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9/11 HEALTH EFFECTS: THE SCREENING AND

MONITORING OF FIRST RESPONDERS

HEARING

BEFORE THE

SUBCOMMITTEE ON GOVERNMENT MANAGEMENT,

ORGANIZATION, AND PROCUREMENT

OF THE

COMMITTEE ON OVERSIGHT

AND GOVERNMENT REFORM

HOUSE OF REPRESENTATIVES

ONE HUNDRED TENTH CONGRESS

FIRST SESSION

SEPTEMBER 10, 2007

Serial No. 110–87

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

(

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

http://www.oversight.house.gov

(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

JIM JORDAN, Ohio

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 September 10, 2007 ..................................................................... 1

Statement of:

Bascetta, Cynthia A., Director, Health Care, U.S. Government Accountability Office; Lorna Thorpe, Deputy Commissioner, Division of Epidemiology, New York City Department of Health and Mental Hygiene;

Dr. Spencer Eth, vice president, Department of Psychiatry, medical

director, Behavioral Health Services, Saint Vincent’s Catholic Medical

Centers; Dr. James Melius, administrator, New York State Laborers’

Health and Safety Trust Fund; and Thomas McHale, detective, Port

Authority Police Department, Port Authority Police Detectives Endowment Association, National Association of Police Organizations .............. 15

Bascetta, Cynthia A. ................................................................................. 15

Eth, Spencer .............................................................................................. 52

McHale, Thomas ........................................................................................ 66

Melius, James ............................................................................................ 59

Thorpe, Lorna ............................................................................................ 43

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

Bascetta, Cynthia A., Director, Health Care, U.S. Government Accountability Office, prepared statement of ........................................................... 17

Eth, Dr. Spencer, vice president, Department of Psychiatry, medical director, Behavioral Health Services, Saint Vincent’s Catholic Medical

Centers, prepared statement of ................................................................... 55

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

of New York, various articles ....................................................................... 78

McHale, Thomas, detective, Port Authority Police Department, Port Authority Police Detectives Endowment Association, National Association

of Police Organizations, prepared statement of .......................................... 69

Melius, Dr. James, administrator, New York State Laborers’ Health and

Safety Trust Fund, prepared statement of ................................................. 61

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

New York, prepared statement of Dr. Reibman ......................................... 7

Thorpe, Lorna, Deputy Commissioner, Division of Epidemiology, New

York City Department of Health and Mental Hygiene, prepared statement of ........................................................................................................... 46

(1)

9/11 HEALTH EFFECTS: THE SCREENING AND

MONITORING OF FIRST RESPONDERS

MONDAY, SEPTEMBER 10, 2007

HOUSE OF REPRESENTATIVES, SUBCOMMITTEE ON GOVERNMENT MANAGEMENT, ORGANIZATION, AND PROCUREMENT, COMMITTEE ON OVERSIGHT AND GOVERNMENT REFORM, Brooklyn, NY.

The subcommittee met, pursuant to notice, at 10:45 a.m., at the

Brooklyn Borough Hall, Ceremonial Courtroom, 209 Joralemon

Street, Brooklyn, NY, Hon. Edolphus Towns (chairman of the subcommittee) presiding.

Present: Representatives Towns and Maloney.

Staff present: Rick Blake, professional staff member; and Cecelia

Morton, clerk.

Mr. TOWNS. The hearing will come to order.

As we begin the business of today, we should remember 6 years

ago, when toxic clouds of smoke from the World Trade Center hung

above lower Manhattan and Brooklyn. On that day and in the

weeks that followed, first responders, construction workers and volunteers came to Ground Zero to work on the rescue and recovery

effort, and we salute them for that.

Many of them have become victims of 9/11, facing health challenges such as pulmonary fibrosis, post-traumatic stress disorder

and more. In February, we learned about all the work that New

York City and New York State have started. We asked the Federal

officials at Health and Human Services for more support of these

programs.

At that time, we questioned the Assistant Secretary of Health

Agwunobi, who told us the administration was working on a report

from a task force which would come up with a plan. We pressed

for more details from HHS and basically got what only can be

called, in my neighborhood, the runaround.

Now, more than 6 months later, we still don’t have a final report

or a plan from the administration for dealing with the long-range

health consequences of 9/11. It was this subcommittee’s intent to

call Dr. Agwunobi back to testify and ask him about his plan. But

instead, we learned that he quit.

But, someone needs to produce it. Even 6 years later, New Yorkers are still dealing with the long-term health effects from this

tragedy. And, we intend to hold the administration accountable.

And, let me put it this way. We are not going away.

I don’t mean to be overly critical, but the lack of a long-range

plan has become a pattern in this administration. 9/11, no plan.

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Katrina, no plan. Iraq, no plan. They simply don’t deal with largescale adversities too well.

Today, we will get an update from witnesses who are the experts

on 9/11 health, both the Government Accountability Office and our

expert witnesses from New York City, have new reports concerning

the health screening and monitoring of our first responders, and information concerning what has really happened in terms of their

physical and mental health. Doctors and first responders will tell

us how health care is being delivered.

I would, at this point, like to thank my colleague and friend,

Congresswoman Carolyn Maloney, for the outstanding work that

she has been doing on behalf of the project, in terms of 9/11 health

care and, of course, responding to the issues and concerns. Congresswoman, you are doing a superb job. And, at this time, I would

like to yield to you for an opening statement.

Mrs. MALONEY. Thank you so much.

First and foremost, I want to thank you, my good friend Congressman Towns, for holding this very important hearing on the

eve of the sixth anniversary of 9/11. This is the third in a series

of hearings on the health effects of 9/11, and I commend you for

your unwavering efforts to bring this issue to the forefront.

I also want to thank my good friend, Jerry Nadler. Working together, we will not rest until everyone exposed to the toxins at

Ground Zero is monitored, and all who are sick are treated as a

result of their exposure, that they get the medical treatment that

they need and that they deserve.

The collapse of the World Trade Center towers took nearly 3,000

lives in an instant and released a massive cloud of asbestos, concrete and other poisons. Due to those toxins, we now know that

thousands more have lost their health.

Six years later, more than 6,500 responders, truly the heroes and

heroines of 9/11, are being treated for 9/11-related health problems

through the federally funded World Trade Center Monitoring and

Treatment Program. And, more than 4,500 have been referred for

mental health care, often for conditions like post-traumatic stress

syndrome.

Every month, another 500 to 1,000 responders sign up for health

monitoring. And, those coming in are more sick than ever before.

Separately, more than 70,000 Americans reported to the World

Trade Center Health Registry. Although most are from New York,

New Jersey and Connecticut, more than 10,000 Americans came

from outside the tri-State area and are registered. Amazingly,

every single State in the Union had representatives at 9/11, including Hawaii and Alaska. This is a health emergency on a national

scale, and it requires a strong Federal response.

Two days ago, at a labor rally at Ground Zero, I joined the New

York AFL–CIO president, Denis Hughes, Representative Nadler,

our Senators and Congressman Rangel, in announcing the 9/11

Health and Compensation Act, which we will be introducing this

week in Congress.

The 9/11 Health and Compensation Act will ensure that everyone

exposed to the Ground Zero toxins has a right to be medically monitored, and all who are sick as a result have a right to treatment.

It will build on the expertise of the Centers for Excellence at

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Mount Sinai, Bellevue and other sites, which are currently providing high-quality care to thousands of responders, and ensuring ongoing data collection and analysis, and expanded care to the entire

exposed community.

The bill also includes care for area residents, workers and school

children, as well as the thousands of people that came from across

the country to assist with the recovery and clean up efforts.

Finally, the bill provides compensation for economic damages and

loss by re-opening the September 11th Victims Compensation

Fund.

I have been fighting for years to make sure that all these things

happen. And I am very proud to be working with representatives

Nadler and Rangel and Towns and many others, with very strong

support of the New York AFL–CIO, to move this comprehensive

package forward.

Only the Federal Government has the resources and the reach to

properly address the health and compensation needs. Only the Federal Government can take care of the thousands and thousands

who responded to help at Ground Zero. But often, it feels like we

in Congress are fighting the Bush administration every step of the

way.

