[House Hearing, 110 Congress]
[From the U.S. Government Publishing Office]
9/11 HEALTH EFFECTS: THE SCREENING AND MONITORING OF FIRST RESPONDERS
=======================================================================
HEARING
before the
SUBCOMMITTEE ON GOVERNMENT MANAGEMENT,
ORGANIZATION, AND PROCUREMENT
of the
COMMITTEE ON OVERSIGHT
AND GOVERNMENT REFORM
HOUSE OF REPRESENTATIVES
ONE HUNDRED TENTH CONGRESS
FIRST SESSION
__________
SEPTEMBER 10, 2007
__________
Serial No. 110-87
__________
Printed for the use of the Committee on Oversight and Government Reform
Available via the World Wide Web: http://www.gpoaccess.gov/congress/
index.html
http://www.oversight.house.gov
----------
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COMMITTEE ON OVERSIGHT AND GOVERNMENT REFORM
HENRY A. WAXMAN, California, Chairman
TOM LANTOS, California TOM DAVIS, Virginia
EDOLPHUS TOWNS, New York DAN BURTON, Indiana
PAUL E. KANJORSKI, Pennsylvania CHRISTOPHER SHAYS, Connecticut
CAROLYN B. MALONEY, New York JOHN M. McHUGH, New York
ELIJAH E. CUMMINGS, Maryland JOHN L. MICA, Florida
DENNIS J. KUCINICH, Ohio MARK E. SOUDER, Indiana
DANNY K. DAVIS, Illinois TODD RUSSELL PLATTS, Pennsylvania
JOHN F. TIERNEY, Massachusetts CHRIS CANNON, Utah
WM. LACY CLAY, Missouri JOHN J. DUNCAN, Jr., Tennessee
DIANE E. WATSON, California MICHAEL R. TURNER, Ohio
STEPHEN F. LYNCH, Massachusetts DARRELL E. ISSA, California
BRIAN HIGGINS, New York KENNY MARCHANT, Texas
JOHN A. YARMUTH, Kentucky LYNN A. WESTMORELAND, Georgia
BRUCE L. BRALEY, Iowa PATRICK T. McHENRY, North Carolina
ELEANOR HOLMES NORTON, District of VIRGINIA FOXX, North Carolina
Columbia BRIAN P. BILBRAY, California
BETTY McCOLLUM, Minnesota BILL SALI, Idaho
JIM COOPER, Tennessee JIM JORDAN, Ohio
CHRIS VAN HOLLEN, Maryland
PAUL W. HODES, New Hampshire
CHRISTOPHER S. MURPHY, Connecticut
JOHN P. SARBANES, Maryland
PETER WELCH, Vermont
Phil Schiliro, Chief of Staff
Phil Barnett, Staff Director
Earley Green, Chief Clerk
David Marin, Minority Staff Director
Subcommittee on Government Management, Organization, and Procurement
EDOLPHUS TOWNS, New York, Chairman
PAUL E. KANJORSKI, Pennsylvania BRIAN P. BILBRAY, California
CHRISTOPHER S. MURPHY, Connecticut TODD RUSSELL PLATTS, Pennsylvania,
PETER WELCH, Vermont JOHN J. DUNCAN, Jr., Tennessee
CAROLYN B. MALONEY, New York
Michael McCarthy, Staff Director
C O N T E N T S
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Page
Hearing held on September 10, 2007............................... 1
Statement of:
Bascetta, Cynthia A., Director, Health Care, U.S. Government
Accountability Office; Lorna Thorpe, Deputy Commissioner,
Division of Epidemiology, New York City Department of
Health and Mental Hygiene; Dr. Spencer Eth, vice president,
Department of Psychiatry, medical director, Behavioral
Health Services, Saint Vincent's Catholic Medical Centers;
Dr. James Melius, administrator, New York State Laborers'
Health and Safety Trust Fund; and Thomas McHale, detective,
Port Authority Police Department, Port Authority Police
Detectives Endowment Association, National Association of
Police Organizations....................................... 15
Bascetta, Cynthia A...................................... 15
Eth, Spencer............................................. 52
McHale, Thomas........................................... 66
Melius, James............................................ 59
Thorpe, Lorna............................................ 43
Letters, statements, etc., submitted for the record by:
Bascetta, Cynthia A., Director, Health Care, U.S. Government
Accountability Office, prepared statement of............... 17
Eth, Dr. Spencer, vice president, Department of Psychiatry,
medical director, Behavioral Health Services, Saint
Vincent's Catholic Medical Centers, prepared statement of.. 55
Maloney, Hon. Carolyn B., a Representative in Congress from
the State of New York, various articles.................... 78
McHale, Thomas, detective, Port Authority Police Department,
Port Authority Police Detectives Endowment Association,
National Association of Police Organizations, prepared
statement of............................................... 69
Melius, Dr. James, administrator, New York State Laborers'
Health and Safety Trust Fund, prepared statement of........ 61
Nadler, Hon. Jerrold, a Representative in Congress from the
State of New York, prepared statement of Dr. Reibman....... 7
Thorpe, Lorna, Deputy Commissioner, Division of Epidemiology,
New York City Department of Health and Mental Hygiene,
prepared statement of...................................... 46
9/11 HEALTH EFFECTS: THE SCREENING AND MONITORING OF FIRST RESPONDERS
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MONDAY, SEPTEMBER 10, 2007
House of Representatives,
Subcommittee on Government Management,
Organization, and Procurement,
Committee on Oversight and Government Reform,
Brooklyn, NY.
The subcommittee met, pursuant to notice, at 10:45 a.m., at
the Brooklyn Borough Hall, Ceremonial Courtroom, 209 Joralemon
Street, Brooklyn, NY, Hon. Edolphus Towns (chairman of the
subcommittee) presiding.
Present: Representatives Towns and Maloney.
Staff present: Rick Blake, professional staff member; and
Cecelia Morton, clerk.
Mr. Towns. The hearing will come to order.
As we begin the business of today, we should remember 6
years ago, when toxic clouds of smoke from the World Trade
Center hung above lower Manhattan and Brooklyn. On that day and
in the weeks that followed, first responders, construction
workers and volunteers came to Ground Zero to work on the
rescue and recovery effort, and we salute them for that.
Many of them have become victims of 9/11, facing health
challenges such as pulmonary fibrosis, post-traumatic stress
disorder and more. In February, we learned about all the work
that New York City and New York State have started. We asked
the Federal officials at Health and Human Services for more
support of these programs.
At that time, we questioned the Assistant Secretary of
Health Agwunobi, who told us the administration was working on
a report from a task force which would come up with a plan. We
pressed for more details from HHS and basically got what only
can be called, in my neighborhood, the runaround.
Now, more than 6 months later, we still don't have a final
report or a plan from the administration for dealing with the
long-range health consequences of 9/11. It was this
subcommittee's intent to call Dr. Agwunobi back to testify and
ask him about his plan. But instead, we learned that he quit.
But, someone needs to produce it. Even 6 years later, New
Yorkers are still dealing with the long-term health effects
from this tragedy. And, we intend to hold the administration
accountable. And, let me put it this way. We are not going
away.
I don't mean to be overly critical, but the lack of a long-
range plan has become a pattern in this administration. 9/11,
no plan. Katrina, no plan. Iraq, no plan. They simply don't
deal with large-scale adversities too well.
Today, we will get an update from witnesses who are the
experts on 9/11 health, both the Government Accountability
Office and our expert witnesses from New York City, have new
reports concerning the health screening and monitoring of our
first responders, and information concerning what has really
happened in terms of their physical and mental health. Doctors
and first responders will tell us how health care is being
delivered.
I would, at this point, like to thank my colleague and
friend, Congresswoman Carolyn Maloney, for the outstanding work
that she has been doing on behalf of the project, in terms of
9/11 health care and, of course, responding to the issues and
concerns. Congresswoman, you are doing a superb job. And, at
this time, I would like to yield to you for an opening
statement.
Mrs. Maloney. Thank you so much.
First and foremost, I want to thank you, my good friend
Congressman Towns, for holding this very important hearing on
the eve of the sixth anniversary of 9/11. This is the third in
a series of hearings on the health effects of 9/11, and I
commend you for your unwavering efforts to bring this issue to
the forefront.
I also want to thank my good friend, Jerry Nadler. Working
together, we will not rest until everyone exposed to the toxins
at Ground Zero is monitored, and all who are sick are treated
as a result of their exposure, that they get the medical
treatment that they need and that they deserve.
The collapse of the World Trade Center towers took nearly
3,000 lives in an instant and released a massive cloud of
asbestos, concrete and other poisons. Due to those toxins, we
now know that thousands more have lost their health.
Six years later, more than 6,500 responders, truly the
heroes and heroines of 9/11, are being treated for 9/11-related
health problems through the federally funded World Trade Center
Monitoring and Treatment Program. And, more than 4,500 have
been referred for mental health care, often for conditions like
post-traumatic stress syndrome.
Every month, another 500 to 1,000 responders sign up for
health monitoring. And, those coming in are more sick than ever
before.
Separately, more than 70,000 Americans reported to the
World Trade Center Health Registry. Although most are from New
York, New Jersey and Connecticut, more than 10,000 Americans
came from outside the tri-State area and are registered.
Amazingly, every single State in the Union had representatives
at 9/11, including Hawaii and Alaska. This is a health
emergency on a national scale, and it requires a strong Federal
response.
Two days ago, at a labor rally at Ground Zero, I joined the
New York AFL-CIO president, Denis Hughes, Representative
Nadler, our Senators and Congressman Rangel, in announcing the
9/11 Health and Compensation Act, which we will be introducing
this week in Congress.
The 9/11 Health and Compensation Act will ensure that
everyone exposed to the Ground Zero toxins has a right to be
medically monitored, and all who are sick as a result have a
right to treatment. It will build on the expertise of the
Centers for Excellence at Mount Sinai, Bellevue and other
sites, which are currently providing high-quality care to
thousands of responders, and ensuring ongoing data collection
and analysis, and expanded care to the entire exposed
community.
