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?errltorial and International Affairs U.S. Department of the Interfor It Is necessary for m to bring to your attentfon a matter of mutual concern which ts becordng lnc~aslngly significant, namely, medfcal costs associated wfth non-radiation related medical cond~t~ons among the Rongelap and Utlrlk people. Thfs has been the subject of several discussions between our Departments, including a netlng on November 23, 1980, attended by the fomer Department of Energy Assistant Secretary for Environment and the former De- ~rtnmt of the Interior Acting Assistant Secretary for International and It Is my understanding that the DepaWnent of the Interior (DOI), through the Government of the Trust Territory of the Paclflc Islands (TTPI), Is responsible for the general health care of the peoples of these Islands, and that such health care Is pmvfded to them dfrectly or Indirectly through various governmental authorities. Ulth regard to this matter, Congressman ?hllllp Burton, in conrnentingupon Publfc Law 96-205, stated, “At the present tfme general health care IS provided In Micronesia through the Departme~t of Supplemental to the above responslbflitfes, the Department of the Interior, together wfth the Ufgh Convnfssionerof the Trust Terrftory of the Pacific Islands and the people of Bfkfnl, sfgned an agreement on August 16, 1978, in whfch the Department of the Interfor stated that the rnedlcal needs of the people removed from B$kfni Island during that month would be met, and that the Department of the Interior would call upon the Department of Energy for assistance. Ufth regard to thfs specfffc matter, your office has authorized the High C2xmnlsslonerto provide formedfcal expenses associated with diseases or illnesses among the Bfkfni people which might be detected by Department of Energy contractor physicians. Slmflar fdentlffcatfon of resources by your offfce for non-radfat~on related illnesses and dfseases among the peoples of Rongelap and Utlrlk has not been made, however. Thfs fs becomfng a sfgnfffcant Issue wfth Increasing frequency for several reasons.
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1. Whereas the %rookhaven National Laboratory and contractor physic~enz reletet diseases to the health authorities of the Trust Territory of the P?clfic Islands, the provisions for medical care at !fajuro ant at Ebeye are such thzt the physicians questfon the proprfety of using these resources, and therefore feel that, where necessary, proper medical care requires referral of such patients to Honolulu, or, possfbly, Guam. 2. Emergency cases from Rongelap and Utfrfk 8?reac!y referred to Hawaii this fiscal year fnclude a person requirfng open heart surgery ($43,002 In medical lxpenses and associated costs) and a pre nant diabetic woman (about ~$13,000 in medical expenses and associated costs . The need for referral lncludin~ cases that are pending. Addftfonal cases may be fdentffieti durfng future vlslts of physicians to Rongelap and Utirik Atolls. As you know, the Department of Energy (DOE) fs requfred by Public Law 95-134 to assume the costs for the care and treatment of radiation related tnjury or Illness occurring In the Rongelap and Utfrik people resulting Except for Public Law 95-134 no statute identifies the Department of Energy as befng responsible at this time, I.e., prior to the adoption of a health care plan pursuant to Publfc Law 96-205, for any health care fn the Marshall Islands. Public Law 96-205 and Its legislative hfstory provide no clear gufdance on thfs point. In any event, funds have not been appropri. ated to the Department of Energy for the care and treatment of non-radiation related dfseases among these people. Since the Department of Energy has no funds appropriated to address the above fssues, since the expenses associated with persons afflicted with nonradlation related Illnesses have depleted the present fiscal year funds rmaining for the care and treatment of persons wfth radfati~n related diseases, and sfnce It appears that the Department of the Interior has Iegfslatfve and fiscal responsibility for general health care In the?larshall Islands, lt would be most helpful ffyou would provfde gufdance as to the posltlon whfch the Department of Energy contract physicians should take with regard to the above. In additfon, it may be appropriate that the Department of the Interior make funds available for the non-radfation related fllnesses and needs Identified above through its legislative authority and resources. Unless assistance is forthcoming in the very near future the Department of Energy will be forced to dfrect fts contract physicians to refrafn from referring persons wfth non-radfation related dfseases to Honolulu or elsewhere. Pending resolution of thfs matter, we have already requested, on an Interim basfs, a sharp curtailment of these referrals.
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Than L yoti very much for your {nnedfate constcferatlon of this matter. I IOOK. for~zrC to your early response so that we might resolve the Issue to the be~e=it ani satisfaction of all concerned. attached for previous