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PROGRESS SINCE SEPTEMBER 11TH: PROTECTING

PUBLIC HEALTH AND SAFETY OF THE RESPONDERS AND RESIDENTS

HEARING

BEFORE THE

SUBCOMMITTEE ON NATIONAL SECURITY,

EMERGING THREATS, AND INTERNATIONAL

RELATIONS

OF THE

COMMITTEE ON

GOVERNMENT REFORM

HOUSE OF REPRESENTATIVES

ONE HUNDRED NINTH CONGRESS

SECOND SESSION

SEPTEMBER 8, 2006

Serial No. 109–246

Printed for the use of the Committee on Government Reform

(

Available via the World Wide Web: http://www.gpoaccess.gov/congress/index.html

http://www.house.gov/reform

(II)

COMMITTEE ON GOVERNMENT REFORM

TOM DAVIS, Virginia, Chairman

CHRISTOPHER SHAYS, Connecticut

DAN BURTON, Indiana

ILEANA ROS-LEHTINEN, Florida

JOHN M. MCHUGH, New York

JOHN L. MICA, Florida

GIL GUTKNECHT, Minnesota

MARK E. SOUDER, Indiana

STEVEN C. LATOURETTE, Ohio

TODD RUSSELL PLATTS, Pennsylvania

CHRIS CANNON, Utah

JOHN J. DUNCAN, JR., Tennessee

CANDICE S. MILLER, Michigan

MICHAEL R. TURNER, Ohio

DARRELL E. ISSA, California

JON C. PORTER, Nevada

KENNY MARCHANT, Texas

LYNN A. WESTMORELAND, Georgia

PATRICK T. MCHENRY, North Carolina

CHARLES W. DENT, Pennsylvania

VIRGINIA FOXX, North Carolina

JEAN SCHMIDT, Ohio

BRIAN P. BILBRAY, California

HENRY A. WAXMAN, California

TOM LANTOS, California

MAJOR R. OWENS, New York

EDOLPHUS TOWNS, New York

PAUL E. KANJORSKI, Pennsylvania

CAROLYN B. MALONEY, New York

ELIJAH E. CUMMINGS, Maryland

DENNIS J. KUCINICH, Ohio

DANNY K. DAVIS, Illinois

WM. LACY CLAY, Missouri

DIANE E. WATSON, California

STEPHEN F. LYNCH, Massachusetts

CHRIS VAN HOLLEN, Maryland

LINDA T. SANCHEZ, California

C.A. DUTCH RUPPERSBERGER, Maryland

BRIAN HIGGINS, New York

ELEANOR HOLMES NORTON, District of

Columbia

———

BERNARD SANDERS, Vermont

(Independent)

DAVID MARIN, Staff Director

LAWRENCE HALLORAN, Deputy Staff Director

BENJAMIN CHANCE, Chief Clerk

PHIL BARNETT, Minority Chief of Staff/Chief Counsel

SUBCOMMITTEE ON NATIONAL SECURITY, EMERGING THREATS, AND INTERNATIONAL

RELATIONS

CHRISTOPHER SHAYS, Connecticut, Chairman

KENNY MARCHANT, Texas

DAN BURTON, Indiana

ILEANA ROS-LEHTINEN, Florida

JOHN M. MCHUGH, New York

STEVEN C. LATOURETTE, Ohio

TODD RUSSELL PLATTS, Pennsylvania

JOHN J. DUNCAN, JR., Tennessee

MICHAEL R. TURNER, Ohio

JON C. PORTER, Nevada

CHARLES W. DENT, Pennsylvania

DENNIS J. KUCINICH, Ohio

TOM LANTOS, California

BERNARD SANDERS, Vermont

CAROLYN B. MALONEY, New York

CHRIS VAN HOLLEN, Maryland

LINDA T. SANCHEZ, California

C.A. DUTCH RUPPERSBERGER, Maryland

STEPHEN F. LYNCH, Massachusetts

BRIAN HIGGINS, New York

EX OFFICIO

TOM DAVIS, Virginia HENRY A. WAXMAN, California

R. NICHOLAS PALARINO, Staff Director

ROBERT A. BRIGGS, Clerk

ANDREW SU, Minority Professional Staff Member

(III)

C O N T E N T S

Page

Hearing held on September 8, 2006 ....................................................................... 1

Statement of:

Bascetta, Cynthia, Director, Health Care, Government Accountability Office; Joseph Zadroga, Little Egg Harbor Township, NJ; Steven Centore,

Flanders, NY; Lea Geronimo, New York, NY; and Lawrence Provost,

Virginia Beach, VA ....................................................................................... 24

Bascetta, Cynthia ...................................................................................... 24

Centore, Steven ......................................................................................... 50

Geronimo, Lea ........................................................................................... 66

Provost, Lawrence ..................................................................................... 70

Zadroga, Joseph ......................................................................................... 55

Howard, John, M.D., M.P.H., J.D., Director, National Institute for Occupational Health, Centers for Disease Control and Prevention, Department of Health and Human Services; Dr. Robin Herbert, co-director

of the World Trade Center Worker and Volunteer Medical Screening

Program, Mt. Sinai Hospital, accompanied by Dr. Steven Levin; Thomas R. Frieden, M.D., M.P.H., commissioner, New York City Department

of Health and Mental Hygiene; Nicholas Scoppetta, commissioner, Fire

Department of New York, accompanied by Dr. Carrie Kelly, head,

Bureau of Health Services, and Dr. David Prezant, chief, Office of

Medical Affairs; and Dr. Joan Reibman, associate professor of medicine,

NYU Medical Center, director, Bellevue Hospital World Trade Center

Health Impacts Clinic ................................................................................... 95

Frieden, Thomas R. ................................................................................... 137

Herbert, Robin ........................................................................................... 122

Howard, John ............................................................................................ 95

Reibman, Joan ........................................................................................... 158

Scoppetta, Nicholas ................................................................................... 145

Letters, statements, etc., submitted for the record by:

Bascetta, Cynthia, Director, Health Care, Government Accountability Office, prepared statement of ........................................................................... 27

Centore, Steven, Flanders, NY, prepared statement of ................................ 52

Frieden, Thomas R., M.D., M.P.H., commissioner, New York City Department of Health and Mental Hygiene, prepared statement of ................... 139

Geronimo, Lea, New York, NY, prepared statement of ................................. 68

Herbert, Dr. Robin, co-director of the World Trade Center Worker and

Volunteer Medical Screening Program, Mt. Sinai Hospital, prepared

statement of ................................................................................................... 124

Howard, John, M.D., M.P.H., J.D., Director, National Institute for Occupational Health, Centers for Disease Control and Prevention, Department of Health and Human Services, prepared statement of ................... 96

Maloney, Hon. Carolyn B., a Representative in Congress from the State

of New York, prepared statement of ........................................................... 9

Nadler, Hon. Jerrold, a Representative in Congress from the State of

New York, prepared statement of ................................................................ 15

Provost, Lawrence, Virginia Beach, VA, prepared statement of .................. 74

Reibman, Dr. Joan, associate professor of medicine, NYU Medical Center,

director, Bellevue Hospital World Trade Center Health Impacts Clinic,

prepared statement of ................................................................................... 161

Scoppetta, Nicholas, commissioner, Fire Department of New York, prepared statement of ........................................................................................ 149

Shays, Hon. Christopher, a Representative in Congress from the State

of Connecticut, prepared statement of ........................................................ 3

Page

IV

Letters, statements, etc., submitted for the record by—Continued

Zadroga, Joseph, Little Egg Harbor Township, NJ, prepared statement

of ..................................................................................................................... 59

(1)

PROGRESS SINCE SEPTEMBER 11TH: PROTECTING PUBLIC HEALTH AND SAFETY OF

THE RESPONDERS AND RESIDENTS

FRIDAY, SEPTEMBER 8, 2006

HOUSE OF REPRESENTATIVES,

SUBCOMMITTEE ON NATIONAL SECURITY, EMERGING

THREATS, AND INTERNATIONAL RELATIONS,

COMMITTEE ON GOVERNMENT REFORM,

New York, NY.

The subcommittee met, pursuant to notice, at 10:30 a.m., in Auditorium, 1st Floor, District Council 37, 125 Barclay Street, Hon.

Christopher Shays (chairman of the subcommittee) presiding.

Present: Representatives Shays and Maloney.

Also present: Representatives Fossella, Nadler, and Weiner.

Also present: Senators Schumer and Clinton.

Staff present: R. Nicholas Palarino, Ph.D., staff director; Robert

A. Briggs, analyst; and Andrew Su, minority professional staff

member.

Mr. SHAYS. The Subcommittee on National Security, Emerging

Threats, and International Relations field hearing entitled,

‘‘Progress Since September 11th: Protecting Public Health and

Safety of the Responders and Residents,’’ is called to order.

Five years after the cataclysmic attacks on the World Trade Center, shock waves still emerge from Ground Zero. Diverse and delayed health problems continue to emerge in those exposed to contaminants and psychological stressors unleashed on September

11th.

Firefighters, police, emergency medical personnel, transit workers, construction crews, and other first responders, as well as volunteers, came to Ground Zero knowing there would be risks, willing to take those risks, but confident their community would sustain them and not let them down. Make no mistake, these individuals did not just go to work on that day, they went to war. However, as we will hear today, Federal, State, and local health support has not provided the care and comfort they need and rightfully

deserve.

After the 1991 war in the Persian Gulf, veterans suffering a variety of unfamiliar syndromes faced daunting official resistance to

evidence linking multiple, low-level toxic exposure to subsequent,

chronic ill health. In part due to work by this subcommittee, longterm health registrants were improved, an aggressive research

agenda pursued, and sick veterans now have the benefit, in law,

of presumption that wartime exposures cause certain illnesses.

2

When the front line is not Baghdad, but Lower Manhattan, occupational medicine and public health practitioners still have much

to learn from that distant Middle East battlefield. Proper diagnosis, effective treatment, and fair compensation for the delayed

casualties of a toxic attack require vigilance, patience, and a willingness to admit what we do not yet know, and might never know,

about toxic synergies and syndromes. Health surveillance has to be

focused and sustained, and new treatment approaches have to be

tried to restore damaged lives before it is too late.

Today it appears the public health approach to lingering environmental hazards remains unfocused and halting. The unquestionable need for long-term monitoring has been met with only shortterm commitments. Screening and monitoring results have not

been translated into timely protocols that could be used by a broader range of treatment physicians. Valuable data sets compiled by

competing programs may atrophy as money and vigilance driving

September 11th health research wane.

We asked our invited witnesses to discuss how the Federal investment in World Trade Center health programs has been used

and how these efforts can be better coordinated and more sharply

focused. We value their perspectives, appreciate their expertise,

and look forward to their testimony.

This Monday our Nation will observe a moment of silence for

those who lost their lives on September 11th. We convene today in

remembrance of those lost, and on behalf of those who came to save

them, the first responders who are suffering physically, mentally,

and in some cases who are dying prematurely, as a result of the

toxic terrors unleashed on that terrible day.

I would like to, before recognizing my fellow member, the ranking member in this effort, Mrs. Maloney, I would like to thank my

committee staff for the work they have done for this hearing, the

one they did 2 days ago, and the work they are doing next week

on the Gulf war on Monday, Wednesday, and Friday. We are putting together five hearings in just 9 days, and I do appreciate what

the staff, both the Republican and Democratic staff, have done.

And then, just to say to my left is Mr. Fossella, who had requested this hearing, to my right is Ms. Malone is who had requested this hearing, and if the truth be known she requested the

one before that and the one before that and the one before that.

So I give you Mrs. Maloney.

[The prepared statement of Hon. Christopher Shays follows:]

3

4

5

Mrs. MALONEY. OK. Thank you very much, Chairman Shays, and

I thank you for holding this hearing. I thank our panelists, and I

thank everyone who is attending and pointing a spotlight on this

very important issue.

This is the fourth hearing that has been held on this issue—four

hearings that have been absolutely invaluable to the September

11th responders and others who are sick. Amazingly, Chairman

Shays is the only chairman to ever call a hearing on this issue.

Now there is a lot of focus on it, but when I started asking for

these hearings there was not, and he came forward and started

building the scientific data and the support that has moved us forward with our monitoring programs and our reaction to our heroes

and heroines and trying to help them.

I would also like to take this opportunity to thank DC 37 for allowing us to use their space today, and especially Lillian Roberts,

the head of the union. You should stand and say hello. She is here

in attendance, as well as her health and safety officer—[applause]—Lee Clarke. They have done such a great job advocating

for a better Federal response to this issue, and I must say it was

Lee Clarke who was the first one to sound the alarm and tell me

and others that the important $125 million for worker’s compensation had been unbelievably removed from the Federal budget, and

we worked very hard jointly to get that restored.

From the immediate aftermath of September 11th, and now on

the fifth anniversary, DC 37 was not only on the site, but they

have played a very, very important part in helping us move forward with the Federal assistance. And we are exactly one block

away from where the Twin Towers once stood, and at the home of

so many of the responders who heroically rushed the workers from

DC 37 and were part of it.

On Monday we mark the fifth anniversary of September 11th,

and once again our Nation will pause to remember that tragic day,

and many of us will renew our pledge never to forget. But as we

do this, we must remember that we lost nearly 3,000 people on

September 11th, but many, many thousands more lost their health.

And to this day, not one single Federal dollar has been spent on

the treatment of the health care needs of the heroes and heroines

of September 11th. And our purpose today is to make sure that

every single person who was exposed to the deadly toxins receives

medical monitoring, and every single person who is sick is treated.

Regrettably, we have seen government running from the sick victims instead of standing beside them and trying to help them. And

I must mention that with us today is Mr. Zadroga, and his son

James Zadroga died prematurely in the bloom of his youth, and to

this day many people will not acknowledge that his death was related to September 11th. His lungs, according to science, weighed

three times more than the normal lung, it was totally black, and

it was filled with phlegm. How dare anyone not acknowledge his

heroic efforts and the fact that he died because of his work saving

the lives of others.

I must tell you that my office and other offices, we are receiving

more information, more of our constituents are coming to us, who

are sick years after the disaster. For some the illness did not

emerge until recently, but we have to be there to help.

6

I do congratulate the New York delegation, and the Connecticut

delegation, the New Jersey delegation, and really the entire Congress and our two Senators who worked so hard to set up the

World Trade Center medical monitoring program that is located at

Mt. Sinai, and this week their very important scientific data that

70 percent of September 11th responders suffered respiratory problems. and 60 percent are still sick as a direct result of their work

at Ground Zero, 40 percent of whom have no health care coverage.

This provides a concrete scientific link between the exposures of

the toxins of Ground Zero and the health problems many are suffering. Earlier this year we learned from the fire department that

the average fire department responder has lost 12 years of lung capacity following their service at Ground Zero, and that many have

been forced to retire or to be reassigned because of their September

11th illness.

And we know at least seven responders’ deaths, according to the

press, are directly related. We believe there are many more, and

we are calling for a fatality investigation to document what has

happened. And I asked the city, how can you come forward after

the heatwave and say authoritatively that 20 New Yorkers died because of the heatwave, yet the city to this day has not acknowledged one death or taken any steps to affirm that these heroes and

heroines lost their lives because of their work at Ground Zero.

[Applause.]

Mr. SHAYS. I need to do something I should have done sooner,

and I understand the applause and the support. This is not a judicial hearing, but it is a very official hearing of Congress with a

transcriber. And we are going to request that there be no signs of

applause, boos, or whatever. That is something that we just need

to have, and so I would like to do this.

If I could, I would like to acknowledge—I have already acknowledge—and I am going to give you back the mic, ma’am—but I want

to acknowledge the presence of Jerry Nadler, who has been at all

of our hearings, and Mr. Weiner as well. And they have been totally engaged in this effort, and I—and Vito Fossella, and I would

like you to applaud of your members for what they have done. And

if we could do that, and that will be the last applause of the day.

Thank you.

[Applause.]

Mrs. MALONEY. Very importantly, today we will hear the testimony of Dr. John Howard, the Federal coordinator of September

11th health. Dr. Howard was appointed before our last hearing

back in February when Vito Fossella and I led a push by the entire

New York delegation for his appointment. He has been very busy.

In April we met with Dr. Howard here in New York, and he explained to us that he would have a plan of how to take care of

those who are sick by this fall. We look forward to hearing and seeing this plan. I commend him for admitting that the funding that

has been made available to date will not go very far, but that it

is only one small part of the problem. We need you, Dr. Howard,

and the administration to give us a full assessment of the need and

a commitment to include funding in the President’s budget.

Yesterday, at a delegation meeting with Dr. Howard and Secretary Leavitt, three Senators were there, our two from New York

7

and Senator Menendez, and 10 Members of Congress, we received

a commitment from Dr. Howard and Secretary Leavitt that the $75

million that Congress appropriated last December will finally start

flowing in October, and that all of the money will be made available for this fiscal year. Now that does deserve an applause. The

first Federal money will be flowing to help our sick heroes and heroines.

At the meeting yesterday we also received a commitment from

Secretary Leavitt that the long-term needs of those sick from September 11th need to be met in a coordinated effort. Secretary

Leavitt also announced the creation of a new task force on September 11th health coordination to be headed by Dr. John Agwunobi.

I welcome this commitment from the Secretary, but quite frankly

the sick responders of September 11th did not need another task

force.

They truly do not need another task force or point person. What

they need is medical treatment and medical monitoring. Our responders did not wait 5 years before they rushed down to Ground

Zero to help others, and government should not wait 5 years to get

the treatment to them.

I, for one, have supported giving Dr. Howard more authority to

do his job. He is the one person in the administration that has

dedicated his time to get to know the problem, and we ought to let

him finish the job. I just hope that he is not getting pushed aside

for speaking the honest truth of how serious the problem is.

One example of how serious the need for a better response can

be seen in the more than 30,000 individuals who enrolled in the

World Trade Center Registry but are ineligible for any of the federally funded medical monitoring programs or soon-to-be treatment

programs. That is why I have introduced with Mr. Shays and Hillary Clinton the Remember the September 11th Health Act, H.R.

566, back in 2004.

And this legislation would make available medical monitoring to

anyone exposed to the deadly toxins of Ground Zero, including residents, office workers, children, and treatment to anyone who is

sick. It would also provide for much needed research and coordination, but I also recognize that we need to do more than just provide

medical monitoring and health care.

We need to make sure that sick September 11th responders who

have lost their jobs, have no medical care, and cannot pay their

bills, they cannot support their families because of their selfless

service, we need to make sure that they are taken care of. And

that’s why I have introduced the James Zadroga Act with Congressman Fossella to reopen the Victims Compensation Fund to

help these people.

Let us not just call them heroes and heroines. Let us take care

of them. If there was ever a case that demonstrates that need it

is James Zadroga.

I really want to make a commitment to everyone that I will not

stop this fight until everyone exposed to the toxins at Ground Zero

is medically monitored and everyone who is sick is treated. And our

true test as a Nation will not be what is the response today, which

is a highly visible, 5-year anniversary, but what our government’s

response is 5 years from now, 10 years from now, 30 years from

8

now, when the carcinogens have turned to cancer and are causing

deadly problems to the men and women who rushed to save the

lives of others.

I thank everyone, and particularly the chairman, Christopher

Shays, for his consistent work and attention on the health care

needs of the September 11th responders.

Thank you.

[The prepared statement of Hon. Carolyn B. Maloney follows:]

9

10

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Mr. SHAYS. Thank the gentlelady. We have heard from the two

members of the committee. I need to ask unanimous consent that

Mr. Fossella, Mr. Nadler, and Mr. Weiner can participate as full

members of the committee. Without objection, so ordered.

And let me take care of this now. If Senators Clinton or Schumer

or Menendez also come to participate, that without objection they

may participate as if they were members.

And at this time, Mr. Fossella, thank you for your work, and you

are recognized.

Mr. FOSSELLA. Thank you, Mr. Chairman, and I would like to

thank you up front, as others have already, for convening this

hearing, the fourth of its kind, and I know it won’t be the last. As

my colleague, Mrs. Maloney, has stated, you have provided a venue

and an opportunity for the unsung heroes and victims of September

11th to continue to tell their story.

And I think it is bearing fruit, and I urge you not to let up, and

I know you won’t. So it is greatly appreciated on behalf of not just

so many who suffer from across the city, but in particular the people I represent in Staten Island and Brooklyn.

Let me thank my colleagues, in particular Congresswoman

Maloney, who have basically argued I think very effectively in our

Congress to get the attention that it deserves to help those who

have suffered.

We know that there were at least two sets of victims of September 11, 2001—the dramatic image of those who came with the

burning building whose lives were destroyed, and we continue to

mourn and honor their loss and memory. But there is another set

of victims where their lives are broken, and I think that our country needs to do everything physically possible to make their lives

more whole.

We forget sometimes that it was not the United States that was

attacked but New York City. In fact, it was America that was attacked. It happened to be in New York City. And as a result, that

attack on America requires, demands, and deserves an American

commitment, an American response, to those who didn’t ask any

questions but rushed to the pile at Ground Zero, who helped out

for months without hesitation at the Fresh Kills Landfill or other

ports around the city, digging and participating in the rescue and

recovery effort.

As they did not ask questions in an effort to save other lives and

to help rebuild the city, our Congress should not be asking questions on how we are going to go about paying to help them rebuild

their lives. We know over the last several years, and now substantiated with a report released this week, what many of us already

know—that common sense, anecdotal, just observation, just reality,

that people’s lives have been taken away from them in many ways.

Young men and young women who had no problem running a

mile in 6 minutes now have difficulty walking up a flight of stairs.

We know from the fire department studies how they see young men

constantly leaving way before their prime, because they can’t continue to do the job that they love—helping to save and rescue others—because they can’t take the risk of running into the burning

building, physically and/or mentally.

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We know that there are thousands of victims who continue to

suffer and it will only get worse. We have learned to discover that

while there have been attempts to help, it is insufficient. As Mrs.

Maloney has indicated we were successful to obtain $125 million,

$75 million for the first time to go to treatment from the Federal

Government, but there needs to be more done.

With the appointment of Dr. Howard as the health coordinator,

and now with Secretary Leavitt committing another task force, we

know that action is needed and studies become less important, although important less important than the treatment action that

will follow.

We know earlier this week that the mayor of the city of New

York has, as he has done for the last several years, constantly reminded us how important it is not to forget the victims of September 11th. But let me clear: it should not be just borne by the city

taxpayers or the State taxpayers. We need help from the Federal

Government, which is why these hearings I think lend a hand.

As we go forward, I know there will be many who want to point

fingers and look back and undo history. We can’t. There will be

many who want to say, ‘‘How come we didn’t follow this advice or

do this?’’ We can learn from that, but I think the responsible thing

we need to do is everybody who responded to Ground Zero who is

suffering today, we need to help them get their lives back.

We need to keep the Congress and the Federal Government at

the table participating to the fullest extent possible, to complement

the work of the city and the State government, as well as the nongovernmental organizations. And you have our commitment that

we will not rest until that job is done.

Thank you, Mr. Chairman, for convening this. I look forward to

hearing from not just the first panel but others as we continue to

hear those stories of the untold victims of September 11th.

Mr. SHAYS. At this time, we would welcome Senator Clinton, but

we will give her a chance to catch her breath, and we will go to

Mr. Nadler. And, Mr. Nadler, thank you for all you do.

Mr. NADLER. Thank you, Mr. Chairman, and thank you for holding this hearing, and welcome to the 8th Congressional District.

Mr. Chairman, the barbaric attacks of September 11, 2001, posed

a true test of our collective and individual characters. Unfortunately, the Federal, State, and city governments failed the test of

September 11th.

The EPA told residents, workers, and school children that it was

safe to return to the area, when clearly it was not, placing all these

people in harm’s way. In addition to outright deceptions, September 11th residents and workers have had to endure so-called

‘‘cleanup plans’’ that are totally lacking in scientific merit, and inexcusable delays that continue to endanger the health and lives of

countless people.

Beginning just days after September 11th, with EPA Administrator Christie Todd Whitman’s completely false statement, based

on no empirical data, that the air is safe to breathe and the water

is safe to drink, the EPA began systematically lying to the public

about the safety of the environment. To this day we have still not

had the comprehensive indoor testing and cleanup program that is

so desperately needed to avoid thousands of more people being

13

slowly poisoned, and that the EPA’s own Inspector General called

for 3 years ago.

There is no doubt that people are sick from World Trade Center

contamination. The most recent study to show this released by Mt.

Sinai earlier this week found that 70 percent of the more than

9,000 first responders studied suffered health problems related to

their work at Ground Zero. But this is not really news. We have

known for years that people are sick.

In fact, this very subcommittee has been holding hearings on this

topic since 2003. And while some funds have been appropriated for

first responder monitoring and treatment, it is not a fraction of

what is needed. It is a national disgrace that Hollywood has spent

more money making and promoting a film on the World Trade Center than the Federal Government has set aside for the medical

monitoring and treatment of our first responders—much less of the

students, residents, workers, and tourists whose health was also

assaulted.