Let me give you just one of many examples. In my very first

hearing of the year of the subcommittee, we heard from Dr. John

Agwunobi, who was Assistant Secretary of Health at the Department of Health and Human Services and who also acted as Chair

of the Department’s World Trade Center Task Force. Many of us

left that hearing feeling like there were many more questions left

than good answers given. Since then, we have learned that the

World Trade Center Task Force briefed HHS Secretary Leavitt

with their recommendations. Remarkably, still no action has been

taken on these recommendations. And, Dr. Agwunobi has resigned,

effective September 4th, without releasing the plan of action he

promised, and that has been promised to us repeatedly, over and

over and over again, from the administration.

So, along with Senators Clinton, Schumer, Nadler, Pallone,

Towns and many others, we have written to Secretary Leavitt to

request a meeting to find out when he intends to appoint a new

Chair for the World Trade Center Task Force.

Let me close by saying that I look very much forward to the

hearing and the testimony of our witnesses today. I thank each and

every one of you for being here and for doing your part to help others. And, you are here really doing important work to ensure that

those exposed to the toxins are monitored and those who are sick

are treated. That is the least we can do, as the wealthiest nation

on Earth, take care of the people who rushed selflessly into burning buildings to help others.

I yield back the balance of my time.

Mr. TOWNS. Thank you, very much, Congresswoman Maloney.

We have been joined by Congressman Nadler, who, of course,

represents Manhattan and Brooklyn and who has been very, very

involved in this issue over the years. Ladies and gentlemen, Congressman Nadler.

Mr. NADLER. Thank you, Mr. Chairman.

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Mr. Chairman, let me begin by thanking you for holding this

hearing, by thanking Congresswoman Maloney for the work she

has done on this issue, and thanking the AFL–CIO for the work

that they have done on this issue, in particular on helping us craft

the bill that Congresswoman Maloney and I and some others will

be introducing shortly.

When the Twin Towers came down on September 11, 2001, our

first responders—firefighters, police officers, EMTs, steel workers

and countless others—selflessly put their lives in danger so that

they might save the lives of others. Workers and volunteers came

from all five boroughs, from New Jersey and Connecticut and from

every other State in the Union. At the moment when our country

was under attack, these responders were on the front lines, sifting

through the rubble of the World Trade Center searching desperately for survivors.

Many of them did this without proper protective equipment, because government officials—the EPA, OSHA and the White

House—told them it was safe. Now, 6 years later, many of them

are sick.

At the Pentagon, OSHA enforced regulations requiring the use of

respirators. No workers became sick. At Ground Zero, Con Edison

made sure that its workers wore respirators, and none of the Con

Edison workers became sick. But, OSHA failed to enforce its own

regulations at the World Trade Center site, as did the EPA, as did

the city of New York. Someone made the deliberate decision not to

enforce the OSHA laws, and 70 percent of the first responders who

worked on that site are sick, and some others have already died.

As Chair of the Subcommittee on the Constitution, Civil Rights

and Civil Liberties, I held a hearing in June where we heard for

the first time from the former head of OSHA, who testified under

oath that OSHA had properly protected the health and safety of

workers at Ground Zero.

He also testified that OSHA’s breathing zone samples showed exposures were below the agency’s permissible levels, even though

independent tests showed otherwise.

Back in 1986, under the Reagan administration, EPA concluded

that there are no safe levels, no minimum safe levels of asbestos.

The former head of OSHA—the same former head—even signed a

letter explaining that all World Trade Center dust would be considered to contain asbestos, and that, therefore, triggered all the laws

regarding cleanup of asbestos. And yet, OSHA handed out paper

filament masks on 9/11 that were clearly marked, ‘‘Warning: This

mask does not protect your lungs.’’

OSHA claims that it conducted safety and health inspections to

ensure that standards were followed and the workers were properly

protected. Had this been the case, the agency should have alerted

workers to the grave health and safety violations at the World

Trade Center site and enforced regulations that required that all

workers wear respirators. If all workers had been wearing respirators, first responders like Marvin Bethea, for example, who has

testified at many hearings, would not be suffering from 9/11 health

effects.

In 2002, EPA issued a report called ‘‘Lessons Learned in the

Aftermath of September 11, 2001,’’ which states that, ‘‘EPA’s misVerDate 11-MAY-2000 11:47 Apr 06, 2009 Jkt 000000 PO 00000 Frm 00008 Fmt 6633 Sfmt 6633 C:\DOCS\48063.TXT KATIE PsN: KATIE
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sion was to protect front line responders and residents from dust

and contaminants released when commercial aircraft were deliberately crashed.’’ It goes on to say, ‘‘Mission accomplished.’’

If EPA’s response to Ground Zero indeed constituted ‘‘mission accomplished,’’ then first responders like John Sferazo, who has testified at many hearings, would not today be suffering from 9/11 effects.

The response of the Federal Government is totally inadequate.

Indeed, I have often said that the Federal Government has betrayed our first responders. The brave men and women who

worked seemingly endless days at the World Trade Center site deserve answers to their questions and deserve help for their afflictions.

Why did OSHA not enforce the law in New York, with respect

to the non-city or State employees on the site, despite repeated requests from the city to do so? The OSHA head testified at our hearing in June that they had no jurisdiction to force city workers to

comply with those regulations. But, they did have jurisdiction to

enforce the law with regard to non-city and State employees. Why

did they no do so, despite repeated requests from the city to do so.

Why did OSHA hand out inadequate paper masks that did not

protect against asbestos or ultra fine particulates to workers? Why

did EPA shirk its responsibility to warn all those people in New

York, in Lower Manhattan, that the air was not safe to breathe?

Indeed, why did they knowingly and deliberately lie, telling people

the air was safe to breathe, when there were ample tests results

that showed to the contrary?

In the meantime, we have been forced to go hat in hand, begging

for health care for the first responders. Despite all the published

scientific reports and all the 9/11 community rallies, we still find

ourselves shouting that we need help.

The Federal Government put these men and women in harm’s

way on 9/11 and is now treating them like pests rather than heroes. Doctors at Mount Sinai and at Bellevue have been doing a

fantastic job. Mount Sinai is doing a fantastic job of treating those

responders, and Bellevue is treating local residents who need care.

But, doing so has been a struggle, as they receive only a fraction

of the funding their program needs.

A July GAO report found that efforts by the Federal Government

to provide services to first responders have been intermittent and

haphazard, at best.

Abraham Lincoln said, in his second inaugural address that we

must ‘‘care for him who shall have borne the battle.’’ And so we

should. I am pleased that Congresswoman Maloney and I and others will soon be introducing legislation to provide long-term

healthcare to all those with 9/11-related illnesses. Our legislation

would build on the efforts of the Centers of Excellence in New York

City and would extend to people who came from all over the country to aid in the massive rescue and recovery efforts after 9/11. I

encourage all my colleagues to support this bill and to pass it without delay.

Dr. Joan Reibman of Bellevue has prepared testimony on behalf

of the New York Health and Hospitals Corp.

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I ask, Mr. Chairman, that it be submitted in whole for the

record.

Mr. TOWNS. Without objection.

[The prepared statement of Dr. Reibman follows:]

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Mr. NADLER. And I again thank the AFL–CIO for its help and

leadership in preparing this legislation.

Tomorrow, we mark 6 years of incompetence and malfeasance on

the part of the Federal Government. I would call it more malfeasance than incompetence. I call on EPA to stop covering up its

harmful and illegal actions in response to the attacks of 9/11. I call

on EPA to conduct a proper testing and cleanup program in Lower

Manhattan, in Brooklyn, in Queens, and to fulfill its legal mandate

to clean up indoor air, not just in Lower Manhattan, but also in

Brooklyn and in any other areas that were contaminated by the

World Trade Center dust.

And, I call on Congress to pass the bill that Congresswoman

Maloney and I will be introducing to provide comprehensive

healthcare benefits to all those who are suffering the health effects

of 9/11.

And, I call on the Bush administration to take their heads out

of the sand, stop denying the obvious and start treating the first

responders as heroes and stop treating them as pests.

I thank you, and I yield back.

Mr. TOWNS. Thank you, very much, Congressman Nadler.

We have been joined by the deputy borough president of Brooklyn. And I want to just sort of first thank them for allowing us to

come in and use the facility here. And I am always happy and anxious and eager to introduce the deputy borough president of Brooklyn, because some of you might not know that I served as a deputy

borough president of Brooklyn for many, many years. So, I have a

special kind of feeling when it comes to deputy borough president.

So, it is my honor and my pleasure to present to you Yvonne

Graham, the deputy borough president of Brooklyn.

