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9/11 HEALTH EFFECTS: FEDERAL MONITORING

AND TREATMENT OF RESIDENTS AND RESPONDERS

HEARING

BEFORE THE

SUBCOMMITTEE ON GOVERNMENT MANAGEMENT,

ORGANIZATION, AND PROCUREMENT

OF THE

COMMITTEE ON OVERSIGHT

AND GOVERNMENT REFORM

HOUSE OF REPRESENTATIVES

ONE HUNDRED TENTH CONGRESS

FIRST SESSION

FEBRUARY 28, 2007

Serial No. 110–2

Printed for the use of the Committee on Oversight and Government Reform

(

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

http://www.oversight.house.gov

(II)

COMMITTEE ON OVERSIGHT AND GOVERNMENT REFORM

HENRY A. WAXMAN, California, Chairman

TOM LANTOS, California

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

JOHN F. TIERNEY, Massachusetts

WM. LACY CLAY, Missouri

DIANE E. WATSON, California

STEPHEN F. LYNCH, Massachusetts

BRIAN HIGGINS, New York

JOHN A. YARMUTH, Kentucky

BRUCE L. BRALEY, Iowa

ELEANOR HOLMES NORTON, District of

Columbia

BETTY MCCOLLUM, Minnesota

JIM COOPER, Tennessee

CHRIS VAN HOLLEN, Maryland

PAUL W. HODES, New Hampshire

CHRISTOPHER S. MURPHY, Connecticut

JOHN P. SARBANES, Maryland

PETER WELCH, Vermont

TOM DAVIS, Virginia

DAN BURTON, Indiana

CHRISTOPHER SHAYS, Connecticut

JOHN M. MCHUGH, New York

JOHN L. MICA, Florida

MARK E. SOUDER, Indiana

TODD RUSSELL PLATTS, Pennsylvania

CHRIS CANNON, Utah

JOHN J. DUNCAN, JR., Tennessee

MICHAEL R. TURNER, Ohio

DARRELL E. ISSA, California

KENNY MARCHANT, Texas

LYNN A. WESTMORELAND, Georgia

PATRICK T. MCHENRY, North Carolina

VIRGINIA FOXX, North Carolina

BRIAN P. BILBRAY, California

BILL SALI, Idaho

——— ———

PHIL SCHILIRO, Chief of Staff

PHIL BARNETT, Staff Director

EARLEY GREEN, Chief Clerk

DAVID MARIN, Minority Staff Director

SUBCOMMITTEE ON GOVERNMENT MANAGEMENT, ORGANIZATION, AND PROCUREMENT

EDOLPHUS TOWNS, New York, Chairman

PAUL E. KANJORSKI, Pennsylvania

CHRISTOPHER S. MURPHY, Connecticut

PETER WELCH, Vermont

CAROLYN B. MALONEY, New York

BRIAN P. BILBRAY, California

TODD RUSSELL PLATTS, Pennsylvania,

JOHN J. DUNCAN, JR., Tennessee

MICHAEL MCCARTHY, Staff Director

(III)

C O N T E N T S

Page

Hearing held on February 28, 2007 ....................................................................... 1

Statement of:

Agwunobi, Admiral John O., M.D., MBA, MPH, Assistant Secretary for

Health, Department of Health and Human Services; and John Howard,

M.D., MPH, J.D., Director, National Institute for Occupational Health,

Centers for Disease Control and Prevention, Department of Health

and Human Services ..................................................................................... 19

Agwunobi, John O. .................................................................................... 19

Gibbs, Linda I., co-Chair of Mayor Bloomberg’s World Trade Center

Health Panel and New York City deputy mayor for health and human

services; Edward Skyler, co-Chair of Mayor Bloomberg’s World Trade

Center Health Panel and New York City deputy mayor for administration, accompanied by Joan Reibman, M.D., associate professor of medicine and environmental medicine, director NYU/Bellevue Asthma Center, director of Bellevue WTC Environmental Health Center; David

Prezant, M.D., chief medical officer, Office of Medical Affairs, co-director, WTC Medical Monitoring and Treatment Programs, New York

City Fire Department; Eli J. Kleinman, M.D., supervising chief surgeon, New York Police Department; Robin Herbert, J.D., director,

World Trade Center Medical Monitoring Program Data and Coordination Center, associate professor, Department of Community and Preventive Medicine, Mount Sinai School of Medicine; Jonathan Sferazo,

disabled union iron worker; and Marvin Bethea, paramedic .................... 43

Bethea, Marvin .......................................................................................... 88

Gibbs, Linda I. ........................................................................................... 43

Herbert, Robin ........................................................................................... 77

Sferazo, Jonathan ...................................................................................... 92

Skyler, Edward .......................................................................................... 52

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

Agwunobi, Admiral John O., M.D., MBA, MPH, Assistant Secretary for

Health, Department of Health and Human Services, prepared statement of ........................................................................................................... 21

Bethea, Marvin, paramedic, prepared statement of ...................................... 90

Fossella, Hon. Vito, a Representative in Congress from the State of

New York, prepared statement of ................................................................ 10

Gibbs, Linda I., co-Chair of Mayor Bloomberg’s World Trade Center

Health Panel and New York City deputy mayor for health and human

services, prepared statement of ................................................................... 46

Herbert, Robin, J.D., director, World Trade Center Medical Monitoring

Program Data and Coordination Center, associate professor, Department of Community and Preventive Medicine, Mount Sinai School of

Medicine, prepared statement of ................................................................. 80

Kleinman, Eli J., M.D., supervising chief surgeon, New York Police Department, prepared statement of ................................................................. 74

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

of New York, prepared statement of ........................................................... 99

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

New York, prepared statement of ................................................................ 5

Prezant, David, M.D., chief medical officer, Office of Medical Affairs,

co-director, WTC Medical Monitoring and Treatment Programs, New

York City Fire Department, prepared statement of .................................. 67

Reibman, Joan, M.D., associate professor of medicine and environmental

medicine, director NYU/Bellevue Asthma Center, director of Bellevue

WTC Environmental Health Center, prepared statement of .................... 60

Page

IV

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

Sferazo, Jonathan, disabled union iron worker, prepared statement of ...... 94

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

of Connecticut, prepared statement of ........................................................ 111

Skyler, Edward, co-Chair of Mayor Bloomberg’s World Trade Center

Health Panel and New York City deputy mayor for administration,

prepared statement of ................................................................................... 55

Towns, Hon. Edolphus, a Representative in Congress from the State

of New York, prepared statement of ........................................................... 16

(1)

9/11 HEALTH EFFECTS: FEDERAL MONITORING AND TREATMENT OF RESIDENTS AND

RESPONDERS

WEDNESDAY, FEBRUARY 28, 2007

HOUSE OF REPRESENTATIVES,

SUBCOMMITTEE ON GOVERNMENT MANAGEMENT,

ORGANIZATION, AND PROCUREMENT,

COMMITTEE ON OVERSIGHT AND GOVERNMENT REFORM,

Washington, DC.

The subcommittee met, pursuant to notice, at 12 p.m., in room

2247, Rayburn House Office Building, Hon. Edolphus Towns (chairman of the subcommittee) presiding.

Present: Representatives Towns, Murphy, Welch, Maloney, Nadler, Bilbray, Duncan, Platts, and Fossella.

Staff present: Michael McCarthy, staff director; Rick Blake, professional staff member; Velvet Johnson, counsel; Cecelia Morton,

clerk; Lakeshia Myers, editor and staff assistant; Susie Schulte and

Christopher Bright, minority professional staff members; and Benjamin Chance, minority clerk.

Mr. TOWNS. The subcommittee will come to order. Welcome to today’s hearing to help the thousands of New York City residents

who were exposed to dangerous toxins after the terrorist attacks on

the World Trade Center. This is the first hearing of the Government Management Subcommittee in this Congress. We are taking

on the issue of 9/11 health effects for two reasons: First, it is a sign

of how important this issue is for the House Oversight Committee.

Second, we want to continue the bipartisan work that was done on

this issue in the previous Congress and set the tone for continued

cooperation in this subcommittee to make sure our 9/11 responders

and affected residents get the health care they need. We also want

to work toward our larger goal of making sure Government is

working effectively and efficiently for all Americans.

I have invited several members of the New York City delegation,

and Mr. Shays, to be here today, and I would ask unanimous consent that they be able to participate in this hearing. It is our practice to recognize members of the committee first, then after that,

we can go to other Members who are present. We also have with

us Congressman Nadler, who is from New York, and of course,

from within the district in which the incident occurred. We are delighted to have him with us and we will extend the same courtesy

to him. Hearing no objection, that’s an affirmative.

We also have here my colleague from New York, Mr. Fossella. I

would also like to thank my colleague, Mrs. Carolyn Maloney, who

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I understand is on her way. She has also played a great role in

planning today’s hearing and I want to thank her for that. Mrs.

Maloney has been called to the House floor.

Due to time constraints, the Chair and ranking member will each

have 5 minutes to make opening statements. I don’t like to do that,

but on this particular day we will have no choice. So at this time,

I would like to yield to the ranking member.

Mr. BILBRAY. Thank you, Mr. Chairman. Mr. Chairman, I appreciate the fact that the bipartisan team from the region that was attacked so terribly so many years ago, and that is living with the

problems and the repercussions of that attack by Al Qaeda every

day, I think that bipartisan approach is what American people not

only want but expect from us, and I appreciate the fact that on this

issue we have given, I think, the American people the kind of leadership that they have been desiring.

Mr. Chairman, I think that we need to remember that this

wasn’t just an incident, it was an attack by a foreign body against

the people of the United States, not just an incident in New York.

The terrorist attack was unprecedented. The response was appropriate in the matter of the American people call to arms and to protect our neighbors. The impact of the response, and let me just say

this, those of us that are involved in emergency response understand it. Those of you that have never been in an emergency team

may not. But to ask a firefighter, a paramedic, a lifeguard, a police

officer not to respond to this kind of incident is asking for the world

not to spin for 24 hours, asking to fight the laws of nature. Those

of us who are involved in emergency response, a response is natural and immediate, and is not voluntary. You go in because that

is what you do.

I think that kind of response is what we desperately need in this

country. We have to understand the repercussions of that kind of

response is something we need to address.

It is not an issue that just affects New York and Connecticut and

the surrounding areas. We had responders from San Diego getting

out and going into the area as quickly as possible. This is a national issue. It was an attack by foreign powers on U.S. soil, but

it was a response by all of America.

I think the brave individuals who exposed themselves to the

toxics, to all of the environmental threats here, need to be addressed here. We need to remind ourselves that the problems have

not gone away. They are with us today. I think the President including $25 million in the budget for the coming year as placing

a placeholder is a step in the right direction. But I think that we

need to make sure that what resources we put to addressing the

problems are as effective and comprehensive as possible.

Finally, let me say, there is no disagreement with the fact that

things could have been done better. All I have to say is that anyone

who has ever managed an emergency response effort will always

know that after the response, there is a process that we call debriefing, where everyone understands there are things that could

have been done better. There were breakdowns in systems, that

emergency response, much like war, is organized chaos. And you

just hope to minimize that level of chaos and inefficiency.

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So hopefully, we will be able to build from and learn from that,

move forward from here. Again, Mr. Chairman, I appreciate the

chance to have this hearing. I hope we all remember that this was

not a natural disaster. This wasn’t something that happened to one

State or one community. This was an attack by a foreign power directed at the American people. And the target here happened to be

New York and Washington, DC.

But it just happened to hit those two cities because the people

wanted to strike at the American people, not New Yorkers or

Washingtonians. I think that is one of the things that all of us

need to remember. Again, this was an attack by a foreign power,

this was caused by an attack by a foreign power and we have to

remind ourselves again and again that the enemy is still out there.

The enemy created this situation and we need to make sure we address it appropriately.

At this time, I will yield back, Mr. Chairman.

Mr. TOWNS. Thank you very much. We will give each Member 2

minutes for an opening statement. We have time restrictions, let

me go to Mr. Nadler from New York.

Mr. NADLER. Thank you, Mr. Chairman. Let me say at the beginning I appreciate the consideration shown to me to enable me to

sit in on this hearing, though I am not a member of this committee.

I have an opening statement which I would ask be put into the

record. It is considerably longer than 2 minutes, I won’t read it

now.

Mr. TOWNS. Without objection, so ordered.

Mr. NADLER. Thank you. Let me just say that I hope that this

is the first of a series of hearings, both in this committee and other

committees in the House, and I know Senator Clinton is going to

hold a hearing in the Senate, that will begin to deal with these

problems.

I have had to spend the better part of my last 5 years in public

life cajoling the Federal Government to tell the truth to its citizens

about 9/11 air quality, insisting that there must be a full and proper cleanup of the 9/11 environmental toxins that to this day are

still poisoning New Yorkers, because they were never properly

cleaned up, and for those already sick, demanding that the Government provide long-term comprehensive health care. I hope that today’s hearing will be the beginning of a process under which we

can achieve what I believe are the four things that we must

achieve.

First, to increase and expand the Federal funds that are beginning to be made available to provide for long-term monitoring and

treatment of all the victims of 9/11. Second, to bring into this process and to be clear that we are covering and giving the same help

to residents and workers, not just to first responders, because it is

clear that residents and workers in lower Manhattan and Brooklyn, maybe in Queens, we are not even sure where, were also affected by this.

Third, to get the Federal Government to do the proper inspection

and environmental cleanup of New York and possibly New Jersey

that was recommended by the EPA Inspector General 3 years ago,

without which we will continue to poison people for decades to

come, unknowingly, from toxins that are still present inside buildVerDate 11-MAY-2000 11:38 May 14, 2007 Jkt 000000 PO 00000 Frm 00007 Fmt 6633 Sfmt 6633 C:\DOCS\34912.TXT HGOVREF1 PsN: HGOVREF1
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ings, city government buildings, State government buildings, and

regular non-government buildings all over perhaps Manhattan,

Brooklyn, Queens, northern New Jersey, for all we know.