The President talks about the war on terror. In an earlier war,

President Lincoln spoke of society’s obligation to ‘‘care for him who

shall have borne the battle.’’ One can only conclude that the Federal, State, and city governments have betrayed those who have

borne the battle—the residents and workers caught in the plume

on September 11th, or still working or living today in contaminated

spaces, and the 40,000 first responders, the heroes of September

11th, who worked in a highly toxic environment for weeks and

months without proper protection. Thousands of these people are

now sick and are being shown the back of the hand when they seek

medical or other assistance.

But events of the last few days show that the 5-year cover-up is

finally rapidly breaking down. On Wednesday Governor Pataki finally admitted we were misled by the EPA. Yesterday Christie

Todd Whitman and former officials of the Giuliani administration

began pointing their fingers at each other. But we can sort out the

blame—moral, political, probably criminal—later. The important

thing now is to provide comprehensive medical treatment for all

those exposed to World Trade Center contamination.

That is why yesterday I announced the introduction, along with

a number of other co-sponsors, of the 9/11 Comprehensive Health

Benefits Act, which would provide medical care to all those suffering adverse health impacts from September 11th in a sensible,

easy-to-access and cost-effective manner through the Medicare system. This includes mental health benefits where necessary.

All costs—all costs—including premiums, deductibles, and copays related to September 11th-connected illnesses would be covered, and the benefits would provide total care. The bill authorizes

the necessary funds to cover these costs, so as not to impair the

solvency of the Medicare Trust Fund.

Under this bill, people will be able to use the long-established

Medicare framework to see their own doctors, or practically any

specialist they feel necessary, without having to navigate a bureaucracy designed to contest their claims.

The September 11th victims’ frustrating experience with the adversarial bureaucracy of the State worker’s compensation system

has shown that we need a very different approach from one based

14

on worker’s compensation. There is no time limit on Medicare, so

people will be able to receive treatment 10 or 20 years down the

line when people are no longer focused on this, should their symptoms persist. And people will be able to receive treatment when

what I am afraid will be thousands of cases of asbestosis, mesothelioma, and lung and other cancers begin to emerge in the years

ahead.

Medicare has a low overhead and administrative costs of only 2

percent. And since it already covers over 40 million people and routinely accepts approximately 2 million new people each year, it can

easy absorb this new population which might eventually total

50,000 or 60,000 people.

There is no need to reinvent the wheel or create a new bureaucracy or force September 11th victims to wait until the Federal Government gets its act together. All we need to do is give the September 11th victims immediate access to Medicare, just as we do for

millions of other people every year. My bill would do just that, and

I hope that Republicans and Democrats in Congress, and the Bush

administration, will support this approach.

The bill would also establish a federally funded consortium of institutions, practitioners, and community-based organizations with

expertise in providing outreach, screening, monitoring, treatment,

and research for September 11th-related health conditions, and a

state-of-the-art clinical facility would be established in Lower Manhattan.

Recovering from September 11th is not simply a matter of building skyscrapers, transit hubs, and memorials. It is also about coping with the long-term health and environmental consequences of

this unprecedented attack on American soil. The terrorists attacked

the United States, and the City and State of New York should not

be expected to shoulder the enormous financial burdens associated

with providing essential health care. Not to mention the fact that

the Federal Government is largely to blame for sending people back

into contaminated spaces, and for not enforcing occupational safety

and health laws at the World Trade Center site.

Until we adequately protect the health and safety of all those

still at risk from the attacks of September 11th, we perpetuate and

exacerbate the tragedy of that day. It would be truly a national disgrace if future historians are compelled to record that dishonest actions by the city and State and Federal Governments, followed by

callous inaction by the Federal and local governments, ultimately

were responsible for more deaths than was Osama bin Laden.

Thank you for this opportunity to address the committee, and I

look forward to the witness testimony.

[The prepared statement of Hon. Jerrold Nadler follows:]

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Mr. SHAYS. I thank the gentleman very much. I am torn between

whether I recognize a future President or a future mayor of this

city, but I think protocol will lead me to recognize our Senator, and

to thank you, Senator Clinton, for all that you do and your concern

about this issue. And thank you for honoring this House committee

with your presence.

Senator CLINTON. Thank you, Congressman, but I am not running for mayor. [Laughter.]

I want to thank my colleagues in the House of Representatives,

Congressman Shays, Congresswoman Maloney, Congressman

Fossella, Congressman Nadler, and Congressman Weiner. They

have been part of our bipartisan New York regional team to bring

this issue to public attention and to work until we obtain support

for those who are suffering the consequences of their exposures to

the toxic stew at the World Trade Center site and at Fresh Kills.

I also want to thank Lillian Roberts, Executive Director of DC

37, for welcoming us to your home, all the labor leaders who are

here who have been absolutely instrumental in pursuing this struggle to get attention to the needs of so many thousands of responders, workers, volunteers, and residents, and all of the people who

have been directly affected, those who did respond, those who

worked, those who live, those who volunteered. Thank you for

being here and being part of this important hearing.

I also want to recognize and thank some of the people with whom

I have worked on this for now nearly 5 years. I see Dr. Carrie

Kelly, Dr. David Prezant in the audience. They were among the

very first to sound the alarm on behalf of the fire department, the

firefighters, and fire officers. I will never forget Dr. Kelly’s extraordinarily vivid testimony before a committee in the Senate on which

I sat within weeks of September 11th about what the physical and

mental challenges and stresses confronting the firefighters would

be going forward because of their experiences.

I also want to thank Dr. Robin Herbert and Dr. Steven Levin

who were among the very first to take up this cause, working out

of Mt. Sinai to try to help create a system to conduct the monitoring and screening that would give us the evidence that we needed

to support what we could see, feel, smell, and taste ourselves, that

what happened with the collapse of the buildings, with the implosion and sending into the atmosphere the pulverized concrete, the

minuscule glass shards, the asbestos particles, and so much else,

was going to impact over many years the health and well being of

thousands and thousands of men and women.

We are about to have the fifth anniversary of this horrible event,

and we will rightly recognize and honor the sacrifice and commitment of our first responders who conducted the greatest rescue

mission in the history of the world. It is not in any way an overstatement to suggest that probably 25,000 people’s lives were saved

because we had brave men and women who went into danger on

behalf of others.

It is also going to be a time for us to take stock in our country

as to what lessons we have learned, what work we are doing to ensure our safety going forward, and whether we are honoring our

commitments to those who were affected, directly and directly, by

the events of September 11th.

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The work that commenced from the very moment the first plane

hit was hazardous and different. And for as long as 9 months, you

had first responders, trade and construction workers, and others

who were working amidst the dust and the fog and the smog, a

toxic mix of debris, smoke, and chemicals.

From the very first visit that I made, within 24 hours of the attacks, I met people who were emerging from that dark curtain of

hell covered with the results of the collapse of the buildings. Standing there with other public officials I could feel and smell what

they were working in. It was clear to us that these were not

healthy working conditions and that the air was not safe to

breathe.

Unfortunately, different assurances were provided, and there

wasn’t a concerted effort to try to convince obviously committed

workers on that pile to where whatever respiratory protective devices were available.

Starting in October 2001 I began, with the support of people like

those whom I have mentioned, along with Dr. Phil Landergen, one

of the Nation’s experts in the environmental impacts of various

working conditions and exposures on people’s health, to agitate for

a program to monitor and screen those who had been exposed, and

to make sure that the fire department had the resources it needed

to conduct its own monitoring and screening, which was fully appropriate because they had the information available from before

September 11th that they could compare to post-September 11th

health conditions.

I was very grateful that we were able to secure $12 million in

December 2001 to establish the World Trade Center Worker and

Volunteer Medical Screening Program at Mt. Sinai. When it was

obvious that money was woefully inadequate, we all worked together to get an additional $90 million to expand the number of

workers and volunteers who were eligible.

This week the report was released, and it confirmed our worst

fears, and it confirmed an earlier report from the fire department’s

study that also confirmed our worst fears. Thousands, I would say

tens of thousands, of first responders, workers, volunteers, and

residents have experienced mental and medical health problems.

You know the litany all too well—asthma, bronchitis, persistent sinusitis, laryngitis—and for these individuals their illnesses are a

constant reminder of that terrible day and of the days and weeks

and months later.

But so many had much more serious illnesses develop, and we

are only beginning to understand the extent of those. You will hear

from some witnesses on the first panel who will tell their stories

or the stories of their loved ones. And the prayers and love and

compassion that were offered in the wake of September 11th were

a wonderful tribute to our spirit and our resilience, but it is not

enough.

It is not enough to say we stand with our police officers or our

firefighters or our iron workers or our laborers or anyone else.

Words at this point, nearly 5 years later, are really inadequate.

That is why we must stand up for and obtain the support and the

resources required to treat those who are suffering.

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I was proud to work with DC 37 and others who formed a coalition to fight to get the resources we thought we needed. We secured

money, more than $100 million, for medical screening and health

monitoring, and then there was a dispute over the money, the $125

million all together. We made an allocation, $50 million for workers

comp claims related to the September 11th attacks, and $75 million

for long-term medical and mental health needs.

Just yesterday the group before you, along with some other of

our colleagues, met with Secretary Leavitt. He made a commitment

to us that the $75 million which has been sitting in the Federal

treasury that has been designated to get out to help people will finally be delivered. And we are going to hold him to that promise.

We have heard these promises before. If promises counted for anything, everybody would be taken care of by now, because we have

had more than our fill of them.

And we have to make sure that this time the money is delivered,

and I want to thank Dr. John Howard, who was put into the position of helping to move this along at the Federal level, given no

staff, no budget, and he, despite some considerable obstacles, has

been a real support to those of us waging this struggle.

So we hope out of this hearing will come a greater awareness

even than we have now, a greater commitment than we have had

until now, and an absolute rock-solid decision that we are going to

get the help we need from all levels of government for everyone

who requires it.

There is nothing we can do to turn the clock back. There is nothing we can say to comfort those who have lost loved ones. And

there is very little we can say to healthy young men and women

who on September 10th 5 years ago were running marathons and

lifting weights and just feeling full of vigor and vitality who today

can hardly breathe.

But one thing I know for certain is that we cannot rest until we

put into place a system to take care of every single person who was

affected by September 11th. And I thank my colleagues, and I particularly thank the witnesses and all of those who have worked so

hard to make the progress on this important issue for what we

have done up until now, but let us keep going, because we have a

long way to go, we have miles to go and promises to keep.

Thank you very much.

Mr. SHAYS. Thank you very much, Senator. And at this time we

will have Mr. Weiner be our closer, and to thank him for his patience and to thank him for all his good work on this issue over

so many years.

And then, we will get to our witnesses, and I will just say to our

witnesses, this is part of the process of members going on the

record beforehand, your listening to the comments we are making

and, of course, hearing what we are saying may want to include

in your comments, references that you agree or disagree with comments that were made by us.

So at this time, Mr. Weiner, thank you so much for being here.

Mr. WEINER. Thank you very much, Mr. Chairman, and I won’t

take the full time allotted. So much of the foundation has been

laid, and we are eager to hear from the witnesses. I want to thank

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you for continuing to do what I think we haven’t done enough of

in this process, and that is vigorous oversight.

It is customary to call hearings like this fact-finding hearings.

But, in fact, the facts have largely been established. It is a fact that

thousands of New Yorkers, in fact thousands of citizens from the

entire country, rushed to Ground Zero to rescue, to recover, and to

help honor those who were the targets of this attack. We are joined

in the room by Secretary—by Commissioner Scoppetta of the fire

department, 343 were lost that day, many of those in my district.

It is also now a fact that thousands of people are sick, getting

sicker, and tragically dying for the service that they gave to their

country and to their neighbors. This is not speculation. This is not

an anecdote from a neighbor. These are now the facts as we have

seen this week.

It is also, I would say, a fact that it is the Federal Government’s

responsibility, both for the sickness that they are experiencing and

to help them recover. Former Secretary Whitman we learned yesterday is engaged in a Herculean effort in behind-covering about

her actions. It has now become a fact that Secretary Whitman has

lied.

She either was telling the truth on September 12, 2001, September 14, 2001, September 16, 2001, September 18, 2001, when she

repeatedly told the public, told those that were down at the rubble,

told members of government, told average citizens that it was safe

to be there, or, alternatively, she is lying on September 7, 2006,

when she said that she knew better.

Either way we know that the Secretary of the Environmental

Protection Agency, whose job it was on that day, was not to rush

into a burning building like the heroic firefighters, was not to help

dig out their neighbors and friends from the rubble, her job was to

answer a simple question: is it safe down there? And she didn’t say

it once, she didn’t say it twice, she said it at least four times, including at least twice after evidence had emerged within our own

agency, that led all of us to know, and especially her to know, that

what she was saying was not true.

Now to reveal after the fact, 5 years later, as her contribution to

honoring those lost, to her contribution to furthering the discussion

about how it is we make those people whole who are sick and

dying, her contribution was today that she whispered into the ear

of government officials, ‘‘Oh, by the way, disregard what I have

said publicly, disregard what I have said repeatedly, I am telling

you, it might not be so safe.’’

She was either lying then, or she is lying today. Either way it

is a scandal, and I believe it might be criminal.

So now that we have established those facts we need to focus on

what we are going to do about it. The studies have ben done, the

facts are clear, now, how do we act? Congressman Nadler has suggested we fold these workers into Medicare. That is an excellent

idea. It allows us to act quickly with an established infrastructure.

The Daily News and Congresswoman Maloney and others have

suggested we create a compensation fund similar to that we did in

the Feinberg Commission. This time we have to recognize having

a one- or 2-year statute of limitations is simply not going to work.

Tragically, there are people who are walking around today who

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might feel healthy, who may find out in 6 months or a year or 5

years that they are not, but the fact is, the final fact is, that we

have to act soon.

The President, Secretary of Health, met with us yesterday and

say they are putting in the A team. We are gratified for that, but

it is not enough just to say we are going to do $75 million. We have

to make a commitment that we are going to make those people who

are sick—as much as we can we have to honor what they have

done. That is the fact.

And I yield back the balance of my time.

Mr. SHAYS. I thank the gentleman. At this time I—before recognizing the witnesses, I want to just thank District Council 37 for

allowing us to conduct our oversight hearing in their auditorium.

Ms. Lillian Roberts, Executive Director of DC 37, as well as her

staff, have provided the subcommittee with all of the resources and

tools necessary to conduct this field hearing, and their help has

been very, very, very appreciated.

At this time I do want to recognize the witnesses. I need to swear

our witnesses in, so I will wait until we have all our witnesses

here. But I recognize Ms. Cynthia Bascetta, Director, Health Care,

Government Accountability Office; Mr. Joseph Zadroga, Little Egg

Harbor Township, NJ; Mr. Steven Centore, Flanders, NY; Ms. Lea

Geronimo, New York, NY; and Sergeant Lawrence Provost, from

Virginia Beach, VA.

I will—I am going to do what I don’t usually do and just have

you, Ms. Bascetta, start your testimony before you are sworn in.

But when we have all our witnesses, I will be swearing all our witnesses in at the same time. So we will start with you.

STATEMENTS OF CYNTHIA BASCETTA, DIRECTOR, HEALTH

CARE, GOVERNMENT ACCOUNTABILITY OFFICE; JOSEPH

ZADROGA, LITTLE EGG HARBOR TOWNSHIP, NJ; STEVEN

CENTORE, FLANDERS, NY; LEA GERONIMO, NEW YORK, NY;

AND LAWRENCE PROVOST, VIRGINIA BEACH, VA

STATEMENT OF CYNTHIA BASCETTA

Ms. BASCETTA. Thank you, Mr. Chairman, members of the subcommittee, and Senator Clinton.

Mr. SHAYS. Here is what I am going to—these are the kind of

mics that singers tend to use. They have to be a little closer to you.

Ms. BASCETTA. How is that?

Mr. SHAYS. Yes, that is better. I am sorry. They are not the ones

that you can keep further away.

Ms. BASCETTA. OK. I am pleased to participate in this hearing

on programs that monitor and provide treatment for people whose

health was adversely affected by the September 11 attack on the

World Trade Center. Our work for you has focused on the estimated 40,000 responders, who include New York City firefighters

and police officers, Federal Government personnel, and other government and private sector workers and volunteers from New

York, and many other areas, who risked their lives to help in the

rescue response and cleanup operations.

Ongoing studies of the health effects experienced by these responders documents the serious long-term physical and mental

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health toll resulting from their heroic efforts. The results of the Mt.

Sinai study published yesterday are especially sobering.

This February we testified that officials from the fire department, the worker and volunteer program, and the registry were

concerned that Federal funding may run out before monitoring

could identify all long-term health problems. We also reported that

the program for Federal responders had accomplished little and

lagged behind programs for other responders.

In revisiting these issues today, I will discuss actions CDC has taken to award $75 million appropriated to it in December 2005 to

support responder programs. As you’ve noted, this appropriation

provided the first Federal dollars for treatment in addition to continued support for screening and monitoring.

But first I will update you on the status of HHS’s Federal responder program. Since it began, HHS has registered more than

1,700 Federal responders. About 1,400 of the total have been registered since your February hearing, including about 1,100 current

Federal workers and 250 former Federal workers.

Unfortunately, we don’t know the percentage of Federal responders this represents, because the total remains uncertain. For those

registered, Federal occupational health have completed screening

examinations for just over 900 by late August, 380 of them since

February. The worker and volunteer program is now screening

former Federal workers under an agreement with NIOSH, and as

of July 31st had provided exams for about 13 former Federal workers and scheduled 11 more. Most of the former Federal workers reside outside the New York Metro area, but NIOSH has not yet

completed making arrangements with providers to screen and provide treatment for them.

Turning to the appropriations, the law gave priority for funding

to the existing programs that provide screening, monitoring, and

treatment services. So far, as you have noted, CDC has awarded

less than $5 million, beginning with $2 million for the registry. A

few weeks ago in August CDC made two emergency awards, $11⁄2

million to the fire department for leasing treatment space, and $1.1

million to the worker and volunteer program to hire administrators

and a medical assistant, as well as an additional physician to help

reduce the 3 to 4-month waiting time that recently developed at

the Mt. Sinai Clinical Center.

The waiting time was caused by a spike in people seeking monitoring who had seen media reports about illnesses and responders,

and notably because the proportion of responders who needed to be

referred for treatment had increased. CDC also expects to award

a total of $41⁄2 million this month to the POPA program and

Project Hope to help meet the mental health needs of responders.

CDC’s proposed spending plan shows that the bulk of the funds,

more than $50 million, will be awarded to the fire department and

the worker and volunteer programs. Until yesterday CDC had not

expected to make awards until February 2007 after it had reached

certain decisions about the coverage of treatment services such as

which prescription drugs would be covered.

The proposed spending plan showed that about 63 percent of the

funds would have been awarded in fiscal year 2008. During the

course of our work this summer it became clear that CDC did not

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know how quickly treatment costs may deplete the available funds,

but the fire department and the worker and volunteer program officials told us that they expected that the funds would be depleted

well before the end of 2008.

In summary, the results of the study released yesterday suggest

an upward trend in the costs for responders due to the chronic nature of the health effects they sustained in the aftermath of the

September 11th attack. CDC has proposed a plan to award the $75

million appropriation it received last year, but it still hasn’t made

decisions about what treatment services will be covered by Federal

funds.

Moreover, responders who live outside the New York City area,

including former Federal workers, continue to have limited access

to services, because screening arrangements for them are still incomplete. Resolving these issues in a timely manner is critical, so

that the funds appropriated will be available to help ensure that

the responders who risked their lives have access to the treatment

services they need.

That concludes my comments.

[The prepared statement of Ms. Bascetta follows:]

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Mr. SHAYS. Thank you very much.

At this time, I would like all of you—and if you, Mr. Centore, are

able to stand as well, I would like all of you to stand. We will be

swearing you in.

The only person I never swore in the 10 years I have been chairman—I chickened out—is the senior Senator from West Virginia.

[Laughter.]

[Witnesses sworn.]

Mr. SHAYS. Mr. Centore, you will need to put that mic fairly close

to you, and probably on this side of you, since you are looking at

us in this direction.

STATEMENT OF STEVEN CENTORE

Mr. CENTORE. Thank you. My name is Steve Centore. I am a

member of the U.S. Department of Energy. During the September

11th period I was the Regional Response Coordinator for the Radiological Assistance Program. All this should be covered in the testimony that I sent out to Bob Briggs, and he was supposed to put

it in your handout.

Let me just say it is a privilege and an honor to be here today

in front of you and participate in this hearing. And I have nothing

but the utmost respect for this panel.

However, having said that, there is always a disclaimer. My

mother is a little Scottish woman from the hills of West By God

Virginia. My father is a little Italian fellow from the Bronx. So, you

know, even tempers running—[laughter]—you know, stretching

throughout my family. So if I have a tendency to get a little excited

when we get to certain topics, you will understand why.

In your letter that you sent out, your invitation, there was two

questions that you asked. One you wanted to know how effective

were the medical screening and monitoring programs for individuals that responded to the World Trade Center disaster. You know,

and right now I feel like I have been set up, because I am sitting

next to a member from HHS, and I am probably one of the few

Federal emergency responders that——

Mrs. MALONEY. Point of clarification, she is not from HHS, she

is from the General Accounting Office, an independent arm of government.

Mr. CENTORE. Oh, OK. I am sorry. That takes a load off my

mind. [Laughter.]

Because they were No. 1 on my list to talk about.

I spent the first 4 months at Ground Zero in a HAZMAT support

role, providing support to New York City FDNY/NYPD, after which

I was reassigned to covert ops in different parts of the country

doing different things which I can’t go into.

It took about 4 years I believe before we ever got our first letters

from FOH, the Federal Occupational Health, about medical screening. Me and my team, the five guys on my team, we got our letters

around November/December timeframe last year, 2005. I finally got

an opportunity to go to my medical screening in I believe it was

April 2006, and I thought, oh boy, this is great, because I had already been diagnosed with PTSD, anxiety disorder, my liver was

failing, my gallbladder was almost completely shot, my spleen was

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enlarged, my lungs, my throat, I had varices, I had bursitis, and

I have bone narrow——

Mrs. MALONEY. Could you pull your microphone a little closer?

People are having difficulty hearing.

Mr. CENTORE. Sorry. That is a problem I have now, I have lost

my memory.

Mrs. MALONEY. You were talking about going to get your screening.

Mr. CENTORE. Right, yes.

Mrs. MALONEY. Federal screening.

Mr. CENTORE. So I went to—I went to the satellite office that

FOH opened up in Islip at the Federal Building. And when I went

in, you know, the nurse started taking my data, and one of the

things she had mentioned was, ‘‘You know, there is no treatment.

We don’t provide any treatment. We don’t provide any reimbursement of expenses or anything.’’

And I got to thinking about it for a while and I said, ‘‘So I am

just a data point for you on the map.’’ And she said, ‘‘Yes, basically.’’ I said, ‘‘So when I die, I become a second data point for you.’’

And she said, ‘‘Unfortunately, that is right.’’ And I am like, well,

why am I wasting my time here?

I had already engaged my own local doctors to provide, you

know, medical treatment for me. At the time I was seeing an internist, a GI specialist, hematologist, a psychologist, and a psychiatrist. All of this I paid for out of my own pocket. I had to use up

all my own sick leave and my own annual leave, and I couldn’t figure that out, how you could get injured on the job. Now that you

are injured on the job, it is my responsibility, you know? I mean,

I was made to feel like a bad guy, like I did something wrong. And

for the longest time I had a guilty feeling, and I couldn’t understand why. I still don’t.

But anyhow, to get back to your—the issue that you want to discuss, is this program working? The program is doing exactly what

it was supposed to do—collect data. Is it helping anybody? No. Not

one bit.

[The prepared statement of Mr. Centore follows:]

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Mrs. MALONEY. Thank you for your very moving testimony.

Thank you.

Mr. Zadroga.

STATEMENT OF JOSEPH ZADROGA

Mr. ZADROGA. First of all, thank you for inviting me, and I agree

with your committee reference to you have an independent study,

I would really like to see a Grand Jury with subpoena powers and

charge people criminally for what occurred that day.

Senator Clinton, I would like to personally thank you. You are

one of the few people that called the day that my son passed and

gave condolences. Actually, you were the only one from New York

that gave condolences to my family when my son passed, and I

thank you for that. That was very well received.

My wife would like to be here today, but unfortunately she had

to stay home and take care of Tylerann. And sometimes she has

the way of saying things, if you are reading a paper, she gets to

the point a little too fast. And, you know, as I always say you can

take the girl out of the north, but you can’t take the north out of

the girl. So we decided to leave her home for the day.

As you know, my name is Joseph Zadroga. I was a police officer

for 27 years in North Arlington, and I was also Chief of the Bergen

County Police Academy for 6 years.

Jimmy worked for 13 years with the New York City Police Department. He worked in the Sixth Precinct for 6 years, and he

worked on street crime for 6 years. He was well respected within

the department, and in street crime he was one of the highest performers in the Street Crime Unit.

He was very street-wise, and he knew how to speak to people

and get them to break—to confess to their crimes. And because of

that he was transferred to the apprehension squad within the

homicide squad, and I really believe he had a true future in the

New York City Police Department, because someone with 13 years

on, without any rabbis or hooks, don’t get transferred to homicide

squad.

They really had a future set for him, because he was really well

liked and he knew what he was doing out there. And he wasn’t one

to brag either. He had over 40 citations, which I never knew about

until the day of his funeral when his partner told me.