Ms. GRAHAM. Thank you, Congressman Towns. It is my honor to

present these remarks on behalf of borough president Marty

Markowitz.

Good morning, Chairman Towns and members of the Subcommittee on Government Management, Organization, and Procurement.

Tomorrow, of course, marks the sixth anniversary of the tragic

events of September 11, 2001. The scars of 9/11 are still fresh, and

that horrific event continues to harm the collective memory of all

New Yorkers. So, I thank you for organizing this hearing on the

health impacts of 9/11 particularly as they relate to the brave men

and women who came to our city’s aid on that terrible day and who

worked for so many months afterwards to help us heal.

I am extremely grateful to the New York delegation for working

in bipartisan cooperation to secure Federal funding for monitoring,

research and treatment programs that 9/11 responders both need

and deserve. Our city and Nation must help those who volunteered

so selflessly during and after the attack.

According to an article in last week’s Village Voice, statistics indicate that 3.6 percent of the 25,000 Ground Zero workers have reported symptoms of asthma after working at the site. The article

also reports that more than 3,000 firefighters have sought medical

treatment for respiratory conditions since 9/11, and more than 25

percent of all New York City’s firefighters show symptoms of asthma.

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We must address these health issues now and continue that commitment well into the future. Since these respiratory ailments and

cancers can develop over time and appear years later, it is critical

that everyone who worked at Ground Zero be monitored for health

conditions and be given access to long-term healthcare programs,

if need be.

We all know that mistakes were made. The air was not immediately tested after the disaster. And, residents and responders

were told that the air was safe to breathe. Although it may be too

late to change that history, it is not too late to address the short

and long-term health effects that may have resulted.

As elected officials, our No. 1 priority is ensuring the well-being

of our residents. Our call to action should be making sure that New

Yorkers who are suffering from complications as a result of the attacks get the healthcare and services they need. Our mandate must

be securing Federal funding for research, monitoring and long-term

treatment, so that all victims can be treated now and in the future.

Tomorrow, the halls of government will echo with the phrase

‘‘Never forget,’’ referring to those we lost. We honor their memory.

And, we must also never forget those who, without regard to their

own safety, hurried to the site of the tragedy to help a city in need.

Thank you all for refusing to forget.

Mr. TOWNS. Thank you, very much, Deputy Borough President

Graham. Thank you for your statement and also, again, thank you

for allowing us to come in.

And, to those of you who might not know, she was very, very involved in healthcare herself, before becoming deputy borough president of Brooklyn.

Thank you, so much, for coming.

At this time, we would introduce our witnesses.

We have Cynthia Bascetta, Director of Health Care, U.S. Government Accountability Office. Thank you for coming.

Dr. Lorna Thorpe, deputy commissioner of health, New York City

Department of Health and Mental Hygiene, and director of Division of Epidemiology.

Dr. Spencer Eth, senior vice president and medical director, Behavioral Health Services, Saint Vincent’s Medical Center of New

York. Welcome, and thank you for coming.

And, of course, Dr. James Melius, administrator of New York

State Laborers Health and Safety Trust Fund.

And, Thomas McHale, detective with the Port Authority of New

York and New Jersey Police.

Thank you all for coming. It is our longstanding policy that we

swear in our witnesses. So, if you would stand and raise your right

hands?

[Witnesses sworn.]

Mr. TOWNS. Let the record reflect that the witnesses have answered in the affirmative.

We are going to move right down the line, from your right to

your left.

We will start with you, Ms. Bascetta. Thank you. If you would,

just use like 5 minutes to give us a summary. And, the reason for

it is that we want to be able to get into questions. And, of course,

I know that these Members have something else that they need to

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do. And, of course, I am involved in that, as well. So, while—and

we want to be able to cover as much, so we think in the questionand-answer you may be getting into all the other things that you

might not be able to say in your statement. OK? Thank you so

much.

And we will go right down the line.

STATEMENTS OF CYNTHIA A. BASCETTA, DIRECTOR, HEALTH

CARE, U.S. GOVERNMENT ACCOUNTABILITY OFFICE; LORNA

THORPE, DEPUTY COMMISSIONER, DIVISION OF EPIDEMIOLOGY, NEW YORK CITY DEPARTMENT OF HEALTH AND MENTAL HYGIENE; DR. SPENCER ETH, VICE PRESIDENT, DEPARTMENT OF PSYCHIATRY, MEDICAL DIRECTOR, BEHAVIORAL HEALTH SERVICES, SAINT VINCENT’S CATHOLIC

MEDICAL CENTERS; DR. JAMES MELIUS, ADMINISTRATOR,

NEW YORK STATE LABORERS’ HEALTH AND SAFETY TRUST

FUND; AND THOMAS MCHALE, DETECTIVE, PORT AUTHORITY POLICE DEPARTMENT, PORT AUTHORITY POLICE DETECTIVES ENDOWMENT ASSOCIATION, NATIONAL ASSOCIATION OF POLICE ORGANIZATIONS

STATEMENT OF CYNTHIA BASCETTA

Ms. BASCETTA. Mr. Chairman and members of the subcommittee,

thank you for inviting me to discuss the implementation of federally funded health programs for responders who served in the

aftermath of the World Trade Center disaster.

As you know, these responders were exposed to numerous physical hazards, environmental toxins and psychological trauma,

which has continued to exact a toll for many of them, even 6 years

after the attack.

My testimony today is based on our body of work, including four

testimonies from our July 2007 report. In this work, we found that

HHS-funded programs as separate efforts serving different categories of responders; for example, firefighters, police, other workers and volunteers and the Federal responders. We also highlighted

that the Federal responder screening program had accomplished

little, in light of the kind of programs for other responders.

My remarks today focus on the status of NIOSH’s awards for

treatment to World Trade Center health program grantees, the

services provided to Federal responders and efforts by NIOSH to

provide services for non-Federal responders residing outside the

New York City metro area.

To do our work, we reviewed numerous documents and interviewed officials of the Federal Government and private-sector organizations.

Last fall, NIOSH awarded and set aside funds totaling $51 million from its $75 million appropriation to pay for treatment programs, notably the first time that Federal funds were awarded for

this purpose. And about $44 million was for outpatient treatment,

and about $7 million was set aside for inpatient hospital care. The

bulk of the funding went to the fire department and the New York/

New Jersey Consortium. In addition to outpatient care, Federal

funds paid for 34 hospitalizations of responders so far. NIOSH is

now planning how to use the $50 million emergency supplemental

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appropriation made in May 2007, to continue support for treatment

into the year 2008.

We reported this July that HHS has had continuing difficulties

ensuring the uninterrupted availability of services for Federal responders who had been eligible only for a one-time screening examination. First, the provision of these screening examinations has

been intermittent. HHS suspended them from March 2004 to December 2005, resumed them for about a year, then placed the program on hold and suspended scheduling exams from January to

May 2007. The interruptions occurred because interagency agreements were not put in place in time to keep the program fully operational.

Second, the provision of specialty diagnostic services associated

with screening has also been intermittent, Responders often need

further diagnostic tests from ear, nose and throat physicians, cardiologists and pulmonologists, and the program had referred responders and paid for these diagnostic services. However, because the

contract with a new provider network did not cover these services,

they were unavailable from April 2006 until the contract was modified in March 2007.

NIOSH was considering expanding the services for Federal responders to include monitoring examinations, the same followup

physical and health examinations provided to other responders.

Without followup, their health conditions may not be diagnosed

and treated, and knowledge of the health effects caused by the disaster may be incomplete.

We also found that NIOSH has not ensured the availability of

screening and monitoring services for non-Federal responders outside of the New York City area, although it recently took steps to

expand their availability. Similar to the intermittent service pattern for Federal responders, NIOSH’s formation of a network of occupational health clinics to provide services nationwide were onagain/off-again. NIOSH renewed its efforts to expand the provider

network, however; and in May 2007, had completed about 20

exams.

Mr. Chairman, despite HHS’s recent consideration of ways to add

monitoring for Federal responders and to improve the availability

of screening and monitoring services for Federal and non-Federal

responders nationwide, these efforts remain incomplete. Moreover,

the start-and-stop history of the Department’s efforts to serve these

groups does not provide assurance that the latest efforts to extend

screening and monitoring services to these responders will be successful and will be sustained over time.

As a result, we recommended in our July 2007, report that the

Secretary take expeditious action to ensure the availability of

health screening and monitoring services for all people who responded to the attack on the World Trade Center, regardless of

their employer or their residence. To date, HHS has not responded

to our recommendation.