The bill also includes care for area residents, workers and
school children, as well as the thousands of people that came
from across the country to assist with the recovery and clean
up efforts.
Finally, the bill provides compensation for economic
damages and loss by re-opening the September 11th Victims
Compensation Fund.
I have been fighting for years to make sure that all these
things happen. And I am very proud to be working with
representatives Nadler and Rangel and Towns and many others,
with very strong support of the New York AFL-CIO, to move this
comprehensive package forward.
Only the Federal Government has the resources and the reach
to properly address the health and compensation needs. Only the
Federal Government can take care of the thousands and thousands
who responded to help at Ground Zero. But often, it feels like
we in Congress are fighting the Bush administration every step
of the way.
Let me give you just one of many examples. In my very first
hearing of the year of the subcommittee, we heard from Dr. John
Agwunobi, who was Assistant Secretary of Health at the
Department of Health and Human Services and who also acted as
Chair of the Department's World Trade Center Task Force. Many
of us left that hearing feeling like there were many more
questions left than good answers given. Since then, we have
learned that the World Trade Center Task Force briefed HHS
Secretary Leavitt with their recommendations. Remarkably, still
no action has been taken on these recommendations. And, Dr.
Agwunobi has resigned, effective September 4th, without
releasing the plan of action he promised, and that has been
promised to us repeatedly, over and over and over again, from
the administration.
So, along with Senators Clinton, Schumer, Nadler, Pallone,
Towns and many others, we have written to Secretary Leavitt to
request a meeting to find out when he intends to appoint a new
Chair for the World Trade Center Task Force.
Let me close by saying that I look very much forward to the
hearing and the testimony of our witnesses today. I thank each
and every one of you for being here and for doing your part to
help others. And, you are here really doing important work to
ensure that those exposed to the toxins are monitored and those
who are sick are treated. That is the least we can do, as the
wealthiest nation on Earth, take care of the people who rushed
selflessly into burning buildings to help others.
I yield back the balance of my time.
Mr. Towns. Thank you, very much, Congresswoman Maloney.
We have been joined by Congressman Nadler, who, of course,
represents Manhattan and Brooklyn and who has been very, very
involved in this issue over the years. Ladies and gentlemen,
Congressman Nadler.
Mr. Nadler. Thank you, Mr. Chairman.
Mr. Chairman, let me begin by thanking you for holding this
hearing, by thanking Congresswoman Maloney for the work she has
done on this issue, and thanking the AFL-CIO for the work that
they have done on this issue, in particular on helping us craft
the bill that Congresswoman Maloney and I and some others will
be introducing shortly.
When the Twin Towers came down on September 11, 2001, our
first responders--firefighters, police officers, EMTs, steel
workers and countless others--selflessly put their lives in
danger so that they might save the lives of others. Workers and
volunteers came from all five boroughs, from New Jersey and
Connecticut and from every other State in the Union. At the
moment when our country was under attack, these responders were
on the front lines, sifting through the rubble of the World
Trade Center searching desperately for survivors.
Many of them did this without proper protective equipment,
because government officials--the EPA, OSHA and the White
House--told them it was safe. Now, 6 years later, many of them
are sick.
At the Pentagon, OSHA enforced regulations requiring the
use of respirators. No workers became sick. At Ground Zero, Con
Edison made sure that its workers wore respirators, and none of
the Con Edison workers became sick. But, OSHA failed to enforce
its own regulations at the World Trade Center site, as did the
EPA, as did the city of New York. Someone made the deliberate
decision not to enforce the OSHA laws, and 70 percent of the
first responders who worked on that site are sick, and some
others have already died.
As Chair of the Subcommittee on the Constitution, Civil
Rights and Civil Liberties, I held a hearing in June where we
heard for the first time from the former head of OSHA, who
testified under oath that OSHA had properly protected the
health and safety of workers at Ground Zero.
He also testified that OSHA's breathing zone samples showed
exposures were below the agency's permissible levels, even
though independent tests showed otherwise.
Back in 1986, under the Reagan administration, EPA
concluded that there are no safe levels, no minimum safe levels
of asbestos. The former head of OSHA--the same former head--
even signed a letter explaining that all World Trade Center
dust would be considered to contain asbestos, and that,
therefore, triggered all the laws regarding cleanup of
asbestos. And yet, OSHA handed out paper filament masks on 9/11
that were clearly marked, ``Warning: This mask does not protect
your lungs.''
OSHA claims that it conducted safety and health inspections
to ensure that standards were followed and the workers were
properly protected. Had this been the case, the agency should
have alerted workers to the grave health and safety violations
at the World Trade Center site and enforced regulations that
required that all workers wear respirators. If all workers had
been wearing respirators, first responders like Marvin Bethea,
for example, who has testified at many hearings, would not be
suffering from 9/11 health effects.
In 2002, EPA issued a report called ``Lessons Learned in
the Aftermath of September 11, 2001,'' which states that,
``EPA's mission was to protect front line responders and
residents from dust and contaminants released when commercial
aircraft were deliberately crashed.'' It goes on to say,
``Mission accomplished.''
If EPA's response to Ground Zero indeed constituted
``mission accomplished,'' then first responders like John
Sferazo, who has testified at many hearings, would not today be
suffering from 9/11 effects.
The response of the Federal Government is totally
inadequate. Indeed, I have often said that the Federal
Government has betrayed our first responders. The brave men and
women who worked seemingly endless days at the World Trade
Center site deserve answers to their questions and deserve help
for their afflictions.
Why did OSHA not enforce the law in New York, with respect
to the non-city or State employees on the site, despite
repeated requests from the city to do so? The OSHA head
testified at our hearing in June that they had no jurisdiction
to force city workers to comply with those regulations. But,
they did have jurisdiction to enforce the law with regard to
non-city and State employees. Why did they no do so, despite
repeated requests from the city to do so.
Why did OSHA hand out inadequate paper masks that did not
protect against asbestos or ultra fine particulates to workers?
Why did EPA shirk its responsibility to warn all those people
in New York, in Lower Manhattan, that the air was not safe to
breathe? Indeed, why did they knowingly and deliberately lie,
telling people the air was safe to breathe, when there were
ample tests results that showed to the contrary?
In the meantime, we have been forced to go hat in hand,
begging for health care for the first responders. Despite all
the published scientific reports and all the 9/11 community
rallies, we still find ourselves shouting that we need help.
The Federal Government put these men and women in harm's
way on 9/11 and is now treating them like pests rather than
heroes. Doctors at Mount Sinai and at Bellevue have been doing
a fantastic job. Mount Sinai is doing a fantastic job of
treating those responders, and Bellevue is treating local
residents who need care. But, doing so has been a struggle, as
they receive only a fraction of the funding their program
needs.
A July GAO report found that efforts by the Federal
Government to provide services to first responders have been
intermittent and haphazard, at best.
Abraham Lincoln said, in his second inaugural address that
we must ``care for him who shall have borne the battle.'' And
so we should. I am pleased that Congresswoman Maloney and I and
others will soon be introducing legislation to provide long-
term healthcare to all those with 9/11-related illnesses. Our
legislation would build on the efforts of the Centers of
Excellence in New York City and would extend to people who came
from all over the country to aid in the massive rescue and
recovery efforts after 9/11. I encourage all my colleagues to
support this bill and to pass it without delay.
Dr. Joan Reibman of Bellevue has prepared testimony on
behalf of the New York Health and Hospitals Corp.
I ask, Mr. Chairman, that it be submitted in whole for the
record.
Mr. Towns. Without objection.
[The prepared statement of Dr. Reibman follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Nadler. And I again thank the AFL-CIO for its help and
leadership in preparing this legislation.
Tomorrow, we mark 6 years of incompetence and malfeasance
on the part of the Federal Government. I would call it more
malfeasance than incompetence. I call on EPA to stop covering
up its harmful and illegal actions in response to the attacks
of 9/11. I call on EPA to conduct a proper testing and cleanup
program in Lower Manhattan, in Brooklyn, in Queens, and to
fulfill its legal mandate to clean up indoor air, not just in
Lower Manhattan, but also in Brooklyn and in any other areas
that were contaminated by the World Trade Center dust.
And, I call on Congress to pass the bill that Congresswoman
Maloney and I will be introducing to provide comprehensive
healthcare benefits to all those who are suffering the health
effects of 9/11.
And, I call on the Bush administration to take their heads
out of the sand, stop denying the obvious and start treating
the first responders as heroes and stop treating them as pests.
I thank you, and I yield back.
Mr. Towns. Thank you, very much, Congressman Nadler.
We have been joined by the deputy borough president of
Brooklyn. And I want to just sort of first thank them for
allowing us to come in and use the facility here. And I am
always happy and anxious and eager to introduce the deputy
borough president of Brooklyn, because some of you might not
know that I served as a deputy borough president of Brooklyn
for many, many years. So, I have a special kind of feeling when
it comes to deputy borough president.
So, it is my honor and my pleasure to present to you Yvonne
Graham, the deputy borough president of Brooklyn.
Ms. Graham. Thank you, Congressman Towns. It is my honor to
present these remarks on behalf of borough president Marty
Markowitz.
Good morning, Chairman Towns and members of the
Subcommittee on Government Management, Organization, and
Procurement.
Tomorrow, of course, marks the sixth anniversary of the
tragic events of September 11, 2001. The scars of 9/11 are
still fresh, and that horrific event continues to harm the
collective memory of all New Yorkers. So, I thank you for
organizing this hearing on the health impacts of 9/11
particularly as they relate to the brave men and women who came
to our city's aid on that terrible day and who worked for so
many months afterwards to help us heal.
I am extremely grateful to the New York delegation for
working in bipartisan cooperation to secure Federal funding for
monitoring, research and treatment programs that 9/11
responders both need and deserve. Our city and Nation must help
those who volunteered so selflessly during and after the
attack.