On September 11th he arrived home to speak—just prior to the

buildings collapsing, and he knew he was going to go right back

again. He woke up his wife just as he arrived in the house, told

his wife what was occurring, and then started packing up his

clothes to leave. And she says, ‘‘Where are you going?’’ He says, ‘‘I

am going back to the city to help.’’ And she said, ‘‘No, no, you have

to stay here.’’ And he said, ‘‘No, it is my job. I have to go back. And

this is what I do for a living, and this is what I want to do.’’

However, he did say it was the hardest thing in his life to back

down the driveway with his wife, who was 7 months pregnant,

kneeling in the driveway crying, asking him not to go, but he went.

His wife passed away several years later from the stress of taking

care of the household and taking care of him and his 2-year old

daughter.

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So then he had to move in with us, and obviously, you know, that

is very difficult, for an adult to move back in with their parents.

But there was no way that he could live alone by himself with his

medication, and so forth.

When he passed, we were very fortunate that Dr. Breton, the

medical examiner in Ocean County, requested an autopsy, because

I am sure if we were in New York City I don’t think that would

have occurred. And the doctor basically stated that his lungs were

very severely damaged, and they were black, they were—he had

black lung disease, besides several other diseases. He had all types

of chemicals in his lungs, bone particles, and dust and sand and

glass.

Since Jimmy’s passing, his mother and I felt that the best thing

we could do was help make aware how all these other heroes are

being treated by the NYPD and the government. He never received

any assistance from the city. All he received was more stress, and

he was treated like a dog. And if a dog was—someone observed a

dog being treated the way he was, they would have been arrested.

I just want to read a brief statement that he wrote the first year

anniversary to his father-in-law, who was a minister in Florida. It

is a three-page letter, but I am just going to read a brief sentence.

‘‘To this day, I can still hear the mass confusion from the first day

to the engine sirens that came afterwards.’’ He said, ‘‘My nights

will never be the same. Everyone praises the dead as heroes, as

they should, but there are more living suffering than dead.’’

And I will pass up a little further where he said, ‘‘Yes, they remember the dead, but they don’t want to acknowledge the sick or

living. I am not the only one out there. There are many suffering

similar, if not the same, symptoms as myself. The city doesn’t care

about any of their employees, and it is sad not to mention that 90

percent of Americans that we know are sick.’’

‘‘I just wish for once that the city would open their eyes and help

the living and stop getting political feedback from the dead, get

more personal, not political, on how can this make us money. That

is all the city cares about. If you ever meet a New York City copy,

a firefighter, or an EMS, just tell them thanks, because that is all

that you will ever get.’’

I know I am running short on time, so I am just going to—I was

asked to give some suggestions.

Mr. SHAYS. Mr. Zadroga, you just go as long as you want to go,

sir.

Mr. ZADROGA. Oh, OK. Thank you. Jimmy worked close to 500

hours at the World Trade Center, with the only protection a paper

mask. Within weeks he developed a cough that would later be

known as the World Trade Center cough. He also developed shortterm memory loss, acid reflux, high fevers, and would go into spells

where he would sleep for days without eating or moving. He had

severe breathing problems and was placed on oxygen 24/7, all this

while the police department refused to admit that he was sick and

attempted to return him to work continuously.

Jimmy’s wife Ronda, as I said, passed 2 years after his illness

due to the cowardice approach of the city and all the stress that

she was under. She was just—she was like a daughter to me, and

she was a lovely person, and she just couldn’t take the stress of—

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could not believe that people could treat other people that way. I

honestly believe that is what killed her.

We watched him progressively get worse until he died at home

on the floor in his bedroom with his daughter sleeping on the bed.

I found him that morning, as I always expected to when he didn’t

come down for his medication, lying on the floor. As soon as I

opened the door, I knew he was gone. I laid down beside him. He

had his baby’s bottle in his hand. At that time I woke up the baby,

and the baby said—I said, ‘‘Your father is gone.’’ The baby said,

‘‘No, he is just sleeping. You always said that.’’

I heard him during the night. I heard him getting the bottle. And

I heard him fall, but he always does that, and he usually wakes

up. I had to convince her that he was gone, and her words to me

was, ‘‘I knew he was sick, but I didn’t think it would be this fast.’’

This is a 4-year old girl saying this.

Dr. Breton, the medical examiner, reported that James died of a

severe lung condition, and making him the first police officer whose

death was diagnosed to be a direct result of working at the World

Trade Center, yet the city still refused to recognize his cause of

death was related to September 11th. The city even proceeded to

belittle Dr. Breton in the press.

Since Jimmy’s passing, his mother and I felt the best thing we

could do, and what we felt that Jimmy would want us to do, was

help make aware of how all these heroes are being treated by the

NYPD and the government. We need our government to do the just

and proper thing here and help these heroes. We can’t do anything

for our son now, but we want to make sure that the other workers

get the treatment that they need when they are sick. They all deserve a real commitment from our representatives to provide for

long-term monitoring and treatment.

This statement was—my wife and I tried for 4 years prior to his

passing to get his treatment, and yet we could not get doctors to

treat him. Now that we have everyone’s attention as a result of our

son’s death, we feel we have the right to make suggestions to help

the surviving heroes.

And as some of the panel said, we must make priority first the

treatment of our heroes to improve their health. This study should

be secondary to priorities. I used to answer the phone for Jimmy,

because the last 2 years he didn’t even want to talk on the phone.

He was so depressed and had post-traumatic stress.

And I would just like to do one conversation that I had with one

of these monitoring boards that called, and they wanted to see how

he was. They used to call every 6 or 8 months. And the phone call

went like this, ‘‘Hello,’’ he said, and then, ‘‘James Zadroga?’’ He

said, ‘‘Speaking.’’ They said, ‘‘How are you feeling today?’’ He would

say, ‘‘I am feeling terrible. I never felt worse in my life.’’ ‘‘How is

your lung capacity?’’ ‘‘My lungs, they hurt so much that I can’t believe it. I can’t take the pain. I am on heavy medication.’’

‘‘How do you feel mentally?’’ ‘‘I feel like I want to kill myself. I

want to bite the bullet and get it over with. But the only reason

I am staying here is because of my daughter.’’ And she said, ‘‘Oh,

thank you for the information, and then hung up.’’ And that was

the help that we got.

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Again, I agree, we should not worry about what it costs or what

kind of money we are going to need to help these heroes with their

health. I can’t understand how this country can place value—such

little value on life for heroes that worked for them.

In my 30 years working in government, I have yet to see where

politicians that wanted to get something done, no matter how much

they complained that they didn’t have the money, but they wanted

to get it done for their own pet project, they always found the

money. So the money is out there.

We should recruit the best doctors in the city, if not the world,

to help these people. Obviously, their illnesses are different from

any others. We could never get a doctor to treat James. Someone—

and I don’t know if it was in the government or if it was the health

care, would always call and tell them to get him out of the hospital

as quick as they could, so they would shoot him up with steroids

and send him home.

I had two doctors tell me they wouldn’t treat him because of a

phone call, and I had one doctor tell me they wouldn’t treat him

because they felt the insurance wouldn’t pay. In the future I know

we are going to need organ donors and transplants for these heroes. And I think we should at this time set up a bank for the heroes, set up a donor list for organs that are going to be needed for

them.

I know the police, fire, EMS, and the good people of New York

would gladly sign up. Matter of fact, I will be the first one to sign

up on the list. My son was just going for a lung transplant—well,

I shouldn’t say going for a lung transplant. We went to Philadelphia, and the doctor felt concerned up there. He was the only one

that really gave any concern for Jimmy’s health, and he told us

when we come back the next time, which was January 10th, he

was going to introduce Jimmy to the lung transplant team. Unfortunately, he passed on the 5th.

I also strongly recommend that the Federal Government must reinstitute the comprehension fund. Jimmy used the comprehension

fund, and that did help him pay his doctor bills, his past bills from

his credit cards, and his hospital bills that were well over $50,000

prior to receiving that money.

And by reestablishing this compensation fund I believe it also

will reduce the lawsuits that we are talking about. Everybody is

worried about these lawsuits out there. I for one, I don’t worry

about lawsuits. There are many ways of handling—the government

could handle these lawsuits. I feel that if they are going to the compensation fund, these people could be helped immediately rather

than wait 10, 15 years down the line for court settlements.

And that is about all I have to say. I thank you for having me

here today.

[The prepared statement of Mr. Zadroga follows:]

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Mr. SHAYS. Mr. Zadroga, we are so grateful you came today, and

I know it hasn’t been easy for you to give your testimony. But the

reason why we have you as our first panelist, that we want everyone who follows to know what you all are saying.

Mr. Centore, we get your message loud and clear, and we know

what you are asking for, and what you are asking for needs to be

met. And we thank you as well for your testimony.

Ms. Geronimo, welcome, and thank you for being here.

STATEMENT OF LEA GERONIMO

Ms. GERONIMO. Good afternoon.

Mr. SHAYS. Good afternoon.

Ms. GERONIMO. My name is Lea Geronimo, and I wanted to

thank you for the opportunity to finally speak up after 5 years of

waiting. I am resident of the Lower East Side of Manhattan, and

I also work just three blocks away from where the World Trade

Center stood.

The September 11 disaster has changed my life forever. I am

here today to share my story as one of the forgotten victims of that

tragic day. The toxic World—the toxic World Trade Center dust

was not contained just at the Ground Zero site on September 11th.

For more than a year it permeated my office as well as my neighborhood. But as a result of repeated assurances by the Federal

Government stating that the air was OK, I had no choice but to

go back to work less than a week after the disaster.

Whether at home or at work I could not escape the dust and the

fumes. Within months of September 11th I developed bronchitis.

What I thought was just a random occurrence is now a chronic

problem. Since September 11th I have had bronchitis nine times.

Nine months after September 11th I developed constant menstrual bleeding that continued every day for 5 months. I was given

a sonogram, but the doctors could not explain why I was going

through this. Last year I developed lesions and polyps on my cervix

and my uterus, and I had them removed, and to this day my doctors still do not know why I had these problems at such a young

age of 35.

Additionally, I started to get small psoriasis spots like this one

on my elbow. There are others on my scalp and my back, and recently my thighs and my scalp broke out in dozens of new spots,

painful, very painful. I had to use a combination of various prescription medicines, including two different creams to use on my

face and my body, as well as a prescription shampoo and a scalp

medication.

Additionally, over the last 3 months I have had to receive UV

light treatments three times a week in order to treat the spots all

over my legs and torso. These treatments and the medicine regimen are not only taxing but they are costly. To date, even with my

limited health insurance, I have paid more than $15,000 out of

pocket. To make matters worse, I have had to take a 10 percent

salary cut. I have also started to get deductions from my salary to

pay toward my health insurance.

Today I face worsening health problems, skyrocketing medical

expenses, and shrinking health care. But my story is not unique.

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In fact, it is increasingly the norm for countless of families and low

income workers in the Lower East Side and Chinatown.

As a member of the Beyond Ground Zero Network, a coalition of

grass roots organizations, legal and health care advocacy groups,

we recognize the mounting health crisis brewing in our community.

Within weeks of September 11th we began outreach and surveyed

over 2,000 residents and workers who put their health as the No.

1 priority.

We found thousands of residents and local workers suffering

from new and worsened cases of asthma, severe breathing problems, and intense coughing. Today whole families suffer from asthma, respiratory problems, skin problems, and gastrointestinal problems.

Without any funding we launched a collaborative, a September

11th treatment program with Bellevue Hospital. This pilot program

got off the ground with intense community participation by the Beyond Ground Zero Network and has just expanded over the last

year. Today we have a backlog of over 700 residents and workers

representing the tip of the iceberg.

As the only September 11th treatment program for residents and

local workers in Lower Manhattan, our collaborative treatment

program is only the smallest step toward addressing the existing

health crisis within our local community. There is no excuse for

taking small steps on the fifth anniversary of September 11th. Our

health, my health, has been destroyed, and I can’t get this back.

Our lives will never be the same, and we will not tolerate any halfmeasures and the whisper of a promise.

We demand reparations for the lies about the toxic air. We need

immediate compensation, because we can no longer work due to

these health problems. We need a comprehensive long-term treatment and study program to provide medical care for residents and

workers in Lower Manhattan, and to continue investigating the

complex, emerging September 11th health problems.

We demand from the Federal Government today. Our lives depend on it. Now is the time to act.

Thank you for your time.

[The prepared statement of Ms. Geronimo follows:]

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Mr. SHAYS. Thank you, Ms. Geronimo, very much.

Sergeant Provost.

STATEMENT OF LAWRENCE PROVOST

Mr. PROVOST. Good afternoon, and thank you for inviting me to

come. First, I have to say that anything I say here today does not

represent the opinions of the Department of Defense or the U.S.

Government. However, it is as a soldier that I volunteered to respond to the attack on our Nation on September 11, 2001.

I arrived at the World Trade Center site on my own initiative,

in uniform, after gaining clearance from my military unit to do so,

to assist in the search and rescue and remained there for the first

7 days. On September 11, 2002, my Army Reserve Unit landed in

Afghanistan, and we returned home to New York on March 11,

2003. In September 2004, my team again went overseas to Iraq,

and we arrived home on March 11, 2005.

Much has happened in the past 5 years, but it is impossible not

to forget that what has happened to all of us these past 5 years

has been more or less because of September 11th. Our war began

at home, and our war ultimately must be fought and won at home.

Speaking as a member of two groups in the September 11 community—the military volunteers at the World Trade Center site

and the so-called undocumented victims, those who did not work

for the city or State of New York—we are faced with three major

issues in regards to September 11 illnesses—emotional, physical,

and spiritual health.

I am not ashamed to admit as a person in uniform that it has

been a very tough road mentally because of September 11th. The

severe PTSD issues that I have faced have been a major burden

on my family, my friends, my job, and it has been hard. You know,

and there is a real stigma that exists because of that, because you

are a person in uniform, whether you are in the military or a police

officer or a firefighter, or even in everyday society I think we still

see that.

I was even penalized in one of my evaluation reports because I

went and sought help from a military clinic regarding my World

Trade Center emotional health issues, and I am still fighting this

evaluation but it is going to remain forever in my file. I probably

will not be promoted again, and this is just very symptomatic of

what is going on with so many people. And, unfortunately, it is sad

to say that I have it pretty easy compared to other people, frankly.

In regards to the physical health issues, there are many of them.

On September 14, 2001, at the site I began to develop severe rashes on my arms, back, and neck. These continue to this day, and you

can probably see many of the red blotches that are across my face

now. I was treated onsite, but because I did not go to the hospital

I was denied Federal compensation related to September 11th. The

victims comp fund said you had to be treated at a hospital within

the first 48 hours.

Well, when we were onsite, one, we didn’t care about going to a

hospital; second, there was no place to sign in. You know, we just

went ahead and we did what we had to do.

At age 27, I am much weaker physically now than I was before

September 11th. And though I do not experience—and as I said, I

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do not experience most of the symptoms the others have, at least

as far as yet—I have it easy, because I am not dying. Bernie

Gidfried, a friend of mine, whose ambulance corps was contracted

to the city of New York but was not a part of the FDNY, she was

buried twice that day, once by each tower. She is on 22 different

medications now.

Father Lyndon Harris, he gave me permission to say this, most

people don’t know, but he is the priest who ran St. Paul’s Relief

Operation. Father Harris is sick. He has severe PTSD, and his

lungs are deformed. He was told this by the Mt. Sinai Medical Institute. What are we to say to heroes like Father Harris who

gave—who literally gave their all for all of us rescue workers down

there?

My battle buddy, who was only onsite for 2 days, is on a respirator day and night. I was there 7 days. He was there 2 days,

and he has to suffer because of this.

People from out of the State came, and they have already died.

Lieutenant Dave Michael, another Army Reservist who came as a

part of his police department from the Midwest, he only worked at

Fresh Kills, and he has died in his forties recently.

I feel as thought preventative treatment from the beginning

would have helped many of the chronically, critically, and terminally ill have a longer life span. And many of the monitoring program’s specific toxins are identified while strain on the heart and

the atrophy of the organs continues.

As I said before, Father Harris’ lungs are currently deformed,

and he has a history of coughing. He has not received workman’s

compensation. He is about to lose his medical insurance. I mean,

I just—it is mind-boggling, and there are so many of these stories.

I mean, this is—this is like what happened to John Lindsay before

he died. You have a great individual who does so much, and then

it is like nothing. You have no medical insurance, and you are

going to die alone.

Governor Pataki’s recent bill was for city and State public servants, not people such as on this panel. In New York City, 49 percent of emergency medical services are volunteers, are private ambulance services, that are not covered by the FDNY. If you were

down there giving to your country, you should be given treatment.

And what about the downtown residents whose only crime was living and working in the greatest city in the world?

We have seen little assistance from the mayor and the Governor.

Each is in a power grab for their piece of the most valuable real

estate in the world, the World Trade Center site, while neglecting

first the families of the victims, the developer, and now the first

responders and residents of Lower Manhattan.

The mayor’s administration has not declared war on first responders and residents, but its actions in effect have sent the message for us to drop dead and to stop being a nuisance. What they

have not realized by their actions is that what they are doing is

not in the best interest of the city, it is not in the best interest of

the soul of the Nation. They have not yet realized that the billions

they will inevitably spend on lawsuits would have made it more

profitable for them to save people than to let them be killed by terrorists.

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And I don’t think that this is the stronger and better New York

that Mayor Giuliani spoke of. And I do believe this leads to the

issue of our spiritual health. And while our government cannot

compel State-sponsored religion, any program that the Federal

Government does develop does have to take into account the faith

component and the faith healing.

Again, we saw what happened over at St. Paul’s Chapel where

people of all faiths went. That is just something that in any program, especially for people who are dying, who are getting ready

to meet their maker, these are issues that we definitely have to

confront.

In regard to spiritual health, as a military reservist I feel terrible

in knowing that there are remains of our military brothers and sisters in the garbage dump at Fresh Kills Landfill, and even today

around the World Trade Center site, where hundreds of remains

have been found in the Deutsche Bank Building over the summer.

I saw it here, I saw it in Afghanistan, and I saw it in Iraq. Remains can be, and usually are, everywhere. I can guarantee that

there are remains from September 11 in other places in Lower

Manhattan, in air ducts, in roofs, in vents. And I don’t believe it

is good for the spiritual well being of our city knowing that there

is a continuing graveyard down at the World Trade Center site.

We are at war, and the only way to win wars is by total immobilization of the national government in all areas to defeat the

enemy, and this includes the area of September 11 help. Many suspect that the attack on the World Trade Center itself will never actually be considered anything more than the result of a criminal

conspiracy, but our definitions of war are too far outdated.

The fact is, those attacks on September 11 were coordinated by

a foreign non-State enemy, and people, whether they liked it or

not, were automatically thrust into the role of being a soldier, a

sailor, an airman, or a marine that day. A Federal law to cover all

affected and treat them as victims of an attack by a foreign entity

is certainly called for.

We live in a strange world with many different and often conflicting interests, but putting September 11 under the umbrella of

the Federal Government is the best guarantee that no one is left

behind and creates a win situation for all parties concerned. Any

solutions to be taking place have to cover all military volunteers at

all sites related to September 11, including military mortuaries,

but this only addresses part of the problem.

All downtown residents and people from out of State must also

be covered by any Federal program, and I believe Mr. Nadler’s bill

is a great place to start. In future disasters, you will also have to

take new account that volunteers will not be sitting at home. They

will, in fact, run toward sites, and that is something that also has

to be addressed. Data bases need to be set up beforehand, and comprehensive programs need to be in place beforehand to respond to

these disasters.

Congress should enact reforms immediately to discourage the

military culture which penalizes those who admit they need any

sort of physical or psychological assistance relating to the war on

terror, including September 11th.

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And I don’t want to take up too much time, because we have a

great deal many questions, but I just want to say this is the greatest country in the world. We are at war despite the issues that we

are being faced. I believe the best of humanity is in this room. I

believe that going together that we can succeed, and that we can

make sure that those who have died and, frankly, those who are

continuing to die, that they will not have died in vain. And I believe perhaps in that way that America can prevail, and we need

your help.

Thank you.

[The prepared statement of Mr. Provost follows:]

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Mr. SHAYS. I thank you all very, very much. The line of questioning would be from me ordinarily, and then from Mrs. Maloney, and

then I would go to Senator Clinton, and then to Mr. Fossella, and

then to Mr. Nadler and Mr. Weiner. I am going to speak at the

very end, ask questions at the very end, and give my time to Mr.

Fossella.

Mr. FOSSELLA. Thank you, Mr. Chairman. Thank you all for your

testimony. It was very moving, and, again, just a strong reminder

of why we are all here and why we can’t go away.

Now, for Ms. Bascetta, I think it is a consensus here that the

Federal Government needs to be fully behind this effort with

money now and resources for treatment, among others, continued

monitoring. But one thing that we often ignore is the fact that

many people who have lived in New York City and the surrounding

area have moved already to other parts of the country, and will

continue to move.

And I think many of us—and it has been confirmed by people

like Dr. Howard and others—that this is a 20, 30, 40-year commitment that needs to be made as we monitor and treat those who suffered.

So along those lines, in your study or professional opinion, does

GAO have any recommendations on how to better coordinate existing efforts to address what we believe is a health crisis as we go

forward? Do you have any suggestions how we can start down the

path of determining, in conjunction with the non-governmental organizations, as well as governmental organizations, how many affected, the cost of treatment, and what we can expect in the coming

years?

Ms. BASCETTA. We are, of course, very concerned and troubled

most by the fact that 5 years later there have obviously been many

lost opportunities, starting with the fact that there was no roster

of who helped. A very obvious lesson learned is that we need to

know that from day one in the future and not to be trying to reconstruct that after the fact. It is very expensive, and, frankly, we will

probably never know how many people participated in the cleanup

and rescue operations.

Another lesson that we need to learn is that we need one program for everybody. A multiplicity of programs isn’t the optimum

clinical treatment, because people are people. It doesn’t matter

whether you are with the city, the State, or the Federal Government, if you were exposed you ought to be treated the same from

a clinical standpoint.

In addition, for the long-term monitoring, you want to have the

most robust epidemiological evidence you can have, and that would

require there again to be one program, one set of uniform standards, that will be applied to people regardless of whether they were

volunteers or workers from an array of different agencies.

Mr. FOSSELLA. Is there a model that this country is—or other

parts of the country have—we can point to, given the scale and

size?

Ms. BASCETTA. I am not sure about that. I would have to give

that some additional thought. Certainly, we were hoping that even

though it was 5 years later that the appointment of Dr. Howard

as the Federal coordinator of all this could at least make up for

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some last time and—lost time and lost opportunities to perhaps,

you know, begin to lay out what the parameters of a model might

be to deal with future situations like this.

Mr. FOSSELLA. Any sense on how long that process would take,

that one particular program at least you have in your mind?

Ms. BASCETTA. Setting up the parameters, do you mean? Well,

you know, I think there is lots of good science, both clinical and

statistical, that could be brought to bear immediately to fashion a

program. You also asked me about cost. There is certainly, you

know, a wealth of expertise that could be brought to bear to combine the epidemiological evidence that we have now with various

statistical and economic programs that could cost out a range of

scenarios, the best case and the worst case, depending on, you

know, how the health of the responders evolved over time.

But I think Chairman Shays had said in his opening statement

that requires vigilance and patience, and certainly that is the case.

Mr. FOSSELLA. Is there any way that GAO can undertake that

responsibility?

Ms. BASCETTA. We would do whatever the Congress asked us to

do.

Mr. FOSSELLA. I yield back. Thank you, Mr. Chairman.

Mr. SHAYS. Thank you. At this time the Chair would recognize

Mrs. Maloney.

Mrs. MALONEY. I thank all of you for your very moving testimony. You certainly have pointed out what we need to do. And I

thank, again, the chairman for this hearing. I yield my time to the

junior Senator from New York.

Senator CLINTON. Well, I thank my friend and colleague, and I

want to thank all of our witnesses for their moving and eloquent

and helpful testimony. I think that there are several action items

that have to come out of this hearing. Obviously, one is that we

need to expedite not only the $75 million but begin to put together

a budget request for money in addition to the $75 million.

If there is a supplemental request before the end of this year

from the administration to fund matters such as the war in Iraq,

or continuing help for people along the Gulf Coast because of

Katrina, or to deal with the drought in Iraqi Mountain West, whatever the reason is we will work very hard to get additional money

in that for the treatment that is so desperately needed.

We will also begin to work to get a budget item in the President’s

budget. This is an ongoing Federal Government commitment, and

it needs to continue year to year without the kind of fits and starts

that unfortunately we have experienced over the last several years.

I think it is also first and foremost the responsibility of the Federal Government to take care of Federal employees. And, Mr.

Centore, I am so sorry. I just cannot express strongly enough my

sympathy for what you have been through as a Federal employee

and someone who has given a lifetime of commitment to our country.

And as we heard from Ms. Bascetta, the Federal Government has

failed on many levels, but it has miserably failed in taking care of

its own workers. And that has to be addressed with renewed commitment.

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Additionally, we have to set up systems to deal with this going

forward, and I appreciated Congressman Fossella’s line of questioning. I have introduced legislation, bipartisan legislation, in the Senate with Senator Voinovich from Ohio. Why? Because there was a

team of people from Ohio who came to help us in New York.