That concludes my remarks, and I would be happy to answer any

questions.

[The prepared statement of Ms. Bascetta follows:]

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Mr. TOWNS. Thank you very much for your statement.

Dr. Thorpe.

STATEMENT OF LORNA THORPE

Dr. THORPE. Good morning, Chairman Towns, Congresswoman

Maloney, Congressman Nadler and Deputy Borough President

Yvonne Graham, if she is still with us.

My name is Lorna Thorpe, deputy commissioner of the Division

of Epidemiology at the New York City Department of Health and

Mental Hygiene. Thank you for inviting me to discuss two scientific

studies done on the health impacts of the World Trade Center disaster among rescue and recovery workers.

These studies, conducted using the largest sample of exposed

workers and volunteers assembled to date, add important new findings to the growing body of information on the physical and mental

health effects of the disaster. They are based on interviews of more

than 25,000 rescue and recovery workers who enrolled in the World

Trade Center Health Registry during 2003 and 2004.

By way of background, the World Trade Center Health Registry

is one of the Nation’s main platforms for understanding possible

short and long-term World Trade Center-related illnesses. It was

developed as a collaboration between the New York City Health

Department and the Agency for Toxic Substances and Disease Registry [ATSDR], with the goal of tracking exposed individuals for up

to 20 years.

Initially funded through FEMA, and later through special 9/11

congressional appropriations, the Registry has sufficient funding to

last through Federal fiscal year 2008. We estimate that it requires

at least $4.5 million per year to maintain the Registry going forward.

In all, more that 71,000 individuals voluntarily enrolled in the

Registry, including persons from every State and almost every congressional district in the United States. More than 20 percent of

the enrollees lived outside of New York State on September 11,

2001.

In addition to enrolling workers, the Registry includes another

14,000 Lower Manhattan residents, 10,000 tower survivors and

survivors of other damaged or destroyed buildings, 19,000 occupants of other Lower Manhattan buildings near the World Trade

Center site, 3,000 children, 13,000 people who were on the street

or in transit around the World Trade Center at the time of the

building collapse.

The Registry will monitor the health of enrollees over a 20-year

time period through periodic health surveys, special in-depth studies and routine assessments of cancer incidence and mortality. Special studies initiated by either government or academic institutions

is open for external research.

The two peer-reviewed studies published this month reported the

development of asthma and on post-traumatic stress disorder

among rescue and recovery workers after 9/11. Both are potentially

lifelong conditions that can be controlled with appropriate treatment.

The asthma study, published this month in the journal Environmental Health Perspectives, found that among more than 25,000

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previously asthma-free rescue and recovery workers, 3.6 percent reported having been diagnosed with new-onset asthma by a physician within a 2 to 3-year time period after working at the site. That

is a rate 12 times higher than expected in the general adult population.

The study also shows that asthma rates were highest among two

groups of workers: those who arrived soon after the buildings collapsed, particularly those arriving on September 11th and September 12th; and those who worked for long durations at the site, over

90 days. For workers who arrived on September 11th and worked

more than 90 days, rates of asthma were as high as 7 percent,

more than 20 times higher than would have been expected in the

general population.

Certain respirators or masks can reduce exposure to hazardous

dust when used correctly. While the survey did not distinguish between different types of respirators or masks, or gauge correct

usage, we did find that reported mask use afforded moderate protection against developing asthma.

For example, workers who wore them on September 11th and

September 12th reported significantly lower rates of newly diagnosed asthma than those who did not. Generally, the longer the period of not wearing respirators or masks, the greater the risk, although asthma levels were elevated in all worker groups, including

those who wore mask.

The asthma findings in this study and their dose response relationship to the World Trade Center exposures are consistent with

and add important additional information to prior lung function decline studies by the New York City Fire Department and the

Mount Sinai Medical Monitoring program.

The other study published this month in the American Journal

of Psychiatry examined survey responses of nearly 29,000 rescue

and recovery workers who worked directly at World Trade Center

site.

In this study, we found that one in eight workers, or 12.4 percent, had post-traumatic stress disorder at the time of their interviews. The prevalence of post-traumatic stress disorder [PTSD], in

the U.S. population is roughly 4 percent at any given time. This

is three times that rate.

Post-traumatic stress disorder can be devastating, affecting the

sufferer’s families and their work lives.

People with PTSD are at greater risk of suffering from depression and substance abuse.

We found that levels of PTSD among workers varied significantly

by occupation, with rates ranging from 6.2 percent among police officers, to 21.2 percent among volunteers not affiliated with an organization. Workers from non-emergency occupations, such as construction, engineering and sanitation workers, also suffered particularly high rates of PTSD, which may reflect that these workers

do not typically have disaster preparedness training or prior experience with emergencies, both of which can help buffer psychological trauma.

As with the asthma study, people who started work or soon after

9/11, or who worked for longer periods of time, were more vulnerable to developing PTSD.

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The study also found that working outside of one’s area of expertise increased the risk of developing PTSD—for example, civilian

volunteers engaged in firefighting, or engineering and sanitation

workers performing search and rescue. Sustaining and injury and

having to evacuate a building also increased their risk.

These two studies demonstrate the need for continued monitoring

and care of exposed workers. They also offer important lessons to

help emergency planners reduce the impact of future disasters,

such as ensuring the availability of respiratory and other protective

equipment, and proper training in its use; the value of disaster preparedness training for all types of emergency responders; the use

of shift rotations to reduce workers’ duration at emergency sites;

and the importance of limiting exposure of those who have had less

experience with trauma response, such as volunteers.

In addition to these two studies, we have a number of other registered studies under peer review, including ones examining the

health impacts on the residents of Lower Manhattan and children.

Mr. TOWNS. If you could, sum up, please.

Dr. THORPE. The New York City Health Department is also conducting special in-depth studies, using the Registry as a foundation. First among these is a clinical investigation of respiratory

health, in collaboration with Bellevue Hospital. This study focuses

on residents and building occupants in Lower Manhattan who report persistent respiratory symptoms.

The collapse of the World Trade Center towers on 9/11 was an

unprecedented urban environmental disaster brought on by a terrorist attack upon our Nation. We are grateful to the New York

City congressional delegation and to Mayor Bloomberg for providing funding to support both the Centers of Excellence and the

World Trade Center Registry.

We are confident that working together with our elected officials

nationwide, we can improve the medical and healthcare services to

address the needs of first responders, recovery workers, residents

and all those who may have suffered health effects related to the

events of September 11, 2001.

Thank you.

[The prepared statement of Dr. Thorpe follows:]

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Mr. TOWNS. Thank you, very much.

Dr. Eth.

STATEMENT OF SPENCER ETH

Dr. ETH. Good morning, Congressman Towns, Congresswoman

Maloney, Congressman Nadler and other distinguished guests.

My name is Dr. Spencer Eth, and I am medical director of Behavioral Health Services at Saint Vincent Catholic Medical Centers, and professor of psychiatry at New York Medical College.

It is a privilege to speak today about a subject that is of the utmost importance to me as a psychiatrist, and indeed to everyone

present here today.

Six years ago tomorrow, I was completing psychiatric rounds in

Saint Vincent’s Hospital when a plane crashed into the north

tower. As the closest academic medical center to the World Trade

Center and as the hospital that had received most of the victims

of the February 1993, bombing, Saint Vincent’s immediately implemented its disaster plan in anticipation of the expected onslaught

of patients. Beds were cleared, elective surgeries and clinics were

canceled, and all professional staff stood ready for action. However,

within the first 2 hours, only 400 patients presented to the Saint

Vincent’s emergency room, most having suffered minor injuries.

Then, the sirens stopped, and few new patients arrived for emergency medical care. There was no second wave of injured survivors.

Tragically, the 2,800 people trapped in and adjacent to the towers

died, while the majority of others in the vicinity were not seriously

hurt. Saint Vincent’s did not perform a single surgery that day.

Instead, what transpired was astounding. Saint Vincent’s became

surrounded by hundreds of people in acute emotional distress—people who were terrified and desperately seeking information, reassurance and crisis counseling.

We mobilized our mental health staff, and within hours, began

seeing all of these people at Saint Vincent’s, and soon afterwards

at the nearby New School University.