According to an article in last week's Village Voice,
statistics indicate that 3.6 percent of the 25,000 Ground Zero
workers have reported symptoms of asthma after working at the
site. The article also reports that more than 3,000
firefighters have sought medical treatment for respiratory
conditions since 9/11, and more than 25 percent of all New York
City's firefighters show symptoms of asthma.
We must address these health issues now and continue that
commitment well into the future. Since these respiratory
ailments and cancers can develop over time and appear years
later, it is critical that everyone who worked at Ground Zero
be monitored for health conditions and be given access to long-
term healthcare programs, if need be.
We all know that mistakes were made. The air was not
immediately tested after the disaster. And, residents and
responders were told that the air was safe to breathe. Although
it may be too late to change that history, it is not too late
to address the short and long-term health effects that may have
resulted.
As elected officials, our No. 1 priority is ensuring the
well-being of our residents. Our call to action should be
making sure that New Yorkers who are suffering from
complications as a result of the attacks get the healthcare and
services they need. Our mandate must be securing Federal
funding for research, monitoring and long-term treatment, so
that all victims can be treated now and in the future.
Tomorrow, the halls of government will echo with the phrase
``Never forget,'' referring to those we lost. We honor their
memory. And, we must also never forget those who, without
regard to their own safety, hurried to the site of the tragedy
to help a city in need.
Thank you all for refusing to forget.
Mr. Towns. Thank you, very much, Deputy Borough President
Graham. Thank you for your statement and also, again, thank you
for allowing us to come in.
And, to those of you who might not know, she was very, very
involved in healthcare herself, before becoming deputy borough
president of Brooklyn.
Thank you, so much, for coming.
At this time, we would introduce our witnesses.
We have Cynthia Bascetta, Director of Health Care, U.S.
Government Accountability Office. Thank you for coming.
Dr. Lorna Thorpe, deputy commissioner of health, New York
City Department of Health and Mental Hygiene, and director of
Division of Epidemiology.
Dr. Spencer Eth, senior vice president and medical
director, Behavioral Health Services, Saint Vincent's Medical
Center of New York. Welcome, and thank you for coming.
And, of course, Dr. James Melius, administrator of New York
State Laborers Health and Safety Trust Fund.
And, Thomas McHale, detective with the Port Authority of
New York and New Jersey Police.
Thank you all for coming. It is our longstanding policy
that we swear in our witnesses. So, if you would stand and
raise your right hands?
[Witnesses sworn.]
Mr. Towns. Let the record reflect that the witnesses have
answered in the affirmative.
We are going to move right down the line, from your right
to your left.
We will start with you, Ms. Bascetta. Thank you. If you
would, just use like 5 minutes to give us a summary. And, the
reason for it is that we want to be able to get into questions.
And, of course, I know that these Members have something else
that they need to do. And, of course, I am involved in that, as
well. So, while--and we want to be able to cover as much, so we
think in the question-and-answer you may be getting into all
the other things that you might not be able to say in your
statement. OK? Thank you so much.
And we will go right down the line.
STATEMENTS OF CYNTHIA A. BASCETTA, DIRECTOR, HEALTH CARE, U.S.
GOVERNMENT ACCOUNTABILITY OFFICE; LORNA THORPE, DEPUTY
COMMISSIONER, DIVISION OF EPIDEMIOLOGY, NEW YORK CITY
DEPARTMENT OF HEALTH AND MENTAL HYGIENE; DR. SPENCER ETH, VICE
PRESIDENT, DEPARTMENT OF PSYCHIATRY, MEDICAL DIRECTOR,
BEHAVIORAL HEALTH SERVICES, SAINT VINCENT'S CATHOLIC MEDICAL
CENTERS; DR. JAMES MELIUS, ADMINISTRATOR, NEW YORK STATE
LABORERS' HEALTH AND SAFETY TRUST FUND; AND THOMAS MCHALE,
DETECTIVE, PORT AUTHORITY POLICE DEPARTMENT, PORT AUTHORITY
POLICE DETECTIVES ENDOWMENT ASSOCIATION, NATIONAL ASSOCIATION
OF POLICE ORGANIZATIONS
STATEMENT OF CYNTHIA BASCETTA
Ms. Bascetta. Mr. Chairman and members of the subcommittee,
thank you for inviting me to discuss the implementation of
federally funded health programs for responders who served in
the aftermath of the World Trade Center disaster.
As you know, these responders were exposed to numerous
physical hazards, environmental toxins and psychological
trauma, which has continued to exact a toll for many of them,
even 6 years after the attack.
My testimony today is based on our body of work, including
four testimonies from our July 2007 report. In this work, we
found that HHS-funded programs as separate efforts serving
different categories of responders; for example, firefighters,
police, other workers and volunteers and the Federal
responders. We also highlighted that the Federal responder
screening program had accomplished little, in light of the kind
of programs for other responders.
My remarks today focus on the status of NIOSH's awards for
treatment to World Trade Center health program grantees, the
services provided to Federal responders and efforts by NIOSH to
provide services for non-Federal responders residing outside
the New York City metro area.
To do our work, we reviewed numerous documents and
interviewed officials of the Federal Government and private-
sector organizations.
Last fall, NIOSH awarded and set aside funds totaling $51
million from its $75 million appropriation to pay for treatment
programs, notably the first time that Federal funds were
awarded for this purpose. And about $44 million was for
outpatient treatment, and about $7 million was set aside for
inpatient hospital care. The bulk of the funding went to the
fire department and the New York/New Jersey Consortium. In
addition to outpatient care, Federal funds paid for 34
hospitalizations of responders so far. NIOSH is now planning
how to use the $50 million emergency supplemental appropriation
made in May 2007, to continue support for treatment into the
year 2008.
We reported this July that HHS has had continuing
difficulties ensuring the uninterrupted availability of
services for Federal responders who had been eligible only for
a one-time screening examination. First, the provision of these
screening examinations has been intermittent. HHS suspended
them from March 2004 to December 2005, resumed them for about a
year, then placed the program on hold and suspended scheduling
exams from January to May 2007. The interruptions occurred
because interagency agreements were not put in place in time to
keep the program fully operational.
Second, the provision of specialty diagnostic services
associated with screening has also been intermittent,
Responders often need further diagnostic tests from ear, nose
and throat physicians, cardiologists and pulmonologists, and
the program had referred responders and paid for these
diagnostic services. However, because the contract with a new
provider network did not cover these services, they were
unavailable from April 2006 until the contract was modified in
March 2007.
NIOSH was considering expanding the services for Federal
responders to include monitoring examinations, the same
followup physical and health examinations provided to other
responders. Without followup, their health conditions may not
be diagnosed and treated, and knowledge of the health effects
caused by the disaster may be incomplete.
We also found that NIOSH has not ensured the availability
of screening and monitoring services for non-Federal responders
outside of the New York City area, although it recently took
steps to expand their availability. Similar to the intermittent
service pattern for Federal responders, NIOSH's formation of a
network of occupational health clinics to provide services
nationwide were on-again/off-again. NIOSH renewed its efforts
to expand the provider network, however; and in May 2007, had
completed about 20 exams.
Mr. Chairman, despite HHS's recent consideration of ways to
add monitoring for Federal responders and to improve the
availability of screening and monitoring services for Federal
and non-Federal responders nationwide, these efforts remain
incomplete. Moreover, the start-and-stop history of the
Department's efforts to serve these groups does not provide
assurance that the latest efforts to extend screening and
monitoring services to these responders will be successful and
will be sustained over time.
As a result, we recommended in our July 2007, report that
the Secretary take expeditious action to ensure the
availability of health screening and monitoring services for
all people who responded to the attack on the World Trade
Center, regardless of their employer or their residence. To
date, HHS has not responded to our recommendation.
That concludes my remarks, and I would be happy to answer
any questions.
[The prepared statement of Ms. Bascetta follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Towns. Thank you very much for your statement.
Dr. Thorpe.
STATEMENT OF LORNA THORPE
Dr. Thorpe. Good morning, Chairman Towns, Congresswoman
Maloney, Congressman Nadler and Deputy Borough President Yvonne
Graham, if she is still with us.
My name is Lorna Thorpe, deputy commissioner of the
Division of Epidemiology at the New York City Department of
Health and Mental Hygiene. Thank you for inviting me to discuss
two scientific studies done on the health impacts of the World
Trade Center disaster among rescue and recovery workers.
These studies, conducted using the largest sample of
exposed workers and volunteers assembled to date, add important
new findings to the growing body of information on the physical
and mental health effects of the disaster. They are based on
interviews of more than 25,000 rescue and recovery workers who
enrolled in the World Trade Center Health Registry during 2003
and 2004.
By way of background, the World Trade Center Health
Registry is one of the Nation's main platforms for
understanding possible short and long-term World Trade Center-
related illnesses. It was developed as a collaboration between
the New York City Health Department and the Agency for Toxic
Substances and Disease Registry [ATSDR], with the goal of
tracking exposed individuals for up to 20 years.
Initially funded through FEMA, and later through special 9/
11 congressional appropriations, the Registry has sufficient
funding to last through Federal fiscal year 2008. We estimate
that it requires at least $4.5 million per year to maintain the
Registry going forward.
In all, more that 71,000 individuals voluntarily enrolled
in the Registry, including persons from every State and almost
every congressional district in the United States. More than 20
percent of the enrollees lived outside of New York State on
September 11, 2001.
In addition to enrolling workers, the Registry includes
another 14,000 Lower Manhattan residents, 10,000 tower
survivors and survivors of other damaged or destroyed
buildings, 19,000 occupants of other Lower Manhattan buildings
near the World Trade Center site, 3,000 children, 13,000 people
who were on the street or in transit around the World Trade
Center at the time of the building collapse.
The Registry will monitor the health of enrollees over a
20-year time period through periodic health surveys, special
in-depth studies and routine assessments of cancer incidence
and mortality. Special studies initiated by either government
or academic institutions is open for external research.
The two peer-reviewed studies published this month reported
the development of asthma and on post-traumatic stress disorder
among rescue and recovery workers after 9/11. Both are
potentially lifelong conditions that can be controlled with
appropriate treatment.