And finally, that there should be a comprehensive medical

screening and long-term care system put into place for all these

people that is not dependent on annual appropriations in the future from Congresses and Presidents who may be more or less sympathetic or ignorant than this Congress is in the future. Because

this problem is going to be with us for the next 30 or 40 or 50

years.

So I hope this is the beginning of this process, and I thank you,

Mr. Chairman.

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

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Mr. TOWNS. You can be assured that we will be holding additional hearings because this is a very important issue.

Now let me recognize the person who was the Chair of this subcommittee in the last Congress, who did a magnificent job, while

setting a model in terms of how important it is to work together

in a bipartisan fashion. I want to say to you, Mr. Platts, that I plan

to continue in that same spirit.

Mr. PLATTS. Thank you, Mr. Chairman. I don’t have a formal

opening statement either, but I do commend you for holding this

hearing today. I especially want to congratulate you, Mr. Chair. It

was an honor to serve as Chair of this subcommittee and it is indeed an honor to serve with you. Thank you, Mr. Chairman.

Mr. TOWNS. Thank you very much.

Now Congressman Murphy.

Mr. MURPHY. Thank you, Mr. Chairman. I don’t have a formal

opening statement, either, except to say that it is a great honor,

as a new Member, to be sitting here with both you and Ranking

Member Bilbray as well as our colleagues from New York who have

led this fight so valiantly, paying no attention to party or ideology.

My only point of introduction is to say that Connecticut also sent

many brave men and women down in those days, weeks, and

months, following that tragic event and are now suffering from

those same very effects that have befallen those in the districts of

Mr. Nadler and Mr. Fossella and so many others who have fought

for this issue.

So I am very happy and honored to be part of this subcommittee

and very glad that this is our opening salvo as a subcommittee into

an issue which has great regional importance for the ConnecticutNew York-New Jersey region. Thank you.

Mr. TOWNS. Thank you. Let me turn to my colleague from New

York, Congressman Fossella.

Mr. FOSSELLA. Thank you, Mr. Chairman.

[The prepared statement of Hon. Vito Fossella follows:]

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Mr. TOWNS. Thank you very much, Mr. Fossella.

The attacks that destroyed the World Trade Center on September 11, 2001 created a human tragedy on an enormous scale. That

day we knew immediately that thousands had lost their lives in the

collapse of the Twin Towers. What we now know is that the toxic

environment created when the towers collapsed claimed still more

victims. First responders, rescue, recovery and clean-up workers,

volunteers from all 50 States, area residents, office workers, and

school children. All may have been exposed to a range of dust,

smoke and toxic pollutants.

Sometimes when people are hurt or killed in an accident, we say

that they were in the wrong place at the wrong time. For the responders who rushed to the scene of the World Trade Center on 9/

11, and those who worked on and around the pile afterwards, it is

just the opposite. They were in the right place at the right time,

doing their jobs, coming to the aid of their fellow citizens at the

hour of greatest need. Now many are suffering from a wide range

of diseases and disabilities and require medical care. It is our obligation as a Nation to make sure they get the care they need.

The range of people who are now ill goes beyond just those responders who were working at or around Ground Zero right after

the attacks. The collapse of the towers created an enormous dust

cloud that covered lower Manhattan, then blew east across the

river and through Brooklyn. New York City residents and workers

were exposed to these toxins with some developing serious illnesses. They too, are victims of 9/11. The Government has an obligation to treat people who have become sick and monitor those who

were exposed to toxins so we can identify, and prevent if possible,

diseases that emerge from people whose lives have been greatly

disrupted.

Today’s hearing will examine what the Federal Government is

doing to help those suffering from 9/11-related illnesses. The answer is ‘‘not enough.’’ More than 5 years have passed since 9/11,

and just recently the Federal Government has finally put in place

some medical monitoring and treatment programs. These programs

are doing good work and we will hear from the doctors who are

treating patients with 9/11-related diseases.

But why has this happened so late? The Federal programs we

have right now suffer from two serious flaws. The first is that they

are not inclusive enough. The programs cover those who worked

and volunteered on the rescue and recovery effort, but there is no

Federal program for residents who were affected by the toxins in

the air. Not only is there no Federal plan to treat these residents,

there is not even a program to monitor them and gather essential

data that may help us track and treat 9/11-related illnesses.

The second problem is that the existing programs lack sufficient

and sustained funding. The programs are running out of money

and will have to shut down if this shortfall isn’t addressed. We

have a temporary fix from the administration, which is helpful, but

we need something more permanent. Some of the serious health effects from 9/11 are illnesses like post-traumatic stress disorder.

The last thing people suffering from these types of illnesses need

is fear and uncertainty that their treatment will be cutoff due to

lack of funding.

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The administration says they are working on a plan, but even

now it is not clear if that plan will include everyone who was exposed and everyone who is sick. Five and a half years after 9/11,

we need to have something better than what we have now, and we

need to have it right now.

I look forward to hearing from our doctors and first responders

about what the medical needs are, and from our government witnesses what they are doing to create inclusive and sustainable

medical monitoring and treatment programs.

The government has to do more to help people who are still suffering from the effects of 9/11. I hope we can learn more today

about how to help, and then work together to make sure it happens.

[The prepared statement of Hon. Edolphus Towns follows:]

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Mr. TOWNS. At this time, I would like to ask the witnesses to

please stand to be sworn in.

[Witnesses sworn.]

Mr. TOWNS. Our first panel is made up of two physicians and

leaders from the Department of Health and Human Services, Dr.

John Agwunobi, Assistant Secretary for Health at the Department

of Health and Human Services. He is also an Admiral leading the

Commissioned Corps of the U.S. Public Health Service.

We also have with us Dr. John Howard, who is the Director of

the National Institute for Occupational Safety and Health at HHS.

He is a board certified specialist in internal medicine and occupational medicine, as well as an attorney, and serves as a Federal 9/

11 health coordinator at HHS.

Why don’t we just start with you, Dr. Agwunobi?

STATEMENTS OF ADMIRAL JOHN O. AGWUNOBI, M.D., MBA,

MPH, ASSISTANT SECRETARY FOR HEALTH, DEPARTMENT

OF HEALTH AND HUMAN SERVICES; AND JOHN HOWARD,

M.D., MPH, J.D., DIRECTOR, NATIONAL INSTITUTE FOR OCCUPATIONAL HEALTH, CENTERS FOR DISEASE CONTROL

AND PREVENTION, DEPARTMENT OF HEALTH AND HUMAN

SERVICES

STATEMENT OF JOHN O. AGWUNOBI

Dr. AGWUNOBI. Good afternoon, Chairman Towns and distinguished members of the subcommittee. As was just indicated, my

name is John Agwunobi and I am indeed the Assistant Secretary

for Health for the U.S. Department of Health and Human Services.

Beside me is a close colleague and friend, Dr. John Howard. He

is the Director of NIOSH.

I thank you for holding this hearing on the Federal response to

the health impacts of 9/11. On September 11, 2001, within hours

of that terrorist attack, HHS, our Department, dispatched the first

group of emergency medical and mortuary teams to the New York

City area to assist local emergency personnel and health providers

in caring for those affected by the terrorist attacks on the World

Trade Center.

Within 8 days of the attacks, the Federal Government and the

State of New York jointly created and implemented a disaster relief

Medicaid waiver. Now, this Federal Government waiver, which was

provided to the State of New York as a Medicaid program, was to

the tune of about $333 million. It was designed to support the

treatment of individuals affected. Over 340,000 individuals eventually enrolled and were able to access the full array of medical benefits and treatments that were offered through that waiver.

Between 2001 and 2002, the Department released over $239 million, which went to support health centers and hospitals, mental

health programs and environmental monitoring, and research in

and around New York City for that same purpose. In early 2002,

NIOSH developed a baseline medical screening program to address

the gap in medical screening of World Trade Center responders.

This program was subsequently expanded in 2004 to provide longterm medical monitoring for the World Trade Center rescue and recovery workers and volunteers, including current and retired New

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York City firefighters. The medical monitoring program has now

conducted more than 30,000 initial examinations and 17,000 followup examinations since its inception back in 2002.

In 2002, the World Trade Center health registry was established.

This registry collects self-reported survey data to evaluate potential

short and long-term physical and mental health effects of the exposure to the disaster. So far, more than 71,000 individuals are currently enrolled in that registry. In 2006, $75 million was provided to further support existing

HHS World Trade Center programs and to provide treatment to responders, rescue workers and recovery workers. Thus far, based on

the reports from those responders and our partners and our analysis of some scientific analysis, Secretary Leavitt decided that we

needed to do more. He established an internal task force which I

chair, and Dr. John Howard is the task force’s co-chair.

The mission of the task force is to provide the Secretary with an

analysis of all the available data that we can get our hands on related to the World Trade Center associated health conditions, so

that the administration can devise a pathway to the future, a pathway that addresses the needs of care and the needs for more research. The World Trade Center task force is comprised of top

science and health policy experts from throughout the Department

of Health and Human Services. It actually began meeting back in

October of last year.

HHS continues to collect information pertaining to 9/11 health effects and is committed, absolutely committed, to providing passionate and appropriate support to the responders affected by the

World Trade Center, those that were exposed following the terrorist attacks. The President’s fiscal year 2008 budget does indeed include $25 million for the continuation of treatment for the World

Trade Center responders. The administration intends to review

this budget request, using all the data that we gather in our analysis, the task force’s work, as we look to the future.

Sir, I thank you again for this opportunity. I know that Dr. Howard and I would be happy to answer questions. I would just end

by saying, we believe that this is a very important, very, very important duty that we have been given, to analyze and review the

data in order to further advise the Secretary. I have no doubt that

he, upon hearing from us, will enter into dialog with Congress and

the administration. I look forward to working alongside all of you,

sir.

[The prepared statement of Dr. Agwunobi follows:]

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Mr. TOWNS. Thank you very much.

Dr. Howard.

Dr. HOWARD. Mr. Chairman, I don’t have a written statement, I

am in a supporting role today.

Mr. TOWNS. We thank you very much.

Let me begin by asking a few questions about the task force.

First of all, when will we get the report from the task force?

Dr. AGWUNOBI. Mr. Chairman, the task force, our work is largely

analytical in nature. We gather data, we review that data and we

are supposed to advise and inform the Secretary with what we

find. We currently are not engaged in the writing of a report for

public dissemination. We are actually engaged in trying to review

all the information so that we can advise the Secretary.

Mr. TOWNS. Now, are you including the area residents in this?

This is a serious problem, as you heard from some of our colleagues

in the opening statements.

Dr. AGWUNOBI. Very clearly there are many unanswered questions that relate to residents. I have no doubt that there will be

much dialog and discussion going forward on that subject. But the

work of the task force that John and I chair, Dr. Howard and I

chair, is focused on the responders to the event, firefighters, volunteers, retired workers, those that responded to the event, in the

day of and the days following.

Mr. TOWNS. Well, there is a school that was in the area and they

are complaining. It is a high school, and they are saying that as

a result of 9/11, that many young people now are having health

problems. So I was just wondering, would you include them in it

somehow? I am saying I think we should make treatment and care

inclusive.

Dr. AGWUNOBI. Yes, sir. The Secretary has asked us to report

back to him quickly with the data that we have, the analysis of the

information that we have. We will do that. If the Secretary then

asks us to go on and review further data or, I have no doubt, as

I have said, that there will be dialog on that issue going forward.

Mr. TOWNS. When will residents have access to the Federal programs?

Dr. AGWUNOBI. Following our completion of our analysis and our

presentation to the Secretary, Michael Leavitt, as to the breadth,

the scope, the issues involved in this particular situation, I have no

doubt, as I have said, that he will engage in dialog. That dialog will

no doubt include Congress and the rest of the administration. It is

a little unclear to me, sir, as to the exact time lines, as to that

process. I imagine you will be a part of that process as well.

But the current programs, as they were appropriated, the appropriations for the current programs focus the programs on responders, not on the residents. We are speaking now about the program

at Mount Sinai and the associated program at FDNY. My understanding is that the Bellevue program, which has funding from, I

think a little bit of funding from the Federal Government, most of

its funding is from the city. That program does actually allow residents into access for treatment.

Mr. TOWNS. Right. Well, will we know about it within 3 months,

6 months, a year? I hate to push you, but we need to know.

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Let me just say this. I don’t see this as a blame situation. I think

we all have to work on this together. I think that we need certain

information for us to be of assistance. I think that we are talking

about the lives of people from all over this country, all 50 States.

We are talking about young people in high school, and of course,

they are now complaining.

And these are issues that I think we have to recognize and have

to find ways and methods to deal them. So that is the reason why

I am really trying to push you on a timeframe.

Dr. AGWUNOBI. Sir, I would concur that urgency is important in

this situation. There are real people out there suffering and there

are individuals who are in need. Our process is designed to try and

gather data so we can use that data to design programs for the future.

The Secretary has been very, very straight on this with me. He

wants us to go as fast as we can, but he wants our analysis to be

based on data, as much data as we can gather. He has indicated

that he wants us to brief him in March, and we will. But that, as

I have said, is a part of a process that would no doubt include dialog with the administration and indeed, with Congress.

Mr. TOWNS. Thank you. I yield to the ranking member, Mr.

Bilbray.

Mr. BILBRAY. Thank you, Mr. Chairman. I apologize for turning

your mic off. Like everything else in this town, everything operates

opposite of the rest of the world.