True to our mission, the Saint Vincent’s Department of Psychiatry made a commitment to care for everyone who needed our help

without charging a single fee. Operating around the clock, we provided over 7,000 sessions and answered over 10,000 telephone calls

in that first week. I will never forget the impact our services had

on so many suffering New Yorkers in this immediate crisis phase

of the disaster response.

We knew that our professional staff would soon have to return

to their regular duties treating patients with mental illness and

substance abuse. Consequently, we recognized the need to hire and

train new clinicians to meet the demands of the World Trade Center victims and first responders. And, in order to do so, we actively

sought donations to cover the additional personnel costs. We were

fortunate that many corporations, foundations and individuals supported this phase of our work.

On September 26, 2001, I testified in Washington at a special

hearing of the Senate Health, Education, Labor and Pensions Committee. I vividly recall the moving testimony of the other witnesses,

who included Dr. Kerry Kelly, the medical director of the FDNY.

I also remember the reactions of the committee members. ChairVerDate 11-MAY-2000 11:47 Apr 06, 2009 Jkt 000000 PO 00000 Frm 00056 Fmt 6633 Sfmt 6633 C:\DOCS\48063.TXT KATIE PsN: KATIE
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man Kennedy and Senators Clinton, Wellstone, Warner and Frist—

all of them pledged to supply the Federal funds that would be necessary to meet the mental health needs of the survivors of the terrorist attack.

On that basis, Saint Vincent’s developed special long-term psychiatric programs to treat the World Trade Center victims, first responders and public safety workers who were at the pile. Thousands of adults and children were seen at our hospital and in site

at the FDNY firehouses, at the schools in Lower Manhattan, in the

Port Authority Police Department trailers surrounding Ground

Zero and, in the following year, at the Saint Vincent’s World Trade

Center Healing Services offices at 170 Broadway.

Finally, in 2002, the promised Federal funds began to flow. In

particular, FEMA’s New York State Project Liberty allowed us to

broaden the scope of our programs. However, FEMA mandated that

only crisis counseling could be provided through Project Liberty.

Many of the World Trade Center survivors we saw were already

suffering from more serious mental conditions. These disorders

generally required a course of psychotherapy and possibly psychotropic medication. The limitations of the FEMA regulations prevented the sickest victims from receiving effective treatment in

Project Liberty funded programs.

Another Federal agency, SAMHSA, awarded Saint Vincent’s one

of its seven Public Safety Worker Program grants. That expanded

our ability to evaluate and treat first responders. We assessed the

mental health needs of this population and delivered psychiatric

care in proximity to work sites. We noted that although the number of patients decreased over the 3-year life of the grant, the severity of their symptoms actually worsened. In addition, many patients presented for the first time only years after trying unsuccessfully to cope with their suffering.

Although the work of the healing was far from complete, the Federal funding for Project Liberty and the Public Safety Worker Program ended 2 years ago. Saint Vincent’s has continued to meet its

commitment to those still suffering the emotional wounds of 9/11.

In our current phase of disaster relief, Saint Vincent’s is once

again dependent on private donations, especially support from the

9/11 funds of the American Red Cross and the New York Times

Foundation. We are receiving no Federal, State, or city funding,

which has been exclusively directed to Bellevue and Mount Sinai

Hospitals. This is despite our record of treating over 60,000 survivors for mental health needs.

Looking to the future, our clinical experience suggests—and I

will be done in just——

Mr. TOWNS. Yes. Please wrap up.

Dr. ETH [continuing]. About 30 seconds——

Mr. TOWNS. OK.

Dr. ETH. Our clinical experience suggests that there will be an

ongoing need for mental health care for 9/11 workers and others

exposed to the terrorist attack and its aftermath. The study co-authored by Dr. Thorpe demonstrated chronic PTSD in 12 percent of

rescue and recovery workers, 2 to 3 years after 9/11. This mental

condition is well-known to be difficult to treat and to be associated

with long-term emotional distress and occupational disability.

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Further, many victims of 9/11 are developing pulmonary and

other medical illnesses arising from their exposure to toxic substances. These individuals can also be expected to experience new

and worsening psychiatric symptoms that will erode their level of

function and their ability to cope.

These are not theoretical concerns, but actual findings from our

evaluation and treatment of first responders. But, despite our best

efforts, Saint Vincent’s will not be able to continue going it alone.

We need Federal assistance to provide mental health care to our

current and future patients. We look to the Congress—we look to

you—to honor the promise——

Mr. TOWNS. Doctor, please sum up.

Dr. ETH [continuing]. To honor the promise to our first responders and our Nation made 6 years ago by the Senate Health Committee. Please provide the funding to keep these vital programs

alive.

[The prepared statement of Dr. Eth follows:]

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Mr. TOWNS. Thank you.

Dr. ETH. Thank you, Mr. Chairman.

Mr. TOWNS. Thank you very much.

OK, Dr. Melius.

STATEMENT OF JAMES MELIUS

Dr. MELIUS. Honorable Chairman Towns, Representatives

Maloney and Nadler: I greatly appreciate the opportunity to appear

before you at this hearing.

I am James Melius. I am an occupational health physician, and

as you indicate, I work for the Laborers’ Union. But I have also

spent much of my career working to document problems experienced by emergency responders exposed to toxic chemicals as part

of their work. And, for over 20 years, I have served as Chair of the

Medical Advisory Committee for the International Association of

Fire Fighters, advising that union and its many members in the

United States and Canada on occupational health issues.

And, in that capacity, I have had the opportunity, over the last

few years, to talk to many emergency responders from other parts

of the country who came and helped out at the World Trade Center

in the aftermath of the 9/11 attacks.

For the past 4 years, I have also served as the Chair of the

Steering Committee for the World Trade Center Medical Monitoring and Treatment Program. And, therefore, I have been in a position to oversee, and I think I can provide some understanding of

the situation with that particular program.

First, I would like to say that there is ample evidence that the

large numbers of firefighters, police and other workers involved in

the September 11th response have become ill as part of their work.

Dr. Thorpe has presented two of the new findings of the New York

City Health Department. And, there were ample studies in the literature already and ongoing research that will document the problems. So, very serious health problems are being experienced by literally thousands of the people who responded to that event, as well

as by the residents and public people in the community.

We know that there is—through the efforts of our congressional

delegation, particularly Representatives Maloney and Nadler, Senator Clinton, we have established a very good medical program

and, more recently, a federally funded treatment program for those

workers.

However, as we have heard from the Government Accountability

Office today, there are some shortcomings of that program, and

those shortcomings particularly affect two groups of workers. One

is the Federal workers who responded to the event; and the second

are police and firefighters, other emergency responders from

around the country who came to help at that event.

I won’t repeat the findings of the GAO report about Federal

workers, but I would indicate that, despite efforts on the part of

the Federal Government, those workers are continuing not to receive the full monitoring and treatment that they deserve. The

problems seem to be within the government, within the bureaucracy, in making arrangements to get everybody transferred over

and to coordinate the care, particularly those who are residing in

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other parts of the country, outside of the New York City metropolitan area.

Also, firefighters, police and other emergency responders from

outside the immediate New York City area have had great difficulty getting adequate care. The Federal Government has tried a

number of different approaches—and, again, those are documented

by the GAO report—to arrange for monitoring and treatment. They

have been able to provide some of that, but frankly most of the

treatment to this day continues to be funded by the Red Cross and

not by the Federal Government. And, it appears that it may be

many more months before the government can arrange for treatment funding to be provided for those people living outside of the

New York City metropolitan area.

And this problem with the—both of these problems, for the Federal worker program, as well as for emergency responders from

outside of New York City, creates a number of problems for the individuals involved. They are becoming increasingly frustrated with

delays in getting care and the lack of ability to be able to arrange

for care.

Just as one example, the new program for national responders,

for people from outside the area, the new contract with this outside

national organization have managed to arrange exams for fewer

than 100 people so far, in the last several months. And, we know

that there are literally hundreds, if not thousands, of responders

out there waiting to receive their followup monitoring. And for

them to get referred for treatment is quite difficult.

And, we know that there are resources outside of the New York

area that can provide care for them. It is a question of really making the arrangements to do that.

However, I really think there are also problems with getting full

monitoring and treatment for people within the New York area.

What we really need is a comprehensive approach to this problem.

I think the delegation from New York has called for that, and I

think now is the time to move forward. We can’t continue to piecemeal together a program. We need a comprehensive legislative solution that would provide care.