The asthma study, published this month in the journal
Environmental Health Perspectives, found that among more than
25,000 previously asthma-free rescue and recovery workers, 3.6
percent reported having been diagnosed with new-onset asthma by
a physician within a 2 to 3-year time period after working at
the site. That is a rate 12 times higher than expected in the
general adult population.
The study also shows that asthma rates were highest among
two groups of workers: those who arrived soon after the
buildings collapsed, particularly those arriving on September
11th and September 12th; and those who worked for long
durations at the site, over 90 days. For workers who arrived on
September 11th and worked more than 90 days, rates of asthma
were as high as 7 percent, more than 20 times higher than would
have been expected in the general population.
Certain respirators or masks can reduce exposure to
hazardous dust when used correctly. While the survey did not
distinguish between different types of respirators or masks, or
gauge correct usage, we did find that reported mask use
afforded moderate protection against developing asthma.
For example, workers who wore them on September 11th and
September 12th reported significantly lower rates of newly
diagnosed asthma than those who did not. Generally, the longer
the period of not wearing respirators or masks, the greater the
risk, although asthma levels were elevated in all worker
groups, including those who wore mask.
The asthma findings in this study and their dose response
relationship to the World Trade Center exposures are consistent
with and add important additional information to prior lung
function decline studies by the New York City Fire Department
and the Mount Sinai Medical Monitoring program.
The other study published this month in the American
Journal of Psychiatry examined survey responses of nearly
29,000 rescue and recovery workers who worked directly at World
Trade Center site.
In this study, we found that one in eight workers, or 12.4
percent, had post-traumatic stress disorder at the time of
their interviews. The prevalence of post-traumatic stress
disorder [PTSD], in the U.S. population is roughly 4 percent at
any given time. This is three times that rate.
Post-traumatic stress disorder can be devastating,
affecting the sufferer's families and their work lives.
People with PTSD are at greater risk of suffering from
depression and substance abuse.
We found that levels of PTSD among workers varied
significantly by occupation, with rates ranging from 6.2
percent among police officers, to 21.2 percent among volunteers
not affiliated with an organization. Workers from non-emergency
occupations, such as construction, engineering and sanitation
workers, also suffered particularly high rates of PTSD, which
may reflect that these workers do not typically have disaster
preparedness training or prior experience with emergencies,
both of which can help buffer psychological trauma.
As with the asthma study, people who started work or soon
after 9/11, or who worked for longer periods of time, were more
vulnerable to developing PTSD.
The study also found that working outside of one's area of
expertise increased the risk of developing PTSD--for example,
civilian volunteers engaged in firefighting, or engineering and
sanitation workers performing search and rescue. Sustaining and
injury and having to evacuate a building also increased their
risk.
These two studies demonstrate the need for continued
monitoring and care of exposed workers. They also offer
important lessons to help emergency planners reduce the impact
of future disasters, such as ensuring the availability of
respiratory and other protective equipment, and proper training
in its use; the value of disaster preparedness training for all
types of emergency responders; the use of shift rotations to
reduce workers' duration at emergency sites; and the importance
of limiting exposure of those who have had less experience with
trauma response, such as volunteers.
In addition to these two studies, we have a number of other
registered studies under peer review, including ones examining
the health impacts on the residents of Lower Manhattan and
children.
Mr. Towns. If you could, sum up, please.
Dr. Thorpe. The New York City Health Department is also
conducting special in-depth studies, using the Registry as a
foundation. First among these is a clinical investigation of
respiratory health, in collaboration with Bellevue Hospital.
This study focuses on residents and building occupants in Lower
Manhattan who report persistent respiratory symptoms.
The collapse of the World Trade Center towers on 9/11 was
an unprecedented urban environmental disaster brought on by a
terrorist attack upon our Nation. We are grateful to the New
York City congressional delegation and to Mayor Bloomberg for
providing funding to support both the Centers of Excellence and
the World Trade Center Registry.
We are confident that working together with our elected
officials nationwide, we can improve the medical and healthcare
services to address the needs of first responders, recovery
workers, residents and all those who may have suffered health
effects related to the events of September 11, 2001.
Thank you.
[The prepared statement of Dr. Thorpe follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Towns. Thank you, very much.
Dr. Eth.
STATEMENT OF SPENCER ETH
Dr. Eth. Good morning, Congressman Towns, Congresswoman
Maloney, Congressman Nadler and other distinguished guests.
My name is Dr. Spencer Eth, and I am medical director of
Behavioral Health Services at Saint Vincent Catholic Medical
Centers, and professor of psychiatry at New York Medical
College.
It is a privilege to speak today about a subject that is of
the utmost importance to me as a psychiatrist, and indeed to
everyone present here today.
Six years ago tomorrow, I was completing psychiatric rounds
in Saint Vincent's Hospital when a plane crashed into the north
tower. As the closest academic medical center to the World
Trade Center and as the hospital that had received most of the
victims of the February 1993, bombing, Saint Vincent's
immediately implemented its disaster plan in anticipation of
the expected onslaught of patients. Beds were cleared, elective
surgeries and clinics were canceled, and all professional staff
stood ready for action. However, within the first 2 hours, only
400 patients presented to the Saint Vincent's emergency room,
most having suffered minor injuries.
Then, the sirens stopped, and few new patients arrived for
emergency medical care. There was no second wave of injured
survivors. Tragically, the 2,800 people trapped in and adjacent
to the towers died, while the majority of others in the
vicinity were not seriously hurt. Saint Vincent's did not
perform a single surgery that day.
Instead, what transpired was astounding. Saint Vincent's
became surrounded by hundreds of people in acute emotional
distress--people who were terrified and desperately seeking
information, reassurance and crisis counseling.
We mobilized our mental health staff, and within hours,
began seeing all of these people at Saint Vincent's, and soon
afterwards at the nearby New School University.
True to our mission, the Saint Vincent's Department of
Psychiatry made a commitment to care for everyone who needed
our help without charging a single fee. Operating around the
clock, we provided over 7,000 sessions and answered over 10,000
telephone calls in that first week. I will never forget the
impact our services had on so many suffering New Yorkers in
this immediate crisis phase of the disaster response.
We knew that our professional staff would soon have to
return to their regular duties treating patients with mental
illness and substance abuse. Consequently, we recognized the
need to hire and train new clinicians to meet the demands of
the World Trade Center victims and first responders. And, in
order to do so, we actively sought donations to cover the
additional personnel costs. We were fortunate that many
corporations, foundations and individuals supported this phase
of our work.
On September 26, 2001, I testified in Washington at a
special hearing of the Senate Health, Education, Labor and
Pensions Committee. I vividly recall the moving testimony of
the other witnesses, who included Dr. Kerry Kelly, the medical
director of the FDNY. I also remember the reactions of the
committee members. Chairman Kennedy and Senators Clinton,
Wellstone, Warner and Frist--all of them pledged to supply the
Federal funds that would be necessary to meet the mental health
needs of the survivors of the terrorist attack.
On that basis, Saint Vincent's developed special long-term
psychiatric programs to treat the World Trade Center victims,
first responders and public safety workers who were at the
pile. Thousands of adults and children were seen at our
hospital and in site at the FDNY firehouses, at the schools in
Lower Manhattan, in the Port Authority Police Department
trailers surrounding Ground Zero and, in the following year, at
the Saint Vincent's World Trade Center Healing Services offices
at 170 Broadway.
Finally, in 2002, the promised Federal funds began to flow.
In particular, FEMA's New York State Project Liberty allowed us
to broaden the scope of our programs. However, FEMA mandated
that only crisis counseling could be provided through Project
Liberty. Many of the World Trade Center survivors we saw were
already suffering from more serious mental conditions. These
disorders generally required a course of psychotherapy and
possibly psychotropic medication. The limitations of the FEMA
regulations prevented the sickest victims from receiving
effective treatment in Project Liberty funded programs.
Another Federal agency, SAMHSA, awarded Saint Vincent's one
of its seven Public Safety Worker Program grants. That expanded
our ability to evaluate and treat first responders. We assessed
the mental health needs of this population and delivered
psychiatric care in proximity to work sites. We noted that
although the number of patients decreased over the 3-year life
of the grant, the severity of their symptoms actually worsened.
In addition, many patients presented for the first time only
years after trying unsuccessfully to cope with their suffering.
Although the work of the healing was far from complete, the
Federal funding for Project Liberty and the Public Safety
Worker Program ended 2 years ago. Saint Vincent's has continued
to meet its commitment to those still suffering the emotional
wounds of 9/11.
In our current phase of disaster relief, Saint Vincent's is
once again dependent on private donations, especially support
from the 9/11 funds of the American Red Cross and the New York
Times Foundation. We are receiving no Federal, State, or city
funding, which has been exclusively directed to Bellevue and
Mount Sinai Hospitals. This is despite our record of treating
over 60,000 survivors for mental health needs.
Looking to the future, our clinical experience suggests--
and I will be done in just----
Mr. Towns. Yes. Please wrap up.
Dr. Eth [continuing]. About 30 seconds----
Mr. Towns. OK.
Dr. Eth. Our clinical experience suggests that there will
be an ongoing need for mental health care for 9/11 workers and
others exposed to the terrorist attack and its aftermath. The
study co-authored by Dr. Thorpe demonstrated chronic PTSD in 12
percent of rescue and recovery workers, 2 to 3 years after 9/
11. This mental condition is well-known to be difficult to
treat and to be associated with long-term emotional distress
and occupational disability.
Further, many victims of 9/11 are developing pulmonary and
other medical illnesses arising from their exposure to toxic
substances. These individuals can also be expected to
experience new and worsening psychiatric symptoms that will
erode their level of function and their ability to cope.
These are not theoretical concerns, but actual findings
from our evaluation and treatment of first responders. But,
despite our best efforts, Saint Vincent's will not be able to
continue going it alone. We need Federal assistance to provide
mental health care to our current and future patients. We look
to the Congress--we look to you--to honor the promise----
Mr. Towns. Doctor, please sum up.