Mr. TOWNS. Oh, you turned my mic off? [Laughter.]

Mr. BILBRAY. Yes, I just turned myself off, too. It’s typical, this

is the only town where you un-push something to get it to turn on.

Let me first ask, the city of New York and the locals seem to be

doing a very aggressive approach to this health risk assessment.

Frankly, as somebody who comes from the local, I was a disaster

preparedness chairman for a small, intimate group of 3 million people in San Diego County. I prefer to have the local people do as

much as humanly possible, because they tend to be more efficient,

more sensitive and more effective. But there is a situation where

this impacted and affected not just one municipality, it had a

broad, regional impact. What are we doing about monitoring the

impacts on the areas outside of the city of New York, in the adjacent areas? What kind of response are we getting there?

Dr. AGWUNOBI. If I may, I am going to turn over to my colleague

who has been involved in the monitoring from the very beginning.

But I will say that the work of the task force today does contemplate what you just said, the fact that even if it is not a big

portion of the individuals that are affected that live outside of New

York today, in the future it might be, as people retire and move

around the country. So as we think this through, as we perform

this analysis, we are contemplating the notion that it might need

to be something that has, whether it be quality, access or cost, it

needs to have a national scope to it in terms of our thinking and

our planning.

I will turn over to my colleague, Dr. Howard, if you want to add

on what we have done so far.

Dr. HOWARD. Sure. Mr. Bilbray, as a fellow San Diegan, I am

certainly very much aware of all the search and rescue and disasVerDate 11-MAY-2000 11:38 May 14, 2007 Jkt 000000 PO 00000 Frm 00037 Fmt 6633 Sfmt 6633 C:\DOCS\34912.TXT HGOVREF1 PsN: HGOVREF1
34

ter medical assistance teams that came from all over the United

States. Actually, when we have looked at that population of national responders, we find them in about 2,000 different zip codes

throughout the United States. So it is one of our, probably our

greatest challenge, is to be able to provide medical monitoring services and now treatment to that highly dispersed population.

So since the program began with both private as well as Federal

moneys, we have developed a network of clinics which are coordinated through Mount Sinai in which responders that are in other

States can avail themselves of medical monitoring services as well

as now treatment services. So that is probably, as I want to emphasize one more time, that is a significantly challenging area of our

program development. Because we are trying to put together a national set of clinics, the only kind of model for that in this country

is the Veterans Administration, for instance. There is really no national clinics that we have to rely on. So we are putting that together as we have gone through the last few years.

Mr. BILBRAY. The task force, how frequently has it met since its

inception in 2006?

Dr. AGWUNOBI. The task force has a structure where most of its

work is done not unlike here, in subcommittee. So we have a full

task force that has met three times since October and will probably

meet a couple of other times, maybe one more time before we are

completely done. But most of the work has been actually farmed

out to two subcommittees, one that focuses mostly on science and

research with a view to the future, what are we going to need in

the future in terms of research, in terms of clinical systems, clinical

issues and Dr. Howard has very kindly chaired that subcommittee.

The other subcommittee focuses on the issues of health financing,

the different, what are the costs and what are the projections into

the future and what are the different health financing models that

we need to study in order to fully inform the Secretary. Between

the different subcommittees, and there are small groups that break

off of them and meet, there have actually been quite a few meetings in between each, in the order of tens of meetings between the

main subcommittee meetings. So there has been a fair amount of

meeting going on. A lot of our work, because we are all in the same

department, is actually done in the hallways and in sidebars as we

meet continuously across the course of our business day. We are all

colleagues within the Department.

Mr. BILBRAY. As pointed out before, this is sort of a unique situation. In all fairness, from a disaster preparedness point of view, it

is so different because unlike people that live out west and know

they are moving into an earthquake area, know that is part of the

decision they are making as individuals, or people that move down

south into a hurricane area, you know there is an exposure there.

This is one that was totally unforeseen and can’t be foreseen. But

more importantly, the people in New York don’t have to worry

about earthquakes, and people in Chicago don’t worry about hurricanes.

But everybody has to worry about, in the future, the same situation could occur in any city. In San Diego, we have three nuclear

carriers, one of them with a big name across it called Ronald

Reagan. It is a sitting target. So the big key there is what do we

35

learn for future applications? What do we learn that can help us

prevent the kinds of long-term problems that we are seeing here

and the next response that we may have?

And let’s just stop a second and say, one thing we don’t do

enough of in this country is say, thank the Lord, thank the system,

thank the Government for doing the right things we do. And one

of the right things is, we haven’t seen this happen again. I think

we take it too much for granted that it hasn’t happened. But what

are we doing to prepare in case it happens again, if Chicago is hit,

if San Francisco is hit? Where are we looking at this kind of thing?

And I can just imagine the respiratory issue. Don’t send anybody

in unless they have the right equipment. Does that mean that we

try to provide this equipment to every local responder? Is that

going to be cost effective? Or are we talking about having a mobile

capability to bring in this kind of equipment to be available wherever it happens? We are looking at that prevention in the future

if another incident occurs.

Dr. AGWUNOBI. One of the tasks of the science subcommittee of

our task force is to see through research whether or not there are

lessons that we can learn from those that are tragically affected

today, lessons in terms of diagnosis, lessons in terms of treatment.

The task force, however, is not performing an after-action, a review, an audit of the events that occurred on 9/11 and the days

that transpired. Those after-actions were done or are being done,

I would imagine, at the different levels of agencies, cities, State,

and the Federal Government when they work on how they did and

how can they do it better. Our focus has been on the victims that

are suffering as a result of exposure today and how can we learn

from their experience going forward in order to assure that the systems that we use to, in these circumstances in the future, are responsive to the needs of the victims.

Mr. BILBRAY. Mr. Chairman, I appreciate the time. I just want

to say that one of the problems for those of us who will be at the

local government level or the local community level, if we don’t

know the health risks, at least some projection of risk out there,

how do we know a good example of downwind, do you shut down

the schools like we would with an air response, don’t let the kids

out or do we move them out of the area. Those kinds of questions,

we need to have the health data on to be able to make those local

decisions in case it happens again.

Dr. AGWUNOBI. Sir, that is exactly the sort of thing that the

science subcommittee is learning and hopefully we are going to

have research going forward that helps us answer many of these

questions.

Dr. Howard, did you want to add to that?

Dr. HOWARD. I will just add that the World Trade Center health

registry, which is operated by the New York City Department of

Health and Mental Hygiene, is envisioned to be a 20 year project

that will gain a lot of data about population health.

The issue that you mentioned is really huge. When you look at

it from the perspective of the responders and what we are dealing

with now in terms of their symptomatology, their lung function abnormalities, in the Department, what we are doing is looking at

pre-deployment preparation, during deployment services that are

36

necessary for responders and post-deployment, debriefing, medical

evaluations, etc. So we are looking from all the lessons that we are

deriving from the medical and scientific literature from this event

and trying to design a program that will cover all three phases of

responder deployment.

Mr. TOWNS. Thank you.

I recognize Mr. Murphy.

Mr. MURPHY. Thank you, Mr. Chairman.

I come at this from a slightly different perspective than some

people sitting around this table. I wasn’t a Member of Congress

when this happened, I was a member of the public going through

it with my community in Connecticut, like everyone else did. And

so Doctor, when I hear you talk about the need for urgency here,

and then I also hear that 5 years after the fact, we are convening

the first task force that is going to start to look into a comprehensive health care strategy, there is a disconnect there for me, there

is a disconnect for the folks in my district, there is a disconnect for

the folks in Connecticut who went down and assisted in this effort.

And so my question is very simple. What is your answer to people who say that 5 years after the fact, after putting in very small,

relatively small amounts of money that simply don’t comport with

the estimates that have been given by Dr. Howard’s organizations

and others, as to the full cost of this, how do you provide an answer

to people who have said that the only reason we are even here

today is that you have come kicking and screaming to the table,

being dragged there by members of the New York delegation and

advocates? What is your answer to folks who just don’t buy that

there is a sense of urgency coming from the administration?

Dr. AGWUNOBI. The administration’s commitment is to make sure

that where there are unmet needs, that those needs are met, and

where there are lessons learned from science, that those lessons

are applied. Many of the conditions, I will defer to my colleague to

give you detail on this, but many of the World Trade Center related

illnesses are an emerging phenomena, in that we are learning with

the passage of time that No. 1, they are related, and that No. 2,

that there are needs that are specific to that population, to those

specific conditions, that need to be met.

We recognize that over the long run, there are going to be needs

that our work has to meet. But we are committed to trying to use

data and science that has been gathered, that is gathering over

time. The data will improve even going forward. Our commitment

is to use that data to construct systems and responses that are sustained and that make a difference. Because they are founded in

science, founded in what we have learned.

Mr. MURPHY. Here is the problem as I see it, or one of the problems. It sounds to me as if what you are saying is that you want

to very methodically and carefully make sure that the diseases and

the complications, the health complications are directly related to

what happened on that site. But for the folks that rushed down

there, they didn’t wait to see the data or the science on what those

chemicals were going to do to their body. They saw this as a national emergency. And the response back that we are hearing today

is, well, we have to be very careful about how we go about the

treatment to make sure that the science is right.

37

Well, the folks that went down there didn’t make sure the

science was right and they are suffering for it. So shouldn’t there

be a sense that maybe we should err on the side of inclusiveness

instead of erring on the side of making sure the science is exactly

right?

Dr. AGWUNOBI. Sir, indeed, the Federal Government, the city especially and philanthropy, in a very real way, provided care from

the very beginning. What we are talking about here today is what

do we design for the future? What do we design to assure that the

needs of the individuals that are being met today are met 60, 50,

40 years from now? It is true that in response to 9/11, these heroes,

and that is what they were, responded without second thought,

emergently, to the event. It is also true that the health community

responded right on their heels, whether it was Federal programs,

State programs, philanthropic programs. The world rallied, the

health world rallied to the site. That is why Mount Sinai, that is

why FDNY, that is why other programs have been there working

pretty much from the beginning.

Now, what our job is going forward is to make sure that Government, all of us, that we make sure that these programs, that programs are there for people to meet their needs in the future.

Mr. MURPHY. I yield back the balance of my time, Mr. Chairman.

I guess my point is that I think it is hard to make the case when

we are seeing estimates that this is going to have an annual cost

of anywhere from $250 million to $390 million, that a President’s

budget that includes $25 million is evidence of our national Federal

health care community rallying to the cause. I hope that is a

placeholder, because we know and you know, Dr. Howard certainly

does, because he has looked at these numbers, know that it is going

to take a lot more to convince a lot of us in Congress that we are

indeed putting our money where our mouth is on this issue.

So I yield back the balance of my time, Mr. Chairman.

Mr. TOWNS. You don’t have anything to yield. [Laughter.]

Congressman Duncan.

Mr. DUNCAN. Thank you, Mr. Chairman.

Dr. Agwunobi, you mentioned the figure 340,000 at one point.

Was that the number eligible? Or maybe I misunderstood that.

Dr. AGWUNOBI. Yes.

Mr. DUNCAN. That is what I thought you said. The staff said that

was the number eligible, but you have 340,000 actually enrolled.

Dr. AGWUNOBI. Following the attack, the Federal Government

provided the State of New York, through its Medicaid program,

pretty quickly, within weeks, a $330 million waiver to help support

the care of individuals in the months and years that followed. Over

340,000 individuals enrolled in that program and received care as

a result of that program.

Mr. DUNCAN. Well, let me ask you this. I have seen in Tennessee

and throughout the country, we have this sick workers program for

the Department of Energy. We have found that many, many people, because there is a big pot of money there, they are coming in

and claiming money, even family members, of people who weren’t

exposed. So we are finding that we have to be somewhat skeptical

of some of these claims to be fair to the taxpayer.

38

Now, I know every Government agency wants to expand its mission and expand the number of people that it is taking care of or

helping out. But is somebody being at least a little bit skeptical

about whether all these things are related to 9/11? In other words,

what I am getting at is this: I sure don’t want to sound mean, but

if 9/11 had never happened, all of these people would have gotten

sick, would have gotten various types of diseases, would have gotten cancer or other forms of disease. Everybody would, all of them

would have died at some point, hopefully after a long life.

But are we at the point now where anything that ever goes

wrong with these people is going to be in some way tied in to 9/

11? I mean, if somebody comes in with measles, where we do draw

the line here? Is this a program that you are talking about it lasting 50 or 60 years, you are talking about it already ballooning to,

one of our colleagues just said $390 million. Is it going to be a

multi-billion dollar program in the very near future?

Dr. AGWUNOBI. Sir, the task force, our work, analyzing information and bringing together data in order to inform the Secretary

and the administration, we haven’t approached this with skepticism. We have approached this with a deep-seated respect for

science and for data. One of the reasons we are being deliberative

about this is that we believe you should start with a foundation of

solid data, where you have that available to you, and with science.

As to the rest of your question, related to the kinds of diseases, we

are very proud of the work that NIOSH has done, we are very

proud of the work that clinicians and others across the community

have done in gathering data.

Dr. Howard, did you want to talk a little bit to the kinds of conditions, the kinds of patterns that you are seeing?

Mr. DUNCAN. You are going to have to do it very quickly, because

we have votes unfortunately that are starting. I apologize.

Dr. HOWARD. I will just mention, Mr. Duncan, that also being in

the same institute that handles the Energy Employees Occupational Compensation Program, it is extremely important that we

have the best, the most fulsome, the most robust science. Right

now what we are seeing are associations between exposure and certain populations.

I would have to look chiefly, and I would be happy to give you

information, and the fire department medical officers are here

today. If we look at that cohort of individuals, all of which are

being examined, all of which were exposed, we look at the literature that has come out of that particular experience. We see

people not only with symptomatology, primarily respiratory, but we

see lung function abnormalities, objective tests. And that is our

best indicator, these are the people that were maximally exposed.