I believe that the legislation introduced by Congressman

Maloney and Nadler really will address those problems. I would

add that would directly address the problems that I have mentioned with the national program, as well as the problems that

Saint Vincent’s Hospital talked about today, in terms of being able

to arrange for followup treatment for the many people that need

it, even in the New York area.

Thank you for your time today, and I would be glad to answer

questions.

[The prepared statement of Dr. Melius follows:]

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

Mr. McHale.

STATEMENT OF THOMAS MCHALE

Mr. MCHALE. Good morning, Chairman Towns and members of

the subcommittee.

My name is Thomas McHale, and I am a police detective with

the Port Authority of New York and New Jersey Police Department. I am also a member of the Port Authority Police Detectives

Endowment Association, an associate member of the Port Authority

Police Benevolent Association, which are member organizations of

the National Association of Police Organizations. NAPO is one of

the largest police organizations in the Nation, representing over

238,00 sworn rank-and-file law enforcement officers throughout the

United States.

When lives are at stake, America’s first responders do not hesitate to rush directly into harm’s way. We do our jobs, searching for,

rescuing and aiding victims, regardless of what unseen dangers

and health risks and health hazards await. The substantial risks

that we face when responding to disasters are no more clearly illustrated than by the suffering brought on as a result of the response

to the September 11th attacks on the World Trade Center. As you

are aware, the World Trade Center was the headquarters of the

Port Authority and was a worldwide symbol of New York and

America.

Seven years after the attack on our Nation, we continue to

mourn the 84 Port Authority personnel, including 37 members of

the Port Authority Police Department, 23 New York City Police Department officers, 11 New York State and Federal law enforcement

officers, 343 firefighters and over 2,200 civilians who lost their

lives.

While the Nation remembers those we lost, those who responded

to the World Trade Center continue to suffer from the physical and

mental traumas suffered that day and in the days following. According to the Mount Sinai Medical Center study on 9/11 health effects, 70 percent of the first responders at Ground Zero suffer from

chronic lung ailments.

Today, I would like to take the opportunity to address my personal 9/11-related health issues and the need for extended funding

for the World Trade Center Medical Monitoring and Treatment

Fund. For purposes of character and integrity, I would like to provide you with a brief biography.

I am 46 years of age, married, with four daughters, and I am a

non-smoker. I am a Port Authority of New York and New Jersey

police detective, with 22 years of service. Since 1995, I have been

assigned to the FBI Joint Terrorism Task Force of Newark, NJ. In

addition to the Task Force, since 2001, I have been co-assigned to

the NYPD Major Case Squad, specializing in cold case homicides

of police officers.

Unfortunately, I am no stranger to traumatic incidents. On February 26, 1993, I was critically injured in the bombing of the World

Trade Center. On September 11, 2001, minutes after the first plane

struck, I responded to the World Trade Center and I joined in the

rescue effort from my Major Case office at 1 Police Plaza here in

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New York. I survived the collapse of the first tower from inside the

World Trade Center.

After escaping the first collapse, I returned to the Trade Center

and continued with search and rescue. Before the second tower collapsed, I escaped through 5 World Trade Center into the street,

where again I was caught in the debris cloud.

I remained at the site throughout the evening and into the early

morning hours of September 12th, taking part in the rescue of two

Port Authority Police Officers that were trapped in the rubble.

In addition to being a police detective, I am also a Union Ironworker. For the first 10 days following 9/11, I was on full-time assignment at the Trade Center site as part of the Port Authority Police Rescue and Recovery Team. I utilized my ironworking skills in

the recovery of victims’ bodies.

During the second week of the rescue and recovery, the Port Authority Police Department ordered me to resume my position with

the Joint Terrorism Task Force, which was investigating the attack. I complied with the order, but returned to the site at the end

of my shift.

I worked the site as a volunteer ironworker with Ironworkers

Local 40, New York, and as a PA Police Detective. I worked this

schedule until the end of January 2002.

From the end of January 2002, to the beginning of April 2002,

I was on JTTF assignment in Pakistan and Afghanistan. On March

17, 2002, after a suicide bomber attacked a church in Islamabad,

Pakistan, I took part in rescue and recovery of those injured and

killed. Upon my return to the States, I resumed working both jobs,

but not as rigorously as before. On May 28, 2002, Ironworkers

Local 40 invited me to participate in the removal of the last column

from the World Trade Center.

To the present day, I have been diagnosed with reactive airway

disease, lung scar tissue, asthma, atrial fibrillation, sinus tachycardia, chronic rhinitis, turbinate hypertrophy, and Barrett’s esophagus. I am currently under the primary care of Dr. David Fischler,

my pulmonologist, and Dr. Rakesh Passi, my cardiologist. In addition to my primary care physicians, my current health issues are

being managed and monitored by the World Trade Center Medical

Monitoring and Treatment Program under Dr. Iris Udasin, Environmental and Occupational Health Science Institute Clinical Care

in Piscataway, NJ.

On November 1, 2006, I underwent a pulmonary vein ablation in

my heart at Robert Wood Johnson University Hospital, New Brunswick. While in recovery, I suffered aspiration pneumonitis and was

transferred to the critical care unit. On November 7, 2006, I was

discharged from the hospital. In March 2007, I was able to return

to work.

My doctors, two cardiologists and two pulmonologists and the

doctors from the World Trade Center Medical Monitoring Program

all attributed my medical conditions to my exposure at the World

Trade Center. The Port Authority Medical Division, without a thorough examination or consulting my doctors, ruled that my medical

conditions are not related to the events of 9/11. Fortunately, for

me, the Port Authority Police Director, Samuel J. Plumeri, agreed

with my physicians and overruled PA Medical’s decision. Director

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Plumeri ruled that my injuries were, in fact, 9/11-related, thus entitling me to line of duty status.

On July 20, 2007, I underwent nasal surgery to clear an obstruction of my nasal airway at Robert Wood Johnson. I returned to

work 11 days later, on July 31st. The PA Medical Department,

again without examination or consulting any of my physicians, determined that my nasal obstruction was not related to my exposure

at Ground Zero. Once more, PA Police Director Plumeri overruled

PA Medical’s decision. Director Plumeri agreed with my physicians’

findings that my nasal injuries or disease may, in fact, have been

caused by my exposure at Ground Zero.

On September 5, 2007, due to chronic acid reflux, I underwent

an upper endoscopy at Robert Wood Johnson Hospital. The procedure revealed that I have Barrett’s esophagus, which is caused by

chronic acid reflux and is considered to be a pre-malignant condition. Barrett’s is associated with an increased risk of esophageal

cancer. I am currently awaiting the results of my biopsy.

Most of the costs associated with my lung and heart procedures

have been processed through my medical insurance. The World

Trade Center Medical Screening and Treatment Program have incurred some of the costs for surgery and treatment associated with

my nasal and gastro ailments.

In fact, it was Dr. Udasin, at EOSHI, who referred me to the ear,

nose and throat doctor and gastroenterologist who diagnosed my

most recent ailments.

I would like to state that I did not file a claim for the Federal

moneys that were available in 2001 and 2002. Although entitled,

I could not bring myself to complete and file the same form as that

of the survivors of those who were killed. I do, however, have a

pending State Workers Compensation claim.

As the health risks associated with exposure to the World Trade

Center site become more manifest, it is important to ensure that

workers in the rescue and recovery effort are properly monitored

and treated for exposure-related diseases. I appreciate all you are

doing to support those of us who have fallen ill due to our response

and subsequent exposure at the World Trade Center. I urge Congress to continue to support the funding for the World Trade Center Medical Monitoring and Treatment Program in order that first

responders like myself can maintain, or regain, their good health.

Thank you for this opportunity to speak to you on behalf of the

dedicated first responders who responded to the 9/11 attacks in

New York City. I ask that my printed testimony, in addition to my

spoken testimony, be made a part of the record. And, I would be

happy to answer any questions you may have.

[The prepared statement of Mr. McHale follows:]

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Mr. TOWNS. Thank you very much, and your entire statement

will be included in the record.

Let me begin by first thanking you for your service and, of

course, all of you, for your testimony.

Let me just sort of raise a question. I guess I will begin with you,

Dr. Melius. I am concerned that we had people who came from

across the country to volunteer their services and to respond to the

crisis that we had. And, of course, if we do not treat them properly,

we might discourage people from volunteering, and I think that is

the last thing that we want to do.