Dr. Eth [continuing]. To honor the promise to our first
responders and our Nation made 6 years ago by the Senate Health
Committee. Please provide the funding to keep these vital
programs alive.
[The prepared statement of Dr. Eth follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Towns. Thank you.
Dr. Eth. Thank you, Mr. Chairman.
Mr. Towns. Thank you very much.
OK, Dr. Melius.
STATEMENT OF JAMES MELIUS
Dr. Melius. Honorable Chairman Towns, Representatives
Maloney and Nadler: I greatly appreciate the opportunity to
appear before you at this hearing.
I am James Melius. I am an occupational health physician,
and as you indicate, I work for the Laborers' Union. But I have
also spent much of my career working to document problems
experienced by emergency responders exposed to toxic chemicals
as part of their work. And, for over 20 years, I have served as
Chair of the Medical Advisory Committee for the International
Association of Fire Fighters, advising that union and its many
members in the United States and Canada on occupational health
issues.
And, in that capacity, I have had the opportunity, over the
last few years, to talk to many emergency responders from other
parts of the country who came and helped out at the World Trade
Center in the aftermath of the 9/11 attacks.
For the past 4 years, I have also served as the Chair of
the Steering Committee for the World Trade Center Medical
Monitoring and Treatment Program. And, therefore, I have been
in a position to oversee, and I think I can provide some
understanding of the situation with that particular program.
First, I would like to say that there is ample evidence
that the large numbers of firefighters, police and other
workers involved in the September 11th response have become ill
as part of their work. Dr. Thorpe has presented two of the new
findings of the New York City Health Department. And, there
were ample studies in the literature already and ongoing
research that will document the problems. So, very serious
health problems are being experienced by literally thousands of
the people who responded to that event, as well as by the
residents and public people in the community.
We know that there is--through the efforts of our
congressional delegation, particularly Representatives Maloney
and Nadler, Senator Clinton, we have established a very good
medical program and, more recently, a federally funded
treatment program for those workers.
However, as we have heard from the Government
Accountability Office today, there are some shortcomings of
that program, and those shortcomings particularly affect two
groups of workers. One is the Federal workers who responded to
the event; and the second are police and firefighters, other
emergency responders from around the country who came to help
at that event.
I won't repeat the findings of the GAO report about Federal
workers, but I would indicate that, despite efforts on the part
of the Federal Government, those workers are continuing not to
receive the full monitoring and treatment that they deserve.
The problems seem to be within the government, within the
bureaucracy, in making arrangements to get everybody
transferred over and to coordinate the care, particularly those
who are residing in other parts of the country, outside of the
New York City metropolitan area.
Also, firefighters, police and other emergency responders
from outside the immediate New York City area have had great
difficulty getting adequate care. The Federal Government has
tried a number of different approaches--and, again, those are
documented by the GAO report--to arrange for monitoring and
treatment. They have been able to provide some of that, but
frankly most of the treatment to this day continues to be
funded by the Red Cross and not by the Federal Government. And,
it appears that it may be many more months before the
government can arrange for treatment funding to be provided for
those people living outside of the New York City metropolitan
area.
And this problem with the--both of these problems, for the
Federal worker program, as well as for emergency responders
from outside of New York City, creates a number of problems for
the individuals involved. They are becoming increasingly
frustrated with delays in getting care and the lack of ability
to be able to arrange for care.
Just as one example, the new program for national
responders, for people from outside the area, the new contract
with this outside national organization have managed to arrange
exams for fewer than 100 people so far, in the last several
months. And, we know that there are literally hundreds, if not
thousands, of responders out there waiting to receive their
followup monitoring. And for them to get referred for treatment
is quite difficult.
And, we know that there are resources outside of the New
York area that can provide care for them. It is a question of
really making the arrangements to do that.
However, I really think there are also problems with
getting full monitoring and treatment for people within the New
York area. What we really need is a comprehensive approach to
this problem. I think the delegation from New York has called
for that, and I think now is the time to move forward. We can't
continue to piecemeal together a program. We need a
comprehensive legislative solution that would provide care.
I believe that the legislation introduced by Congressman
Maloney and Nadler really will address those problems. I would
add that would directly address the problems that I have
mentioned with the national program, as well as the problems
that Saint Vincent's Hospital talked about today, in terms of
being able to arrange for followup treatment for the many
people that need it, even in the New York area.
Thank you for your time today, and I would be glad to
answer questions.
[The prepared statement of Dr. Melius follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Towns. Thank you very much, Doctor. Thank you.
Mr. McHale.
STATEMENT OF THOMAS MCHALE
Mr. McHale. Good morning, Chairman Towns and members of the
subcommittee.
My name is Thomas McHale, and I am a police detective with
the Port Authority of New York and New Jersey Police
Department. I am also a member of the Port Authority Police
Detectives Endowment Association, an associate member of the
Port Authority Police Benevolent Association, which are member
organizations of the National Association of Police
Organizations. NAPO is one of the largest police organizations
in the Nation, representing over 238,00 sworn rank-and-file law
enforcement officers throughout the United States.
When lives are at stake, America's first responders do not
hesitate to rush directly into harm's way. We do our jobs,
searching for, rescuing and aiding victims, regardless of what
unseen dangers and health risks and health hazards await. The
substantial risks that we face when responding to disasters are
no more clearly illustrated than by the suffering brought on as
a result of the response to the September 11th attacks on the
World Trade Center. As you are aware, the World Trade Center
was the headquarters of the Port Authority and was a worldwide
symbol of New York and America.
Seven years after the attack on our Nation, we continue to
mourn the 84 Port Authority personnel, including 37 members of
the Port Authority Police Department, 23 New York City Police
Department officers, 11 New York State and Federal law
enforcement officers, 343 firefighters and over 2,200 civilians
who lost their lives.
While the Nation remembers those we lost, those who
responded to the World Trade Center continue to suffer from the
physical and mental traumas suffered that day and in the days
following. According to the Mount Sinai Medical Center study on
9/11 health effects, 70 percent of the first responders at
Ground Zero suffer from chronic lung ailments.
Today, I would like to take the opportunity to address my
personal 9/11-related health issues and the need for extended
funding for the World Trade Center Medical Monitoring and
Treatment Fund. For purposes of character and integrity, I
would like to provide you with a brief biography.
I am 46 years of age, married, with four daughters, and I
am a non-smoker. I am a Port Authority of New York and New
Jersey police detective, with 22 years of service. Since 1995,
I have been assigned to the FBI Joint Terrorism Task Force of
Newark, NJ. In addition to the Task Force, since 2001, I have
been co-assigned to the NYPD Major Case Squad, specializing in
cold case homicides of police officers.
Unfortunately, I am no stranger to traumatic incidents. On
February 26, 1993, I was critically injured in the bombing of
the World Trade Center. On September 11, 2001, minutes after
the first plane struck, I responded to the World Trade Center
and I joined in the rescue effort from my Major Case office at
1 Police Plaza here in New York. I survived the collapse of the
first tower from inside the World Trade Center.
After escaping the first collapse, I returned to the Trade
Center and continued with search and rescue. Before the second
tower collapsed, I escaped through 5 World Trade Center into
the street, where again I was caught in the debris cloud.
I remained at the site throughout the evening and into the
early morning hours of September 12th, taking part in the
rescue of two Port Authority Police Officers that were trapped
in the rubble.
In addition to being a police detective, I am also a Union
Ironworker. For the first 10 days following 9/11, I was on
full-time assignment at the Trade Center site as part of the
Port Authority Police Rescue and Recovery Team. I utilized my
ironworking skills in the recovery of victims' bodies.
During the second week of the rescue and recovery, the Port
Authority Police Department ordered me to resume my position
with the Joint Terrorism Task Force, which was investigating
the attack. I complied with the order, but returned to the site
at the end of my shift.
I worked the site as a volunteer ironworker with
Ironworkers Local 40, New York, and as a PA Police Detective. I
worked this schedule until the end of January 2002.
From the end of January 2002, to the beginning of April
2002, I was on JTTF assignment in Pakistan and Afghanistan. On
March 17, 2002, after a suicide bomber attacked a church in
Islamabad, Pakistan, I took part in rescue and recovery of
those injured and killed. Upon my return to the States, I
resumed working both jobs, but not as rigorously as before. On
May 28, 2002, Ironworkers Local 40 invited me to participate in
the removal of the last column from the World Trade Center.
To the present day, I have been diagnosed with reactive
airway disease, lung scar tissue, asthma, atrial fibrillation,
sinus tachycardia, chronic rhinitis, turbinate hypertrophy, and
Barrett's esophagus. I am currently under the primary care of
Dr. David Fischler, my pulmonologist, and Dr. Rakesh Passi, my
cardiologist. In addition to my primary care physicians, my
current health issues are being managed and monitored by the
World Trade Center Medical Monitoring and Treatment Program
under Dr. Iris Udasin, Environmental and Occupational Health
Science Institute Clinical Care in Piscataway, NJ.
On November 1, 2006, I underwent a pulmonary vein ablation
in my heart at Robert Wood Johnson University Hospital, New
Brunswick. While in recovery, I suffered aspiration pneumonitis
and was transferred to the critical care unit. On November 7,
2006, I was discharged from the hospital. In March 2007, I was
able to return to work.
My doctors, two cardiologists and two pulmonologists and
the doctors from the World Trade Center Medical Monitoring
Program all attributed my medical conditions to my exposure at
the World Trade Center. The Port Authority Medical Division,
without a thorough examination or consulting my doctors, ruled
that my medical conditions are not related to the events of 9/
11. Fortunately, for me, the Port Authority Police Director,
Samuel J. Plumeri, agreed with my physicians and overruled PA
Medical's decision. Director Plumeri ruled that my injuries
were, in fact, 9/11-related, thus entitling me to line of duty
status.
On July 20, 2007, I underwent nasal surgery to clear an
obstruction of my nasal airway at Robert Wood Johnson. I
returned to work 11 days later, on July 31st. The PA Medical
Department, again without examination or consulting any of my
physicians, determined that my nasal obstruction was not
related to my exposure at Ground Zero. Once more, PA Police
Director Plumeri overruled PA Medical's decision. Director
Plumeri agreed with my physicians' findings that my nasal
injuries or disease may, in fact, have been caused by my
exposure at Ground Zero.