When they returned home, they got sick. And it was the same

kind of problem that we began seeing with our people, and so we,

along with several other of our colleagues in the Senate and with

my colleague, Congresswoman Maloney, in the House have introduced the Disaster Area Health and Environmental Monitoring

Act, which would give the President authority to carry out a program for the protection, assessment, monitoring, study of the

health of people exposed to harmful substances, and then simultaneously we need something along the lines of what—Congressman

Nadler or Congressman Maloney has a different approach. We need

some kind of system to guarantee the treatment.

Now, I can’t help but add—you might expect this from me—if we

had a health care system in America that took care of everybody

we would not be talking about creating special little programs to

take care of people. We wouldn’t have, you know, Mr. Zadroga,

being turned away for treatment as we heard his father describe

to us.

This is something that, you know, is long overdue in our country,

and eventually we are going to have to get around to doing it. We

are wasting billions of dollars, and we are destroying lives because

we won’t face up to the fact that we are not fulfilling our responsibility as the richest country in the world to provide quality, affordable health care to every single American, especially to those

people who are harmed because of an attack on our country.

So I think there is a lot of work ahead of us, and I just want

to, you know, end by underscoring the fact that we do need to understand what went wrong, because we cannot learn those lessons

if we are not courageous and honest enough to face them. And a

lot of things went wrong.

But that should not be an additional excuse for not taking care

of the people who need our help now. And I really believe that the

testimony we have heard from each of our witnesses on this first

panel does more than any of us up here can to underscore the continuing responsibility we all feel.

And I recall that we had a hearing like this in February 2002.

It was a hearing that I called that the Senate had, and we began

hearing these stories then. And it was very hard to get people’s attention. I will never forget the testimony of one of the representatives from the cit. When we said, ‘‘Well, who is responsible for the

air?’’ and the response was, ‘‘We do water; not air.’’

And there was just this I think feeling that, oh my gosh, we have

so many other things to worry about, we are just not going to be

able to focus on this yet. Well, finally we are focused. The need is

obvious, and we have a lot of work ahead of us. And I think I can

speak for all of the Members of the congressional delegation is that

we will remain working together in a bipartisan fashion until we

get answers to the money for the treatment, the systems that need

to be set up, and then policies to try to make sure this never happens again.

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And I thank our conveners for holding this hearing.

Mr. SHAYS. I thank the Senator from New York. Mrs. Clinton,

thank you very much. And at this time, I would recognize Mrs.

Maloney for your time.

Mrs. MALONEY. I thank the gentleman for yielding, and I thank

our two Senators for their commitment and dedication to this issue.

Just yesterday they joined Vito Fossella and myself at a meeting

with Secretary Leavitt, and their presence and commitment helped

us secure Secretary Leavitt’s and John Howard’s commitment to

release the $75 million by October 1st. It cannot help Mr. Zadroga’s

son, but it can help others, and I thank them for their leadership.

I yield my time to the senior Senator from New York.

Senator SCHUMER. Well, thank you, Carolyn. I want to thank you

for your really exquisite leadership on this issue, along with Vito

Fossella and my colleague, Senator Clinton, who has taken such a

lead on this issue in the U.S. Senate.

I also want to thank Chris Shays for holding this hearing in a

timely fashion here in New York yards from the scene of both the

terrible tragedy and the countless acts of heroism right during the

attack and in the days, weeks, and months afterwards.

And let me just say this. We came together as a society in a really amazing and refreshing way after September 11th. The partisan

differences, the geographic differences vanished. We were all New

Yorkers. We were all people who had been injured by what happened. And what we are doing—what we are talking about here is

a test. Has our society forgotten about what happened?

The victims we have heard from and heard about were injured

every bit as much as those who were hurt immediately as a result

of the planes crashing into the Twin Towers. It is only their symptoms that emerged later, and it took too long, just really until the

last week, until the views of so many that damage occurred, real

damage, although its effects would not be known 5 years, 10 years,

even 20 years later, were real.

And we have to summon the same energy, the same focus, and

the same unity in helping these folks as we did in helping those

who were injured immediately thereafter. That is our job. Make no

mistake about it, $75 million isn’t going to be close to enough. And

when we met with the Secretary yesterday, a number of us were

a little skeptical I guess I would say because he wouldn’t give an

unequivocal commitment that everyone would be taken care of. We

need that commitment.

We need that commitment now. It is, we all believe, a Federal

responsibility. Just as helping those who were injured, and the

families of those who perished in the Twin Towers, was agreed to

be a Federal responsibility. And there are going to be other—there

are going to be several different approaches that are taken. The

real answer is simply to get the treatment, the health care, the

help for the people who need it.

And I wanted to come by and apologize to everybody, because I

had so many other prior commitments, to tell this panel in particular, but everyone here, that I will join in the effort to do everything

that we can to see that what happened to those who helped early

on, but show symptoms of illnesses that came from that help years

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later are treated every bit as fairly as those who were hurt on that

terrible day, 9/11/01.

Thank you, Chris, and thank you, Carolyn, for yielding your

time.

Mr. SHAYS. Thank the gentleman very much. I appreciate his

being here to speak in unity with this effort.

At this time, the Chair would recognize Mr. Nadler. And as the

gentleman rightfully pointed out, I think we are in his district.

Mr. NADLER. We are indeed. Thank you very much, Mr. Chairman. First of all, I said in my opening statement that I felt that

the Federal, State, and city governments have betrayed the first responders and the people who came to help and the people who live

in downtown Manhattan. I think the testimony we have heard

strengthens that statement.

So as a member of the Federal Congress, not the administration

or anything but the Congress, let me apologize to those of you who

were—who live downtown or are—or were responders and have

gone through what you have gone through, for the betrayal by the

Federal Government. And we will try to reverse that, to the extent

we can now, and that is the purpose of this hearing.

Second of all, Mr. Centore, you testified about—that when requesting Federal assistance you talked about how you couldn’t get

real help. And when requesting Federal assistance such as workman’s compensation or disability retirement, you had various problems. Could you elaborate a bit on the problems and frustrations

that you have had or that you know that others have had in trying

to get help from the Federal worker’s comp system?

Mr. CENTORE. I can only speak from, you know, my own experience. I can back it up with hearsay from other parties. But the biggest concern in the last letter that I received from Department of

Labor concerning workman’s comp was, ‘‘How do we know you were

there?’’ And I am like, well, I have eight or nine pictures with me

on the pile, and they said, ‘‘Well, they could have been doctored

up.’’

I said, ‘‘You work for the Federal Government, don’t you?’’ because I know where this is going. I mean, this was—you know, it

was just mind-boggling that the man would question my integrity

like that.

Mr. NADLER. We have heard the same thing from other people,

but go ahead.

Mr. CENTORE. OK. No, that is all I am going to say. That was

the biggest——

Mr. NADLER. In other words, it is an adversarial system where

they seem to try to avoid certifying you as someone who ought to

get help?

Mr. CENTORE. Well, if I can be candid——

Mr. NADLER. Please.

Mr. CENTORE [continuing]. I feel like it is a contest between me

and them. It is a contest to see if they are going to give in first

or I am going to die first. And I have made a solemn promise to

myself that I am going to collect that one nickel, just one nickel,

before I go anywhere. It is like—it is insane. My doctors don’t believe that I still have to go to work, even in my condition.

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Mr. NADLER. So do you think, given your experience, that it

would be a good idea to make the major means of first responders

and others with—the people who live or work downtown who have

gotten sick as a result of September 11th, do you think it would

be a good idea to make the major means of access to Federal help,

to medical treatment, the worker’s comp system? Or should we try

something else?

Mr. CENTORE. Well, I do, but, you know, I think you have to start

at the very beginning. And if you read the paper that I submitted

to the committee, the very first thing I said that we have to do is

somebody has to stand up and say, ‘‘Yes, this is attributable to the

September 11th incident.’’ And that somebody has to be the Federal Government. I mean, that is the power that, you know, speaks

for the entire country.

If the Federal Government is willing to stand up and say that,

I think you will have more doctors and more people in the medical

community finally stepping forward. I have—right now I have as

many doctors as I have pills, which scares me. But they all treat

all of my illnesses in a traditional manner, with the exception of

a few who have been—had some experience dealing with other September 11th responders.

And I am like, I don’t know where you get this information from.

You know, that is the first step. Somebody has to admit that this

was caused by September 11th. And then, second, which it is going

to be a lot longer, is we have to educate local medical communities

on symptoms and diagnoses of having to deal with situations such

as the World Trade Center.

Mr. NADLER. Thank you. I have a couple questions which I wanted to ask Mr. Centore and Mr.—Sergeant Provost. And to the extent that Mr. Zadroga has information from his son, I would ask

you to answer this, too, but it may not apply in any case.

The first question is, when you served on the pile—I will ask Mr.

Centore first, and then Mr. Provost, and, Mr. Zadroga, if you want

to—were you issued a respirator?

Mr. CENTORE. I am glad you brought that question up. We started off with the paper mask. The problem with that was——

Mr. NADLER. That is useless. Were you issued——

Mr. CENTORE [continuing]. They got clogged up. You couldn’t

breathe, so you were either going to suffocate and your lungs were

going to be OK, or you took the doggone thing off so you could

breathe, but you run the risk of, you know, developing——

Mr. NADLER. Let me just say that we have had testimony on

other occasions that the paper mask was useless to protect anyone’s health anyway.

Mr. CENTORE. Right.

Mr. NADLER. But, so were you issued a respirator?

Mr. CENTORE. Eventually. Near the end, a friend of mine, actually he is my counterpart in the EPA, I ran into him. He was doing

monitoring for the EPA down on the pile, and he begged me and

pleaded with me, he said, ‘‘Hey, if you go back down to the pile,

make sure you wear at least the half-face, if not a full-face, respirator.’’

Mr. NADLER. Because of health hazards.

Mr. CENTORE. Oh, yes.

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Mr. NADLER. OK. And were you told that it was the law under

the Occupational Safety Health Act that you must wear a respirator?

Mr. CENTORE. No, sir. What we were told was we went over the

schoolhouse, and they would put up a sign that—when respirators

were required. So 1 day they would have the sign up, next day they

would take the sign down.

Mr. NADLER. OK.

Mr. CENTORE. Next day they would have the sign up.

Mr. NADLER. And did you see—and did you see EPA or OSHA

officials enforcing the Federal occupational safety laws?

Mr. CENTORE. No, sir.

Mr. NADLER. Walking around the site to see whether people were

wearing respirators?

Mr. CENTORE. Not until they were able to get a handle on the

situation.

Mr. NADLER. OK. And my final question, and then I will ask Sergeant Provost the same questions, did anyone tell you that you

were not allowed on the site without proper protection gear?

Mr. CENTORE. No, sir.

Mr. NADLER. Thank you. The reason I am asking these questions

is that Christie Todd Whitman has said that they told workers to

wear their gear, and that at the Pentagon, the cleanup at the Pentagon, the law was enforced and no one was allowed on the site

without wearing respirators.

I will ask if Sergeant Provost can give shorter yes or no answers

to the same questions. I will repeat the questions. Were you issued

a respirator?

Mr. PROVOST. No, sir.

Mr. NADLER. Were you told of the health hazards of working on

the site?

Mr. PROVOST. No, sir.

Mr. NADLER. Were you told of OSHA requirements to wear respirators or any other protective gear?

Mr. PROVOST. No, sir.

Mr. NADLER. Did you see EPA or OSHA officials enforcing Federal occupational safety laws?

Mr. PROVOST. Never, sir.

Mr. NADLER. And did anyone tell you that you were not allowed

on the site without wearing proper protective gear?

Mr. PROVOST. Never, sir.

Mr. NADLER. Thank you. Mr. Zadroga, do you have any information on this that you could give or——

Mr. ZADROGA. Yes. All my son was ever issued was a paper

mask, and he was never told that he had to wear a respirator. Matter of fact, at one point he asked to have a respirator from a lieutenant that was walking by carrying 10 of them, and the lieutenant

refused to give it to him and said, ‘‘It is for the higher command

only.’’

Mr. NADLER. Thank you. Let me just add one thing, and that will

finish my questioning. Actually, I have finished the questioning. I

wanted to make one comment with this panel, because Congressman Fossella I think it was, maybe it was someone else, I don’t—

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pirators could have been requisitioned from the Army, that they

could have been gotten somewhere.

At the ombudsman’s hearings, the EPA ombudsman at my request held hearings downtown in February and again in March

2002 on very much the same topics we are holding hearings on 41⁄2

years later. Because of his conclusions, EPA ombudsman’s office

was later dismantled by Christie Todd Whitman, but at those hearings we had testimony from police officers—and this is February

2002—we had testimony from police officers that they requested

respirators, that they were not available, that they were not made

available, that thousands of them were in National Guard armories

all over the metropolitan areas, including New York City, and

never requested, never requisitioned, and never used, because no

one thought to do it apparently.

But those who requested respirators, at least from those police

officers who testified, it was never made available to them.

I thank you very much. And, again, on behalf—I can’t say on behalf of the Federal Government, but on my own behalf I certainly

apologize for the terrible treatment that your country has extended

to you.

Mr. SHAYS. I thank the gentleman very much for his questions,

and at this time the Chair would recognize Mr. Weiner.

Mr. WEINER. Thank you, Mr. Chairman, and I thank the panel.

And I want to echo what Congressman Nadler said. We have said

you are heroes, we have said we are grateful, it is time for the

United States to say we are sorry and we are going to make it up

to you.

I would like to ask you all a question about the comments that

the Secretary of the Department of Environmental Protection made

in the period after September 11th. I remember the comments and

questions, among many others, were: is it safe to be living in New

York during that time, given what was in the air?

My office was in Sheep’s Head Bay, Brooklyn, and there were

embers that were falling that far away from Ground Zero. When

on September 13 the Secretary—when Christie Whitman said, ‘‘The

EPA is greatly relieved to have learned that there appears to be

no significant levels of asbestos dust in the air in New York City.’’

Mr. Centore, did you read that?

Mr. CENTORE. No, sir, but I can—I can tell you that is not true,

because I was—we were stationed at the corner of Chambers and

West Side, and I could feel all the silica fibers clinging to my skin.

Mr. WEINER. Mr. Centore, those of us in public life who didn’t

spend weeks down there but spent hours just seeing the site, when

we went home we had dust on our shoes, things coming out of our

nose from 15 or 20 minutes of exposure.

Mr. Zadroga, when on September 14 Christie Whitman said,

‘‘The good news continues to be that air samples have taken—have

been taken, have all been at levels that caused no concern.’’ You

were there, your son was there, can you tell us, had you heard

those comments from the Secretary? Did you take some relief in

them?

Mr. ZADROGA. Mr. Shays. Well, sir, I wasn’t there. My son was

there. But I did hear those statements, and I couldn’t believe they

were saying that. It was just totally unacceptable as far as I was

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concerned. I knew there was asbestos in that building, because one

of my friends that I grew up with, he told me they had asbestos

in that building on like the first—he told me first 40 or 50 floors.

Mr. WEINER. Ms. Geronimo, you who live in the area, this must

have been of monumental concern, seeing what was going on in the

neighborhood you lived and worked. When you heard on September

16 Christie Whitman say, ‘‘There is no reason for concern,’’ did that

set your mind at ease? Did you at least feel that the Federal Government was checking and was giving it a clean bill of health?

Ms. GERONIMO. To be quite frank, no. I knew she was lying. We

were given paper masks in our office also. But you have to understand, the way that our office receives air, it gets the air from the

outside, filters it backs through the building, and gets it in. And

for over a year, especially during the summer, there were times

there was no air in the building at all, because they had to shut

all the air vents.

But I was still expected to walk through all of the military barricades, I was still expected to walk through all the debris that was

still flying in the air for weeks to come, and there is a smell that

none of us will ever forget that was made out of human remains,

the crushed concrete, the glass, the asbestos, and other toxins that

I am sure of were created from all of those fires that day.

Mr. WEINER. Mr. Provost, on September 18 when Christie Whitman said, ‘‘Given the scope of the tragedy from last week, I am

glad to reassure the people of New York and Washington, DC, that

their air is safe to breathe, that their water is safe to drink.’’ When

she said that, since then it has now become clear and now become

the fact that she herself and the EPA knew that was not true, but

did you believe her based on what you were seeing?

Mr. PROVOST. No, sir, I didn’t, because I had to leave the site the

day before because of all the rashes and the physical issues that

I was already having based on being there only a week. So I knew

it was a lie.

Mr. WEINER. Well, I just want to wrap up by asking the panel

yes/no, do you believe, Mr. Centore, that Christie Whitman was

honest with you?

Mr. CENTORE. Remembering that I am still under oath, and I

just—I know you want a yes/no answer, but it is not that clearcut.

What I started to allude to before was my counterpart with the

EPA was part of one group that was doing air monitoring on the

pile, and I said, ‘‘But you guys gave us a clean bill of health. You

said that the air was OK.’’ That was the second team that was sent

somewhere north of NoHo to take air samples. I said, ‘‘There is nobody up there.’’ And that is what—those were the samples they

were using to decide whether we had to have respirators on or not.

Mr. WEINER. Mr. Zadroga, do you believe that Christie Whitman

and the EPA has been honest with you and your family?

Mr. ZADROGA. No.

Mr. WEINER. Ms. Geronimo, do you believe Christie Whitman

and the EPA has been honest with you and your family?

Ms. GERONIMO. No.

Mr. WEINER. Mr. Provost, do you believe that Christie Whitman

and the EPA has been honest with you and your family?

Mr. PROVOST. No, sir.

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Mr. WEINER. Thank you, Mr. Chairman.

Mr. SHAYS. I thank the gentleman. At this time the Chair would

recognize Mrs. Maloney.

Mrs. MALONEY. Mr. Chairman, I feel I should yield to you, since

we would not even have these hearings if you had not responded

to my request. But since you have yielded, I would like to ask Mr.

Zadroga, has the city of New York to this day acknowledged that

your son died because of the exposures of the toxic dusts at September 11th?

Mr. ZADROGA. No, they have never acknowledged that. Matter of

fact, they never acknowledged his death. I never received even a

letter of condolence. The only thing I ever received from New York

City was from the Pension Board saying that ‘‘Your son passed

away. Would you please sign this paper so we can send you payment?’’

Mrs. MALONEY. OK. As you know, I have followed up on one of

your recommendations to open up the victims compensation fund

for the workers and responders.

Mr. ZADROGA. Yes, thank you for that.

Mrs. MALONEY. Prior to your son’s death, was there anything

that the city, State, or Federal Government did to make sure that

your son got the medical attention that he needed? And one of your

statements in your testimony, you said, ‘‘One doctor was getting

ready to treat my son and then he got a phone call and refused to

treat my son.’’ Could you elaborate?

Mr. ZADROGA. Well, that was actually on, you know, more than

one occasion. We took my son to many different hospitals and

many different doctors seeking help. The one doctor that refused,

he was from Columbia Presbyterian, and he just said, no, he will

not help us. He said because of—he actually never said a reason.

Dr. Murphy from DeBoer, he——

Mrs. MALONEY. OK. Did the city, State, or Federal Government

assist you in any of the medical treatment?

Mr. ZADROGA. No.

Mrs. MALONEY. Thank you. And, Mr. Zadroga, it appears that

Dr. Howard is responding to a request that Congressman Vito

Fossella and I made to him to make sure that the determinations

of who died from their injuries of Ground Zero, that they come forward with some type of fatality program so that we can make the

connection between the deaths and the Ground Zero toxins and exposure.

And they have come forward by saying that they will be working

with the New York City Health Department by setting up a fatality

investigations program together with the New York City Health

Department. Do you have an opinion on this?

Mr. ZADROGA. Well, first of all, I did sit with Dr. Howard when

he was first appointed with the DEA for 2 hours, giving him my

son’s medical records, autopsy records, and he agreed with us

that—or agreed with me that my son died from a pulmonary disease.

However, weeks later we went away for a weekend, and then we

came back and we just happened to come across a news article that

one of his first statements to the news was that my son died from

a heart condition. So to me his credibility was destroyed. I called

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his office and requested confirmation on why he would say something like that, and they—the secretary or whoever I spoke to said,

‘‘He didn’t say that.’’ I said, ‘‘Well, I have it right in front of me.’’

And she said, ‘‘Well, I will get back to you,’’ and never got back to

me. The Health Department never did anything to help my son.

I would also like to say that my son had a biopsy done at DeBoer

of his lungs, and they were sent to two Federal military bases, and

we never received a true biopsy report back from them. I only received a generic one upon threat of subpoena.

Mrs. MALONEY. So is it fair to say that you do not trust the city

of New York or the Federal Government to come forward with the

fatality determination on fatalities from Ground Zero? Is that a correct analysis of your statement?

Mr. ZADROGA. That is correct. And that is why I suggested that

a Grand Jury hearing be established with subpoena powers, so that

we could get the underlings that work for these people who know

what really happened to come forward and say what happened. I

am sure they were told do not treat them, get them out, because

every time we went to the hospital, as I said, he was just—they

told him they would take good care of him, and then it was like

somebody threw a switch, and then they just threw him out of the

hospital.

Mrs. MALONEY. Thank you. I would like to ask GAO, Ms. Cynthia Bascetta, in your testimony I would like to ask a specific question on payment and funding. And I want to know from your testimony, you talked about the recent payments to Mt. Sinai’s consortium program and the fire department program. And in your testimony you said these payments were made on August 11th.

And it seems to me that based on your testimony, that this

money was not expected, and did they have an explanation for this

funding? And before you answer, remember the question, because

we are under the 6-minute rule, and I want to get some questions

in to the other panelists very quickly.

I want to ask Ms. Geronimo, has there been any assistance to

you in any other area, workers from the city, State, or Federal Government, to deal with your health problems as a direct result of

September 11th? And how do you feel about the statutorily requirement that residents cannot be part of the World Trade Center consortium project? Remember the question, and I am going to Mr.

Provost of the National Guard.

Mr. PROVOST. Army Reserve.

Mrs. MALONEY. Excuse me.

Mr. PROVOST. I am sorry.

Mrs. MALONEY. Army Reserve. Excuse me, Army Reserve. And

have any of your fellow men and women in the Army Reserve, have

any of your people who responded to September 11th been eligible

for any type of long-term medical monitoring or treatment? And

has there been any coordination by the Federal Government to

make sure that you and the others from the Army Reserve or Navy

Reserve or other military areas receive treatment? And do you

think it is wrong that you had to go to Iraq and Afghanistan in

order to get medical treatment from the Federal Government and

to get a response to your concerns?

91

And finally, Mr. Centore, you are a Federal worker, and when

Mrs. Clinton and I were fighting to establish a medical monitoring

program we tried to include Federal workers, but the administration countered that they would take care of Federal workers, and

that they would establish their own separate program for Federal

workers. And has that program worked for Federal workers, or do

you believe Federal workers should be part of the World Trade

Center consortium program which is treating all of the other workers that have been part of the effort?

My time is up, but you have time to respond, and I would like

to go first to the General Accounting Office.

Ms. BASCETTA. Your question was, did they explain the August

awards? And let me give you the context. We were updating our

work. We wanted to be fair to the Department, so we asked them

whether they had——

Mrs. MALONEY. Was it expected, or was it a surprise?

Ms. BASCETTA. No, it was a surprise.

Mrs. MALONEY. It was a surprise.

Ms. BASCETTA. They termed them as emergency awards. They

said that they were able to make the awards very quickly, because

they had in contact with the recipients, and because they had draft

applications. But I have worked for the Federal Government for 28

years. We saw the applications. One was dated the 10th, and one

was dated the 11th, and the payments went out. The awards were

made on the 11th. I have never seen anything that rapid. It was

certainly very unusual, and——

Mrs. MALONEY. Never seen anything like it in 28 years.

Ms. BASCETTA. No. And, you know, I would make the point that

they obviously were able to change their process, which was to

have all of these awards undergo peer review, so I would imagine

that sets a precedent for them for the process that they plan for

getting the awards out this October.

Mrs. MALONEY. Thank you. Ms. Geronimo.

Ms. GERONIMO. I believe your question was whether or not I

thought that the government—Federal, State, or city—has given

any attention to the residents that live in Lower Manhattan, and

I say no.

Mrs. MALONEY. Do you think the residents, given the health

problems they are exposed to, should be part of the consortium that

many of us have worked to have you be part of that consortium?

Ms. GERONIMO. Of course. There wasn’t a bubble over the

Ground Zero site. It is not as if all the toxicities remained in the

area. You know, it went everywhere. It went as far as Brooklyn,

it went uptown. As trucks were being led to the Bronx or to Staten

Island with the debris, it was there.

When there were people being brought—bodies being brought to

the Javitz Center, it was there. It was all over the city, quite frankly, and it is true—there were many volunteers from the city and

the country that had come here, even if they helped for only a day

or a year and a half, and they were all affected by this toxic air.

Mrs. MALONEY. Remember the September 11th Health Act that

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ment for everyone who was sick. And so I want you to know about

that bill.

Ms. GERONIMO. Thank you. But I would also like to give special

thanks to Jerrold Nadler. With his legislation that he announced

yesterday he has acknowledged that grass roots organizing and the

people that live in Lower Manhattan have helped to work with him

to create the criteria as well as the availability for all people that

were affected here, not just the first responders, the New York City

fire department, and the policemen, not just the military volunteers that came down and gave their time, but also residents.