Then we go from there to other cohorts, then to other affected

populations. As we go through that sort of transition, there are

variable levels of association that we are seeing.

Mr. DUNCAN. Well, all I am saying is, we need to take care of

things that are directly attributable to the events of 9/11. But we

can’t just take care of anything that happens to anybody just because there happens to be a pot of money there and they happen

to be in this pool. I had a group of these sick workers from Oak

Ridge who came to see me one time. One woman broke down and

39

cried and said that the work at Oak Ridge killed her father. And

I started asking here what his story was, and he had retired at the

age of 62 and had died 27 years later. I can tell you, almost every

man around would say 89 good healthy years of living is a pretty

good deal.

But at any rate, I think some people just need to look at this

very closely before it just balloons totally out of control. Thank you

very much.

Mr. TOWNS. Congressman Welch.

Mr. WELCH. I yield my time to my colleague from New York.

Mr. NADLER. I thank you very much.

Let me say that I am very cognizant of the very important need

to increase the funding and make it a reliable stream to the centers

of excellence in New York, to Mount Sinai, to Bellevue, which by

the way, Bellevue has not received any Federal funding as far as

I know, and to expand other programs that would treat a huge percentage of the 9/11 health cases. But I have a couple questions.

No. 1, how do we deal with the fact going forward 15, 20, 30

years from now that the current Federal funding approach is subject to the whims of an annual appropriation process? Shouldn’t we

be looking at setting up some sort of an ongoing, automatic system,

so that people who because of 9/11 are still struggling with emphysema or cancer or whatever, 30 years from now don’t have to worry

about an annual appropriation process?

Dr. AGWUNOBI. Sir, I am poorly qualified to comment on the annual appropriations process. It is one that I work for and live

under and respect greatly. I do believe, however, that it is important that we give this planning, this process, a long-term horizon,

that we focus not just on today’s needs or on today’s population,

but on the needs of that population in the future.

Mr. NADLER. Thank you. Second, your task force is focusing very

strongly and properly so, as far as it goes, on the first responders,

the people who worked on the pile and many of whom, 70 percent

of whom, according to the Mount Sinai report, are getting sick. But

my concern is and has been for a long time, what about residents

in the area? What about workers who come in to work in that area,

not only that day, but subsequent? We know some people who have

gotten sick because they work for the SEC, the Securities and Exchange Commission, in a building nearby. And they have lung-related problems now, because they worked in a building that was

not a Federal Government building, not properly cleaned up after

the disaster.

So what is your task force doing about looking at the question

of residents, workers, students, living in New York on the day of

the disaster, or in Connecticut or New Jersey, and after the disaster? In particular, we know that the Inspector General of EPA said

that they never did a proper cleanup, that thousands of buildings

may still be contaminated, and that people may be being poisoned

on an ongoing basis. Are you looking at that question, at implementing perhaps the EPA Inspector General’s recommendations for

how to deal with that question, and if not, why not?

Dr. AGWUNOBI. Sir, the task force’s charge is very clear. We look

at issues that relate to responders.

40

Mr. NADLER. So in other words, there is nobody in the executive

branch now that you know of of the Federal Government looking

beyond the responders?

Dr. AGWUNOBI. I have no doubt, however, that information on

residents will be a part of the dialog on the data and science at the

Department of Health and Human Services.

Mr. NADLER. Well, in terms of being a part of that dialog, you

do realize that the EPA abolished the Office of Ombudsman of the

EPA, because they told them what they should be doing. They have

disregarded the EPA’s Inspector General, who 3 years ago told

them what they should be doing. They have disbanded scientific

advisory panels, who also told them what they should be doing.

And they have ignored every single recommendation and conducted

so-called cleanups that the EPA Inspector General characterized as

phony cleanups. And that as far as we know, the Federal Government is doing nothing to protect the health of people who live and

work in the New York area from the ongoing contamination that

every scientific body that has looked at it at the request of the Federal Government said is ongoing and is not being dealt with.

Dr. AGWUNOBI. Sir, I represent the Department of Health and

Human Services.

Mr. NADLER. Let me then apologize for unloading on HHS what

is really a question for EPA and for the President and for the Federal Government. I do that because we have been stonewalled for

5 years so far when we try to raise this question anywhere else.

It is, as far as I am concerned, two cover-ups were conducted. One

cover-up was of the health effects of the first responders. That

cover-up started unraveling a year ago with the Mount Sinai report

and then with some very good work done by, in particular, the

Daily News of New York. And now at least we are talking about

it, the task force is appointed, etc.

But the other cover-up is still going on. And that cover-up is of

the fact that large areas, well, we don’t know if there are large

areas, but potentially large areas of New York City, New Jersey,

etc., were contaminated, were never properly cleaned up and are

poisoning people to this day, so that we may see thousands of cancer, asbestosis, lung cancer, whatever, 15 years from now. We have

to uncover that cover-up and get it out to the public and have the

Federal Government deal with that, as well as the fact that the

Federal Government is first beginning to deal with the first responder problem.

Thank you.

Mr. TOWNS. Let me thank the gentleman. At this time, we will

hear from Mr. Fossella. We have votes on the Floor, and immediately after Mr. Fossella, we will adjourn until 1:30.

Mr. FOSSELLA. Thank you, Mr. Chairman. I think part of this

hearing process is education, judging by some of the questions and

speculation. Clearly, as someone who always wants to insure that

taxpayer money is spent wisely, I think we have an education process. I would like to submit for the record Mayor Bloomberg’s report.

On page 3, it lists the eligibility criteria that was established by

Mount Sinai for those who can participate in the program.

Mr. TOWNS. Without objection.

41

[NOTE.—The referenced information entitled, ‘‘Addressing the

Health Impacts of 9–11, Report and Recommendations to Mayor

Michael R. Bloomberg,’’ may be found in subcommittee files.]

Mr. FOSSELLA. Thank you, Mr. Chairman. Because it is clear

that still many Americans don’t fully appreciate the tens of thousands, if not hundreds of thousands of people who were left exposed and are suffering as a result of 9/11. And they will continue

to do so for years to come. I think it is essential that we get and

build that support.

Dr. Agwunobi, has HHS completed its internal cost estimate, or

at least has a project of what it would cost in this coming fiscal

year and beyond?

Dr. AGWUNOBI. Sir, we have. Our process involves, as I said, reviewing all the data, doing an analysis of that, informing the Secretary. He will then take the next step, which is to engage in dialog. Let me just say that we don’t stop at costs, we look at what

are the ways to assure quality care for these people. Then you

move to what is the best way to assure access to that quality care,

the structure of the system, how it lays out across the Nation, what

are the best ways to assure access to that quality care. Only then

do we say, OK, of the different ways this might be done, what are

the different costs.

Mr. FOSSELLA. OK. I am going to try to ask you, and I appreciate, given the time, if you could shorten those answers, if you

can. The data example compiled by the fire department and Mount

Sinai, is that not sufficient data to date to at least say something

publicly or declare publicly what it is going to cost, at least in the

short-term or the next couple of years, do you think so?

Dr. AGWUNOBI. Sir, that is one data point.

Mr. FOSSELLA. What other data points exist?

Dr. AGWUNOBI. We look at every source of data you have talked

about, Mount Sinai, data from other systems, in the past, we are

looking at every source of data.

Mr. FOSSELLA. So you don’t think, for example, the fire department, where I think 96 percent of the responders who participated

in that program is a pretty good or significant data point?

Dr. AGWUNOBI. I think we are absolutely in our system going to

have data from the authority events, port authorities and subsequently. However, to fully inform the Secretary, we need to look at

all the data we can get our hands on.

Mr. FOSSELLA. You say in terms of developing cost estimates, do

you anticipate supporting the current programs, for example,

Mount Sinai, Fire Department and Bellevue centers of excellence

already in place, or do you anticipate using different sources to

fund the health needs?

Dr. AGWUNOBI. I’m sorry, sir?

Mr. FOSSELLA. Are there programs, other than the existing ones

that are currently treating the vast, vast majority of 9/11 responders, are you considering creating or funding those programs to

treat 9/11 World Trade Center victims?

Dr. AGWUNOBI. We are going to look at all of them, from all the

data that we have, including the mayor’s report. But I can’t say

what that net result in terms of the decision will be.

42

Mr. FOSSELLA. Is it safe to say that anyone receiving treatment

in any of these centers of excellence for this coming what is called

fiscal year will continue to receive treatment and will not be let go

as a result of diminished Federal funding?

Dr. AGWUNOBI. Our focus is on the people who are in need.

Mr. FOSSELLA. But can you say that anybody receiving treatment

this year will receive that treatment, they will not be denied as a

result of lack of Federal funding?

Dr. AGWUNOBI. I think we have recommended to assure that everyone that has a need that is not met that they are taken care

of.

Mr. FOSSELLA. At least for this fiscal year, as you begin to develop the long-term, and I don’t think anyone is denying that there

is a long-term commitment, for those triage people who need work

on a day to day basis, the names of, for example, the people who

can’t breathe, for the sake of argument, we are not saying, the Federal Government is not telling them they are going to be denied?

Dr. AGWUNOBI. I misunderstood your question. Funding for the

current program will get us through the end of this fiscal year.

Mr. FOSSELLA. Second, do you think that there is an effort or a

noble or national effort that we can say that these centers of excellence, we can look to for research or for registry purposes that will

help to serve a national population that is already moving, whether

it be to California or Florida or Connecticut, that health care professionals in those areas can turn to these centers of excellence to

help treat those individuals that ultimately, if not now, will need

care?

Dr. AGWUNOBI. Sir, I would say that lessons learned, information

we acquire, that we would share freely and openly with every one

of these centers.

Mr. FOSSELLA. Thank you, Mr. Chairman.

Mr. TOWNS. We will recess until 1:30. We will discharge this

panel, and panel No. 2 will be at 1:30.

[Recess.]

Mr. TOWNS. Let me apologize for being late. There were a lot of

votes on the floor and it lasted much longer than we ever anticipated. So may I now ask all of you to stand and be sworn.

[Witnesses sworn.]

Mr. TOWNS. I would like to welcome our second panel. I will

briefly introduce each witness. Linda Gibbs is the deputy mayor of

New York City for health and human services. We are delighted to

have you. Ed Skyler is the deputy mayor of New York City for administration. We are delighted to have you as well. Together they

chair the City’s World Trade Center health panel and will be presenting the recommendations of the panel which Mayor Bloomberg

has endorsed.

They are accompanied by three physicians who have been treating New York City responders and residents: Dr. Joan Reibman, director of the World Trade Center Environmental Health Center at

Bellevue Hospital. Welcome. Dr. David Prezant represents the fire

department; Dr. Eli Kleinman represents the police department of

New York.

Dr. Robin Herbert is another experienced physician who leads a

program to monitor and treat 9/11 illnesses. Dr. Herbert is with

43

Mount Sinai Hospital, serves as director of the World Trade Center

Medical Monitoring Program Data and Coordination Center.

We have also with us John Sferazo, who was one of the workers

at Ground Zero on the morning of September 12th, before sunrise.

He worked on search and rescue and burned iron on the pile in

search of survivors of the disaster. For more than 30 days he

worked at Ground Zero. Mr. Sferazo has diminished breath and

lung capacity from the exposure to 9/11 pollutants. He has been

unable to work since August 2004 because of his health impairments.

We also have with us paramedic Marvin Bethea, who was buried

in debris when the first World Trade Center Tower fell, but he got

out. As the second building started to collapse, he helped an older

woman across the street into a hotel and was covered in debris

again. He returned to provide more aid on September 14th. Five

weeks later, he suffered a stroke attributed to 9/11 stress. Later he

was diagnosed with adult onset asthma, post-traumatic stress disorder and chronic bronchitis.

We are honored to have such a distinguished panel here with us

today. As with the first panel, of course, let me just say that we

will go right down the line. We will start with you, Deputy Mayor

Gibbs.

STATEMENTS OF LINDA I. GIBBS, CO-CHAIR OF MAYOR

BLOOMBERG’S WORLD TRADE CENTER HEALTH PANEL AND

NEW YORK CITY DEPUTY MAYOR FOR HEALTH AND HUMAN

SERVICES; EDWARD SKYLER, CO-CHAIR OF MAYOR

BLOOMBERG’S WORLD TRADE CENTER HEALTH PANEL AND

NEW YORK CITY DEPUTY MAYOR FOR ADMINISTRATION, ACCOMPANIED BY JOAN REIBMAN, M.D., ASSOCIATE PROFESSOR OF MEDICINE AND ENVIRONMENTAL MEDICINE, DIRECTOR NYU/BELLEVUE ASTHMA CENTER, DIRECTOR OF

BELLEVUE WTC ENVIRONMENTAL HEALTH CENTER; DAVID

PREZANT, M.D., CHIEF MEDICAL OFFICER, OFFICE OF MEDICAL AFFAIRS, CO-DIRECTOR, WTC MEDICAL MONITORING

AND TREATMENT PROGRAMS, NEW YORK CITY FIRE DEPARTMENT; ELI J. KLEINMAN, M.D., SUPERVISING CHIEF

SURGEON, NEW YORK POLICE DEPARTMENT; ROBIN HERBERT, J.D., DIRECTOR, WORLD TRADE CENTER MEDICAL

MONITORING PROGRAM DATA AND COORDINATION CENTER, ASSOCIATE PROFESSOR, DEPARTMENT OF COMMUNITY AND PREVENTIVE MEDICINE, MOUNT SINAI SCHOOL

OF MEDICINE; JONATHAN SFERAZO, DISABLED UNION IRON

WORKER; AND MARVIN BETHEA, PARAMEDIC

STATEMENT OF LINDA I. GIBBS

Ms. GIBBS. Thank you, Chairman Towns, Ranking Member

Bilbray, Congress Members from New York and additional members of the subcommittee, thank you so much for convening this

hearing today and inviting me and Deputy Mayor Skyler to testify.