On September 5, 2007, due to chronic acid reflux, I
underwent an upper endoscopy at Robert Wood Johnson Hospital.
The procedure revealed that I have Barrett's esophagus, which
is caused by chronic acid reflux and is considered to be a pre-
malignant condition. Barrett's is associated with an increased
risk of esophageal cancer. I am currently awaiting the results
of my biopsy.
Most of the costs associated with my lung and heart
procedures have been processed through my medical insurance.
The World Trade Center Medical Screening and Treatment Program
have incurred some of the costs for surgery and treatment
associated with my nasal and gastro ailments.
In fact, it was Dr. Udasin, at EOSHI, who referred me to
the ear, nose and throat doctor and gastroenterologist who
diagnosed my most recent ailments.
I would like to state that I did not file a claim for the
Federal moneys that were available in 2001 and 2002. Although
entitled, I could not bring myself to complete and file the
same form as that of the survivors of those who were killed. I
do, however, have a pending State Workers Compensation claim.
As the health risks associated with exposure to the World
Trade Center site become more manifest, it is important to
ensure that workers in the rescue and recovery effort are
properly monitored and treated for exposure-related diseases. I
appreciate all you are doing to support those of us who have
fallen ill due to our response and subsequent exposure at the
World Trade Center. I urge Congress to continue to support the
funding for the World Trade Center Medical Monitoring and
Treatment Program in order that first responders like myself
can maintain, or regain, their good health.
Thank you for this opportunity to speak to you on behalf of
the dedicated first responders who responded to the 9/11
attacks in New York City. I ask that my printed testimony, in
addition to my spoken testimony, be made a part of the record.
And, I would be happy to answer any questions you may have.
[The prepared statement of Mr. McHale follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Towns. Thank you very much, and your entire statement
will be included in the record.
Let me begin by first thanking you for your service and, of
course, all of you, for your testimony.
Let me just sort of raise a question. I guess I will begin
with you, Dr. Melius. I am concerned that we had people who
came from across the country to volunteer their services and to
respond to the crisis that we had. And, of course, if we do not
treat them properly, we might discourage people from
volunteering, and I think that is the last thing that we want
to do.
I think that we always want to make certain that people
feel, to respond and come to the aid of others. But, if we are
not treating people properly that came and gave of their
service, what does this do to volunteerism? And, of course,
what is the labor movement saying about these kind of issues.
Dr. Melius. Now, you raise an excellent point, and it is
certainly one, I think, that we should all be concerned about.
I will say, if you talk to people that did volunteer, even
many of those that become ill, they would tell you they would
do it again in that circumstance. There has been a long
tradition, I think, of being willing to come forward.
However, if one sees that one is ill and disabled, and we
know that the firefighters, the other emergency responders have
become ill and disabled and are now struggling economically
because they can no longer work, certainly it creates a second
thought. And certainly on the part of all of us, I think,
including organized labor, we want to make sure that if someone
does volunteer in that situation, or is assigned--some of them,
I think, were assigned to come in and work on the site--that
they, one, are properly protected. We don't want this to be
happening again.
However, should they develop illness, that the followup be
provided for that. There should be a mechanism in place. They
should not have to wait 6 years. They shouldn't have to wait so
long to get the medical monitoring and treatment that they
rightfully deserve.
And, it certainly could affect, in the long term, the
willingness to do it again, or to come back, knowing that you
are not going to be taken care of. You are risking your
family's future by doing that, as well as your own health, by
coming forward to help.
Mr. Towns. Thank you very much.
Why can't we move to get a comprehensive monitoring system?
This is sort of for, I guess, GAO and, of course, in
particular, Dr. Thorpe.
I mean, why can't we get that going? A comprehensive
monitoring system. What do you think the problems are?
Ms. Bascetta. It is not a matter of not knowing what to do.
I can only conclude that it is a matter of, well, the
administration, you know, has within its sphere the expertise
to develop the programs, and the Congress has pushed hard for
funding. And it just hasn't happened.
But there is no substantive reason why we shouldn't be much
farther along at this point. And, for that matter, the really
sad thing is that we need to learn a lesson from 9/11, so that
in future disasters, whether they are manmade or natural, we
are better prepared.
Mr. Towns. All right. Any other comments on that? Yes, Dr.
Melius?
Dr. Melius. I would just echo that one of the problems is
with the lack of commitment on the part of the administration.
This program has been funded through Congress on, basically,
emergency appropriations each time. And then, the government,
the Federal administration, then makes the wrong assumption
that, therefore, the program isn't going to continue beyond
that.
And, when Dr. Agwunobi came here right after the treatment
program was initially funded, I believe it was last November or
December, he immediately wanted to send out letters telling the
responders that the treatment program would be discontinued. He
wasn't even going to wait until the program got started.
We need a commitment on the part of the administration to
move this forward and to plan. I believe Dr. Howard has done an
excellent job in these circumstances, of trying to develop a
good, solid program to provide the continuity of care that is
needed.
But, we need certainly a longer-term commitment. I think
that is going to take the kind of legislation that
Representatives Maloney and Nadler are going to take--and
Congressman Towns, you are a co-sponsor also--to move this
forward and establish a long-term program that will deal with
this comprehensively.
It shouldn't have taken that, and it shouldn't have taken 6
years of non-response to get there, but I think that is really
what we are faced with, certainly at the present time.
Mr. Towns. Right. Thank you, very much.
And, Dr. Eth, I know you have personally treated many first
responders for mental health conditions. Do you think we have
adequately met the need.
Dr. Eth. Clearly, we haven't adequately met the needs. We
are barely scratching the surface of the needs of those people
who have chronic conditions.
As we have heard, PTSD can often be successfully treated if
the patient is seen early. However, many patients with PTSD
develop chronic illnesses, and then we are into symptom
management. And, there is no system in place to deliver that
kind of care.
Congressman Nadler quoted President Abraham Lincoln. That
quotation is the motto of the Department of Veterans Affairs.
What we need is a system of care for first responders who, like
our Veterans, were there to protect us and to take care of us
and deserve the kind of treatment that will persist over the
years, to make sure that their distress and disability is
medically treated as best we can.
Mr. Towns. You know, there has been some media coverage.
You know, you always get this when we are trying to move
forward, where they said that some people are faking a mental
health condition.
I know that you have treated, of course, many of these
responders. Do you think that this is a widespread practice?
Because you get one situation, and they just blow it up, you
know.
Dr. Eth. Right. Unfortunately, this issue of faking or
malingering has been around for a very long time. There was the
dramatic scene in the movie ``Patton,'' where General Patton
slapped the soldier who was suffering from combat fatigue,
because he thought he was a malingerer.
These are real psychiatric conditions that impose suffering
on patients, on their family, and deserve the care that we can
provide. Fortunately, we have the treatments, but we are
limited because of the stigma associated with these conditions,
the stigma that is amplified when people are thought to be
malingering. And, there are delays of care, there is access
issues. And, the thing is, we do have effective ways to manage
symptoms.
Mr. Towns. What do you think needs to be done in Congress?
What do you think that we should do? And, let me just run down
the line, very quickly. We don't have a lot of time. So----
Mr. McHale. Obviously, the team of the World Trade Center
medical management, in addition to making sure that a
comparative amount is put into research, as well, for that. And
I know I, don't mind my health screening put into kind of a
data base that may help another first responder who may have
the symptoms that I had, prior to being diagnosed with the
disease that I have.
So, a multiple, comprehensive data base that can be used to
compare each responder's conditions, so that it may help
another one needing treatment.
Mr. Towns. Thank you. Right down the line, if there are any
other comments.
Dr. Melius. Certainly, as I have said, I think the No. 1
priority is to make this into a comprehensive program, provide
the framework through legislation that will ensure that
everybody who responded at the World Trade Center, worked
there, who were exposed, including people in the community, can
receive medical monitoring and get treatment, if needed. And,
that is a life-long commitment. I think we need to do that
comprehensively and do that over the long term.
Second, I think we also need to look at how do we prevent
some of the outcomes that have occurred. We need to make sure
that there is adequate protection. My personal belief is that
OSHA needs to be mandated to provide enforcement action at
those sites, to ensure that people are properly protected.
I will add that, in order to do that, we also need research
in the development of protective equipment.
Mr. McHale and I were talking before the hearing, and there
are circumstances that he was working in where there was no
respirator that is currently available that would have allowed
him to do his work in a safe manner. He needed to communicate
with his friends while he was doing that, in a very enclosed,
tight space, and it was very difficult, and no respirator that
was currently available, I believe, would have allowed him to
do that.
We also know of the communication problems that occurred,
with the firefighters at the site. So, there is technology that
needs to be worked on, and we need to invest in that in order
to protect people.
So, one, it is a comprehensive solution of medical
followup. Second, it is prevention and enforcement at the site.
And then, on the part of EPA and the city Health Department to
make sure that people in the community are also protected.
Mr. Towns. Thank you, very much. Thank you. And, run right
down the line.
Dr. Eth. Well, Congress and the administration has to honor
its promise to first responders to deliver the care that they
need in the long-term way, and we need to expand the number of
treatment programs available to first responders, so that they
can get the care.
Mr. Towns. Thank you.
Dr. Thorpe. I would like to repeat that very fact, that the
World Trade Center Medical Monitoring Program and the other
Centers of Excellence at FDNY and at Bellevue Hospital, these
are programs that were established with Federal funds. The
patients who are enrolled in these programs have an expectation
to a certain commitment to their long-term monitoring and care.
And so, it is really that these are federally funded programs
that can't be dismantled mid-mission.
This would also be true for the World Trade Center Health
Registry, which is also federally funded. These were
established for long-term care, and we need to ensure that the
long-term care is provided and not being withdrawn mid-mission.
Mr. Towns. Right, thank you.
