBA, NY, NY Alice Grow RN, Newfield, NY Adam Law MD, Ithaca, NY Sueane Hemmer Goodreau ND RN CFNP, Ithaca, NY Graham Ottoson CNM NP, Ithaca, NY Julie Huntsman DVM, Town of Otsego Council, Otsego, NY Kenneth Jaffe MD, Slope Farms, Meredith, NY David W Kalb BS MS and current RN student, Freeville, NY Lila J Kalinich MD, Professor Columbia University, NYC, NY Antoinette Kuzminski MD, Fly Creek, NY

Eric London MD, Bethel, NY Judith Maidenbaum PhD, Psychoanalyst, Kauneonga Lake, NY Mary Menapace RN, Women's Health, Upstate Medical University, Syracuse, NY Kevin Millar MSN CRNA, Owego, NY Karen Joy Miller, Founder, Huntington Breast Cancer Action Coalition, Inc. Ramon Murphy MD MPH, Professor of Pediatrics, Mount Sinai School of Medicine, NYC, NY Robert Oswald PhD, Professor, Department of Molecular Medicine, Cornell University, Ithaca, NY Julia Parete, Nurse Practitioner, Trumansburg, Town of Hector, NY Margaret A Rafferty DNP MPH, NYC, NY Leia Raphaelidis RN FNP, Ithaca, NY Marian H Rose PhD, Bedford, NY Toby G Rossman PhD, Professor of Environmental Medicine, NYU Langone School of Medicine, Tuxedo, NY William Sawyer PhD, Toxicology Consultants & Assessment Specialist, LLC, Skaneateles, NY Ted Schettler MD MPH, Science Director, Science and Environmental Health Network Stephen S. Schneider DDS, Oral and Maxillofacial Surgeon, Deposit, NY Peter Schwarz MD, Ithaca, NY Howard Silcoff MD, Town of Dryden, NY Ken Spaeth MD MPH, Assistant Professor, Hofstra University School of Health Sciences Sandra Steingraber PhD, Distinguished Scholar in Residence, Department of Environmental Studies, Ithaca College Tompkins County Medical Society Paul F Torrisi MD, Retina-Vitreous Surgeons of CNY Inc., Associate Clinical Professor Ophthalmology Upstate Medical University, Syracuse, NY Mary Jane Uttech RN MSN, Marathon, NY Gregory Weiland PhD, Associate Professor of Pharmacology, Cornell University, Groton, NY Laura Weinberg, Great Neck Breast Cancer Coalition, NY Richard Weiskopf MD, Syracuse, NY