We are accompanied here today by Dr. Joan Reibman of Bellevue, Dr. David Prezant of the fire department and Dr. Eli

Kleinman of the police department. We would ask that you submit

their testimony to the record.

Mr. TOWNS. Without objection, so ordered.

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Ms. GIBBS. Thank you.

I am here today as the co-chair, with Deputy Mayor Skyler, of

a panel that Mayor Bloomberg convened in September 2006, the

fifth anniversary of 9/11, to examine the health effects of the 9/11

attacks and attack the sufficiency of resources devoted to World

Trade Center-related health needs. The result of the panel’s efforts

was the most exhaustive examination of the health impacts of 9/

11 to date and it was laid out in an 83-page report, co-authored by

panel directors Rima Cohen and Cas Holloway, who are also with

us here today.

In this process, the panel started with the evidence. Let me summarize some of that for you. Over the past 5 years, medical researchers and clinicians have reported in peer review studies and

from their own treatment experiences that thousands of people endured physical and mental health conditions that were caused or

exacerbated by the 9/11 exposure. While many have recovered, others continue to suffer from a range of ailments. The most common

are respiratory illnesses, such as asthma, and mental health conditions, such as post-traumatic stress disorder, anxiety and depression. We do not yet know the extent to which these conditions will

remain or can successfully be resolved with treatment.

We also know that the health issues associated with 9/11 affect

not only New Yorkers but tens of thousands of volunteers and

workers from across the Nation, including every State represented

on this subcommittee, who responded to the call to help and participated in the unprecedented rescue, recovery and cleanup effort

that followed the terrorist attacks. These rescue and recovery workers are those most likely to experience ill health related to the exposure. For example, more than 2,000 of the fire department’s

14,000 first responders, 15 percent, that is, have sought treatment

for respiratory conditions since September 11th. More than twice

that number have sought services for mental health care. Among

a sample of 9,400 rescue and recovery workers examined at the

World Trade Center Health Program, coordinated by the Mount

Sinai Medical Center, 32 percent self-reported lower respiratory

system and 50 percent reported upper respiratory systems near the

time of their initial medical evaluation.

Area residents, school children, commercial workers and others

also reported a variety of illnesses in the aftermath of 9/11, including acute breathing problems, worsening of asthma, nausea, headaches and stress-related illness and anxiety. Data from the New

York City Department of Health World Trade Center Registry, the

largest public health surveillance effort of this kind, has been documenting the physical and mental health conditions reported by

over 70,000 participants. Its data showed that two-thirds of adult

enrollees reported new or worsened sinus or nasal problems after

the exposure to 9/11, two-thirds.

Fortunately, help is available for many of those in need. Among

the dozens of health and mental health programs that developed

over the years since the attack, three have emerged as centers of

excellence in diagnosing and treating World Trade Center-related

health conditions. You have heard a lot about them here already

today. The first at the New York City Fire Department, serving

firefighters and EMS workers; the free monitoring and treatment

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program coordinated by Mount Sinai Medical Center is the second,

which meets the needs of all other first responders, workers and

volunteers; and third, the World Trade Center Environmental

Health Center at Bellevue, which has served all the area residents,

commercial workers and other non-first responders.

These programs have provided a virtual lifeline to thousands of

individuals from across the Nation. Equally important, the data

generated by these programs and research efforts by the Registry

and the New York City Police Department have led to important

scientific studies, and have also informed the development of clinical guidelines for diagnosing and treating 9/11-related health problems. That is the good news.

But the panel also found that these efforts and the critical research they generate are in serious jeopardy. Each of these programs faces a bleak future unless we secure ongoing Federal funding. Even with President Bush’s recent pledge of $25 million, the

fire department and Mount Sinai clinical programs are expected to

run out of funds before the end of this fiscal year. The Federal Government has provided no support to the Bellevue program, the only

program available to the thousands of residents, school children,

Chinatown businesses and commercial workers who may have 9/11-

related conditions.

That is why the Mayor’s panel recommended that New York City

vigorously pursue Federal funding to support the programs that

form the cornerstone of our response to 9/11 health impacts. As

Mayor Bloomberg said when he accepted our report, ‘‘Individuals

who are now suffering from 9/11 health effects were responding to

an act of war against this Nation.’’ Congressman Bilbray spoke eloquently about this this morning, that the Government is responsible for assisting them, and New York City cannot bear the responsibility on its own, especially for those who aided New York in

its time of need, but now live in other States.

We are asking the Federal Government to step up to the plate,

stand shoulder to shoulder with us to support these brave men and

women. Let me turn this over now to Deputy Mayor Ed Skyler.

[The prepared statement of Ms. Gibbs follows:]

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STATEMENT OF EDWARD SKYLER

Mr. SKYLER. Thank you. Good afternoon. My name is Edward

Skyler. I am the New York City deputy mayor for administration

and I co-chair the Mayor’s World Trade Center Health Panel with

Deputy Mayor Gibbs.

I want to first echo Mayor Gibbs’ thanks to you, Chairman

Towns, Ranking Member Bilbray, members of the subcommittee,

such as Congresswoman Maloney, Congressman Murphy, as well

as members of the New York delegation who are here, Congressman Nadler, Congressman Fossella, especially members of the New

York delegation and their staffs, who have long made this issue a

top priority.

I also want to note that we have copies of the Mayor’s report

here for you and your staff.

Deputy Mayor Gibbs walked you through some of the panel’s

medical data, existing treatment and research options and the core

recommendations. I want to cover two related topics: what we need

from the Federal Government at a minimum to provide the direct

treatment, research and information that people suffering from 9/

11-related health effects need; and the urgent need for Congress to

reopen the Victim Compensation Fund.

The Federal Government contributed substantially to New York’s

economic and physical recovery from the 9/11 attacks. Mayor

Bloomberg and the people of New York City are grateful for the

Federal Government’s strong support. But Federal support has

been slow in coming to address the health care needs of those who

responded on and after 9/11, and of the residents and other people

of New York City, who have remained since the attacks and have

done so much to contribute to the city’s resurgence. And the aid

that has come is far less than is needed.

Based on informed but necessarily contingent assumptions, the

estimated gross annual costs to provide health care to anyone who

could seek treatment for potentially 9/11-related illness, whether

through the fire department, Mount Sinai, Bellevue programs or

from a personal physician or any other source, is $393 million a

year. That $393 million covers the cost to treat anyone anywhere

in the country for a potentially 9/11-related illness, including the

thousands of responders and others who answered New York City’s

call from 50 States. We estimate that 45,000 people from outside

New York City and New Jersey were exposed on 9/11.

If you assume that number is a reliable estimate of gross costs

in each of the 5-years since 9/11, then the total cost of 9/11 health

impacts has already surpassed $2 billion. We estimated that the

minimum amount of Federal support needed, just to sustain and

expand existing treatment and research programs, and to implement the rest of the panel’s recommendations is $150 million next

year, increasing to $160 million by fiscal year 2001. Put another

way, that $150 million is the amount needed to fill the gaps in

available information and treatment for 9/11-related health needs.

What will that money pay for? Sustaining the fire department’s

monitoring and treatment program at current levels; sustaining the

Mount Sinai program, which is monitoring and treating thousands

of NYPD responders and other workers and volunteers who participated in recovery operations at the World Trade Center site; susVerDate 11-MAY-2000 11:38 May 14, 2007 Jkt 000000 PO 00000 Frm 00056 Fmt 6633 Sfmt 6633 C:\DOCS\34912.TXT HGOVREF1 PsN: HGOVREF1
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taining and expanding the Bellevue program to evaluate and treat

up to 12,000 patients over the next 5 years, the only program that

treats residents in lower Manhattan; sustaining and expanding

mental health services made available through the city’s health department; expanding the treatment and research capacity of the

police department and implementing the remainder of the panel’s

recommendations.

The health impacts of 9/11 are substantial and will be with us

for years to come. Without the help of Congress and the administration, there is a real risk that health care needs of those who responded on 9/11 or who stayed with the city to help us and the Nation rebuilt will go unmet. We should work immediately and urgently to prevent this entirely preventable outcome.

Second, I want to briefly talk about the panel’s recommendation

to reopen the Victim Compensation Fund. When Congress created

the Victim Compensation Fund in 2001, it chose a no-fault compensation program. Those injured were compensated without any

need to establish negligence or fault. Those who did not meet the

eligibility criteria or did not sign up in time had no choice but to

go the traditional litigation route. Congress worked with the city

to create the World Trade Center captive insurance company, to insure the city and its approximately 150 contractors whose construction and other workers played a critical role in the World Trade

Center cleanup for claims arising from those operations. The insurance company was funded with $1 billion of the $20 billion that

Congress and President Bush made available to the city after the

9/11 attacks.

But this insurance mechanism is not suited for what we are

faced with today. More than 6,000 city employees and other workers have already sued the city and its contractors, alleging harm

in connection with the operations at Ground Zero. Taken together,

those lawsuits allege damages that the city conservatively estimates to be in the billions of dollars. And we don’t know who or

how many people may allege they are harmed because of 9/11 in

the future.

I should note that Congress capped the city’s liability at $350

million, but the potential liability of contractors who participated

is not capped by statute.

The insurance company cannot just hand out the $1 billion Congress provided for insurance coverage. As with any fault-based insurance mechanism, plaintiffs must not only show they were

harmed, but must also prove fault. The city and its contractors

have strong defenses for what was clearly a necessary response to

a national attack.

New Yorkers have always been proud of the way the city came

together after 9/11. But this drawn-out and divisive litigation is undermining that unity. The fundamental point is, compensating people who were hurt on 9/11 should not be based on a legal finding

of who is to blame. We all know who is to blame: 19 savages with

box cutters. We are here today because New York City would rather stand with all those who filed suit than against them in a court

room. At its core, reopening the Victim Compensation Fund is

about fairness. There is no reason why people harmed as a result

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of 9/11 should now have to go to court and prove liability. Proof of

harm should be enough to receive fair and fast compensation.

Simultaneously with the reopening of the fund, it is essential

that Congress eliminate any liability of the city and its contractors

arising from the recovery and cleanup. Congress could then move

the $1 billion now available to captive insurance to the newly reconstituted Victim Compensation Fund. Only by taking these steps

can we ensure that those who were harmed by 9/11 get compensation quickly. Only by taking these steps can we ensure that in the

event of another terrorist attack, whether in New York, San Diego,

Boston, Chicago, anywhere on American soil, the private sector will

come to the country’s aid as swiftly and with the same selflessness,

energy and determination that was brought to bear on September

11, 2001. Reopening the funds and eliminating liability to the contractors is not just about providing health care and compensation,

it is necessary to our country’s safety in the future.

Thank you for the opportunity to testify before you today.

[The prepared statements of Mr. Skyler, Dr. Reibman, Dr.

Prezant, and Dr. Kleinman follow:]

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Mr. TOWNS. Thank you very much, Deputy Mayor Skyler and

also Deputy Mayor Gibbs, for your testimony.

Now we will move to Dr. Herbert.

STATEMENT OF ROBIN HERBERT

Dr. HERBERT. Thank you. Honorable Chairman Towns, Ranking

Member Bilbray, Mrs. Maloney and other members of the subcommittee, as well as the members of the New York delegation who

are here, Mr. Nadler and Mr. Fossella, thank you so much for inviting me today. My name is Dr. Robin Herbert. I am an associate

professor in the Department of Community and Preventive Medicine of the Mount Sinai School of Medicine and currently serve as

the Director of the World Trade Center Medical Monitoring Program Consortium Data and Coordination Center.

In light of our growing understanding of the health consequences

that have resulted from an unprecedented attack on the Nation, it

is an apt time to take stock of how well we as a Nation care for

World Trade Center responders and the many others who have fallen ill or may become ill in the future. The environment in lower

Manhattan following the collapse of the Twin Towers was unlike

anything previously witnessed. But caring for affected populations

of critical need is not unprecedented nor unearned by those involved with this particular tragedy.

It is estimated that well over 50,000 people worked or volunteered in the aftermath of the attacks in and around the World

Trade Center area and the Staten Island landfill. This group included both traditional first responders, such as firefighters, police

officers, paramedics, but it also included a large and very diverse

population of other responders, heavy machine operators, laborers,

iron workers, many others from the building inspection trade, telecommunication workers, transit workers, sanitation workers and a

wide range of volunteers.

Our Nation has celebrated these responders as heroes. Unfortunately, in the course of their selfless work, they have been exposed

to a complex mix of toxic chemicals and to physical hazards and extreme psychological trauma. Because of this many suffer from persistent respiratory and mental health consequences, as well as a

chronic sequelae of injuries.

I think many of us here at the table agree that the physical and

mental health consequences of the disaster have been very well

documented. We, from Mount Sinai, were proud to release in September 2006 a report that detailed findings from our federally

funded program. We examined 9,442 World Trade Center responders between July 2002 and 2004. Among the key findings, fully 69

percent of the responders reported having new or worsened respiratory symptoms at the time of their response work. Fifty-nine

percent still had those symptoms as long as 21⁄2 years after September 11, 2001.

In particular, one of the most worrisome findings, I think, was

an increased rate of breathing test abnormalities when compared

with the general U.S. population. In our non-smoking patients, we

found five times the expected rates of a breathing test abnormality

called low forced vital capacity. This is a finding that can be caused

by a number of different conditions. It can be caused by asthma

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with something called air trapping, it can be caused, frankly, by

being overweight. But it also can be caused by interstitial lung disease of the type that unfortunately we know that some responders

have already developed and unfortunately a few have died from.