I think that is a very big problem, that people in Lower Manhattan are virtuously invisible when it comes to the people affected

after September 11th, because we have no recourse with the exception of the program at Bellevue.

Mrs. MALONEY. If we could have the answers from Mr. Centore

and from Mr. Provost.

Mr. SHAYS. And then I am going to take over. We are going to

finish this panel up in like 3 minutes.

Mr. PROVOST. My colleagues have been told, ‘‘You were never

down there,’’ but ironically enough our headquarters for a task

force of about 250 military volunteers was based in then candidate

Bloomberg’s campaign headquarters on 340 West Street, and he

even addressed us at our closing ceremony on September 13.

But, again, we are told by the city that we were never there. I

do suggest that the committee look into the records of the Office

of Emergency Management for the city of New York, because they

have an extensive data base of volunteers. They even issued volunteer tags for people that were down there. These were the famous

red and orange tags that started to be issued on Friday and Saturday.

And we personally also—I personally have the records of most of

the military volunteers I know that were down there. But no, we

get told that we were essentially never there. And do I think it is

wrong? Yes, I think it is a sin against human decency.

Mr. CENTORE. I think I paraphrased the first part of your question wrong. You asked me about the Federal program, what I—did

I think it was working?

Mrs. MALONEY. Well, two parts, whether you think the Federal

program is working, and, second, Senator Clinton and I tried to get

Federal employees covered in the World Trade Center consortium

monitoring program, which is headquartered at Mt. Sinai, believing

that it would be good to have everybody in one program, yet they

insisted on having a separate program. And is the Federal monitoring program working? And, second, do you think the Federal workers should be folded into the larger program that everyone else is

in——

Mr. CENTORE. Well, first——

Mrs. MALONEY [continuing]. With the exception of residents and

students?

Mr. CENTORE. First of all, is the Federal program working? If you

design a program to do nothing and it does nothing, it is working

I guess. [Laughter.]

Mr. SHAYS. In other words, it is working the way it is intended.

93

Mr. CENTORE. Yes, exactly. You know, I can’t argue with that. I

mean, I didn’t design it. You know, I just—I saw the results of it.

Do I think that the feds should be rolled into the consortium? Most

definitely, because that way now if you try to start a separate program with the feds, you have another whole set of doctors and another whole medical community you have to try to bring up to

speed on dealing with the issues and the ailments and the sicknesses and everything else that you already have established and

paid for with the first consortium.

So that would be my—and one other thing I wanted to say to Ms.

Geronimo. I keep a paper bag tacked to my wall in my room, and

on the very first couple of days that we were down at Ground Zero,

before all of the pizza trucks and everything else came rolling in,

the residents took it upon theirself to make bag lunches and bring

it down to the responders, and on there they would write little

messages of hope. And mine says, ‘‘May God bless you all,’’ and I

still have that to this day on my wall.

Mrs. MALONEY. Thank you for your very moving testimony.

Thank all of you.

Mr. SHAYS. With the time that I have, and I am not using all

the time, I know Mr. Nadler has one very quick question for one

witness. So, Mr. Nadler, quickly please.

Mr. NADLER. Thank you. The question is for Ms. Geronimo. Ms.

Geronimo, Christie Todd Whitman yesterday, it is reported in today’s papers, said that all her statements about the ‘‘air is safe to

breathe,’’ they were for the entire area except for Ground Zero

itself, that of course she understood that the people on Ground

Zero, on the pile, that they needed protection, but across the street

everything else was OK.

As someone who lives in the Lower East Side, and who works a

few blocks from Ground Zero, is this distinction that the air was

not safe on Ground Zero, but was OK a block away or two blocks

away or across the street, does this make any sense to you at all?

Ms. GERONIMO. Well, I will answer your question like this. I

work for a brokerage house on Wall Street, and the government

and the world economy was not very happy that the Stock Exchange had to close for 3 days. So in answer to your question, it

didn’t matter how bad the air was. I had to go back to work.

Mr. NADLER. But was there any distinction between the air on

Ground Zero or a block away?

Ms. GERONIMO. No.

Mr. NADLER. OK. Thank you.

Mr. SHAYS. Thank you.

Ms. GERONIMO. It was just as dirty at 13th Street where I live,

at Wall Street where I work, and right across the street from the

Ground Zero site.

Mr. NADLER. Thank you very much.

Mr. SHAYS. I thank the gentleman. Let me say I just want this

panel to know why you are first, because we wanted your story to

be heard first. That is why you are here.

Mr. Zadroga, I want you to know that your story is for me the

symbol of what we need to do, and I want you to be able to look

back in a few years with all the horrible memories you have of your

son’s mistreatment, I want you to think of the beautiful memories

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you have of your son. And also, my goal is to have you believe and

know for a fact that your testimony today made a world of difference.

And for you and the other panelists I just want you to know that

it is our determination that there be monitoring and that there be

the health provided to meet whatever need is needing to be met,

and that this has the funds necessary on the Federal, State, and

local level.

And I know that you must say ‘‘been there, heard that,’’ but I

know we made a difference, this committee made a difference, with

Gulf war illnesses. We had the help of a few other people like Ross

Perot who stepped in, but we know that if the story gets out, and

if the media is listening to people like you, that there will be a

world of difference.

So I just want to thank you for being here today. I want to thank

you for your testimony. I want you to hold this committee’s feet to

the fire. And I want to just allow you, this panel, an opportunity

to talk to any press that may want to talk with you before we start

the next panel. So we will have a 10-minute recess before we begin

the next panel, and so thank you all very, very much.

[Recess.]

Mr. SHAYS. We have a terrific panel here, and I would like them

to—Commissioner Scoppetta, you are the only one who is standing.

You might want to stay standing, because I am going to invite all

of you to stand, and I am going to swear you all in.

If there is anyone else that may provide testimony on your behalf, I would like them to be sworn in as well, even if we don’t call

on them. Do we have everyone? Raise your right hands.

[Witnesses sworn.]

Mr. SHAYS. We will note for the record that all our witnesses responded in the affirmative, and if anyone who was not called on

but stood up to be sworn in, if they give testimony we will make

sure the transcriber has their full name and title.

Maybe we could, Dr. Herbert, have you slide down just a speck.

Dr. HERBERT. Sure.

Mr. SHAYS. Are we adding—I think what we are going to do is—

I don’t like Dr. Howard being so stuck in a corner there. Can we

have you slide down, Dr. Scoppetta, just a bit? Is that all right, sir?

Thank you. Are we making it work here? OK.

OK. Dr. Howard, it is good to see someone smiling in this room.

Dr. HOWARD. Thank you.

Mr. SHAYS. All right. We are going to start just as I called your

names, and as you are lined up on the table. And, Dr. Howard, we

are going to have you start, and we will go from there.

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STATEMENTS OF JOHN HOWARD, M.D., M.P.H., J.D., DIRECTOR,

NATIONAL INSTITUTE FOR OCCUPATIONAL HEALTH, CENTERS FOR DISEASE CONTROL AND PREVENTION, DEPARTMENT OF HEALTH AND HUMAN SERVICES; DR. ROBIN HERBERT, CO-DIRECTOR OF THE WORLD TRADE CENTER WORKER AND VOLUNTEER MEDICAL SCREENING PROGRAM, MT.

SINAI HOSPITAL, ACCOMPANIED BY DR. STEVEN LEVIN;

THOMAS R. FRIEDEN, M.D., M.P.H., COMMISSIONER, NEW

YORK CITY DEPARTMENT OF HEALTH AND MENTAL HYGIENE; NICHOLAS SCOPPETTA, COMMISSIONER, FIRE DEPARTMENT OF NEW YORK, ACCOMPANIED BY DR. CARRIE

KELLY, HEAD, BUREAU OF HEALTH SERVICES, AND DR.

DAVID PREZANT, CHIEF, OFFICE OF MEDICAL AFFAIRS; AND

DR. JOAN REIBMAN, ASSOCIATE PROFESSOR OF MEDICINE,

NYU MEDICAL CENTER, DIRECTOR, BELLEVUE HOSPITAL

WORLD TRADE CENTER HEALTH IMPACTS CLINIC

STATEMENT OF JOHN HOWARD

Dr. HOWARD. Thank you, Mr. Chairman, and good morning, everyone. My name is John Howard, and I am the Director of the National Institute for Occupational Safety and Health in the Centers

for Disease Control and Prevention in the U.S. Department of

Health and Human Services.

I am very pleased to appear in front of you again today to report

on the progress that we have made and the progress that we still

need to make on the health needs of those who served in response

to the World Trade Center attack on September 11, 2001, and the

affected communities.

Since February I have been privileged and honored to serve as

the HHS World Trade Center programs coordinator. The Secretary

of Health and Human Services, Michael Leavitt, asked me to perform this activity and charged me with the important task of assuring that programs addressing the health of World Trade Center

responders and nearby residents are well coordinated. I have been

to New York a number of times, and I want to thank everyone in

New York for their generosity and their time in meeting with me

and working with me on my coordination activities.

Participating in these dialogs has enabled me to better understand the needs of those who have been affected medically by the

World Trade Center disaster, and also to hear suggestions and

comments about those steps that we still need to do. From the perspective that I have as a medical doctor, I am also pleased to work

with the Secretary’s new task force, which is a policy guidance

body in the Department of Health and Human Services, to bring

to them as their eyes and ears of the Secretary here in New York

City.

I am very pleased to be here again. I am pleased to answer any

question that you may have. Thank you very much, Mr. Chairman.

[The prepared statement of Dr. Howard follows:]

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Mr. SHAYS. Thank you, Dr. Howard. Dr. Herbert.

STATEMENT OF ROBIN HERBERT

Dr. HERBERT. Good morning.

Mr. SHAYS. Good morning.

Dr. HERBERT. Or good afternoon. I am Dr. Robin Herbert, Director of the Data and Coordination Center of the World Trade Center

Medical Monitoring Program. I would like to—thanks, can you hear

me better?

Mr. SHAYS. Yes.

Dr. HERBERT. Great. I would like to thank the Chair of the committee, Congressman Christopher Shays, along with

Congressmember Carolyn Maloney of the subcommittee, and the

distinguished Members of Congress who have been here today,

Senators Chuck Schumer and Hillary Rodham Clinton,

Congressmembers Jerrold Nadler, Vito Fossella, and Anthony

Weiner, for having me testify today.

It is particularly an honor to be here after yesterday’s meeting

with Secretary Leavitt of Health and Human Services in which the

commitment was made to allocate the remainder of $75 million in

Federal funding to support vitally needed treatment programs for

World Trade Center responders.

Given the limited time at this hearing, I have submitted written

testimony. I would like to also add to my written testimony a copy

of our recently published or online paper, ‘‘The World Trade Disaster and the Health of Workers: Five-Year Assessment of the

Unique Medical Screening Program.’’

The World Trade Center Medical Monitoring Program, federally

funded through NIOSH/CDC, consists of the data and coordination

center and five clinical centers in New York City, New Jersey, and

Long Island, and we are proud to be the sister program of the program based at the New York Fire Department.

Our program provides periodic comprehensive clinical examinations for World Trade Center responders in the New York/New Jersey metropolitan area and throughout the Nation. We have examined over 16,500 responders to date. Our patients are a highly diverse group that includes members of the building trades, law enforcement officers, utilities and telecommunications workers, transit workers, public sector workers, health care workers, and many

others.

We serve many immigrant workers. Fully 14 percent of our program’s examinations have been conducted in languages other than

English. The unifying factor among our patients is that all rushed

in to respond to the attack on our Nation. They were united by

their service, and now, sadly, many are linked by the illnesses they

have developed.

As many of you are aware, this past Tuesday we released sobering findings on the health impact of the disaster on 9,442 World

Trade Center responders who underwent medical examinations between July 2002 and April 2004. This study, coupled with the findings of other studies, should leave no doubt that many World Trade

Center responders are sick as a result of their work, and that

many—that they will need ongoing health monitoring and many

will need treatment for the rest of their lives.

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Of the patients we reported on, 69 percent developed new or

worsened respiratory symptoms while performing World Trade

Center recovery work, and 59 percent still had symptoms at the

time of their examination as long as 21⁄2 years after the attacks.

Fully one-third had abnormal breathing tests, and the rate of the

most common abnormality, low forced vital capacity, was five times

greater than the rate expected in non-smokers.

There was a very strong relationship between time of arrival at

the World Trade Center site and the prevalence of symptoms and

breathing test abnormalities strongly confirming the relationship

between the World Trade Center response work and respiratory

disease. Subsequent work will focus on the mental health consequences of the disaster in this group, and on characterization of

patterns of self-reported diseases such as interstitial lung diseases

and cancers.

Even before our recent study, because early on we saw many responders who were clinically quite ill but lacked access to needed

specialty medical testing and treatment, at Mt. Sinai we sought

and received philanthropic funding to establish the World Trade

Center health effects treatment program to make sure responders

could obtain the medical care they needed.

At the present time, in addition to the federally funded monitoring program, Mt. Sinai and the other clinical centers have World

Trade Center treatment programs that have been funded largely by

the Red Cross and other private donors. These treatment programs

have been virtual lifelines for our patients.

At our program at Mt. Sinai, we see very ill and vulnerable

workers. About half do not speak English. About 40 percent have

no health insurance, and another 40 percent are underinsured.

Among those whom we saw in the past year 84 percent are still

suffering from upper respiratory diseases such as chronic sinusitis,

47 percent have persistent lower respiratory problems such as

asthma, and 37 percent in our physical health treatment program

have persistent mental health consequences.

Now, as so many World Trade Center responders have become

ill, I hope they will all receive the medical and mental health care

that they need and deserve. We need a comprehensive, coordinated,

and permanent program that guarantees both lifelong medical

monitoring to identify World Trade Center related illnesses and

lifelong treatment for World Trade Center related illnesses, both

physical and mental health.

I hope our Nation will repay the World Trade Center responders

for the sacrifices they made by guaranteeing testing and treatment

for any illnesses they develop as a result of their sacrifices.

Thank you very much.

[The prepared statement of Dr. Herbert follows:]

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Mr. SHAYS. Thank you, Doctor. You are the director of the program, correct?

Dr. HERBERT. I am the director of the data and coordination center, and was co-director with Dr. Levin of the medical screening

program.

Mr. SHAYS. Dr. Levin, thank you for being here. You will be here

to respond to questions as well, and we thank you for that very

much. Commissioner Frieden.

STATEMENT OF THOMAS R. FRIEDEN

Dr. FRIEDEN. Good afternoon, Chairman Shays, Congresswoman

Maloney, and members of the Government Reform Committee. I

am Dr. Thomas Frieden, Commissioner of the New York City Department of Health and Mental Hygiene, and I am pleased to be

here today.

September 11th was an unprecedented urban environmental disaster. In the days and months that followed, millions of people

were affected emotionally, physically, and financially. Many people

have experienced respiratory symptoms and psychological distress

since that time. We share a commitment with others in this room

to do whatever we can to understand health problems better, so

that we can link people in need of care to effective services.

We are grateful to the New York City congressional delegation

and Mayor Bloomberg for securing funding to support medical and

mental health monitoring treatment programs, and we partner

with these programs, as well as other institutions, as well as labor

and community groups, in this world.

We also appreciate the funding provided for the World Trade

Center Health Registry. However, it is essential that Federal Government support continue and expand for health monitoring and

treatment, including extension of the registry and additional funding for health and mental health services.

The city supports legislation introduced by Congresswoman

Maloney, and co-sponsored by Congressman Fossella and many

members of the delegation, to reopen the Federal victims compensation fund established to support families of those who died in

the attack and those physically injured in the aftermath.

Earlier this week the mayor announced initiatives augmenting

screening and treatment programs including establishing a WTC

environmental health center at Bellevue Hospital, expansion of the

World Trade Center health unit at the Health Department, and

creation of a Mayoral Review Panel to ensure maximum coordination among city agencies and sufficiency of resources.

Bellevue, in collaboration with NYU Medical Center, will evaluate and treat anyone exposed to the WTC, including people not covered by existing programs. The initiatives also include an expanded

unit at the Health Department to increase monitoring for WTC related health conditions, increased communication with affected individuals, treating physicians and the public, and expand risk reduction linkage to care and mental health services.

In the past year, the Health Department has led an initiative, in

collaboration with medical experts from the WTC Medical Monitoring and Treatment Programs, the Fire Department, Bellevue, and

other specialists to reach consensus on and disseminate clinical

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guidelines which update previously released Health Department

guidelines on depression, post-traumatic stress disorder, and substance abuse disorders as well as guidelines on the diagnosis and

treatment of respiratory gastrointestinal and sinus diseases previously developed by Mt. Sinai and fire department physicians.

The World Trade Center health registry is the main platform to

enable us to better understand possible WTC related illnesses and

also a major means of assessing treatment needs, more than 71,000

people enrolled in the registry, making it the largest such effort

ever in the United States. Since its establishment, the registry has

maintained a frequently updated resource guide to help both enrollees and the public.

Baseline interviews were completed in November 2004, and we

immediately released preliminary findings. Nearly half of adult enrollees reported new or worsened sinus or nasal problems, shortness of breath, wheezing. Persistent cough and throat irritation

were also common, and 2 to 3 years after the event registrants reported high levels of psychological distress.

We also published an in-depth analysis of physical and mental

health conditions among more than 8,000 registrants from collapsed or damaged buildings. Those caught in the dust cloud were

twice as likely to report newly diagnosed asthma. This adds to the

growing body of literature suggesting that exposure to the dust

cloud on September 11th in particular was a major risk factor for

respiratory disease.

The first biennial followup survey begins this month, and will

provide critical information on prevalence and persistence of symptoms, and at least or more importantly will identify and help address gaps in medical treatment. Collecting information on 71,000

participants will take at least 9 months. We will release initial

findings as soon as possible upon completion of the survey, just as

we did with our baseline survey, and we will conduct additional investigations including an examination investigation for respiratory

illness.

Response to WTC involves many levels of government as well as

private institutions. It will also require a long-term commitment of

Federal and State resources. Much more needs to be done, and if

we work together we can make sure that all of those who experience illness from the attacks on September 11th have access to appropriate medical evaluation and treatment.

Thank you for your support in these efforts.

[The prepared statement of Dr. Frieden follows:]

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Mr. SHAYS. Thank you very much. Commissioner Scoppetta.

STATEMENT OF NICHOLAS SCOPPETTA

Mr. SCOPPETTA. Good afternoon, and thank you for the opportunity to testify today about the health of our September 11th first

responders.

With me today are the Department’s two chief medical officers,

Dr. Carrie Kelly, who is head of our Bureau of Health Services, and

Dr. David Prezant, the Chief of our Office of Medical Affairs. Both

have been sworn and are available to answer questions.

As we approach the fifth anniversary of the World Trade Center

attacks, we continue to remember the tremendous losses of that

day. In a matter of moments, with the collapse of the two towers,

343 of our members perished, along with 60 first responders from

the NYPD and the Port Authority, and more than 2,300 civilians

as well.

New York City’s first responders saved others while risking their

own lives, and we continue to commemorate their bravery and

their dedication while mourning their loss.

In the weeks and months following September 11th, our members worked tirelessly at the site amid the debris and dust resulting from the towers’ collapse. Their rescue and recovery efforts continued through May 2002. During that time FDNY workers experienced more exposure at the World Trade Center site than any

other group of workers.

The physical and emotional toll on our members has been thoroughly documented. Dr. Kelly and her Bureau of Health Services

have been dedicated to ensuring that our members are regularly

evaluated with special attention to members who continue to experience the adverse effects of September 11th.

In the days following September 11th, virtually all of the FDNY

first responders worked at the World Trade Center site. More than

11,000 firefighters and fire officers, and more than 3,000 EMTs and

paramedics, took part in the rescue, recovery, and fire suppression

efforts. Our work force was exposed to the physical hazards at the

site, and the emotional impact associated with the recovery of deceased colleagues.

For those working at the site, respiratory issues surfaced quickly.

In recognition of these symptoms, FDNY initiated the World Trade

Center medical screening and treatment program in October 2001,

just 4 weeks after the attacks. Our VHS partnered with the Centers for Disease Control and Prevention, and the National Institute

of Occupational Health and Safety, to implement medical screening

for the exposed FDNY first responders.

From October 2001 through February 2002, VHS evaluated more

than 10,000 of our FDNY first responders. Since that time we have

continued to screen both our active and retired members for a total

of almost 14,000 FDNY personnel to date. This WTC medical monitoring program has been federally funded and has been a joint

labor management initiative.

The program is dedicated to monitoring the health of our members while the Mt. Sinai consortium addresses primarily the health

issues of non-FDNY responders. Our monitoring programs work

collaboratively, partnering with NIOSH. At this time, more than

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8,000 of our FDNY members have participated in a second round

of medical and mental health monitoring.

In the first few weeks following September 11th, the health consequences of World Trade Center exposure became apparent as

more and more members sought medical treatment primarily for

respiratory symptoms. More than 2,000 of our members have

sought treatment since September 11th. Most have been able to return to work, but more than 600 have developed permanent disabling respiratory illnesses that have led to earlier-than-anticipated retirement among members of an otherwise generally

healthy work force.

In the first 4 years post-September 11th, we experienced a fourto fivefold increase in the number of members retiring with lung

problems on an annual basis. Since VHS performs both pre-employment and annual medical examinations of all of our members, the

World Trade Center medical monitoring program has used the results of these exams to compare pre- and post-September 11th

medical data. This objective information enables us to observe patterns and changes among members.

A significantly higher number of firefighters were found to be

suffering from pulmonary disorders during the year after September 11th than those who suffered from those disorders during the

5-year period prior to September 11th. Further, the drop in lung

function is directly correlated to the initial arrival time at the

World Trade Center site.

On average, for symptomatic and asymptomatic FDNY responders, we found a 375 milliliter decline in pulmonary function for all

of the 13,700 FDNY World Trade Center first responders, but an

additional 75 milliliter decline if the member was present when the

towers collapsed. This pulmonary function decline was 12 times

greater than the average annual decline noted 5 years pre-September 11th.

Over the past 4 years, pulmonary functions of many of our members have either leveled off, improved, or, unfortunately for some,

declined. More than 25 percent of those we tested with the highest

exposure to World Trade Center irritants showed persistent airway

hyperactivity consistent with asthma or reactive airway dysfunction, or RADS.

In addition, more than 25 percent of our full duty members participating in their followup medical monitoring evaluation continue

to report respiratory symptoms. As I noted, many of our members

who were symptomatic have improved with the treatment provided

by Drs. Kelly and Prezant, and the physicians who work with them

and have gone back to work full-time.

Certain reports in the press, however, do not accurately portray

what our doctors have found through their efforts and may create

needless fears. For example, continued reports of possible heavy

metal poisoning from World Trade Center exposures is not supported by the science. Everyone should know that Drs. Kelly and

Prezant and many others at the fire department who worked continually after September 11th to analyze and protect the health of

our members, they did not stop at performing comprehensive respiratory testing, but also performed heavy metal screenings for

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over 13,000 members, and the results consistently found nothing

clinically significant.

The fire department’s preliminary analysis has shown no clear

increase in cancer since September 11th. Pre- and post-September

11th, the fire department continues, however, to see occasional unusual cancers that require continued careful monitoring, and, of

course, we are obviously aware of the fact that cancers may take

a long time before they surface.

Monitoring for future illnesses that may develop and treatment

for existing conditions is imperative, and, as I will discuss in a

minute, should be funded through Federal assistance. As our doctors and mental health professionals can attest, the need for mental health treatment was also apparent in the initial days after

September 11th, that virtually our entire work force faced the loss

of colleagues, friends, and family.

In the close-knit family of the FDNY, more than 60 firehouses

lost members. Nevertheless, those who survived continue to work

in the rescue and prolonged recovery operation at the World Trade

Center site. In recognition of the mental health needs of our members, the FDNY Counseling Services Unit, or CSU, expanded from

one site to six, and added professional staff to provide more services.

Thanks to funding from FEMA and Project Liberty, as well as

the American Red Cross, the International Association of Firefighters, and the National Fallen Firefighters Foundation, we secured critical resources to provide those additional services to our

members and our families.

Our goal was to reduce and eliminate any barrier to treatment,

so that members could easily be evaluated and treated in the communities where they live. Additionally, we sent specially trained

peer counselors to the most affected firehouses, accompanied by

professional counselors, to provide onsite education. We also developed enhanced educational programs for our members to address

coping strategies and help identify early symptoms of stress, depression, and substance abuse.

Nearly 14,000 people have sought mental health services through

CSU since September 11th. We developed also programs for bereaved spouses, parents, and siblings. Now, 5 years later, some of

these groups still need—provide a needed link for these families.

Prior to September 11th, CSU treated approximately 50 new cases

a month. Since September 11th, we have seen that number increase to 160 new cases at its six sites each month. That is more

than 3,500 clients annually. the continued stream of clients at the

CSU indicates that the need for mental health services remains

strong.

Mr. SHAYS. Excuse me. Mr. Scoppetta, you have gone 10 minutes

now, so you need to really wrap it up.

Mr. SCOPPETTA. OK.