I think that we always want to make certain that people feel, to

respond and come to the aid of others. But, if we are not treating

people properly that came and gave of their service, what does this

do to volunteerism? And, of course, what is the labor movement

saying about these kind of issues.

Dr. MELIUS. Now, you raise an excellent point, and it is certainly

one, I think, that we should all be concerned about.

I will say, if you talk to people that did volunteer, even many of

those that become ill, they would tell you they would do it again

in that circumstance. There has been a long tradition, I think, of

being willing to come forward.

However, if one sees that one is ill and disabled, and we know

that the firefighters, the other emergency responders have become

ill and disabled and are now struggling economically because they

can no longer work, certainly it creates a second thought. And certainly on the part of all of us, I think, including organized labor,

we want to make sure that if someone does volunteer in that situation, or is assigned—some of them, I think, were assigned to come

in and work on the site—that they, one, are properly protected. We

don’t want this to be happening again.

However, should they develop illness, that the followup be provided for that. There should be a mechanism in place. They should

not have to wait 6 years. They shouldn’t have to wait so long to

get the medical monitoring and treatment that they rightfully deserve.

And, it certainly could affect, in the long term, the willingness

to do it again, or to come back, knowing that you are not going to

be taken care of. You are risking your family’s future by doing that,

as well as your own health, by coming forward to help.

Mr. TOWNS. Thank you very much.

Why can’t we move to get a comprehensive monitoring system?

This is sort of for, I guess, GAO and, of course, in particular, Dr.

Thorpe.

I mean, why can’t we get that going? A comprehensive monitoring system. What do you think the problems are?

Ms. BASCETTA. It is not a matter of not knowing what to do. I

can only conclude that it is a matter of, well, the administration,

you know, has within its sphere the expertise to develop the programs, and the Congress has pushed hard for funding. And it just

hasn’t happened.

But there is no substantive reason why we shouldn’t be much

farther along at this point. And, for that matter, the really sad

thing is that we need to learn a lesson from 9/11, so that in future

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disasters, whether they are manmade or natural, we are better prepared.

Mr. TOWNS. All right. Any other comments on that? Yes, Dr.

Melius?

Dr. MELIUS. I would just echo that one of the problems is with

the lack of commitment on the part of the administration. This program has been funded through Congress on, basically, emergency

appropriations each time. And then, the government, the Federal

administration, then makes the wrong assumption that, therefore,

the program isn’t going to continue beyond that.

And, when Dr. Agwunobi came here right after the treatment

program was initially funded, I believe it was last November or December, he immediately wanted to send out letters telling the responders that the treatment program would be discontinued. He

wasn’t even going to wait until the program got started.

We need a commitment on the part of the administration to

move this forward and to plan. I believe Dr. Howard has done an

excellent job in these circumstances, of trying to develop a good,

solid program to provide the continuity of care that is needed.

But, we need certainly a longer-term commitment. I think that

is going to take the kind of legislation that Representatives

Maloney and Nadler are going to take—and Congressman Towns,

you are a co-sponsor also—to move this forward and establish a

long-term program that will deal with this comprehensively.

It shouldn’t have taken that, and it shouldn’t have taken 6 years

of non-response to get there, but I think that is really what we are

faced with, certainly at the present time.

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

And, Dr. Eth, I know you have personally treated many first responders for mental health conditions. Do you think we have adequately met the need.

Dr. ETH. Clearly, we haven’t adequately met the needs. We are

barely scratching the surface of the needs of those people who have

chronic conditions.

As we have heard, PTSD can often be successfully treated if the

patient is seen early. However, many patients with PTSD develop

chronic illnesses, and then we are into symptom management. And,

there is no system in place to deliver that kind of care.

Congressman Nadler quoted President Abraham Lincoln. That

quotation is the motto of the Department of Veterans Affairs. What

we need is a system of care for first responders who, like our Veterans, were there to protect us and to take care of us and deserve

the kind of treatment that will persist over the years, to make sure

that their distress and disability is medically treated as best we

can.

Mr. TOWNS. You know, there has been some media coverage. You

know, you always get this when we are trying to move forward,

where they said that some people are faking a mental health condition.

I know that you have treated, of course, many of these responders. Do you think that this is a widespread practice? Because you

get one situation, and they just blow it up, you know.

Dr. ETH. Right. Unfortunately, this issue of faking or malingering has been around for a very long time. There was the dramatic

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scene in the movie ‘‘Patton,’’ where General Patton slapped the soldier who was suffering from combat fatigue, because he thought he

was a malingerer.

These are real psychiatric conditions that impose suffering on patients, on their family, and deserve the care that we can provide.

Fortunately, we have the treatments, but we are limited because

of the stigma associated with these conditions, the stigma that is

amplified when people are thought to be malingering. And, there

are delays of care, there is access issues. And, the thing is, we do

have effective ways to manage symptoms.

Mr. TOWNS. What do you think needs to be done in Congress?

What do you think that we should do? And, let me just run down

the line, very quickly. We don’t have a lot of time. So——

Mr. MCHALE. Obviously, the team of the World Trade Center

medical management, in addition to making sure that a comparative amount is put into research, as well, for that. And I know I,

don’t mind my health screening put into kind of a data base that

may help another first responder who may have the symptoms that

I had, prior to being diagnosed with the disease that I have.

So, a multiple, comprehensive data base that can be used to compare each responder’s conditions, so that it may help another one

needing treatment.

Mr. TOWNS. Thank you. Right down the line, if there are any

other comments.

Dr. MELIUS. Certainly, as I have said, I think the No. 1 priority

is to make this into a comprehensive program, provide the framework through legislation that will ensure that everybody who responded at the World Trade Center, worked there, who were exposed, including people in the community, can receive medical

monitoring and get treatment, if needed. And, that is a life-long

commitment. I think we need to do that comprehensively and do

that over the long term.

Second, I think we also need to look at how do we prevent some

of the outcomes that have occurred. We need to make sure that

there is adequate protection. My personal belief is that OSHA

needs to be mandated to provide enforcement action at those sites,

to ensure that people are properly protected.

I will add that, in order to do that, we also need research in the

development of protective equipment.

Mr. McHale and I were talking before the hearing, and there are

circumstances that he was working in where there was no respirator that is currently available that would have allowed him to

do his work in a safe manner. He needed to communicate with his

friends while he was doing that, in a very enclosed, tight space,

and it was very difficult, and no respirator that was currently

available, I believe, would have allowed him to do that.

We also know of the communication problems that occurred, with

the firefighters at the site. So, there is technology that needs to be

worked on, and we need to invest in that in order to protect people.

So, one, it is a comprehensive solution of medical followup. Second, it is prevention and enforcement at the site. And then, on the

part of EPA and the city Health Department to make sure that

people in the community are also protected.

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Mr. TOWNS. Thank you, very much. Thank you. And, run right

down the line.

Dr. ETH. Well, Congress and the administration has to honor its

promise to first responders to deliver the care that they need in the

long-term way, and we need to expand the number of treatment

programs available to first responders, so that they can get the

care.

Mr. TOWNS. Thank you.

Dr. THORPE. I would like to repeat that very fact, that the World

Trade Center Medical Monitoring Program and the other Centers

of Excellence at FDNY and at Bellevue Hospital, these are programs that were established with Federal funds. The patients who

are enrolled in these programs have an expectation to a certain

commitment to their long-term monitoring and care. And so, it is

really that these are federally funded programs that can’t be dismantled mid-mission.

This would also be true for the World Trade Center Health Registry, which is also federally funded. These were established for

long-term care, and we need to ensure that the long-term care is

provided and not being withdrawn mid-mission.

Mr. TOWNS. Right, thank you.

Ms. BASCETTA. On a smaller scale, holding HHS accountable for

implementing GAO’s recommendations. That is very important.

And, for ensuring that, over the long term, the money is there to

do the screening and monitoring that is required for responders.

And, on a broader scale, exercising your oversight authority to

take a look at the NRP, to make sure that those relationships for

the National Response Plan that are in place go to prevent these

kinds of situations and to ensure that where they can’t be prevented, that the health effects are taken care of after a disaster is

very important.

Mr. TOWNS. All right. Thank you, very much.

And, I yield now to my colleague, Congresswoman Carolyn

Maloney.

Mrs. MALONEY. And, I thank you again, Ed, for having this hearing, and I thank Mr. McHale for his service, and all of you for your

services in your own professional ways. It is deeply appreciated.