Ms. Bascetta. On a smaller scale, holding HHS accountable
for implementing GAO's recommendations. That is very important.
And, for ensuring that, over the long term, the money is there
to do the screening and monitoring that is required for
responders.
And, on a broader scale, exercising your oversight
authority to take a look at the NRP, to make sure that those
relationships for the National Response Plan that are in place
go to prevent these kinds of situations and to ensure that
where they can't be prevented, that the health effects are
taken care of after a disaster is very important.
Mr. Towns. All right. Thank you, very much.
And, I yield now to my colleague, Congresswoman Carolyn
Maloney.
Mrs. Maloney. And, I thank you again, Ed, for having this
hearing, and I thank Mr. McHale for his service, and all of you
for your services in your own professional ways. It is deeply
appreciated.
First off, I want to thank Cynthia Bascetta, the Director
for Health Care at the U.S. Government Accountability Office,
and talk about the really extraordinary work of the GAO that
has led us to the point today.
They have issued five different reports that Ed Towns and I
have requested, and others. They were presented to the
Oversight and Government Reform Committee, on which we both
serve.
And, over the last 3 years, they have been absolutely
invaluable to this committee in informing our work on this
topic. So, I have a series, first of all, for Director
Bascetta.
Regretfully, there have been a series of articles recently
that I would like to put into the record, with official
responses from our Senators and Jerry and myself and many
others. So, in the New York Times.
There is one today in the New York Post that questions
whether or not that there really is a problem. Jerry and I see
sick people every day, who come to see us in our homes and in
our offices, and we know first-hand the crisis.
But, there have been some press reports that have attempted
to cast doubt by questioning the exact extent of the health
problems arising from the deadly toxins at Ground Zero.
In your opinion, Ms. Bascetta, as part of the independent,
non-partisan Government Accountability Office, do you have any
doubt that tens of thousands of people served as responders and
rescue/recovery and clean-up workers and construction workers,
in the aftermath of the World Trade Center disaster, and that
these responders were exposed to numerous physical hazards,
environmental toxins and psychological trauma.
Ms. Bascetta. No, I certainly don't have doubt.
Mrs. Maloney. Now, do you have any doubt that those
physical hazards, environmental toxins and psychological trauma
could potentially cause serious, long-term health effects in
these responders?
Ms. Bascetta. No doubt at all. And, our first report, in
September, had four and a half pages of articles that were
written and published in peer-reviewed journals from the time
of the attack through September 2004, and the body of
literature has grown since then.
Mrs. Maloney. Without objection, may we place that report
in the record, Chairman.
Mr. Towns. Without objection.
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Mrs. Maloney. And, do you have any doubt that currently
thousands of responders are sick, some of them very seriously
sick, because of the exposure they endured during their work in
the aftermath of 9/11.
Ms. Bascetta. No doubt. I believe HHS's own draft plan
notes that there are thousands of sick responders.
Mrs. Maloney. And last, should the government be doing more
to help the sick heroes and heroines of 9/11.
Ms. Bascetta. Absolutely.
Mrs. Maloney. Thank you, Director Bascetta.
And so, the Director for Health at the U.S. Government
Accountability Office, well-known as the independent
congressional watchdog, has no doubt that the health effects of
9/11 are real and serious, and that they are affecting
thousands of people, and that our government should be doing
much more to help. And, I hope that everyone hears this message
loud and clear. And, I think that this is a very important part
of your hearing today, Congressman Towns.
And, I would like to thank Dr. Thorpe for her work with the
New York City Health Department and to ensure that mental
health services are available.
And, I want to know why did you close the Registry.
I will tell you, I know there are 71,000. I know that every
congressional district is in it, and every State in the Union.
But I, to this day, have people who come up to me either on the
street, my congressional office, my home, and say, ``You know,
after 9/11, I wasn't sick. Now, I am sick. It just happened.''
And so, health problems are arising. And, as we know from
Dr. Melius's testimony and from Dr. Eth's, a lot of these
things are going to keep coming up further down the road. And,
I personally don't think the Health Registry should be closed.
I think that people who may die today, or develop the asthma
today, and were there--you know, some will say to me, ``You
know, I was just there on 9/11 and 9/12,'' and I will say,
``Well, that is the worst 2 days. No wonder you have a
problem.''
But why did we close it? Why aren't we making adjustments
for the people that are still sick----
Dr. Thorpe. Thank you, Congresswoman----
Mrs. Maloney [continuing]. Or becoming sick.
Dr. Thorpe [continuing]. Maloney.
The purpose for closing the World Trade Center Health
Registry is not one to shut out the individuals who later
developed illness in any fashion. The purpose of closing the
Registry after a certain period of enrollment was purely for
validation of a similar time period, where people who did
enroll were telling the information that they had on their
exposures within a short, finite time period.
One standard challenge for epidemiologic studies is that
you combine the individuals who described their experiences
early on, at a date after an event, and you combine that with
persons who describe their experience years later, that the
descriptions change over time, or may change over time, and
could call into question the very purpose of the tracking of
the Registry.
All individuals who are developing any late-onset symptoms
should be in a World Trade Center of Excellence program, where
they can be evaluated. And that data and that information is
very important.
This was not a disease registry. This was an exposure
registry. So, the focus was getting a clean snapshot at a
finite period of time, that may track the effects in those
potentially highly exposed people. This is part of the picture
and is an important component.
And similar, the different component of the health profile
of people who were available in the clinical centers at Mount
Sinai, at Bellevue and the Fire Department, are another
profile.
Mrs. Maloney. But, following up on your statement that it
is an exposure registry, I think it should certainly be limited
to those who were exposed, but if there is no doubt that a
firefighter or someone else was exposed on September 11th or
12th or the 13th were fine, and then all of a sudden they are
sick 5 years later, they should be part of it.
And, as you know, the monitoring program at Mount Sinai and
at Bellevue and Queens and some of the other areas that are
there, they are very limited. As you know, they are limited
only to the responders. They do not include the area residents
who were exposed. They do not include the volunteers. They do
not include the school children which, according to your
report, are now coming up with increased asthma. So, I think we
should look at re-opening it.
But I would like to talk to Dr. Eth and Dr. Melius. I know
my time is coming to an end.
And, you were deeply involved, actually representing labor
in the consortium that really worked for 6 years now, through
various routes, to create the 9/11 Health and Compensation Act,
which Mr. Nadler and Mr. Towns and I will be introducing, along
with Charlie Rangel and others, this week.
If passed by Congress and signed into law by the President,
would this legislation allow for the monitoring and treatment
of all those affected, especially those now not covered at all.
And, I regret, Mr. McHale, that you had trouble getting
covered, but your story is like so many other responders, some
of them I see in the room, who were turned down for treatment.
Would this comprehensive bill treat these people?
Dr. Melius. Absolutely. It includes all Federal workers, by
statute, into the bill. And, it also includes provisions for
what we refer to as a national program for covering people
outside of the New York City metropolitan area. So, they would
be covered.
It also provides for the development and naming of new
centers, what we are referring to as ``Centers of Excellence,''
that provide clinical care. So, for example, Saint Vincent's
would become a Center of Excellence, and it would become part
of that program. Certainly, as they have described their
efforts so far, they would, you know, I believe that it would
qualify under the way the legislation is written, at least my
knowledge of it.
So, I think it absolutely would provide the framework for
covering everybody who is now having difficulty getting
covered. It expands the coverage to include residents, workers
who also had, you know, very significant exposures cleaning out
offices and buildings, people in their homes and apartments,
who were exposed, school children. So, I think it really
comprehensively deals with everyone who was potentially
affected, and it will provide them with the monitoring, the
screening, and the health treatment that they deserve.
Mrs. Maloney. So, it doesn't rely on what hat you were
wearing that day, but the extent of your exposure.
Now, since there are some of these articles that are saying
people aren't sick, or maybe they weren't sick from 9/11, how
is that treated in the bill? I understand that there is very
high medical standards written into the bill, because I was
there when we wrote it and that the medical profession would
have certain criteria that they develop that is related to 9/11
and you have to be certified that you had that.
Could you go through how people would be able to be
treated, so that there would be no abuse, but that it would be
there for the people who truly warrant it.
Dr. Melius. Certainly, to be initially eligible for the
screening or for monitoring, the examinations, one has to have
some evidence that they were exposed. And, there are criteria
that have already been developed, as far as the programs that
relate to the type of work that people do, did at the time and
the time period of that work.
And then, similar criteria would be developed for the other
groups. The program at Bellevue Hospital is already working on
that, meeting with community groups, labor groups, others that
are involved there, that aren't covered by the current
responders' programs, and develop those criteria.
So, those would need to be developed. They would be, you
know, promulgated, as far as the program, by the Federal
Government, with significant input from the outside groups,
affected groups.
And second, there are criteria for how people would be--
what conditions would be treated? Currently, there is a list of
conditions that include respiratory, upper respiratory, mental
health conditions, gastrointestinal conditions, that have been
found in significantly higher rates in the responders. That
list can be expanded, additional conditions added.
And, a similar list, based on the initial list, would be
developed for people who living in the community, people that
worked in other areas in ways that are not currently eligible
for the program. Again, that would be done through a public
process, in a timely fashion, so that people would be able to
receive treatment, but will be treated for World Trade Center-
related conditions.
Mr. Towns. All right.
Mrs. Maloney. I thank the Doctor, and my time has expired.
Mr. Towns. Yes.
Mrs. Maloney. Thank you, all the panelists.
Mr. Towns. Right. Let me yield now to Congressman Nadler.
Mr. Nadler. Thank you, thank you, Mr. Chairman.
Let me begin by following up on the first question that
Congresswoman Maloney asked. This morning's New York Post says
the following: ``a searing New York Times piece suggests that
an activist clinic''--meaning Mount Sinai--``egged on by
opportunistic pols and naive (at best) journalists, has blown
health fears way out of proportion. Bottom line: There is scant
reliable scientific evidence to link 9/11's toxic plume to any
serious, chronic health problems. . . . It casts doubt on the
severity of even the short-term fallout. . . . There is scant
evidence that any lives were endangered.''