When this kind of abnormality is found, this is a screening test.

What you need to do is then go and followup to figure out, what

is the cause of that abnormality. And that is the reason that I believe, and I believe that my colleagues, certainly the physicians

with whom I have worked, Dr. Reibman and Dr. Prezant, feel very

strongly that centers of excellence are the way to go to take care

of responders. We see a responder with a low force vital capacity,

we need to get that responder rapidly into treatment with diagnostic tests and with somebody who is an expert in World Trade

Center-related diagnosis and treatment to find out what the cause

of the problem is. I would certainly say the same would be for residents, not just responders.

We have also found that in our treatment program, there are

very similar types of patterns of disease as has been seen and reported in other groups. In our treatment program at Mount Sinai,

where we have seen over 3,600 responders, 86 percent have upper

respiratory problems that are not going away, such as sinusitis.

Half have lower respiratory problems, such as asthma. About a

third have problems like gastrointestinal conditions. Almost a third

have persistent musculoskeletal problems from injuries and almost

40 percent have persistent mental problems. So this is, again, this

is 3,600 people receiving medical care to date for these problems.

We have also found in our treatment program that 44 percent

have no health insurance. If we didn’t have our federally funded

treatment program now, and if we hadn’t previously had philanthropically funded programs, these folks would have nowhere else

to go.

In addition to the 44 percent uninsured, about 20 percent are

under-insured. So access to medical care for responders has been

a huge difficulty.

Basically at this point, given what we know about the health

consequences of the disaster, we believe that regular monitoring

and screening examinations and treatment will be necessary for responders for their lifetimes. We would advocate a program in which

we are able to develop, actually what we have done is develop an

approach to medical care of responders where we link screening examinations to treatment and to disease surveillance. Because the

idea is that you want to do the screening exams to identify health

problems early and get people into treatment. But you also want

to be able to use the information from those examinations to identify emerging disease patterns. Because we know that responders

have been exposed to a range of toxins, including cancer-causing

agents such as asbestos, PCBs, dioxins, and we frankly do not

know what the long-term health consequences will be for the responders.

Because of that, again, we advocate the centers of excellence

model. Right now what we do is we offer standardized comprehensive examinations to identify both possible World Trade Center-related physical and mental health consequences. We then gather the

information on the health impacts and get people into treatment.

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We feel that dissemination of information derived from the disease monitoring and screening and treatment is really important to

improve treatment for World Trade Center responders. And we are

so grateful that we have received Federal funding to date to do

these activities.

In 2002, Mount Sinai received funding for the World Trade Center worker and volunteer medical screening program in response to

growing concerns about health effects among responders. And our

program based at Mount Sinai coordinates a consortium throughout New York, New Jersey, Long Island and nationally. That program has been continued as a medical monitoring program. We

have seen over 20,000 responders to date, more than 7,000 have

had followup examinations. We have seen people from all over the

United States. We have been working with a variety of programs

to provide national exams, and have examined more than 800 responders nationally. It is very challenging, and I really appreciated

your comments earlier today about that.

Recently the funding that we have received has enabled us to

add treatment to our medical monitoring program. This integration

has been critical in affording responders streamlined access to high

quality standardized and diagnostic and treatment services with

clinicians who have unsurpassed diagnostic and treatment experience. Thus, needed service provision for responders and programs

have already been developed and established with successfully operating federally funded initiatives. The New York Fire Department and Mount Sinai centers of excellence are led by NIOSH-CDC

and are coordinated and operated by expert clinicians well versed

in the complex nature of World Trade Center health effects and

outcomes.

The existing programs are models and they need to be preserved

and expanded for the sake of those affected. Today we must choose

to continue to help thousands of those affected by September 11th

as we are best able, through coordinated, experienced and expanded World Trade Center centers of excellence, by providing responders with excellent medical and mental health services, we can

help them to stay in their jobs or begin to work again. We can help

them return to their normal lives and we can provide with some

hope for the future.

As you are likely aware, Federal funding for the World Trade

Center treatment services is due to run out before the end of this

fiscal year. Federal funding for the monitoring program, which was

provided for the first 5 years of what we anticipate will be 20 to

30 years of needed funding, will also run out in July 2009. We implore you to keep these programs alive, as a lifeline for the World

Trade Center responders.

Thank you very, very much.

[The prepared statement of Dr. Herbert follows:]

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Mr. TOWNS. Thank you.

Mr. Bethea.

STATEMENT OF MARVIN BETHEA

Mr. BETHEA. Good afternoon, Mr. Chairman. I would like to take

this time to thank our elected officials for giving me the opportunity to testify at this hearing.

My name is Marvin Bethea and I was a New York City 911

Paramedic for the private hospitals. When I was dispatched by the

New York City Fire Department from the borough of Queens to respond to the World Trade Center, I did. As I crossed the 59th

Street Bridge, I was informed by phone that a big jetliner had

crashed into the second tower. We knew that this was no accident,

this was a terrorist attack.

Did we say, ‘‘We shouldn’t go to this, it is a terrorist attack?’’ Absolutely not. Because we understood we had a duty to act and a

responsibility to protect the city, State and country that we loved

so much. I survived the collapse of both towers, and here we are

5 years later and we are fighting for health care and financial compensation. Can you imagine if it took me 5 years to respond to the

World Trade Center? What would my city, State and country think

of me? I, like so many others, did what President Kennedy asked

of us when he said, ‘‘Ask not what your country can do for you; ask

what you can do for your country.’’

What did doing for our country get us? We got sick, we got injured, and financially ruined. I went from being a happy, hardworking paramedic to becoming a disabled paramedic with numerous health problems. The last I worked was January 8, 2004. I

went from taking two medicines, as you see before you, to currently

now I am taking 15 medicines. And yet they say we are not sick.

I am a broken man that has been given a slow death sentence. And

I pray to God every day that I don’t develop any new health problems, like cancer.

I saw and heard my government promise on a city, State and

Federal level that we wouldn’t be forgotten. They forgot. You can’t

tease us now by allocating some funds for treatment that will only

last maybe a few months. People are starting to get treatment, only

to be threatened with the fact that it may not last for only a few

months. That is cruel. This is equivalent to man who hasn’t eaten

for the past 3 weeks and now you give him steak. You ask him,

do you like that steak? And he has three bites out of that steak

and tells you that it is the best steak he has ever had, and then

your response is, enjoy it, because you are not going to get any

more. Like I said before, that is very cruel.

I am extremely grateful for the $25 million President Bush has

pledged. Here is the problem with that. Senators Clinton and

Shumer’s 9/11 Heroes Health Improvement Act calls for $1.9 billion

in funding. Giving $25 million, it is like me asking you, can I borrow $100,000 and you say, see me today and I will take care of you.

When I see you, you give me $10 and act as if you are doing me

a favor. It is imperative that treatment centers like the Mount

Sinai Health for Heroes Program are continually funded. Mount

Sinai and other programs like them are for occupational health

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doctors. These doctors are specially trained and know what to look

for and treat the horrible things that we have been exposed to.

Financial compensation is another absent component of this

equation. It is no fault of our own that we cannot work any more.

We need to pen up the 9/11 Victims Compensation Fund like it

was. What good is treatment if I am sleeping in my car and I have

lost my family? If I don’t have high blood pressure or depression,

I will have it now for sure. The military has a saying, we leave no

soldier behind. September 11th was an act of war against this Nation. You must not leave anyone affected by 9/11 behind.

I would like to take a special opportunity to thank the elected

officials that I have personally worked with, Senator Clinton, Congresswoman Maloney, Congressman Fossella, Congressman Nadler,

Congressman Hinchey and Congressman Shays for their support

and staying with us. God bless all of you.

Thank you again for this opportunity.

[The prepared statement of Mr. Bethea follows:]

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Mr. TOWNS. Thank you very much, Mr. Bethea, for your moving

testimony.

Mr. Sferazo.

STATEMENT OF JONATHAN SFERAZO

Mr. SFERAZO. Chairman Towns and our bipartisan subcommittee

congressional members, I say thank you. Hello, everyone. I am honored to have been asked to give testimony today to the experiences

I have had with the September 11, 2001 tragedy. My name is Jonathan Sferazo, I am a disabled union iron worker from Local 361,

Brooklyn, NY. We have created the metropolitan area’s skyline.

I responded to the disaster on the morning of September 12th.

The Brooklyn Battery Tunnel was our avenue of approach. We

opened up West Street with the removal of collapsed cars and

trucks and debris, all the way to the South Tower. I am typical of

anyone who stayed approximately 29 to 32 days at that site. My

medical and psychological conditions are reactive airway disease,

restrictive airway disease, sinusitis, continual lung infections,

PTSD, anxiety, depression, sleep apnea, and gastroesophageal

reflux disease.

None of this you would have expected from someone who ran a

5 minute and 30 second mile when I was in high school. I never

had a pulmonological problem, and I want everybody to make sure

they understand that, prior to 9/11. Nor would I ever have been

certified by the New York State Department of Environmental Conservation for wildland search and rescue, certified by the New York

State DEC and Stonybrook.

So you see, I went to Ground Zero because I wanted to help find

and save human life. If I am to be the voice of the responder, then

know that I am outraged by the lack of responsibility and the loss

of obligation that this administration has taken toward us. We are

clearly being shown that we are expendable. President George

Bush came to the Trade Center site and told us, we will never forget. Mr. Chairman, he forgot, sir.

We want to know if those of us who are so severely afflicted have

to lose all we have worked for to be eligible for social services or

if we will ever be given what we were promised?

We have heard too many times, as I have heard here today myself, why weren’t you wearing a mask? Now, hear my answer and

the answer loud and clear. Because we were given paper masks

after several days that continually clogged up and we were told by

our mayor at that time, and I am not referring to our Mayor

Bloomberg presently, members of the Centers for Disease Control,

members of the EPA and Christy Todd Whitman that the air quality was acceptable.

Also, I ask you to put yourself in our place. When we got to the

Trade Center site, most of us had never been thrown in this kind

of a situation before. You had fighter jets flying overhead with

their sonic boom, helicopters hovering above the skyscrapers. You

had emergency whistles blaring above the noise of the equipment

that we were operating, military personnel, police. Do you honestly

think, and I look at you all and ask you directly, do you honestly

think, knowing that there were people in that pile, do you think

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we were concerned with our health, after we had been given a silent message that it was safe and acceptable?

I am here today, Mr. Chairman, Members of Congress, and all

the members who are listening to this voice of mine, I am here because I care and I have cared from the beginning. If I didn’t, I

never would have gone down there. We are trying, because of our

experiences, to get this much-needed health care. Marvin Bethea

and myself, we created a not-for-profit organization called the Unsung Heroes Helping Heroes. We are a licensed 501(c)(3) and we

did this because we saw no response from our administration and

we saw the funding was going to be running out, starting in 5

years.

I am also here to express the outrage from all of us that were

involved in that disaster in that something hadn’t been done immediately. I thank everybody here for their involvement and for hearing me today.

[The prepared statement of Mr. Sferazo follows:]

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Mr. TOWNS. Thank you very much, Mr. Sferazo.

I will call on the ranking member to go first, then I will call on

you, Mrs. Maloney.

Mr. BILBRAY. No, I will yield, Mr. Chairman.

Mr. TOWNS. Mr. Bilbray yields.

Mrs. MALONEY. Thank you. First of all, I really want to thank

the chairman and Ranking Member Bilbray for holding this hearing. It is critically important. I requested it, along with my colleague, Vito Fossella. I regret that I was on the floor with a bill

that was one that I authored that actually passed, which was exciting, also very important to the city of New York, the CFIUS process to have a better review of challenges that may harm our homeland security and encourage foreign investment. There is another

meeting back on the floor, so I am going to have to get back, I

apologize.

I want to thank everybody on this panel. You are really true heroes and heroines. Many of our friends and neighbors who perished

on 9/11, they were victims. But the men and women who went

down there to work, that was their choice, and to protect and work

to save other people. So in my opinion, they are the true heroes

and heroines, along with the people that have made a commitment

with their life work to help them and to protect them and to try

to make them well again.

I have a few questions. I first want to say, we have been making some progress, not enough. We were really pleased with the $25

million that was a placeholder for treatment. This was the first

time we had gotten a line in the Federal budget, and we were

pleased with it, but I do want to say that it has been a long, hard

fight. The administration has really fought us every step of the

way. First, they opposed the original $90 million in funding for

medical monitoring, then they actually rescinded, it is hard to believe, but rescinded the $125 million in the 2006 budget for 9/11

help. The administration resisted, when the New York delegation

worked successfully with our two Senators to restore that funding

and to get the first $75 million dedicated for treatment. They

fought us when Mr. Fossella and I pushed to have one person put

in charge and responsible for 9/11 health. And after the administration finally appointed someone to coordinate the 9/11 health

issues, 6 months later, in September they recreated the wheel and

started a brand new task force, chaired by Mr. Agwunobi.

Five and a half years after the attacks, we still do not have a

plan to monitor everyone who was exposed to the deadly toxins and

to treat everyone who is sick. I understand that Dr. Agwunobi

made clear in his testimony this afternoon that area residents,

workers, and school children would not be included in any plan

they came up with. This is unacceptable. Everyone exposed should

be monitored and everyone who is sick should be treated. That is

the least that we can do as a group as a grateful Nation for the

sacrifices of others.

As for maintaining the current programs that you have testified

about, I have concerns that for ideological reasons or others that

they will not intend to fund the centers of excellence, which many

of you represent. Can you tell me why that would be a mistake, not

to fund the centers for excellence? I open it up to Drs. Herbert,

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Prezant and Reibman, since you are in direct line of these centers

for excellence. What would it mean if these centers for excellence

were not funded?