Mr. SHAYS. Your full testimony is part of the record.

Mr. SCOPPETTA. I understand.

Mr. SHAYS. You are providing us essential information, and we

do thank you for it.

Mr. SCOPPETTA. Well, let me just say in summary fashion, we are

going to need continued funding for many years to come, because

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many of these conditions are not going to surface for many years,

and we really are talking about something that needs funding for

several decades, not for several years.

So going forward, we continue to monitor. We have a huge registry of people that we monitor. We have objective data, because we

examined pre-September 11th.

And just to conclude, our firefighters continue to answer the call

for help every day, despite the risks they face. And careful screening, monitoring, and treatment is what will be essential. Early

treatment of symptoms can reduce the likelihood of disability and

restore function in many members.

Thank you. My apologies for running over.

[The prepared statement of Mr. Scoppetta follows:]

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Mr. SHAYS. You do not need to apologize at all. Your testimony

is very vital, and I will have specific questions to ask you when my

turn comes.

It is Dr. Reibman, is that correct?

Dr. REIBMAN. Yes.

Mr. SHAYS. Dr. Reibman, thank you very much for being here.

STATEMENT OF JOAN REIBMAN

Dr. REIBMAN. Good afternoon, Congressman Shays, Congresswoman Maloney, Mr. Weiner, and Mr. Nadler. My name is Joan

Reibman, and I am an Associate Professor of Medicine and Environmental Medicine at New York University School of Medicine,

and an attending physician at Bellevue Hospital, a public hospital

on 27th Street in New York City.

I am a specialist in pulmonary medicine, and for the past 15

years I was the Director of the Bellevue Hospital Asthma Program.

Most of my patients come from Lower Manhattan. As such, I know

Lower Manhattan well, and know that although it is thought of as

an area replete with office towers, it is also a major residential

community. Almost 60,000 residents of diverse race, ethnic, and

economic backgrounds live south of Canal Street alone.

The destruction of the World Trade Center towers resulted in the

dissemination of dust throughout Lower Manhattan, and these

dusts settled on streets, playgrounds, cars, and buildings, and entered apartments through windows, building cracks, and ventilation systems. The fires continued to burn through December.

Thus, individuals living in the communities of Lower Manhattan

have potential for prolonged exposure to the initial dusts, to resuspended dusts, and to the fumes from the fires. As pulmonologists

in a public hospital, we naturally asked whether the collapse of the

buildings posed a health hazard for these residents.

We, therefore, collaborated with the New York State Department

of Health in a study funded by the Centers for Disease Control to

examine whether there was an increase in the rate of new respiratory symptoms in community residents near Ground Zero. The

study was designed, implemented, and completed in 16 months

after September 11th, and the results have been reported in two

publications.

Community members were actively involved in the design and

implementation of this work, and we surveyed residents in buildings within 1 mile of Ground Zero, and for purposes of control other

low-risk buildings approximately 5 miles from Ground Zero. We

mailed and hand distributed questionnaires to apartments in selected buildings and publicized the study at local events, health

fairs, tenants meetings, community board meetings, and town hall

meetings.

Surveys were analyzed for 2,800 residents in the areas. Approximately 60 percent of individuals in the exposed area, compared to

20 percent in the control area, reported new onset respiratory

symptoms such as cough, wheezing, or shortness of breath at any

time following September 11th. The more important question, however, was whether these symptoms resolved over time or persisted.

We, therefore, examined whether symptoms were present in the

months preceding completion of the study, 8 to 16 months after

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September 11th, and defined persistence of the frequency of symptoms at least twice each week. Such new onset and persistent

symptoms as eye irritation, nasal irritation, sinus congestion, nosebleed, or headaches, were present in 43 percent of the exposed residents, more than three times the number of exposed compared to

control residents.

New onset persistent lower respiratory symptoms of any kind

were present in 26 versus 7 percent of exposed and control residents, respectively, a more than threefold increase in symptoms.

This included an increase in cough, shortness of breath, and 10

percent versus 1.6 percent of residents had wheeze.

In individuals with new onset persistent respiratory symptoms,

many of them had daily symptoms consistent with severe disease.

The respiratory symptoms resulted in an almost twofold increase

in unplanned medical visits in the exposed population compared to

the control population. Moreover, more than twice as many exposed

residents used medications prescribed for asthma.

This study was one of the few studies, and particularly one of the

few with a control population, to describe the incidence of respiratory symptoms among residents of Lower Manhattan after September 11th. It suggested that many residents had symptoms in

the immediate aftermath, and many have persistence of symptoms

in the year after the event.

Do these symptoms persist today, 5 years after the attack, and

some 31⁄2 years after our study? When it comes to the residents, we

have little information. The registry, which was implemented after

our study was completed and closed in 2004, found a similar pattern of symptoms to ours, but did not address the issue of persistence. We look forward to the resurvey planned by the registry

which should help shed light on this question.

While we await more survey information, we are cognizant of

what we are seeing in our clinics. After September 11th, we began

to treat residents who felt they had World Trade Center issues in

our Bellevue Hospital asthma clinic. We were then approached by

the Beyond Ground Zero Network, a coalition of community organizations, and together began an unfunded program to treat residents.

We were awarded an American Red Cross liberty disaster relief

grant to set up a medical treatment program for World Trade Center health issues for residents and responders, which began functioning approximately a year ago. Today we have evaluated and

are treating 570 individuals, including residents and responders.

Most of our patients have persistent upper or lower respiratory

symptoms for which they are seeking care 5 years after September

11th. Interestingly, many of these symptoms did not occur immediately, but either developed or were recognized 1 year or more

after the event. We have a backlog of hundreds of patients waiting

to get into the program suggesting that the need has not abated.

This week Mayor Bloomberg announced new initiatives to provide for evaluation and treatment of individuals with suspected

World Trade Center related illnesses. This much needed support

will serve to provide evaluation and treatment for residents, office

workers, and individuals caught in the dust cloud.

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I would like to thank Mayor Bloomberg and Members of Congress for their continuing efforts to provide funding for monitoring

and treatment, and members present for having this important

hearing. It is paramount that the Federal Government fully fund

ongoing monitoring and treatment for all those who were exposed

to the effects of the September 11th attack in New York City. And,

furthermore, we will need funding for research to understand the

new diseases and to guide our treatment.

Thank you very much.

[The prepared statement of Dr. Reibman follows:]

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Mr. SHAYS. Thank you very much, Dr. Reibman. We will start

out with Mrs. Maloney, and then I will go to Mr. Nadler, Mr.

Weiner, and then I will be asking questions. We are going to do a

10-minute series of questions, so we can do it in a little more

depth.

I basically view the first panel as kind of stating the case and

the problem, and we need to get into some very important issues

as to how we help folks. And I know that my focus is going to be

not at this hearing, maybe there are other hearings and investigations, who did what when. I want to know, what are we going to

do to monitor folks, what are we going to do to provide them health

care, what are we going to do not just in the short run but the long

run, and I hope with the answer to all of our questions that you

are going to tell us what you think that commitment is in both the

short and long run.

So at this time, I would acknowledge that Mrs. Maloney has 10

minutes to ask questions.

Mrs. MALONEY. I thank the chairman for yielding. I thank all of

the panelists for their testimony and hard work. I particularly

would like to thank Dr. Howard for working so hard on a Federal

response, attending so many meetings, and particularly the meeting that we had yesterday with Secretary Leavitt. And I wanted to

go over some of the issues that we discussed yesterday.

Yesterday, Dr. Howard, you and Secretary Leavitt committed to

releasing the $75 million that the delegation and Congress secured

in the budget, and in December releasing this money for monitoring and the first money for treatment in October. Is that correct?

Dr. HOWARD. That is correct.

Mrs. MALONEY. Thank you. You also committed to making this

entire funding with no limitation to spreading it over periods of

time. Is that correct?

Dr. HOWARD. That is correct.

Mrs. MALONEY. Just to be clear, we are going on what you said

yesterday with Secretary Leavitt, and what you are testifying to

today, instead of what was reported to the General Accounting Office, that the funding would not be released until February 2007,

and that it would be spread over 3 years. Correct? You are not

going with that GAO——

Dr. HOWARD. Correct.

Mrs. MALONEY. Thank you. Thank you very much. I would like

to now go to Dr. Frieden, and I want to ask some questions about

the clinical guidelines that thankfully came out last week. When

did the city of New York know that the air around Ground Zero

was not safe and that the Ground Zero dust was toxic?

Dr. FRIEDEN. I can only refer to my personal experience of the

information on this. Actually, a few days after being sworn in as

Health Commissioner, Senator Clinton’s hearing occurred, at which

I testified, and said at that time that we knew—and this was in

February 2002—we knew that there were many people with shortterm health effects. We knew that from other disasters the likelihood of long-term mental health effects was certainly present, and

we did not know what the long-term respiratory or other physical

health impacts would be.

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Mrs. MALONEY. And this was your knowledge after being sworn

in in 2002. Is there any way you can find out what happened earlier with your predecessor, and when did the city of New York and

the Health Department suspect that people were getting sick from

their exposure to the toxins at Ground Zero?

Dr. FRIEDEN. I can certainly look at the literature and get you

any information in the future.

Mrs. MALONEY. Could you find out whether or not the city of

New York’s Health Department was part of a discussion on October

2001 to determine if area doctors were seeing a pattern of illnesses

possibly related to September 11th? I know that NIOSH was there,

the World Trade Center consortium was there, the fire department

was there, and I am told that the city of New York was there. Do

you have any knowledge of this meeting in 2001 discussing the pattern of illnesses?

Dr. FRIEDEN. I am not familiar with the answer, but I can certainly get it and get back to you.

Mrs. MALONEY. Thank you.

Dr. FRIEDEN. We do know that immediately after September

11th, with support of CDC, we implemented a system throughout

area hospitals to monitor for different patterns of complaints. At

that point, as you will recall, there were still concerns about the

potential of a related bioterrorist attack, and that was the primary

purpose of that system of monitoring.

Mrs. MALONEY. Was the city Health Department part of a December 2001 meeting—I am told that they were—where a draft of

World Trade Center clinical guidelines were discussed? And why

did the city’s Health Department choose not to disseminate these

guidelines discussed at the December 2001 meeting?

Dr. FRIEDEN. I have seen reference to that, and the recollection

of people from within the Department who were present at that

meeting was that the majority of people at that meeting felt that

it would be quickest and most efficient to have them post it on the

Mt. Sinai Web site. That was done, and the Health Department

has referred clinicians to that Web site.

Mrs. MALONEY. Most doctors listen to an official directive from

the New York City government or the Federal Government as an

official directive. I wish you would look back to see why Mt. Sinai’s

Web site has more weight and credibility than the city of New

York. I find that astonishing, quite frankly.

And did you mail to doctors the clinical guidelines you did prepare for September 11th mental health issues?

Dr. FRIEDEN. Yes. As soon as we could produce guidelines for

three different conditions that we suspected or had evidence were

related, specifically post-traumatic stress disorder, depression, and

substance abuse disorders, we disseminated those guidelines widely

to all licensed physicians as well as other providers in New York

City as we are doing now with an update of those guidelines.

Mrs. MALONEY. When did you disseminate it? I was told you did

not disseminate it until last week.

Dr. FRIEDEN. No, that is not correct. In terms of the mental

health effects, as soon as we had evidence, we produced a publication called ‘‘City Health Information,’’ which is mailed to all licensed physicians as well as other providers in New York City.

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Mrs. MALONEY. What year did that go out?

Dr. FRIEDEN. There were three different bulletins produced, one

on post-traumatic stress disorder, one on depression, and one on

substance abuse disorders, and I would have to look up and give

you the exact month and year when those were published.

Mrs. MALONEY. Thank you very much. Dr. Howard, you testified

before this committee and in our meetings in February that this is

a long-term problem, 20 to 30-year problem, is that correct?

Dr. HOWARD. Yes.

Mrs. MALONEY. In the 6-plus months that you have been on the

job, has there been any actuarial study of just how much this will

cost?

Dr. HOWARD. No.

Mrs. MALONEY. Has the Health and Human Services Department

employed medical economists?

Dr. HOWARD. No.

Mrs. MALONEY. In the letter that you sent Congressman Fossella

and myself yesterday, which I might note is on my Web site if anyone would like to read along and see his response to our questions,

you have—you talk about 5 years after September 11th, and you

say that there is no estimate of the cost or the extent because of

the uncertainties involved. Is that correct?

Dr. HOWARD. Yes. If I could just expand briefly, I think what we

are looking for now is the experience that we are going to get when

our treatment money is released, which is the October date that I

promised. We have some treatment experience from the World

Trade Center clinical consortium, and from the fire department

based on the limited Red Cross experience.

We would like to see some additional experience, so that we can

do some sound actuarial analysis, to be able to answer some of the

questions that you asked in terms of, what are the 2-year costs?

What are the 5-year costs? What are the 20-year costs?

Mrs. MALONEY. Thank you. Yesterday at our meeting with Secretary Leavitt, you and the Secretary made a commitment to work

toward a coordinated plan to get health monitoring and treatment

for everyone exposed, residents and rescue workers, is that correct?

Dr. HOWARD. Yes, that is correct.

Mrs. MALONEY. And I just would like to say I would like to see

more Federal leadership. The city is doing many good things, the

State is doing many good things, the private sector is doing many

good things, but we really have to pull all this together under one

umbrella, and we are counting on your leadership.

Dr. HOWARD. Thank you very much. I just want to add in response to that, the Secretary, as you know, yesterday in the meeting with the New York delegation pointed out that he is convening

a top-level HHS task force headed by our Assistant Secretary for

Health, Dr. John Agwunobi, and the directors of the operating divisions of HHS.

He is doing that, recognizing that this issue that we are struggling with today needs the entire department’s policy guidance. As

you know, I have represented myself as a physician here, as the

eyes and ears of HHS on the ground. It has been my privilege to

do that. My agency funds a lot of the medical activities that are

going on here in New York City, and I am pleased to see that the

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Secretary is now putting policy guidance as an important link in

that process.

Mrs. MALONEY. OK. Thank you so very much. That is important,

and we look forward to your continued participation in this socalled A team. But as we heard from our first panel, people are

sick, people are dying, and they don’t need a task force, they need

treatment money, and they need to get help. They also are examples of how widespread through many different areas, from the

military to the residents, to the responders, to the Federal Government employees, that the $52 million that we got for treatment is

just a drop in the bucket, so we need your leadership on making

the estimates of what the cost will be, so that we can work on getting a line in this upcoming Federal budget.

But I don’t see how you are going to be able to do it if you

haven’t hired any medical economists or made any estimates on

how—the extent of the problem.

Dr. HOWARD. Well, one of the issues that I will tell you about is

within the Department one of the individuals on the Secretary’s

task force will be the Administrator of the Centers for Medicaid

and Medicare. I can assure you that those centers have numerous

actuaries and economists who work there, so we are going to rely

on their important contribution, and that for me extremely important.

As you may know, in NIOSH we are a research agency for occupational safety and health, so we do not have that expertise. So I

am delighted that we will be able to rely on the expertise of the

Department’s actuaries and economists.

Mrs. MALONEY. I just want to point out, and the chairman has

told me my time is up, but I just want to point out that in the letter that you sent Congressman Fossella and myself yesterday that

you noted that you think that there were 50,000 rescue workers

who are eligible for treatment, while I think the city of New York

has been using the number of 40,000 responders. Am I right in assuming that we do not really have any firm grass on the exact

number of people on the pile and those that responded?

Dr. HOWARD. Well, I think that you are entirely correct. I don’t

know of anyone at any level of government that is able to tell me

the exact number. As our GAO witness pointed out, we don’t—we

never had a master list. One of the great lessons learned in terms

of large public health disaster preparedness is we need to know

who responds, how to reach them, what their number is, so that

we can contact them after the disaster is over for medical monitoring purposes. That is one of the most significant lessons from this

experience that I have been able to acquire in New York City here.

Mrs. MALONEY. Thank you all for your work.

Mr. SHAYS. Thank you. Dr. Howard, it is an amazing comment

you are making, but it strikes us as so obvious times 10 that it is

such an obvious point. Anyway, that needed to be made.

Doctor—excuse me, not Doctor. Mr. Nadler, Congressman Nadler.

Mr. NADLER. Thank you. I chose to be a politician, not a physician, but thank you very much, Mr. Chairman.

Mr. SHAYS. And it is probably a good thing for all of us. [Laughter.]

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Mr. NADLER. At both ends.

Mr. SHAYS. In both respects. [Laughter.]

Mr. NADLER. Thank you, Mr. Chairman. Let me start by saying—by making two comments. First, to Dr. Howard, I simply want

to note and congratulate him for being one of the very few people

in the executive branch of government that I have found in the 5-

years that I have been working on this problem who have honest

and forthcoming and as helpful as possible. It is a very small list

at this point.

Second, I want to disagree with what my colleague Congresswoman Maloney and Dr. Howard were saying a moment ago. It is

interesting to get a cost analysis, but I don’t think it is all that important. What is important is to have a commitment to spend

whatever is necessary and rapidly and to appropriate the money as

necessary.

We never had a decent cost estimate for Iraq, and whatever you

think of the Iraq war, the fact that we didn’t have a decent cost

estimate was not a central issue. We are spending whatever the

administration thinks we ought to spend. We can second-guess

whether we agree with them, but the fact is that if we agree that

there is a major problem here, we ought to start—we are going to

have a program to treat everybody, and whenever the bills come in

pay them. Let me just make that off the top of my head.

Second, I have a series of questions for Dr. Howard first. Doctor,

do you believe there is any doubt that people are sick as a result

of exposure to World Trade Center contamination?

Dr. HOWARD. You know, certainly from the medical studies that

our department has funded, both for the responder population as

well as those studies that have been funded that Dr. Reibman talks

about in the resident population, I don’t think there is any doubt

about the level of symptomatology. We still have some question

about whether it is persistent in the resident population, and we

are looking very much forward to the Health Department’s World

Trade Center health registry’s first followup survey to look at that

persistent issue, which is still an open issue.

Mr. NADLER. But in other words——

Dr. HOWARD. And in the responder treatment program, the responder monitoring program, the research that has come out of

that program is fairly clear to me.

Mr. NADLER. So the answer is there is no doubt.

Dr. HOWARD. There is no doubt.

Mr. NADLER. OK. Thank you. Second, does the administration accept any responsibility because of the fact that people are now sick

from World Trade Center contamination given that the EPA told

people it was safe when it had no basis for saying that, and even

when it had data to the contrary, and that many first responders

were not provided respirators and OSHA rules were not enforced

on the site? Because of all those facts, does the administration accept any responsibility for the level of sickness at this point?

Dr. HOWARD. I am not the one to respond to that question, Mr.

Nadler.

Mr. NADLER. OK. I accept that answer. Thank you. And as you

may know, as you obviously do know, there is no currently—there

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is—currently, there is no federally funded program except for that

$75 million as a first instance to provide medical treatment for

anybody. There is no program to provide medical treatment to residents, to people who work in the surrounding office spaces, or children who go to school in the impacted area.

Many of these people went back to their homes and offices because they were told by Federal EPA it was safe, and they were

told—and, frankly, the city Department of Health told them to

clean up World Trade Center contamination with a wet mop or a

wet rag.

Does the administration support providing all necessary funds

for actual medical treatment, not just screening, for residents who

were affected as well as for first responders? And not just residents, residents, workers, anyone who was in the area then, or may

have been made sick by being in the area subsequently.

Dr. HOWARD. Again, I think that is one of the issues as a physician looking at the medical reports that we funded here in New

York, and the findings of Dr. Reibman and others, the World

Health Center registry’s findings, those are the kind of things that

I will bring back to the Secretary’s policy guidance task force to be

able to wrestle with that issue.

Mr. NADLER. OK. Thank you. And one final question: will all of

the treatment programs at the participating clinical centers provide

uniform services in terms of covered conditions, levels of services,

in-patient versus outpatient, and provision of benefits counseling?

Dr. HOWARD. That is certainly our goal. I must say that it is

challenging to bring all of these different provider agencies together on that point, but that is our goal.

Mr. NADLER. Thank you. Dr. Frieden, I have a number of questions for you. Does the city, in light of all of the recent study results, does the city administration now believe that people are indeed sick as a direct result of exposure to World Trade Center contamination?

Dr. FRIEDEN. There is a lot that we know, and there are some

things we don’t know. Some of the things we know is that most

people exposed to the dust cloud, and many others exposed less intensely, had acute symptoms. We know that some people, either because of the intensity of their exposure or other factors, developed

very severe respiratory illness. There are at least three such cases

that are well documented in the medical literature.

We know that people who were more exposed appeared to be

more ill, and in particular presence in the dust cloud is predictive

of longer term health problems. We know that many people with

pre-existing illnesses, such as asthma, would have had those conditions exacerbated, and that some people who did not have pre-existing conditions would have had new onset illness.

As Commissioner Scoppetta mentioned, hundreds of firefighters

have developed severe enough respiratory illness to become disabled as firefighters. We also know that many, and probably most,

people who had acute symptoms had improvement of those symptoms, but many continue to have symptoms. So, yes, we——

Mr. NADLER. Can I take that as a yes?

Dr. FRIEDEN. Yes.

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Mr. NADLER. The city agrees that this has led to many people

being ill.

Dr. FRIEDEN. Yes.

Mr. NADLER. Despite the mayor’s comments.

Dr. FRIEDEN. I believe that some of the mayor’s comments in the

media were taken out of context.

Mr. NADLER. OK. That is good—yes. I am sorry, go ahead.

Dr. FRIEDEN. There is no doubt from our point of view, the city’s

point of view, that there are people who are ill as a result of exposures to the WTC disaster.

Mr. NADLER. And that includes people who live, work, or go to

school in the area, or those who may be exposed to contamination

inside buildings, not just first responders.

Dr. FRIEDEN. As I was saying in my response, I believe there is

a gradient of exposure, and some of the things we don’t know are

the proportion ill in different groups and what the future course

will be of illness. But the strongest evidence is the evidence that

comes from the examinations on the first responders.

That is not to say that there isn’t illness among others. It is just

that the published evidence so far is strongest for the first responders.

Mr. NADLER. Do you believe there is some illness among others?

Dr. FRIEDEN. I have no doubt that there is mental illness among

others.

Mr. NADLER. Physical?

Dr. FRIEDEN. I believe, depending on the level of exposure, that

there may well be illness among others.

Mr. NADLER. May well be. OK. Thank you.

Commissioner, immediately following September 11th, your department, Department of Health, advised residents, put it on its

Web site—and I know that it stayed there for at least a number

of years, it may still be there for all I know, I checked on it about

2 or 3 years later, it was still there—advised residents returning

to the area to clean up asbestos-laden World—well, to clean up

dust—if they saw World Trade Center dust in their apartments,

said that they should clean it up with a wet mop or a wet rag.

The guidelines just issued say that the dust cloud contained asbestos and other substances that may be carcinogenic. Secretary

Henshaw, the head of OSHA, and the Deputy Secretary of Labor

of the United States, in a memo on January—in January 2002 advised that all World Trade Center dust must be presumed to contain asbestos and triggers all the legal consequences of such a presumption.

On January 1, 2002, the first day of the Bloomberg administration, I advised you of this advice on the Department of Health Web

site and told you my opinion that it ought to be taken down immediately, because it was reckless—it would lead to reckless danger

to life and I thought was illegal because it is illegal to advise people to remove asbestos-laden material without being properly licensed and under proper protection.

You disagreed with me. You said it was fine, it would stay there.

Do you still maintain that? Do you still think that was fine?

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Dr. FRIEDEN. The issue is: what are people going to do with dust

in their home or workplace? If they sweep it, or if they use a routine vacuum cleaner, that is dangerous. That——

Mr. NADLER. Wait a minute. But shouldn’t the advice have been,

if you see World Trade Center in your apartment, call a government agency and we will do something about it, not you do something about it? In fact, isn’t that what was legally required?

Dr. FRIEDEN. The program established by the EPA—I don’t recall

the exact month, it was May or June or July——

Mr. NADLER. That was July 2002, but that was later. That is

right, and that was different.

Dr. FRIEDEN. So what were people to do? The choice was between

not giving guidance that would allow a reduction in risk, and giving guidance in wet mopping and HEPA vacuuming, both of which

were recommended, are accepted ways of reducing risk. There are

ways——

Mr. NADLER. So you are saying that if there is asbestos-laden

material it is OK to advise people to undergo the danger of inhaling that material as they move it by cleaning it up with a wet mop

and a wet rag?

Dr. FRIEDEN. No, I am not saying that.

Mr. NADLER. That is OK?

Dr. FRIEDEN. No, I am not saying that. I am saying that a way

to reduce contamination is wet mopping or HEPA vacuuming. And

we also——

Mr. NADLER. Did it say——

Dr. FRIEDEN [continuing]. We also advised New Yorkers to notify

their building owner and/or fire professionals to clean if the dust

was greater than a minimal amount.

Mr. NADLER. But, Dr. Frieden, the law says it is illegal to move

or remove asbestos-laden material unless you are trained and licensed to do so and wearing proper protective equipment. And you

were advising people who were not trained or licensed and were

not particularly wearing any protective equipment to remove asbestos-laden material at their risk.