Ms. Bascetta and then Dr. Thorpe, could you comment on
those assertions?
Ms. Bascetta. It is a shame that was published. You know,
as I said, I----
Mr. Nadler. Well, it is in the Post, so--[laughter.]
Ms. Bascetta. Well, even the New York Times article, if you
read it closely, didn't say there were no health effects. There
was more argument around the aims of----
Mr. Nadler. Well, that is my next question, on the New York
Times article.
Ms. Bascetta. OK.
Mr. Nadler. I will come to that.
Dr. Thorpe, do you have any comment on this? I mean, on the
observation that there were no long-term health effects, no
evidence of long-term health effects, scant evidence of short-
term health effects.
Dr. Thorpe. I think the consistent--one of the things that
epidemiologists look for by trying to understand the exposure,
causes of disease, is the consistency of the literature. And,
there is growing consistency of literature across the studies,
from the medical monitoring programs, from the World Trade
Center Health Registry, and elsewhere, on physical health
effects and mental health effects among the rescue and recovery
workers.
Mr. Nadler. So, would you both agree or disagree than any
competent, honest epidemiologist would say this is nonsense?
Ms. Bascetta. Yes, I would agree.
Dr. Thorpe. I think that would be different scientists who
analyze data differently, but I think most scientists would
look at the growing literature and say that there are clear
health ramifications from 9/11.
Mr. Nadler. Thank you. Now, as we said that, I read--and
obviously you have read the New York Times article, since you
just referred to it--I was going to ask you if you had. I read
that article very carefully on Friday.
Would it be fair to say, because this is what I found
there, that one of the key points, really, is that to the
extent that there is some doubt in the literature, or doubt as
to control groups, it is because nobody--neither the Federal,
State, or city governments--did adequate studies in the first 9
months, so you don't have a base control, and that is the real
problem, to the extent there is a real problem.
Ms. Bascetta. Well, it is a contributing factor to the
difficulties in doing the research. But, you know, I have a
different response.
One of the--the Fire Department is really the gold
standard. They have baseline data on their workers, and it is
absolutely clear from their studies that the health effects are
simply not questioned.
Second, as Dr. Thorpe has said, there are well-accepted
epidemiological dictates that involve looking for excess rates
of disease in populations where, you know, we don't have very
good medical records, you don't know what their baseline health
was before, so it is more complicated. But, you can certainly
document, and it has been documented, that respiratory effects,
asthma, PTSD, you know, do appear to be diagnosed at rates that
are higher than we would expect.
Mr. Nadler. And, are you familiar with the Mount Sinai
study?
Ms. Bascetta. I am.
Mr. Nadler. Would you say that is a good, competent study?
Ms. Bascetta. It was published in a well-thought-of peer-
reviewed journal. I would have no reason to doubt that their
techniques were in question.
Mr. Nadler. So that the aspersions, the comments, and the
loathage of the Mount Sinai researchers here would have no
foundation, in your opinion.
Ms. Bascetta. I wouldn't weigh them in my assessment of the
literature. I would certainly include some in any view of it.
Mr. Nadler. Thank you.
Dr. Thorpe, in your testimony--first of all, you say, ``We
estimate that it requires at least $4.5 million per year to
maintain the Registry for the remainder of its 20-year life.''
Why only 20 years? Shouldn't we maintain this Registry for
the balance of the lives of all of the people involved in it.
Dr. Thorpe. Twenty years is the commitment that we gave to
participants who enrolled. That does not in any way negate the
potential need for this Registry to move forward beyond 20
years, if we are looking at long-term health ramifications,
development of cancers with long latency periods, or mortality.
There are many reasons why it may----
Mr. Nadler. And it----
Dr. Thorpe [continuing]. Serve for a longer period.
Mr. Nadler. And, since the basic purpose of the Registry is
for research and for knowledge, as you said a few minutes ago,
that would seem to indicate that we should keep the Registry
open much longer.
Dr. Thorpe. Yes, depending on the findings of the first run
of the Registry, yes.
Mr. Nadler. OK, thank you.
I have a second question. You referred in your testimony
quite often to the asthma study found that 3.6 percent of
previous asthma-free rescue and recovery workers reporting
asthma as 12 times the normal rate in the general population.
Further on, you refer to findings in the Fire Department,
showing a higher than normal--the problem of health problems.
These studies demonstrate the need for continued monitoring and
care of exposed workers, etc.
So clearly you and Ms. Bascetta, both, and Dr. Eth, with
respect to mental health conditions, you say clearly that there
is more than ample evidence of heightened rates of all kinds of
pathologies, as a result of the exposure to these toxins.
Dr. Thorpe. There is a lot of evidence on the widespread
experience of respiratory symptoms among the people who
responded to the World Trade Center site as a volunteer or a
worker. There is widespread evidence of long-term mental health
implications. And, I think there are still a lot of unknowns.
Mr. Nadler. OK.
Dr. Thorpe. It is still unknown----
Mr. Nadler. There is a lot of evidence for what you said.
Now, the State and the city and the Port Authority, as we
have heard from Mr. McHale and others, have been contesting
causation on all kinds of Workers Comp and other claims. Now, I
observed before that we know that, as a result of Hiroshima and
Nagasaki, there were wildly increased incidents of cancer in
the exposed population. But, you couldn't prove that an
individual case of leukemia would not have otherwise occurred,
even if it is 90 percent would not otherwise have occurred--
even if 90 percent of the people who came down with leukemia in
Hiroshima would not have done so but for the atomic bomb, and
10 percent would have, the statistic is, you couldn't prove
which was which.
So, is it fair, is it proper for these government agencies
to be denying claims on the basis that you can't prove that
your case of asthma, your case of sarcoidosis, was caused by
this, even though we know that 98 percent would not have
occurred but for this.
Dr. Thorpe. I can't speak to these individual cases. What I
can speak to is the difficulty and the importance of
understanding the relationships between the level of exposure
and the development of a disease. Heart disease and cancer are
common conditions that are going to exist and that are going to
occur, independent of whether or not the World Trade Center
attack----
Mr. Nadler. Occurred.
Dr. Thorpe [continuing]. Has resulted.
Now, the difficulty in identifying whether or not cancers
or heart disease deaths are occurring at a greater rate as a
result of these events----
Mr. Nadler. Or asthma or sarcoidosis or----
Dr. Thorpe [continuing]. Is a very important endeavor, but
it is--and because there are so many background cases----
Mr. Nadler. But my question----
Dr. Thorpe [continuing]. It is a challenge.
Mr. Nadler. It is a challenge, but is there any way--well,
my real question is, is government asking something impossible
and unfair, when it says to a firefighter who was in the peak
of condition and suddenly can't breathe any more, prove this
was World Trade Center-related.
Dr. Thorpe. I can't speak to these single conditions,
Again, what I can speak to is----
Mr. Nadler. I mean, a health condition. Can you assume that
most of these cases are because that--is it unfair ethically,
never mind legally, is it not fair, the requirement to ask that
kind of proof? Is it not realistic to require it, knowing that
most--let me re-phrase the question.
Is it the case that most with sarcoidosis, these lung
diseases, most people who are coming down with it who were
exposed probably would not have, and therefore, it is unfair to
ask the specific proof in each case.
Dr. Thorpe. I am having a difficult time answering your
question----
Mr. Nadler. OK.
Dr. Thorpe [continuing]. Because you are talking about many
different conditions together in one, and I think each
condition merits its own individual evaluation.
Mr. Nadler. Thank you.
Ms. Bascetta, have you seen any evidence that the Federal
Government is doing anything to expand the services that it
provides beyond responders to residents, office workers, school
children, other people who were exposed and who, as a result of
that exposure, are sick or may get sick in the future.
Ms. Bascetta. I have not looked into that. There is another
team at GAO that has done work on ambient air. They have
responsibility for EPA, and I could take a look at that report
and have it submitted to the record.
Mr. Nadler. I would----
Ms. Bascetta. I don't believe that it specifically
addresses the problems of those groups.
Mr. Nadler. Well, I would appreciate if you would, because
I have seen no evidence that the Federal Government has done
anything with response to anybody other than the specific first
responders.
I think my time has almost expired. Let me just thank all
of you for your services in various lines, in particular Dr.
Melius, for your help in developing the legislation which we
are introducing.
I just want to say that I wasn't aware that quote that I
always use from President Lincoln was the motto for the
Veterans Administration. But, it is fitting that it is. And, I
think that this Federal Government, State government, city
government have been incredibly deficient, incredibly guilty in
not meeting the moral debt that we all owe to the first
responders and to the other victims of this terrorist attack on
the United States.
Mr. Towns. Thank you, very much, Congressman. And, let me
just say that I will thank all of you for your testimony.
But, I cannot let this moment pass without saying that,
when you look at the clinics, look at the Borough of Brooklyn,
which has 2.5 million people in it. And, as I remember that
day, as I saw the second plane hit, standing over by the Navy
Yard, that I saw that dark cloud coming over. And of course, I
am sure that it affected people in Brooklyn. And, there are no
ifs, ands, and buts about it.
So, I am hoping that somewhere along the line, that
Brooklyn would get one of these clinics. And the reason I say
that is I really, really mean it, that there are people in
Brooklyn that have never been to Manhattan, have never been to
Manhattan. So, it points out how serious it is to get a clinic
in Brooklyn. You know, I have had the opportunity to talk to
people over the years, who have said to me--I am talking about
adults--that I have never gone to Manhattan. So which means
that we need to establish something in Brooklyn where those 2.5
million people reside.
So, thank you, again, all of you, for your testimony,
because as you know, as we look at the first responders, we
also have to look at the residents, as well. So, thank you for
your testimony. We look forward to working very closely with
you in the days and months ahead.
You can see we are rushing to get to another meeting, and
that is the reason why we are sort of being brief here. So,
thank you, again, for your testimony.
The hearing is now adjourned.
[Whereupon, at 12:30 p.m., the subcommittee was adjourned.]
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