Dr. PREZANT. This is Dr. David Prezant from the New York City

Fire Department. I very much appreciate your support and your

question. We are one of three centers of excellence and also along

with the New York City Police Department that have spent a tremendous amount of time taking care of these patients. The New

York City Fire Department, each one of these centers of excellence

is unique. I am going to talk about the unique aspects of my center

of excellence.

The New York City Fire Department is unique for a variety of

reasons. Our cohort, our group of 16,000 firefighters, EMS workers

and retired firefighters that came to the 9/11 site on those days

was the highest exposed group. They were there, most of them,

over 2,000 during the collapse, nearly 8,000 during the next 36

hours and the rest of them over the next days of the first week.

They continued to work there until the end of the year. They are

the group with pre-9/11 data. And because of that pre-9/11 health

data, we have been able to compare in an objective fashion, scientifically, what has happened to them after 9/11. We were able to

document that in the first year, the average drop in pulmonary

function for our work force was 375 milliliters. That is 11 times

what we saw annually in the 5 years before 9/11.

Only through a center of excellence with pre-9/11 data and then

with longitudinally repeated data, can you come up with that type

of science. In the meetings that we had earlier today, before the

session went into temporary recess, we heard that there was not

adequate science. We disagree with that. The New York City Fire

Department has published nearly 20 papers, scientific peer-reviewed papers, documenting these problems. We are very soon

going to be coming out with a paper showing that sarcoidosis, a

lung disease, was increased in the years after 9/11 in our cohort.

The only way to do that is through a center of excellence that

is able to keep the group together. A fee for service program that

would destroy the centers of excellence and prevent this work from

going forward, both scientifically and from a treatment perspective,

in terms of serving our group, providing them the very necessary

expert work that Dr. Herbert has been talking about in her testimony.

Mrs. MALONEY. Thank you.

Dr. Reibman, would you like to add to that?

Dr. REIBMAN. Thank you very much for inviting me. Let me

begin to answer that by explaining where we are coming from and

the group that we have been taking care of. Again, earlier this

morning we heard that there is not data, or not adequate data on

the health of the population.

Including the residents. And we run an asthma program at

Bellevue Hospital, which is a public hospital associated with New

York University Medical Center. At that time, we were concerned

that there wouldn’t be adequate lung protection for the residents

in lower Manhattan. So in cooperation with the New York State

Department, we were able to document in a controlled study the

increase in symptoms of residents living in lower Manhattan, comVerDate 11-MAY-2000 11:38 May 14, 2007 Jkt 000000 PO 00000 Frm 00101 Fmt 6633 Sfmt 6633 C:\DOCS\34912.TXT HGOVREF1 PsN: HGOVREF1
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pared to residents a distance away. In fact, there was an almost

sixfold increase in symptoms of asthma in the residents who lived

in Lower Manhattan.

Because of that, we began looking at a number of community

treatment programs for residents that were not funded by anyone

in our city or not the Federal Government. A year ago, we were

funded by the American Red Cross for our program to care for residents, as well as responders. And this September, we were very

pleased to receive funding from New York City to take care of the

responders and residents, as well as office workers.

We now currently have a program in place for responders, residents, and office workers, many of whom returned to work 1 week

after the collapse of the buildings. What this has enabled us to do,

as you heard from both Dr. Herbert and Dr. Prezant, is that we

can see people so we can start to understand that there are diseases in individuals who have been exposed. This is particularly

important for the residents who may have been going to a diverse

number of physicians and may not be plugged into a treatment program. But because we are seeing postures of disease and patterns

of disease, it allows us to see the full effects of exposure. That is

a very important reason for a center of excellence.

The second reason, we keep talking about treatment, but we actually don’t really completely understand what the disease are we

are treating or how to treat them. So unless we work with the centers of excellence and work on ways to understand the diagnosis

and look at treatment to see whether treatments are working or

not working, we will not know how to treat the disease symptoms.

Finally, the third reason for centers of excellence is that we need

to continually monitor these diseases. We will not be able to keep

up with the emergence of diseases, hopefully not cancerous, but we

would like to be ready in case we see that, other diseases that

might not be as common, we will not be able to identify those unless we are seeing them in centers of excellence.

Mr. TOWNS. We are going to give a second round, we would be

glad to do so. But you are way over your time.

Mrs. MALONEY. I appreciate the chairman’s indulgence. I appreciate it very much. Thank you so much for having this hearing. My

constituents, I would say, all New York City and all those who suffer are deeply grateful, Mr. Chairman, for your leadership. Thank

you.

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

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Mr. TOWNS. I appreciate your moving it forward, too. Thank you

so much.

I now yield to the ranking member.

Mr. BILBRAY. Thank you, Mr. Chairman.

Dr. Herbert, I will give you the shot.

Dr. HERBERT. Thank you so much.

In addition to Dr. Prezant and Dr. Reibman’s comments, I would

add a few other things that I completely agree with what they laid

out. I mean, first, frankly, I think it would be inhumane to end

these programs now. I don’t know a better way to describe it.

In terms of the group that we are seeing, which is a very diverse

group, and we have in our monitoring program about 15 percent

of our patients do not speak English, they work for multiple employers. We have people, as I said earlier, who came in from

around the Nation. We would lose the ability to track and identify

disease in this very disparate group.

The other thing is that as Dr. Reibman was alluding to, the diagnosis and treatment of World Trade Center illnesses is not

straightforward. It is very complex. We are seeing emerging conditions, we don’t fully understand the entire nature of what we are

seeing. We know at Sinai, we have seen unfortunately responders

who have gone to other providers, as Dr. Reibman mentioned,

maybe had seen doctors who were not so tuned in to the nature of

World Trade Center health problems. We frankly have patients

who are being seen by other doctors and were either not ever diagnosed correctly or were misdiagnosed. That has had very serious

consequences for some of our patients.

Finally, with respect to the folks, and we are seeing the 20,000

plus responders from the New York, New Jersey, Connecticut metropolitan area and the Nation, we know that our patients are going

to age, they are going to retire, they are going to be diffusing across

the Nation. If we don’t have a center of excellence with the capacity

to track people nationally, we will lose the ability to follow that

group over time, and they will lose access to the state-of-the-art

screening and treatment that we feel they need so desperately.

Mr. BILBRAY. Following upon the long-term impacts, I think we

all agree that one of the major things we can do to reduce the adverse impact after exposure has occurred is behavioral activities

that may aggravate that. We all know what the No. 1 behavioral

activity that aggravates particular exposures are. What percentage

of the at-risk population do you think are engaged in smoking at

this time?

Dr. HERBERT. I can look in our environmental health perspectives paper that I referred to. It was lower than the population

norms. Now, it may have been that people had smoked previously,

and have become ill and have stopped.

Mr. BILBRAY. But that is in the past, right? My biggest concern

here is what can we do to proactively now to avoid problems in the

future? I think there is too much assumption that the damage has

been done, and not enough assumption of, there is a whole lot of

things we can do now that can help to reduce the risks, not only

for those who are exposed, but of future exposure.

Dr. HERBERT. I can pull out the number of smokers in our population. But also I would say, additionally, we have also found that

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because our patients are getting depressed, they are also tending

to sometimes not eat——

Mr. BILBRAY. Just so you know my background, I was a member

of the State Air Resources Board in the State of California. Those

of you in New York have been smart enough to follow our leadership on a lot of stuff when it comes to air exposure. [Laughter.]

And the one thing we have run into is that the level of risk for

exposure just skyrockets when you fall into the population that is

continuing to smoke. I hear you guys are finally catching up with

us on the smoking issue, too. I am just wondering if anybody is out

there talking about, and this is where we get in the conflict, because the mental health people will justify not doing the cessation

programs and actively pursuing getting people off of that behavior,

because of the mental health problems that drive them toward the

behavior.

Are we talking out there openly and frankly about trying to

make sure that those who are exposed get off of the consumption

of tobacco products because of the huge increase in exposure?

Dr. HERBERT. I would like to defer the question to Dr. Prezant,

who I think has been a leader in that area.

Mr. BILBRAY. OK, Doctor.

Dr. PREZANT. And then of course, if there is time, other people

can tell about their cohorts. We actually have asked that question

from day one in our cohort in our group of firefighters. We know

exactly how many smoke, 15 percent, which is less than the 24 percent that is on average in New York City. We instituted, along with

some help from the Department of Health of New York City and

various different expert organizations throughout the country. We

instituted an aggressive tobacco cessation program in the first year

and were able to reduce that smoking rate by half, and continue

to offer that tobacco cessation program for free to every one of our

members.

But most importantly, in addition to this, and I agree with you

completely, long-term health effects may have a synergy with tobacco smoking, we have learned that from California and from

every other study.

Mr. BILBRAY. Asbestos exposure.

Dr. PREZANT. Absolutely. But I do want to stress to you one thing

and one thing right away, is that we have statistically analyzed the

group that is medium sick and the group that is most sick in the

New York City Fire Department from the World Trade Center. Tobacco smoking was not a statistically significant co-variant. It will

be in the future, and that is why we are taking these proactive

steps.

Mr. BILBRAY. I am glad you clarified that, because we know that

the impact does not show up in 5 or 10 years. But it will show up

in the future. I just think here is one place where a little tough

love, and we run into it with firefighters again and again. A little

tough love about doing everything we can to get them away from

the behavior that is going to hurt them severely, not just treating

those things that have happened to them, but what they are doing

to themselves, too.

I just bring that up as a child of a victim of tobacco consumption.

My father passed away very early in life because he didn’t do the

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right thing and get off that. But now we have an exposed population that is at such an aggravated risk that there is no justification, they try to avoid it.

Ms. Gibbs, let me shift way over in saying the coordinator that

the Mayor wants, what kind of collaborative, how can we coordinate with the coordinator? Where is the coordinator going to go and

what is the coordinator’s job being proposed for?

Ms. GIBBS. I think this is an example of how the centers of excellence and the registry work will benefit not only the people who are

able to walk through the doors of the three centers of excellence,

but in fact serve those that are suffering from the conditions who

live in places far across the United States. And your example of the

treatment regimens that people should be following who have suffered the positions is a good one to bring light to, to how the coordinator will use the resources of the office of health and mental hygiene, the creation of our Web based application that will provide

knowledge to not only those who are suffering, but physicians as

to what the medical guidelines are to help to assess the conditions

and to understand the best treatment interventions.

So the work of the coordinator will be not just to assist those who

are in the city government that are working with agencies and continue to have direct contacts, but are living far and wide and need

to be kept abreast with the latest developments.

Mr. BILBRAY. Thank you very much. My time has expired.

Mr. TOWNS. Thank you very much.

Let me just ask a few questions, then we will go to our colleague

from New York. Let me begin with you, Dr. Kleinman. I understand that NYPD did a followup study for individuals who were exposed to toxins. What did that study indicate?

Dr. KLEINMAN. Good afternoon, Mr. Chairman and members of

the subcommittee. Thank you for permitting me to present our case

here.

The NYPD had 34,000 emergency responders since 9/11, all of

whom have been monitored and tracked by the NYPD’s medical division since that time. In 2002, a study of 644 emergency service

members of the Department was performed and the initial results

of that study, the preliminary data, revealed that 38 percent of the

people who had been tested suffered from abnormalities. Of those

38 percent, approximately 25 percent were respiratory, another 25

percent were psychological, and the remainder were due to either

hearing, orthopedic problems or other miscellaneous problems. A

second followup study to that study is scheduled for the spring of

2007.

But in addition, the NYPD medical division has undertaken two

5-year followup studies of two cohorts of individuals that represent

the largest group of responders that represent a cross-section of the

population of New York City. One group of responders are the

emergency service workers for whom we have pre-9/11, post-9/11

data. That study should be completed by the end of the summer.

The other 5-year study is a study of other members of the Department who have either persistent respiratory symptoms or new

onset respiratory symptoms. That will be completed in the same

timeframe.

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The importance of these studies, as I mentioned, is that it is the

largest group of individuals that responded to the 9/11 attacks at

the various exposure sites. It represents the cross-section of the

general population of New York. The data that will emerge from

those studies will have wide applications and may be extrapolated

and may be useful to scientists and physicians in terms of planning

for monitoring in the future and for treatment. I cannot over-emphasize the importance of funding that kind of activity. I remind

the subcommittee that the NYPD medical division has not received

any Federal funding for any of its undertakings. It has been selfsustained since 9/11.

I thank you for the opportunity.

Mr. TOWNS. Thank you very much for your comments.

Dr. Reibman, the Bellevue program is the only program open to

residents, office workers and others. Are the conditions in the

group the same as what Dr. Prezant and Dr. Herbert are seeing

among their group of first responders, workers and volunteers?

Dr. REIBMAN. The Bellevue program is open to people who have

symptoms. So it is not a screening program. You have to have some

complaint to get into the program. The complaints that we are seeing are very similar to those that have been identified in the FDNY

and in the Mount Sinai groups. They consist, again, of sinus,

cough, shortness of breath, wheezing and also probably lower extent, but still some gastroesophageal reflux.

Mr. TOWNS. Mr. Bethea and also Mr. Sferazo, you have talked

about the problems you have had with health care. Let me ask you

this, have you experienced any problems dealing with workers compensation?

Mr. SFERAZO. Mr. Chairman, to answer your question, sir, it has

greatly accentuated the problem. And as you ask me this question,

about workers compensation, I wish to bring to light that not only

has this given us a great deal of stress and has created a multiple

amount of further problems, health-wise and psychologically, by

the members not getting their workers comp. But due to the fact

that some of these afflictions, sympotomatics if you will, are of a

latent nature, if I am correct, I am not a medical professional, but

I am only speaking from what I am finding out, our Governor of

the State of New York in relation to the workers compensation situation, sir, has just created legislation to do away with permanent

partial disability.