Mr. SHAYS. Let me just say the gentleman’s time is up, so I

would like you to respond, and then we are going to go to Mr.

Weiner. We will have a second round, so we will be able to cover

some territory.

Dr. FRIEDEN. I am a doctor, not a lawyer, but we will——

Mr. SHAYS. And so let me just say, tread carefully, because you

are—you are not a lawyer.

Dr. FRIEDEN. Yes.

Mr. SHAYS. And the purpose here is to have us understand. The

purpose is not to try to bag anybody.

Mr. NADLER. That is true. I am really looking at this—this was

done. It is past tense. What I am really looking for is to say it

never should have been necessary, because people should not be in

the position of having to do unsafe things because government is

letting them be victims, because I am looking for the future on this.

Mr. SHAYS. And let me just say, all of the witnesses here, you

are—this is a superb panel, and we are going to try to make sure

we, you know, cover the territory with all of you, and we will have

a second round.

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But because we do swear our witnesses in, I never want you to

feel rushed, I never want you to feel like you have to say something

without a lot of thought. The purpose is just for us to understand

the truth, and you all—every one of you have tremendous credibility with us.

At this time, Dr. Weiner—Dr. Weiner, God—[laughter]—what is

happening here? Now, you I might want as a doctor. [Laughter.]

Mr. WEINER. Thank you very much, Mr. Chairman, and I want

to thank this panel. It is an excellent panel, and I want to particularly thank Commissioner Scoppetta, Commissioner Frieden, Dr.

Howard, and the talented people who are giving so much of their

time and energy on behalf of the people of this city and country,

and we are grateful for that.

Dr. Howard, let me ask you, has OMB asked you, in preparation

for a supplemental, to put some kind of a number on the table for

what they think might be asked for in an upcoming appropriation

request? Has there been any effort, anyone asked you to crunch

some numbers to come up with some dollars, for what it would

take to solve this problem?

Dr. HOWARD. No.

Mr. WEINER. Has there been at any time the mandate given from

the Secretary, with whom we met yesterday, to start to do the process of trying to figure out what a compensation fund like that contemplated by Congressmember Maloney, or an expansion of Medicare as contemplated by Congressman Nadler, has anyone asked

you to crunch the numbers on what would be required for that?

Dr. HOWARD. No.

Mr. WEINER. And I asked this because, frankly, if you look at the

difference in response—you know, after September 11 we created

the compensation fund, which was largely speaking an open-ended

fund, we did a rather substantial bailout of the airline industry because it was seen as a Federal responsibility. The acts of September 11, compensating people, was seen as a Federal responsibility.

Is it seen by the administration for whom you work that the—

that compensating people for their health care costs, taking care of

them, is, in whole or in large part, a Federal responsibility by extension of that same thinking?

Dr. HOWARD. Well, I can only quote Secretary Leavitt, who you

met with yesterday, in terms of his commitment for compassionate

care for all World Trade Center responders, and his use of the term

that, when he referred to the $75 million, in terms of adding treatment, as a downpayment. I think when you use the word ‘‘downpayment’’ it implies that there will be future issues.

The third point I wanted to make from the meeting yesterday,

again, he said, ‘‘We all have to work together,’’ and I think he was

talking about the entire New York delegation, the Department of

Health and Human Services, and indeed all of the entities that are

here today—the Health Department, the city, etcetera. I think this

is a problem that we all have to work on.

Mr. WEINER. But did he say we all need to work together, and

then you are going to pay the bill? Or we all have to work together,

and then we are going to divide up the bills?

Dr. HOWARD. Well——

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Mr. WEINER. I mean, the concern that I have, to be honest with

you, Dr. Howard, is it seems latent in some of the comments that

you have made, and the Secretary made yesterday, is this notion

that we have to figure out who is going to pay the bill here, because it could be fairly substantial. And if we reach that mind-set,

we are getting into a morass that could leave many of the victims

of these health problems waiting for a very long time.

Part of the beauty of the compensation fund, with all its laws,

is it provided a certain sense of finality, and frankly a certain sense

of assumption of responsibility by the Federal Government. When

you say we all have to coordinate, we have to synchronize, we have

to get on the same page, does that mean that the administration

doesn’t believe that this is something that should be paid for in

whole by the Federal Government, and that some of these costs

they expect to be borne by the city or State or individuals?

Dr. HOWARD. No, I don’t think that the thinking has advanced

to that direction. I think that is something that I would be happy

to carry back to the Secretary, your issues and questions with regard to that.

Mr. WEINER. Well, I think it would be something that would be—

you know, that should be clarified, because I think that what—the

next question I am going to ask about the fingerpointing that has

emerged within the last 24 hours, about who is responsible for

some of the shocking mistakes that were made in those early hours

and in the time after.

And I am fearful that what we are setting up for here is a high

stakes game of he said/she said that is being—becoming a substitute for the important work that Dr. Herbert and Dr. Reibman

and others are doing to try to find help and care for these people.

And that is my concern, and I kind of see it, in fairness, on the

part of city officials as well, people a little bit concerned about accepting too much responsibility for fear of what kind of liability

that would bring.

If the President of the United States, when he comes here to visit

this weekend, says not we are proud of you, but we are sorry and

we are going to accept responsibility for paying these bills as soon

as we can figure out exactly how to do it, then I think it opens the

door for Carolyn’s bill, it opens the door for Jerry’s bill. Once we

have that commitment made, then I think things become a lot easier.

Commissioner Frieden, you are a health expert, one that has

been recognized. I want to read you something, and tell me just if

from your—the documents that you have read and your experience

as a health professional whether you think this is true.

‘‘If someone said that we, the Federal Government, did everything we could to protect the people from that environment, and we

did it in the best way that we could, which was to communicate

with those people who had the responsibility for enforcing, the city

was that primary responder.’’ Do you think that, in what you know,

that the Federal Government and the EPA did everything that

they could to protect people?

And I want to point out that some of the advice that they gave

in those early days was to wear dust masks, and they urged first

responders and rescue workers to ‘‘change their clothing.’’ Do you

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believe today, with the benefit of hindsight after 5 years, the Federal Government did everything they could to protect people on the

pile and in our city during that period?

Dr. FRIEDEN. This is not as simple a question as can be answered

with a yes or no.

Mr. WEINER. Take your time.

Dr. FRIEDEN. I think the primary issue we are concerned about

is respiratory protection, and the issues are not simple. I think that

reasonable people can disagree on the best course that could or

should have been taken. We know a few things. We know that if

there had been regular wearing of respiratory protection, the risks

would undoubtedly have been lower.

We also know that the respirator that was agreed upon—halfmask, half-face respirator—is very cumbersome to use. And 20/20

hindsight is easy, but if you remember back to those first days people were looking for survivors. And to say to someone in that kind

of an emergency operation ‘‘you can’t go there if you are not wearing this mask’’ when the mask might actually make it very difficult

to work or communicate, is difficult. It is a judgment call.

I will correct the record on the enforcement question in that

quotation that you have just read. It is OSHA and PESH that have

enforcement responsibility and authority. The city Health Department considered and determined that it did not have the authority

to mandate respirator wearing at the site.

Mr. WEINER. But in retrospect, and just as a matter of as close

to fact as we can get, when it was said by the Secretary of EPA—

and this is on September 18—‘‘Given the scope of the tragedy from

last week, I am glad to reassure the people of New York and Washington, DC, that their air is safe to breathe, and that their water

is safe to drink.’’ With the benefit of 5 years of hindsight, that was

not true, was it?

Dr. FRIEDEN. And one of the tenets of risk communication is the

issue of safety is always a very complicated one. And I don’t think

that was an appropriate way to word the message at that time.

Mr. WEINER. Commissioner Scoppetta, can you weigh in on this?

Your men were—based on the numbers that you quoted in your

statement, your men and women of your department, almost every

single one of them, was at some time or another down on the pile

or down near Ground Zero.

Based on the information that you know—that you now have

about the condition of the air, the ailments that have emerged from

your members, was it—was that true, that the air was clean, it was

safe to breathe, and the water was safe to drink? Because part of

the defense that Secretary Whitman has made in this 5-year afterthe-fact revision of history was that she was referring at the time

to the pile, which is where your men were working, or, rather, that

she was not referring to the pile, she was referring to the area

around the pile.

But knowing just what you do as a layperson, is it pretty clear

now after the fact that is not—that wasn’t true at the time?

Mr. SCOPPETTA. Well, as I said in my testimony, within weeks

of the attacks respiratory illnesses were reported, or symptoms of

illnesses. And within 4 weeks we started a monitoring program because of it, so it did become apparent that was the case.

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Now, we did require, and OSHA and PESH worked with us, required that our people working on the pile use masks. But keep in

mind they were working 12-hour shifts. It was a recovery effort. It

is extremely difficult to communicate wearing those masks. So even

those who were wearing them regularly would have to remove

them from time to time to engage in consultation, because it was

extremely important that we recover any remains. And that is why

they were on the pile for 9 months.

And so it—to answer your question directly, it seems——

Mr. WEINER. And I just have——

Mr. SCOPPETTA [continuing]. Clear that the advice we were getting, those mixed messages, I referred to them as our people finding illness and at the same time being told that the air is OK, must

have had an impact on our firefighters who were on the pile.

Mr. WEINER. I see.

Mr. SCOPPETTA. Thinking they could remove the mask for longer

than they should have.

Mr. WEINER. Well, my time has now expired. I just have one

final—this is something that emerged in the meeting with the Secretary yesterday. I just want you to clarify—could you explain to

me what type of health coverage a firefighter who retires—who retires has after they leave service to the fire department, if they

were, God forbid, in a couple of years to emerge with an ailment?

Are they still covered by the health insurance provided by the city

as if they were employed?

Mr. SCOPPETTA. No. Retirees have to rely on their own insurance

to cover their illnesses, and that—in my testimony—maybe I didn’t

get to it, but it is certainly submitted—there are certainly gaps,

insufficiencies we can call them, in insurance coverage for medication, for in-house health care across the board, and that is one of

the reasons why we so desperately need funding for treatment as

well as monitoring.

Mr. WEINER. Thank you, Mr. Chairman.

Mr. SHAYS. I have been looking forward to this opportunity to

have a dialog with all of you. I would like to first ask, if you were

not a question but you would have liked to have answered the

question, I would like you to answer the question. These were good

questions of my colleagues, and so I saw some of you take notes.

If you have an observation that you would like to make—and we

are going to go for a second round here. We are down to the full

committee.

I would like you to—I would like you to respond. Anything that

has been brought up in the first testimony or the first panel or the

second, any question that was raised to one of your colleagues on

your panel that you would like to make an observation or point

about? Yes, Commissioner.

Dr. FRIEDEN. I would like to make two points, if I may. The first,

just to amplify on my response earlier in terms of what the city

said and when. On November 1, 2001, Dr. Jessica Layton testified

before the New York City Council Committee on Environmental

Protection, and among other things noted that, ‘‘Persons at greatest

risk of health effects include unprotected workers on the debris pile

or very close to the site, persons with pre-existing conditions, such

as asthma, chronic obstructive pulmonary disease, heart disease,

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children who have developing systems and greater exposure due to

their body size, elderly.’’ So I think there was recognition and publicity about that early on from the city’s standpoint.

The second point I want to make I think all of us experienced,

sometimes the media coverage being less than as accurate as we

would like it to be, and there were some remarks of mine several

months ago from a television show relating to Mr. Zadroga that I

would like to clarify——

Mr. SHAYS. Sure.

Dr. FRIEDEN [continuing]. And amplify. I would like to apologize

for any misunderstanding that my remarks made. What I did say

in that interview was that some individuals heavily exposed are

having serious respiratory problems that without knowing the details of an individual case I cannot comment on it. But I did not

mean to cast doubt on the specific findings, only to say that I can’t

comment on them.

I do believe it is useful for us to have transparent, agreed-upon

standards so that if and when there are fatalities there can be a

standard that any organization or institution can use to assess

what the causality might be relating to WTC.

Thank you.

Mr. SHAYS. Thank you. Any other comments that you would like

to make?

Dr. HOWARD. Just following the Commissioner’s comment and

Representative Maloney’s comments earlier on my efforts to put

that into action, a fatalities investigation program, and I am happy

to see that the Commissioner is supportive of that in his department.

We are working with the New York Department of Health, and

we are working with experts in my agency, with experts at Mt.

Sinai, and we intend to put that in action, so that we can get a

handle on these reports that all of us read in the print and electronic media of individuals whose deaths are attributed to World

Trade Center exposure. This is extremely important for me as a

project to put into action immediately.

The other issue I wanted to bring up to let everyone know is in

our department, in the Department of Health and Human Services,

we are putting together a Web site on the World Trade Center. So

if you go to HHS.gov, you will see a World Trade Center logo. And

that World Trade Center site will have a one-stop shopping point

of view for all of the issues that we are all talking about in World

Trade Center.

It will have links to every existing resource, including the physician guidelines that the New York City Department of Health and

Mental Hygiene has put out for physicians across the country. This

is something that I would like to acknowledge that the committee

has supported. It is extremely important, and we hope to have that

live very soon.

Mr. SHAYS. Thank you. Dr. Herbert, do you have any comments

that you would like to make about any observations of the first

panel? And, Dr. Levin, I am going to ask the same thing of you,

sir.

And let me just say something. They don’t need to directly relate

to the work that you do. You think about this all the time, so you

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must have opinions outside your own specific requirements. So

what I want is a candid conversation about what was seen. I am

looking for recommendations on how we proceed.

And I just want to make sure that, like you do, all of you do, that

we see change take place in terms of our being able to respond to

this issue.

Dr. HERBERT. I have a couple of thoughts. The first is completely

my own view, and it is that I—you know, I am very concerned

about on the one hand I know there is concern about fingerpointing

between different levels of government. For me as a physician taking care of World Trade Center responders, it has been very troubling to see the difficulties our patients have had receiving medical

care and testing.

And I think that the panelists this morning were—it was heartbreaking to listen to them, and I wish I could say that they were

unusual, but they really represented what all——

Mr. SHAYS. We didn’t bring them because they were unusual,

so——

Dr. HERBERT. Exactly.

Mr. SHAYS [continuing]. So I don’t want you to wish that. I mean,

in the sense that I want people to understand that they had a very

universal message.

Dr. HERBERT. Exactly. And I just wish that, first of all, with respect to responders that we could design a system in which, a)

every responder can get regular medical examinations to look for

both physical and mental health for their lifetime. In terms of

treatment, I think it is in the responder’s best interest if we can

get away from a system in which responders have to prove that

they were there, have to prove that their illnesses is World Trade

Center related, and all the legal—I feel like we spend more——

Mr. SHAYS. Let me just ask—and continue later, go further—but

I think it would be irresponsible if we just assume that anyone who

steps forward and said ‘‘I was there’’—there has to be some way

that someone can document it. But, I mean, yes, not signed, sealed,

and delivered. But I would be—I mean, we saw that with Katrina.

I mean, everybody was making claims, and we just doled out

money.

If we do that, there won’t be enough money to go around. So I

want to make sure that the people who are, in fact, responders get

it. So you are going to have—to win me over on that point, you are

going to have to give me a little bit of what you mean, maybe fill

in——

Dr. HERBERT. OK. I will be a little more precise. I think I am

probably reacting again as a physician to my patients who were

down there for weeks being told—being—you know, men in their

forties and fifties who have worked their whole lives being brought

to tears and worker’s compensation courts being accused of lying

about being down there. So I think I may be reacting to that.

I think the question—the issue is that I think it is worth at least

examining what the possibility of having something along the lines

of a presumption system, so that at least some conditions would be

considered World Trade Center related. You know——

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Mr. SHAYS. It is a different issue, though. The issue is if you

were there, we presume that whatever illness comes along is a result of your being there. And there you and I would be totally——

Dr. HERBERT. Right. And I think, I mean, the issue—right, the

issue—I guess Katrina is—you know, most of our patients, we have

not found that the issue of people not—who come to our treatment

program, we have very stringent criteria, exposure-based eligibility

criteria. So I may look at this in a different way in terms of the

exposure, the establishment of exposure and presence at the World

Trade Center site or having been exposed.

But I think that perhaps what I am trying to say is that right

now so much of the onus remains on the World Trade Center responder to prove that he or she were down there, and to then, you

know, just sort of try and navigate these very complex systems of

access to health care.

So I think that if there were a way to develop a system that—

where at least there was—where it didn’t start out sort of so heavily tipped against the World Trade responders, which is the way it

feels now.

Mr. SHAYS. OK. Well, you know, I would like to pursue that a

little bit, but I am so grateful you are making these points, because

these are the points we need to be discussing. And I am not trying

to convince you your point is wrong. I want you to stay a doctor,

and I want you to think like a doctor. I want to think like a legislator who wants to be helpful, and then let us see where there is a

point where we can do something sensible. Do you have another

point or two?

Dr. HERBERT. I just want to acknowledge that Dr. John Howard

has been extraordinarily helpful to all of our World Trade Center

programs, and I think he has been sometimes not as recognized as

he should be, and I want to acknowledge that.

Mr. SHAYS. Well, you know, Doctor, we are not allowing applause, but just imagine that the place would be a standing ovation. We are. Thank you.

Any other points before I go to Dr. Levin?

Dr. HERBERT. No, thank you very much.

Mr. SHAYS. OK. Dr. Levin.

Dr. LEVIN. Well, I just want to make a couple of points, and I

think everyone knows that in the immediate hours, and even few

days, after September 11—the September 11 attacks it was a chaotic environment. Everyone understands that is so, and when there

is conditions of chaos it is hard to impose organization.

But it is also clear that the September 11th experience should be

teaching us the lesson that we have to be better prepared in advance. For example, the point about registering everyone who was

there—the boundaries were very porous down at Ground Zero for

the first several days, and gradually there evolved checkpoints and

ways to identify who was coming in and who was going out.

If we can’t in advance of the next either a natural disaster or

manmade disaster find ways to identify who was there and have

teams of people prepared to do that as people come into such environments, and leave such settings, then we are going to make the

same mistakes that we made this last time and that we made in

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Katrina. And Katrina was even harder I think than dealing with

what happened in Lower Manhattan.

We will find ourselves in the position of not knowing who was

exposed, dealing with the very question that you just raised and

that is: how do we know if someone was there? We had that terrible story told to us this morning of someone who had several photographs of himself down on the pile and was asked, ‘‘Well, this

could have been digitally altered.’’

To be—I have many patients who have been challenged in the

worker’s compensation process, in the pension process, with exactly

that kind of question. They have a picture book full of photos of

themselves, sometimes with elected officials with arms around

them identifying them as heroes, and yet it wasn’t sufficient for the

worker’s comp process as an identification of the fact that they

were there.

Mr. SHAYS. Well, let me just be clear, since I responded so clearly

about this issue, there has to be common sense.

Dr. LEVIN. Right.

Mr. SHAYS. And that is really I think as a physician trying to

take care of patients and get care for them, to have common sense

prevail we think would be really important. And let me just extend

that a little bit.

You know, in public health there is this notion of the precautionary principle, and it says that if there is reason to believe that

there is hazard, but you don’t know yet whether it is so, you behave as if it is so until you know better. That is a sort of a rephrasing of the general principle.

And I think that approach really wasn’t taken following the September 11 attack. I don’t think that at each government level we

behaved in a way that indicated concern that, in fact, there were

hazards there or might be hazards there. Putting aside Ms. Whitman’s open statement to the contrary, there was in general a failure to recognize the necessity of protecting people and monitoring

them closely.

I am going to make an observation to you, that intuitively those

statements defy logic. But they also defied logic to the press then,

and everybody was given a mask.

Dr. LEVIN. I am not sure which statement to——

Mr. SHAYS. I am going to say to you, to have said—for anyone

to say that this was a safe environment, it defies logic. And everyone knows that. You can’t have what we had and have people believe for a second—and all I am saying to you is that the press is

really on to this issue now. I am not looking to pick a fight with

the press, but I am willing to say to you, everybody was focused

on a lot of other issues.

Dr. LEVIN. Yes, I understand that. And in a way that large population of responders fell through a very large crack, and we are

dealing with the consequences of that now. And I can tell you, just

to follow what you just suggested, there was hardly a physician

with experience in occupational or environmental medicine who

saw people being dragged off of the pile, really choking for breath,

for whom the issue of potential asthma occurrence, sinusitis occurrence, didn’t arise.

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It was an environment so clearly one that had hazards for respiratory illness, never mind psychological——

Mr. SHAYS. We had a—I have a constituent who runs a national

rental business, and they provided, without rent, a lot of this

equipment. They said the equipment literally shut down every few

moments, because it was getting clogged up as it was sucking in

air to feed the gasoline in the engine.

Dr. LEVIN. Under those circumstances, which were obvious to

all—not just to physicians but anybody who was there, people who

watch television, to find ourselves as physicians working so hard

to persuade worker’s compensation officials, pension boards,

etcetera, of the reality of this illness—of these illnesses that developed, even to the current day because so many of our patients still

have unresolved claims, are still fighting to get benefits that really

just help pay the mortgage, that we are not dealing with a common

sense approach never mind a scientific approach, but, rather, we

are dealing with, unfortunately, politics and economics that really

don’t have a place in the public health concerns that I think we are

really talking about here.

Mr. SHAYS. Thank you for your observation. Any other observations?

Dr. FRIEDEN. Since you have asked, you know, what are the

issues to deal with, Chairman Shays, I just—one of the points

made this morning I think shouldn’t be lost, and that is that in addition to the special and significant problems being faced by people

who were there at September 11th and the months that followed,

what we are seeing is that overlaid on a health care system that

has problems, gaps in care, lack of access, co-payments that can be

very significant, even for people with insurance.

Some of the chronic conditions may be hundreds of dollars a

month for medications and specialty service needs. So I think as

we think about what to do, I think that is a point worth not losing.

Mr. SHAYS. We were—I was basically blown away yesterday to

learn that while you are in the fire department you are getting

Medicare, and if you are, you know, on disability and you are out

because you are ill, you are not getting that health care. You are

paying for it yourself. That just blows me away. Blows me away.

An observation, Commissioner, or Dr. Reibman?

Mr. SCOPPETTA. Well, of course, that is one of the points we

make in the testimony about the need for assistance in these particular circumstances. September 11th was an unprecedented

event. The response was unprecedented, and it turns out perhaps

the illnesses that were contracted after that, at least in this particular event—instance our retirees ought to get some help.

Mr. SHAYS. We are going to talk about that. Dr. Reibman.

Dr. REIBMAN. I would just like to say that I think what we have

been hearing about mostly, and appropriately so, are the issues of

the responders. But the responders, maybe they can show a picture, can have some evidence that they were exposed. For many of

the residents, it will be much more difficult to have attribution and

disease. And this is a major issue that we have been dealing with

and will be dealing with, attribution that the disease is due to

World Trade Center dust exposure.

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Mr. SHAYS. See, what we did when we had these hearings, we

had 15, give or take, hearings on Gulf war illnesses. Not being a

physician, it was fascinating to go through this process. But there

was unbelievable resistance on the part of the Department of Defense and VA to acknowledge that people were sick, and we used

to have the generals and the doctors testify first, and then people

who were sick, and hold lots of different ways, and parents of

young kids in a sense who had lost their lives testifying, and the

first panel left so we reversed that.

But it took even the intervention, frankly, of Ross Perot who

started to fund research for what happens when you are exposed

to toxic material when you are under stress. And when you are

under stress, there is a whole different way your body responds.

And there were some breakthrough efforts, but it took 10-plus

years.

What I am struck with is this, and then I am going to go to Mrs.

Maloney for her second round—I have taken my second round right

after my first, that is a privilege the chairman has—but what I am

struck with is there is not a chance in hell that you would have

been able to stop a first responder from going there. And if you

said to them, ‘‘You are going to cut your life by 10 years by going

in there,’’ they are saying, ‘‘My buddies are down there. I am going

to get them. I am going to help them.’’ You couldn’t stop them.

But where I have my big problem is after the first week. Now,

but I also have a big problem for the guys and the women who the

first week were doing that who aren’t getting help, because it is

like we should be on our knees in gratitude and then we should

be saying, ‘‘What can we do to help you? And by the way, what can

we help your young child, that 4-year old child who is growing up

now without a dad, what can we do to help her?’’

So that is kind of where I am reacting. When I get my third

round, I am going to want someone to describe the whole universe

to me. I mean, we have firefighters, police, emergency medical personnel, transit workers, construction crew, and volunteers in general.

I want to have a sense of what the whole—now that is just the

responders, and then, I am going to make an assumption that I

want corrected or not, that the challenge we have for the residents

is that the ones who are probably most affected, who had a pocket

of a cloud, who—so, in other words, that it won’t be evenly dispersed, it will be someone in some apartment building nearby, and

then someone further away, and they would have been exposed to

something really deadly, but everyone in between might not have.

In other words, I just think intuitively that as these clouds disperse, and they weren’t there indefinitely, as they were right above

Ground Zero where there was just a heated furnace for months and

months and months. So I will want to have someone kind of walk

me through that.

Mrs. Maloney, thank you for your patience.

Mrs. MALONEY. Thank you so much, Mr. Chairman. I would like

to ask Commissioner Frieden, earlier we heard some—a very moving statement from the father of James Zadroga, where he testified

that a medical expert in New Jersey directly linked his son’s death

to his work at Ground Zero, the fact the lung weighed three times

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more than a normal lung, was totally black, and was laden with

debris. Does the city of New York recognize these medical findings?

In other words, did James Zadroga die from his work at Ground

Zero? Yes or no.

Dr. FRIEDEN. I cannot comment because I have not seen the details of his situation. But what it highlights is what both I and Dr.

Howard mentioned earlier, I think it is critically important that we

agree on and have everyone have input so people can agree upon

a set of standards that can be used to assess fatalities related to

see whether the weight of evidence suggests that they are related.

From the media reports, it certainly sounds consistent with illness from WTC, but without knowing the details of what examinations were done and what the prior history is, I can’t responsibly

make that determination.

Mrs. MALONEY. The New York Daily News has documented the

death of at least seven responders, including James Zadroga. Many

people come to my office saying their loved ones died as a direct

result. So the Daily News has documented seven, and we have

probably a list of about 30 in my office. How many deaths has the

city’s Health Department documented? You say you didn’t look at

this material. Shouldn’t you have looked at it and given some support to James Zadroga’s father?

Dr. FRIEDEN. His death was in New Jersey, so it was not within

our jurisdiction. In terms of deaths within the jurisdiction here, if

the cases are cases that are referred to the medical examiner or

taken by the medical examiner, then they get a full assessment.

Otherwise, it is a determination of whether the family agrees to

an autopsy, and I really commend families that do that, because it

can be difficult. But that is what allows us to increase our awareness and knowledge of what is happening, so we can all try to get

closure in individual cases as well as more generally.

Mrs. MALONEY. Well, the city’s Health Department has documented at least 20 deaths as a direct result of this summer’s

heatwave. And how can the city a month later know that certain

deaths occurred because of the heatwave, but they are not able to

document any deaths related to the September 11th toxic fumes

that happened 5 years ago?

Dr. FRIEDEN. We will indeed be tracking the deaths and illnesses

and cancers associated with the more than 71,000 people who registered for the WTC health registry. This will provide us with as

close as we can get to a population-based summary.

I would also point out that the process for death certification includes specifically whether it was from heat exposure. So the death

certificate comes in with it written on the death certificate, heat exposure. That does not occur for situations like the WTC, so it is not

as simple as it might seem.

Mrs. MALONEY. Well, you testified there should be guidelines,

there should be transparency. It is 5 years later. People are dying,

and we now know scientifically what we have known in our hearts

that it is related to September 11th. When will the city have the

particular transparent documents that we can get some numbers

and some sense from this?

Dr. FRIEDEN. In terms of the specific fatality investigation, Dr.

Howard and NIOSH are taking the lead on that. And what we inVerDate 11-MAY-2000 11:30 Oct 09, 2007 Jkt 000000 PO 00000 Frm 00189 Fmt 6633 Sfmt 6633 C:\DOCS\36998.TXT HGOVREF1 PsN: HGOVREF1
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tend is for there to be a document that everyone can comment on,

so people can agree at the outset these are the standards that need

to be applied but by whatever institution needs to do the investigation.

Mrs. MALONEY. Well, that is another thing thrown on your plate,

Dr. Howard. You testified earlier and came back and clarified one

of my questions. Earlier you said that November 1, 2001, in testimony before the New York City Council, the then Health Director

did testify that there were illnesses related to September 11th toxic

fumes.

And where were the clinical guidelines for these illnesses and

conditions? The city has known that people were sick since November 1, 2001, according to your testimony but waited until last week

to issue and mail out guidelines to the doctors.

Dr. FRIEDEN. Just to clarify, I did not say that the city said people were sick. What I quoted was testimony that highlighted populations for which there was the greatest risk of health effects, including unprotected workers and others with pre-existing conditions. I would also——

Mrs. MALONEY. Thank you for that clarification, but my question

is: why did it take 5 years to mail out guidelines on physical sickness? The Federal Government got guidelines out on SARS, the

bird flu, and every other flu you can imagine within a very short

period of time. And you testified earlier that you had mailed out

guidelines for mental health.

I would say people dying of respiratory sicknesses, people should

be notified. And I really want to put on the record a study and ask

that this study be put in the record. It was done by the fire department or done by the World Trade Center consortium. I am going

to get this study. This study showed that 30 to 40 percent of the

people that were being reviewed I believe in the World Trade Center consortium were misdiagnosed and mistreated.

They were having lung disease and treated for asthma, and that

this was causing many, many problems. So my question to you, and

I feel very strongly about it, because what you see in this panel is

what members—prior panel is what Members of Congress see in

their offices every week, sick people coming in saying they were

misdiagnosed. Why in the world could the city of New York, the

greatest city on earth, I really believe that, why in the world could

not the city of New York get out the medical guidelines until 1

week ago?

Dr. FRIEDEN. I would like to point out a few things. First, the

conditions that those guidelines go over are actually very common

conditions seen in medical practice—cough, sinusitis, the reflux disease. These are not conditions with which doctors are unfamiliar,

or these are—to say that more clearly, doctors are familiar with

these conditions.

We did not know until relatively recently the extent to which

symptoms have been persisting—mental—not mental health, but

physical health symptoms have been persisting. In fact, really our

first sense of that was in November 2004 when we looked for the

first time at our own data from the registry and saw such a high

rate of respiratory conditions.

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But as Dr. Reibman appropriately pointed out, we didn’t assess

for persistence at that time. Additional information was provided,

case reports were coming out, we began the process in 2005, and

we sought to achieve consensus. Maybe it is better to get something

out that not everyone agrees with, but we felt what is important

is to get something out that not only will we be able to say we got

it out, but people will say, ‘‘We agree with this, we are behind it,

and we are going to do it, we are going to follow these guidelines.’’

All of that said, would I wish that they had gotten out sooner?

Absolutely. I would also wish that we would have had more scientific published evidence sooner that would help us make those

determinations and make those recommendations.

Mrs. MALONEY. I would say everybody with any common sense

knew that there was a medical connection. And I ask you then,

how were you able to get out mental health guidelines but you

were not able to get out medical guidelines? Is mental health

guidelines easier to get a consensus on? What was the difference

between the two that you could get out mental health clinical

guidelines, and you were going to get back to me at what time and

year you got them out.

And also, by the way, after September 11th everybody sort of did

what they could, and my office adopted—they adopted mental

health, and we worked with the mental health community and got

grief counselors out to every business organization that had lost

people on September 11th. So we interact with that community because we worked with them as a special project, and I thank my

office for their help today, and really for every day working on September 11th. It is a top priority of my office.

But mental health doctors did not tell me that they got guidelines, so I would like to know in writing who got these guidelines?

How far were they mailed? Was it to 100 people or every mental

health doctor in New York? Because I know many that we—the offices said they never got them. So I would like to know where it

was sent, when it was sent out, and why can you get out mental

health guidelines—that is important, I congratulate you—but you

could not get out physical health guidelines?

Dr. FRIEDEN. Just to reiterate, we knew from the first moments

of the attack, based on other experience, that mental health effects

would be long lasting and severe, and we began to produce guidelines to address those.

Mrs. MALONEY. Did you not know that those that were breathing

that debris that was so——

Dr. FRIEDEN. No, we did not.

Mrs. MALONEY [continuing]. Thick you could chew it, that you

would not have physical problems?

Dr. FRIEDEN. No, I can say I did not. We certainly knew there

were short-term health effects. What the long-term health effects

were we—I could not predict. Others may have predicted them accurately, but I certainly could not have.

Mrs. MALONEY. Well, did the city of New York have a role in developing the clinical guidelines for mental health and for physical

health? Did the lawyer’s department have a role in developing

these guidelines?

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Dr. FRIEDEN. We have shared early drafts with a wide variety of

individuals including the Law Department, but every technical,

clinical, scientific decision on the guidelines is made solely by the

Health Department in conjunction with our partners in that document, including Mt. Sinai, the fire department, and others.

Mrs. MALONEY. Beyond reviewing the draft clinical guidelines,

what role has the city’s lawyers had when it comes to your public

statements about September 11th health and the toxins at Ground

Zero?

Dr. FRIEDEN. As you know, for all public officials there is a review process, and so our comments are reviewed by the General

Counsel, the Health Department, as well as by the Law Department. They make suggestions. We determine whether or not to

take those suggestions.

Mrs. MALONEY. Did the lawyers review your testimony before us

today? Have you received any advice from the city’s lawyers in

preparation for your appearance today?

Dr. FRIEDEN. Yes.

Mrs. MALONEY. OK. I would like to ask Dr. Howard—can I——

Mr. SHAYS. I want to—it has been 10 minutes here now, and ask

you, Commissioner, about what I want to understand is I want

some—maybe I can have you, Dr. Herbert first, or Dr. Howard,

have me—I am trying to make sure that we get information to be

able to write a report hopefully by this year. And the information

I am asking is relating to not whether someone should have acted

sooner or not, that is not going to help my committee get this done,

and I need to make sure before we leave we get this done.

I need to understand the varying degrees of coverage that all of

these so-called—I want to take the universe—here is what I am

wrestling with. I want to take the universe, and I want to know

who got the best coverage and who got the worst coverage.

And it strikes me—and, Commissioner, I am going to start with

you, it strikes me that almost every firefighter was a potential volunteer at Ground Zero, but that you all should have been able to

determine pretty well how many of the firefighters were. Can you

tell me who they—your universe that you think, of your total number, how many you think were there? Commissioner.

Mr. SCOPPETTA. Me?

Mr. SHAYS. Yes. I am talking firefighters now.

Mr. SCOPPETTA. Yes. Virtually every member of the fire department served some time at Ground Zero.

Mr. SHAYS. It was almost a badge.

Mr. SCOPPETTA. Yes, it is more than 11,000 firefighters, and

more than 300,000 EMTs and paramedics worked at the site

during——

Mr. SHAYS. We can make an assumption almost everybody did.

Mr. SCOPPETTA. Yes.

Mr. SHAYS. OK. Now, I make an assumption that you had monitored all of them, as your testimony—in other words, this is a

group of folks who got monitored early on, and while they are part

of the department are getting health care. The bottom line is,

though, that they are—some may not show any signs of not being

well right—of being sick. But that they may be sick when they are

no longer employed by the department, is that correct?

189

Mr. SCOPPETTA. That is correct.

Mr. SHAYS. But at least—the good news is this, that with our

firefighters they were monitored, and anyone who had health problems were getting attention, their health needs met, is that correct?

Mr. SCOPPETTA. Yes. And we are monitoring retirees now as well.

Mr. SHAYS. And is that being paid for by the department?

Mr. SCOPPETTA. That was paid for—the Federal funds are——

Mr. SHAYS. So that is the Federal dollars.

Mr. SCOPPETTA. Yes.

Mr. SHAYS. And by the way, if I expose some ignorance here, feel

free to jump right in and clarify. You know, I need to know. So

these are the Federal dollars, what enables you to continue this

process for those who no longer are active.

Mr. SCOPPETTA. Yes.

Mr. SHAYS. Dr. Herbert, Dr. Levin, Dr. Howard, Commissioner,

whomever, Dr. Reibman, tell me who comes closest to matching the

firefighters in terms of getting good monitoring and good health

care at least while they are active? Who would that be?

Dr. HERBERT. I would say monitoring and health care are two

different issues.

Mr. SHAYS. Absolutely.

Dr. HERBERT. OK. To be eligible for our program——

Mr. SHAYS. No, I just—let me just—I have given you the folks

that I think are involved here—fire, police, emergency medical personnel, transit workers, construction crew, and then obviously volunteers in general—was there any other—do I rank the firemen,

firefighters, up at the highest level? I am just trying to—I want to

know where people fit in here. Are the construction folks, the guys

who are getting screwed the most, are they getting help? Help me

out here, guys.

Dr. HERBERT. You have in the world of other responders, the people who did——

Mr. SHAYS. Tell me who gets the next best after the firefighters.

Maybe nobody.

Dr. HOWARD. Let me try this.

Mr. SHAYS. And you can take monitoring, and then you can

take——

Dr. HOWARD. Yes. If you are a responder or a volunteer, if you

were rescue, recovery, cleanup, restoration, essential services, OK,

if you were in that category, which we commonly call responder or

volunteer, then there is—there was medical screening for you. Dr.

Herbert’s group reported on her findings recently.

Mr. SHAYS. For those who volunteered to be——

Dr. HOWARD. Exactly. Responder or volunteers.

Mr. SHAYS. Yes.

Dr. HOWARD. Then, they got monitoring——

Mr. SHAYS. Let me just—I am sorry, but I am really trying to

nail this down. When you work for the police department or you

work for the fire department, you are part of a club. If you work

for a union, you are part of a union. You know, you talk to your

colleagues. I want you to separate the volunteers who came just—

and just came every day that weren’t part of any organization. I

want to be able to categorize, so I need a little bit more definition

to what you are telling me.

190

Dr. HOWARD. And your categorization criteria is, which of those

groups that we are going to name has the most availability of medical support, monitoring of treatment.

Mr. SHAYS. Right. And while you are telling me that everyone

who was a potential responder has the right to monitoring, there

is a difference between having the right and actually taking advantage of the right.

Dr. HOWARD. OK. If you look at that, just that question, and you

use the estimate that Mrs. Maloney used that we commonly use of

40,000 as the denominator, in the combined programs that the Federal Government has funded for screening and monitoring we have

screened and monitored about 30,000, so that is about 75 percent.

We still—and we always take every opportunity—I thank the

print and electronic media for giving us the opportunity to say if

you were a responder in that 40,000 group, and you haven’t had

an examination, please come in and get an examination. So out of

that 40,000, we have screened 30,000.

Mr. SHAYS. OK. So, and as Mrs. Maloney points out, and others

point out, and you all have pointed out, being screened, being monitored, and getting health coverage are two different issues.

Now, let us just talk about health coverage. Do you want to talk,

Dr. Levin, about——

Dr. LEVIN. Because health care delivery is such a patchwork

system——

Mr. SHAYS. I am going to ask you to give the mics back to—we

basically have three mics. You are going to share the mic with

Commissioner Scoppetta, so that way you only have to go to two,

OK?

Dr. LEVIN. What we are dealing with is a patchwork health care

delivery system and our patients, the responders. Putting aside

community residents, and putting aside office——

Mr. SHAYS. Well, putting aside community residents, because

that is an important issue, but I just want to first get the responders, the responder community.

Dr. LEVIN. You have a special group of cleanup workers who

were the undocumented workers, often hired from the street corner

to work each day, often struggling to get paid at the end of the day,

offered no protection, and who are very worried themselves about

entering any kind of system because of their concerns about being

identified as undocumented workers.

That is a group that we have been seeing in our center. I know

Dr. Reibman has been seeing a number there, but they are not

easy to reach because of their fears of——

Mr. SHAYS. Seen for what? To get health benefits or——

Dr. LEVIN. To be evaluated and then treated for——

Mr. SHAYS. Oh, to be treated. OK.

Dr. LEVIN. Yes. We know that there are many, many hundreds,

probably thousands, who have never been seen in our programs because of their concerns about being identified as undocumented

workers. That is just one aspect of it.

We have in our population of responders a number of people who

are pure volunteers. In other words, they were not employed down

there. They never received a paycheck. They came to do volunteer

work. It turns out that after some struggle the worker’s compensaVerDate 11-MAY-2000 11:30 Oct 09, 2007 Jkt 000000 PO 00000 Frm 00194 Fmt 6633 Sfmt 6633 C:\DOCS\36998.TXT HGOVREF1 PsN: HGOVREF1
191

tion system in New York did set up a program to cover the health

care costs of volunteers.

Those people had an easier path to getting health care benefits

through the worker’s compensation system than people who in fact

were employed down there and filed worker’s compensation claims.

Mr. SHAYS. I mean, this is the stuff we need to hear.

Dr. LEVIN. I thought that this was the kind of issue that you

were concerned with. The volunteer program had no insurance

company opposing the cases. Employed workers had either insurance companies or self-employed—I mean, self-insured employers

like the city, New York City, or the Transit Authority, or Conn Ed.

These are self-insured worker’s comp programs, and I can tell you

that the track record of our patients in getting through the system,

if they were employed down there, was really nightmarish.

Mr. SHAYS. OK. Nightmarish as it was, once they got it, will they

get it when they retire?

Dr. LEVIN. So long as they have persistent medical problems that

derive from their exposures at Ground Zero or in World Trade Center response work, their medical care is supposed to carry through

for the rest of their lives unless—and if you want this level of detail I think maybe it is useful to you.

Unless they take a lump-sum settlement, which they are vigorously encouraged to do within the system, at which time if they

take a lump-sum settlement they waive all their rights to further

payment for medical care or wage replacement or anything else.

Now, many of our patients who face financial difficulties paying

the rent, dealing with, you know, the kids’ tuition——

Mr. SHAYS. What kind of settlement are we talking about?

Dr. LEVIN. Something in the order of $50, $60, $70,000.

Mr. SHAYS. So it could just be a whisper compared to what they

need.

Dr. LEVIN. Yes, but what it does is it enables them to get out of

debt temporarily.

Mr. SHAYS. I understand that. I am not——

Dr. LEVIN. But, yes, you are right, it is barely enough to cover

a couple year’s expenses, and then they are left on their own. And

as was pointed out before, you are talking about medications alone

that can cost several hundred dollars a month just to keep symptoms under control.

So you have people in the worker’s compensation system who

were delayed in getting care, delayed in getting testing, and ultimately may not be covered for the duration of their illnesses, because they have taken lump sum.

I want to talk about construction workers, because that is a large

group of people who are down there.

Mr. SHAYS. Is that the largest group, do you think?

Dr. LEVIN. In our population, law enforcement and construction

workers were almost comparable in terms of——

Mr. SHAYS. Do you put law enforcement—firefighters as law enforcement?

Dr. LEVIN. No, because the firefighters were not seen as part of

our program.

Mr. SHAYS. OK. I got you.

192

Dr. LEVIN. So construction workers are in the paradoxical situation that if they are ill enough not to be able to put in enough

hours on the job——

Mr. SHAYS. Let me just stop you. We are not going to go too

much longer. Do we have a time problem here? I am sure you do.

OK. How much more time do you have? You both have time problems here.

Let us do this. I am going to just have—we are going to go—if

my colleague wants another 5 minutes, we will go with that and

end with that. Does that meet your needs?

Just finish your question.

Dr. LEVIN. I will finish this, because it—you have the paradoxical

situation for construction workers that they have to put in a

ceratin number of hours on the job in order to retain their health

benefits and the benefits for their families. At the very time that

they are ill from the World Trade Center experiences, and they

can’t work because often their jobs are dusty jobs that provoke

their symptoms, they find themselves losing their health care insurance.

Mr. SHAYS. Let me just interrupt. Your questions will not involve

either Commissioner? OK. Gentlemen, thank you very much.

Thank you.

Mrs. MALONEY. I just want to thank the fire department for their

extraordinarily leadership. They have come to Washington 10, 20

times to lobby for more funds. We are deeply grateful.

Mr. SHAYS. And I also want to thank our Commissioner for being

here. Thank you. You have been at our other hearings, and you

have been very forthcoming and we appreciate it.

Dr. LEVIN. Well, just to continue briefly, you have people who are

falling through what you could consider natural cracks in a patchwork system, but you also have people who are facing the vigorous

opposition of their claims by both insurance companies and self-insured employers. That has been the most common of experiences.

Mr. SHAYS. Do the construction workers get covered by their own

fund, their own health care? That is what I am not clear about.

Does it depend construction to construction?

Dr. LEVIN. Overwhelmingly, the way construction workers get

health care is through joint employer/union administered benefit

funds. And it is part of I think the way construction trades are set

up.

Mr. SHAYS. I will have my staff followup on this.

Dr. LEVIN. But they lose their health care benefits, find their

cases being fought in the worker’s compensation process. And essentially, if it weren’t for the treatment resources that we have

been able to garner at Mt. Sinai, and our partners from Red Cross,

etcetera, these people would do without health care because there

would be no resources available to them.

So even though construction workers seem on the surface of it to

have excellent plans, under ordinary circumstances in the particular situation of the World Trade Center related illnesses, they find

themselves in desperate circumstances because there is no source

that you can identify if it is not from philanthropic sources, and

now the prospect of Federal funding.

193

Mr. SHAYS. Dr. Reibman, do you want to respond to any of this?

OK. Mrs. Maloney.

Mrs. MALONEY. First of all, I would like to thank my staff that

has worked every single day on these issues since September 12,

particularly my chief of staff in Washington, Vince Chevette, my

district chief of staff, Minnie Elias, and Edward Mills, who has

worked with me to draft and implement several legislative proposals and the continual letters that we send out practically every day

on this.

I just would like to ask Dr. Howard, we learn in the Bible that

Moses traveled in the desert for 40 years, because he did not have

a plan. And what has struck me is how every single question keeps

being bounced back in your court, and every time I pick up a paper

I read that you have not even one single staff member assigned to

your—help you on this.

So a lot has been thrown on you, Dr. Howard, and my question

is: when are we going to have in writing, submitted to Congress,

the plan?

Mr. SHAYS. And I am just going to say, in my religious belief

they wandered in the desert for 40 years because the children of

Israel weren’t ready to cross the Promised Land. [Laughter.]

Mrs. MALONEY. But in any event, my constituents can’t wait 40

years. They want the plan now, and they have bounced in your

court the fatality report and the criteria. To me, if someone’s lungs

are black and they are throwing up black phlegm when they are

dying, and their family talks about how they spit out nails and

black phlegm, I would say it is related to September 11th.

But in any event, we need a fatality report that builds on the

science that came out of the Mt. Sinai-World Trade Center consortium science, but we need that also in writing, so it can be implemented.

So my question to you—and I think your question back to us, is

to call Ross Perot and get you some more resources to help get this

research done. But I see a tragic ending here. I know—we can all

be idealistic, but I know if you do not have a plan, if you do not

have cost estimates that are scientifically based, even with all the

plans in the world that are scientifically documented, it is had to

get it in the budget.

So we don’t have a prayer as a New York delegation combined

with Connecticut and New Jersey in getting a budget line for

health care unless we get the plan, unless we get the documentation and the health estimates, which is a huge job. So my question

to you is: we can’t wait 40 years. When are you going to give us

our plan in writing? And thank you very much.

Mr. SHAYS. Is there any comment that any member of the

panel—I thought it was a statement that——

Mrs. MALONEY. No, it was a very sincere question.

Mr. SHAYS. OK. Well, then——

Mrs. MALONEY. He gave us a definite deadline. I hope he can

make it, but God bless him he gave us a deadline of October 1st

for distributing the first money. And if we don’t get a deadline, and

if we don’t get a commitment in some framework, we are going to

be waiting for 40 years. So in all sincerity, it is a sincere question.

Mr. SHAYS. Could you respond?

194

Dr. HOWARD. In terms of the treatment money, yesterday after

our meeting with the Secretary we sent out to the grantees, some

who were sitting very close to me, an e-mail solicitation of 15 items

that we need from them to immediately begin this process, so we

can get their applications in writing and we can begin the review

process, so we can meet that October date.

So that is the important thing. With regard to the World Trade

Center fatality investigations program, we have——

Mrs. MALONEY. May we have a copy of those items?

Dr. HOWARD. Sure. I will send you the e-mail. They will be receiving even more detail——

Mr. SHAYS. Send the full committee the e-mail as well.

Dr. HOWARD. They will be receiving an e-mail on Monday, which

even contains more detailed requirements. So that is moving forward. We hope that we can meet that date. I have every indication

we can.

With regard to the World Trade Center fatality investigations

program, which we talked about, the Commissioner mentioned, we

have a draft which will be coming out for external review next

week. I would like to thank the Mt. Sinai Medical Center, Dr.

Landergen, and others who have worked on that as well.

Mrs. MALONEY. May we see——

Dr. HOWARD. Of course you can. It will be out for external review. And the Health Department. This is a combined effort, and

I would like to thank all of the partners for that.

Mr. SHAYS. Thank you. Let me just ask you, Dr. Howard, one

last question that Vito Fossella wanted to ask. He said——

Mrs. MALONEY. But, sir, you didn’t answer the full plan. We can’t

wait 40 years. Can you give us a general——

Dr. HOWARD. You know, as I have mentioned, I am hoping that

the Secretary’s task force that does give policy guidance will be

able to assist me in that regard.

Mr. SHAYS. Dr. Howard, this is from Vito Fossella. He said, ‘‘Dr.

Howard, at our meeting yesterday Secretary Leavitt announced the

formation of a new task force dedicated to the long-term health

needs of September 11th first responders. In your role as September 11th coordinator, you have already been extremely effective,

and we want to make sure you remain an integral part of this effort. Can you explain how your role will or will not change in the

context of this new task force?

Dr. HOWARD. As I explained before, my role—eyes and ears—as

a program coordinator here on the ground in New York City, will

be to liaison with this high-level policy guidance task force that

will give the Secretary his policy guidance.

Mr. SHAYS. And you will be a part of that task force?

Dr. HOWARD. Yes, sir.

Mr. SHAYS. Fine.

Mrs. MALONEY. Thank you.

Mr. SHAYS. Thanks all very much. We appreciate your testimony.

We want to thank you.

This hearing is adjourned.

[Whereupon, the subcommittee was adjourned.]

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