Now, this, we find, is such a direct blow, because of the latency

of the type of afflictions received by many New Yorkers and members who come from other States who have to file through New

York workers compensation and their afflictions and symptomatic

may not show up for a time to come. And being this is not something, as in my own particular case and in many others, this is not

something that we throw to the wind. Because this is not something we take for short-term medical care and we are going to be

resolved of that issue. These are going to be long-term health effects.

Mr. TOWNS. Let me switch the question to you, Mr. Bethea. What

has that done to your income? Are you making basically the same

amount now?

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Mr. BETHEA. No, not at all. Before I retired I was making about

maybe $95,000 a year. Now I am down to, I get about maybe

$40,000, a little less than that. And I live in New York. And again,

I lived well, I made a good living, I worked hard. I worked three

jobs to make the $95,000, because people say, paramedics making

$95,000, maybe I will be a paramedic. But no, that was working

very hard with three different hospitals.

But getting back to the workers comp, it has been an absolute

nightmare. First of all, I actually had the insurance company, the

workers comp company wouldn’t pay my company that supplies my

medicine. So my medicine was $1,300 a month, so they stopped

sending my medicine.

Finally, they did start paying for my medicine, but this is one of

the common problems we have. My medicine bill had run up to

$8,000. I don’t fault the company that supplied the medicine, they

have a right to get paid, and the insurance company just would not

pay it. I have had to sue my employer just to get information

turned over to my union so I could get a disability benefit from my

union.

So you have to look at the New York City workers comp system

which has been atrocious, as well as, some of the behavior on some

of the employers. We are trying to heal and trying to move on with

our lives. But with the little basic things that we are unable to get,

it is very hard to do that, so this makes you more angry, makes

you more depressed and that is really unfortunate, because again,

we all stepped up to the plate and did what we were supposed to

do that day. Now everyone from the Government, on the city, State

and Federal level, well, the city has been showing more progress,

I must say, in all fairness. But the State and Federal Government

is really lacking. So how do we begin to heal, when we are not getting the basic things that we should be entitled to?

Mr. TOWNS. Thank you both. I really appreciate hearing about

that from you personally.

Now, I turn to a person who has probably done more to keep this

alive, to make certain that we do not forget what happened on 9/

11, and the people that really, really responded and of course,

make certain that they get the proper care. He has been fighting

very hard, Jerry Nadler.

Mr. NADLER. Thank you, Mr. Chairman.

Let me say, before I start asking questions of this panel, to all

of you, it is good to see you again. You are to be congratulated for

selflessly taking up this cause and letting people know what is

going on, for testifying. And to all the people from Mount Sinai and

Bellevue and so forth, we wouldn’t be where we are today with recognition, of at least part of the problem, the work that is being

done at Sinai and Bellevue and research that has been done over

the years helping people, basically eliminated what was a conspiracy by the State and Federal Governments to hide this under a

rock, to pretend there was no real problem, not huge numbers of

people sick, just wanted the issue to go away and the people to go

away. If it weren’t for the work that some of the people sitting here

had done, we would be debating that question. There is very little

denying the reality of this problem.

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I also wanted to say that the work being done at the centers of

excellence is extremely important. The scientific reasons why we

want as much direct response as possible will be obtained through

the centers of excellence, for two reasons. No. 1, because you have

a lot of doctors who rarely see these symptomatology and they are

misdiagnosing and not treating properly some of the subjects. And

the centers where they are specializing in these problems are the

obvious best treatment modality.

Second, the research component, which is documented. Only if

people go through these treatment centers will we get proper treatment and followup for the studies. So whatever we know, we know

the funding has to be there. The only way to look at this and recognize this, we have to continue that.

Let me ask you this. First of all, right now, if someone wants to

be treated at Mount Sinai, be seen at Mount Sinai, and by the way,

we have to obviously make sure that, that is the whole point of this

hearing, that there is adequate funding, whether it is the $1 billion

figure, or the Mayor’s $50 million dollar figure, there has to be annual treatment that is guaranteed for a long time, maybe decades.

It should not ultimately be dependent on an annual appropriations

cycle.

But let me ask this question now. Let’s say someone comes to

Mount Sinai, and is treated and is given a prescription for medicines. Who pays for that medicine?

Dr. HERBERT. Prior to the receipt of the Federal funding for the

federally funded treatment programs, which was released in November 2006, we were fortunate at Mount Sinai to have received

some philanthropic funding. So essentially we had to rely on charity to pay for medication. Now, because there has been funding,

Federal funding for treatment of responders, we are able to use

that Federal funding to pay for medications. The costs are huge.

Mr. NADLER. So we have to make sure, because I was struck by

what Martin Bethea said earlier about the cost of his medications.

We have to make sure we deliver funding for the medications, because of paying for the doctors and the equipment.

Dr. HERBERT. May I add something? I think that often there is

a perception that if people have insurance it means they have access to the necessary medications. I think any of us, the drug copays alone for some of my patients who have what we consider

Cadillac insurance can be $1,500 a month. I know the same is true

for FDNY.

Mr. NADLER. Let me ask Dr. Reibman, talk about the work you

have done with the studies. Do these studies, do they include people who are basically there on 9/11, or do they also include people

who may not have been there on 9/11 but came back to work or

live nearby? And have you differentiated, do you have data as to

the effects, not as their having been there, but having worked in

the area or lived in the area in months or years after?

Dr. REIBMAN. The studies that we have published to date were

of residents. They weren’t necessarily people who worked in the

area, they lived in the area. Some of them, we didn’t differentiate

in those studies whether they were in the dust cloud or not. Many

of them were not in the dust cloud. Many of them moved out of

their apartments, or some of them moved out of their apartments

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but came back over the next several months. They had to have

been back in their apartment by December.

Mr. NADLER. Do you have data with which you could say with

any degree of likelihood that there is or is not, in which you can

evaluate the impact of people living there after the attack?

Dr. REIBMAN. We cannot do that at this point.

Mr. NADLER. Granted everything that has been said about the

necessity and utility, what about people who move away, they go

to Florida or go elsewhere, or have come here and then gone back

after a few weeks, would it be a good idea to have centers elsewhere. But I presume there will be people who will live elsewhere

who will not be subject to, or maybe some who remain in New

York, who will not live near a center of excellence. What can we

do for those people?

Dr. REIBMAN. We have been thinking a lot about that. This is a

really challenging problem. What I think makes the most sense,

based on our current health care system within the country, is at

least for the responders, the 20,000 plus in our cohort, is that we

have mapped by zip code and we know that we have 2,000 plus zip

codes, but we also know that many in the country, outside of New

York, this is nationally. But within that group there are clusters.

So many of the people who are currently in New York are likely

to retire to certain areas.

I think that probably the most rational approach, and one that

we are working on right now, is to identify sort of mini-centers of

excellence that would be connected to the existing centers of excellence that are based at academic medical centers, that we do continuing medical education and work very closely with providers

there. I think you need to have oversight, though, central oversight

of diagnosis and treatment.

And then I think parallel to that, you would want to work with

some network of health care providers who could receive continuous medical education but who would be more geographically accessible for people who live in more outlying regions. I know there is

one State, for example, where we have one responder. We are not

going to set up a center of excellence there.

Mr. NADLER. Thank you. We are obviously going to reopen the

Victims Compensation Fund. We had that, it worked. The Mayor

has suggested the $1 billion that is sitting there could be used in

there. That would not necessarily be the only funding for it. When

we had the Victims Compensation Fund originally, people had a

choice, they could go to the Victims Compensation Fund, or they

could use the captive insurance fund.

Are you suggesting that the mayor’s suggestion to re-establish

the Victims Compensation Fund would allow the choice, give people

the choice to go to the fund or the captive insurance fund?

Mr. SKYLER. That is a good question, Congressman. What the report recommends is that we eliminate the city’s liability, liquidate

the captive insurance fund, transfer it to the Victims Compensation

Fund. Because we recognize in one sense that resources are scarce.

The panel, Deputy Mayor Gibbs and I are sitting before you asking

for $150 million, $160 million annually in Federal funding. That is

not just for the city, it is for the city, it is for Mount Sinai, the program at Bellevue. We believe that if we had the $1 billion, we want

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to use that as basically a first installment in the Victims Compensation Fund. When talking about this, there is a fundamental

issue of fairness. I don’t see, especially having spent some time

with Marvin, John and other first responders, why somebody who

is hurt needs to show fault. If somebody is hurt, the Government

should help them and we should compensate them for lost earnings, for example. If we don’t eliminate the city’s liability, the city

will need to keep the captive insurance the way it is currently constituted and then have a separate Victim Compensation Fund.

We also can’t ever, because we need a long-term solution to this

issue, as you suggested in your remarks, this is subject to annual

appropriations, to some extent. We need a fund that can exist year

to year. We don’t know who is going to come forward in the coming

years and become a plaintiff against the city. The Victims Compensation Fund that existed could handle that.

Mr. TOWNS. I will have to cut you off. I tried not to.

Let me just ask, just before I go to Mr. Fossella, I must say, I

am troubled by something. Why is it all the programs are established in Manhattan? I am a Brooklyn Congressman. I am just curious.

Mr. SKYLER. I believe that the centers of excellence actually have

sites outside Manhattan. I believe Robert Wood Johnson in New

Jersey, the Mount Sinai program especially is a consortium, although it is known as the Mount Sinai program. It is a consortium

of other——

Mr. TOWNS. Where is the one in Brooklyn?

Dr. PREZANT. It is the New York City Fire Department program,

that is centered in the world famous Borough of Brooklyn.

Mr. TOWNS. Tell me where.

Dr. PREZANT. Nine Metrotech Center, a few blocks from the

Brooklyn Bridge on the corner of Flatbush and Tillery.

Mr. TOWNS. Thank you. I feel a lot better. [Laughter.]

Now I yield to Mr. Fossella.

Mr. FOSSELLA. Where is the one on Staten Island? [Laughter.]

Dr. KLEINMAN. Mr. Chairman, if I may respond, the NYPD’s

treatment program is set up such that members of the NYPD can

seek treatment from the physician of their choice anywhere, and it

will be paid for.

Mr. FOSSELLA. Well, let’s jump to that NYPD, Doctor. First of all,

I didn’t say it before, I want to thank my colleague, Carolyn

Maloney. She is not here now, but for the record, she has been instrumental in bringing this together. Thanks for your patience

throughout this whole hearing, all of you.

How many NYPD participated in the World Trade Center rescue,

recovery and cleanup operations, and why do you think it is important for NYPD to get separate funding for monitoring and research

of police officers who were exposed on 9/11?

Dr. KLEINMAN. Thank you, Congressman, for that question and

the opportunity to respond. The NYPD’s brave men and women

had 34,000 responders since 9/11, either responding at Ground Zero

or at one of the other designated exposure sites. At this time, there

have been 2,500 medical claims made by those responders. There

are 300 applications for disability due to problems that arise from,

potentially have arisen from World Trade Center-related exposures.

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As I mentioned earlier, perhaps when you were out of the chamber, the 34,000 members of the largest single responder group that

has been exposed, and as such, monitoring, tracking and obtaining

data on those individuals is of vital importance to the scientific and

medical community and impacts directly on our ability to determine what our appropriate measures for further monitoring and for

treatment. The data that will emerge from the studies that will be

forthcoming later this year, looking at 5-year followups with pre

and post-9/11 data will help inform the medical community and, I

daresay, HHS, which is desperately looking for data, will have the

largest group that represents a cross-section of the population of

the city of New York from which to make some determinations regarding future monitoring and treatment.

Mr. FOSSELLA. Would anyone else like to add to that?

All right. For Deputy Mayor Skyler, two questions. You said that

the estimated gross cost to treat those with potential 9/11-related

illness is $393 million per year. If you can explain, what does that

mean or elaborate. And related to that, you said that the Federal

Government will need a minimum of $150 million to fill the gaps

in treatment and research for 9/11 treatment and illness. What will

that $150 million pay for, and how does it relate to the $393 million figure?

Mr. SKYLER. The $393 million, that figure is essentially an economic impact on the health care system of 9/11. So that includes

somebody getting treatment at Bellevue, somebody getting treatment at the Fire Department, a police officer, it can be a resident.

But it can also be somebody who worked in lower Manhattan, who

lived in New Jersey at the time, was a commuter and possibly even

moved to Chicago or another part of the country, but who has an

illness because of 9/11 and is seeking care because of that illness,

and it associates that cost and the estimate. So it is in a sense a

national figure of how much money is being spent in the health

care system, based on 9/11 illnesses. The $150 million request that the report recommends basically

says that there are centers of excellence that are working that we

need to continue and expand. We see an increased demand for

services at Bellevue. We want to make sure we can provide for

that, that $150 million assumes that cost. It also says that we need

to recognize the Federal Government has not spent a dime on the

police department’s health monitoring services, and we want to rectify that inequity. It also would expand the mental health services

available, with the findings of the report of the widespread mental

health impacts of 9/11. And it also will make available a resource

to the city to advertise and promote the programs it has, to make

resources available through the Internet, and a couple of other

smaller recommendations that would have smaller costs than the

actual treatment.

Mr. FOSSELLA. Thank you, Mr. Chairman. I yield back.

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Mr. TOWNS. Let me thank all of you, we really, really appreciate

your testimony. As you have clearly indicated, we still have a long

way to go. We look forward to working with you in terms of trying

to get there.

So let me thank all of you, and this hearing is adjourned.

[Whereupon, at 3:50 p.m., the subcommittee was adjourned.]

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

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