First off, I want to thank Cynthia Bascetta, the Director for

Health Care at the U.S. Government Accountability Office, and

talk about the really extraordinary work of the GAO that has led

us to the point today.

They have issued five different reports that Ed Towns and I have

requested, and others. They were presented to the Oversight and

Government Reform Committee, on which we both serve.

And, over the last 3 years, they have been absolutely invaluable

to this committee in informing our work on this topic. So, I have

a series, first of all, for Director Bascetta.

Regretfully, there have been a series of articles recently that I

would like to put into the record, with official responses from our

Senators and Jerry and myself and many others. So, in the New

York Times.

There is one today in the New York Post that questions whether

or not that there really is a problem. Jerry and I see sick people

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every day, who come to see us in our homes and in our offices, and

we know first-hand the crisis.

But, there have been some press reports that have attempted to

cast doubt by questioning the exact extent of the health problems

arising from the deadly toxins at Ground Zero.

In your opinion, Ms. Bascetta, as part of the independent, nonpartisan Government Accountability Office, do you have any doubt

that tens of thousands of people served as responders and rescue/

recovery and clean-up workers and construction workers, in the

aftermath of the World Trade Center disaster, and that these responders were exposed to numerous physical hazards, environmental toxins and psychological trauma.

Ms. BASCETTA. No, I certainly don’t have doubt.

Mrs. MALONEY. Now, do you have any doubt that those physical

hazards, environmental toxins and psychological trauma could potentially cause serious, long-term health effects in these responders?

Ms. BASCETTA. No doubt at all. And, our first report, in September, had four and a half pages of articles that were written and

published in peer-reviewed journals from the time of the attack

through September 2004, and the body of literature has grown

since then.

Mrs. MALONEY. Without objection, may we place that report in

the record, Chairman.

Mr. TOWNS. Without objection.

[The information referred to follows:]

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Mrs. MALONEY. And, do you have any doubt that currently thousands of responders are sick, some of them very seriously sick, because of the exposure they endured during their work in the aftermath of 9/11.

Ms. BASCETTA. No doubt. I believe HHS’s own draft plan notes

that there are thousands of sick responders.

Mrs. MALONEY. And last, should the government be doing more

to help the sick heroes and heroines of 9/11.

Ms. BASCETTA. Absolutely.

Mrs. MALONEY. Thank you, Director Bascetta.

And so, the Director for Health at the U.S. Government Accountability Office, well-known as the independent congressional watchdog, has no doubt that the health effects of 9/11 are real and serious, and that they are affecting thousands of people, and that our

government should be doing much more to help. And, I hope that

everyone hears this message loud and clear. And, I think that this

is a very important part of your hearing today, Congressman

Towns.

And, I would like to thank Dr. Thorpe for her work with the New

York City Health Department and to ensure that mental health

services are available.

And, I want to know why did you close the Registry.

I will tell you, I know there are 71,000. I know that every congressional district is in it, and every State in the Union. But I, to

this day, have people who come up to me either on the street, my

congressional office, my home, and say, ‘‘You know, after 9/11, I

wasn’t sick. Now, I am sick. It just happened.’’

And so, health problems are arising. And, as we know from Dr.

Melius’s testimony and from Dr. Eth’s, a lot of these things are

going to keep coming up further down the road. And, I personally

don’t think the Health Registry should be closed. I think that people who may die today, or develop the asthma today, and were

there—you know, some will say to me, ‘‘You know, I was just there

on 9/11 and 9/12,’’ and I will say, ‘‘Well, that is the worst 2 days.

No wonder you have a problem.’’

But why did we close it? Why aren’t we making adjustments for

the people that are still sick——

Dr. THORPE. Thank you, Congresswoman——

Mrs. MALONEY [continuing]. Or becoming sick.

Dr. THORPE [continuing]. Maloney.

The purpose for closing the World Trade Center Health Registry

is not one to shut out the individuals who later developed illness

in any fashion. The purpose of closing the Registry after a certain

period of enrollment was purely for validation of a similar time period, where people who did enroll were telling the information that

they had on their exposures within a short, finite time period.

One standard challenge for epidemiologic studies is that you

combine the individuals who described their experiences early on,

at a date after an event, and you combine that with persons who

describe their experience years later, that the descriptions change

over time, or may change over time, and could call into question

the very purpose of the tracking of the Registry.

All individuals who are developing any late-onset symptoms

should be in a World Trade Center of Excellence program, where

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they can be evaluated. And that data and that information is very

important.

This was not a disease registry. This was an exposure registry.

So, the focus was getting a clean snapshot at a finite period of

time, that may track the effects in those potentially highly exposed

people. This is part of the picture and is an important component.

And similar, the different component of the health profile of people who were available in the clinical centers at Mount Sinai, at

Bellevue and the Fire Department, are another profile.

Mrs. MALONEY. But, following up on your statement that it is an

exposure registry, I think it should certainly be limited to those

who were exposed, but if there is no doubt that a firefighter or

someone else was exposed on September 11th or 12th or the 13th

were fine, and then all of a sudden they are sick 5 years later, they

should be part of it.

And, as you know, the monitoring program at Mount Sinai and

at Bellevue and Queens and some of the other areas that are there,

they are very limited. As you know, they are limited only to the

responders. They do not include the area residents who were exposed. They do not include the volunteers. They do not include the

school children which, according to your report, are now coming up

with increased asthma. So, I think we should look at re-opening it.

But I would like to talk to Dr. Eth and Dr. Melius. I know my

time is coming to an end.

And, you were deeply involved, actually representing labor in the

consortium that really worked for 6 years now, through various

routes, to create the 9/11 Health and Compensation Act, which Mr.

Nadler and Mr. Towns and I will be introducing, along with Charlie Rangel and others, this week.

If passed by Congress and signed into law by the President,

would this legislation allow for the monitoring and treatment of all

those affected, especially those now not covered at all.

And, I regret, Mr. McHale, that you had trouble getting covered,

but your story is like so many other responders, some of them I see

in the room, who were turned down for treatment.

Would this comprehensive bill treat these people?

Dr. MELIUS. Absolutely. It includes all Federal workers, by statute, into the bill. And, it also includes provisions for what we refer

to as a national program for covering people outside of the New

York City metropolitan area. So, they would be covered.

It also provides for the development and naming of new centers,

what we are referring to as ‘‘Centers of Excellence,’’ that provide

clinical care. So, for example, Saint Vincent’s would become a Center of Excellence, and it would become part of that program. Certainly, as they have described their efforts so far, they would, you

know, I believe that it would qualify under the way the legislation

is written, at least my knowledge of it.

So, I think it absolutely would provide the framework for covering everybody who is now having difficulty getting covered. It expands the coverage to include residents, workers who also had, you

know, very significant exposures cleaning out offices and buildings,

people in their homes and apartments, who were exposed, school

children. So, I think it really comprehensively deals with everyone

who was potentially affected, and it will provide them with the

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monitoring, the screening, and the health treatment that they deserve.

Mrs. MALONEY. So, it doesn’t rely on what hat you were wearing

that day, but the extent of your exposure.

Now, since there are some of these articles that are saying people

aren’t sick, or maybe they weren’t sick from 9/11, how is that treated in the bill? I understand that there is very high medical standards written into the bill, because I was there when we wrote it

and that the medical profession would have certain criteria that

they develop that is related to 9/11 and you have to be certified

that you had that.

Could you go through how people would be able to be treated, so

that there would be no abuse, but that it would be there for the

people who truly warrant it.

Dr. MELIUS. Certainly, to be initially eligible for the screening or

for monitoring, the examinations, one has to have some evidence

that they were exposed. And, there are criteria that have already

been developed, as far as the programs that relate to the type of

work that people do, did at the time and the time period of that

work.

And then, similar criteria would be developed for the other

groups. The program at Bellevue Hospital is already working on

that, meeting with community groups, labor groups, others that are

involved there, that aren’t covered by the current responders’ programs, and develop those criteria.

So, those would need to be developed. They would be, you know,

promulgated, as far as the program, by the Federal Government,

with significant input from the outside groups, affected groups.

And second, there are criteria for how people would be—what

conditions would be treated? Currently, there is a list of conditions

that include respiratory, upper respiratory, mental health conditions, gastrointestinal conditions, that have been found in significantly higher rates in the responders. That list can be expanded,

additional conditions added.

And, a similar list, based on the initial list, would be developed

for people who living in the community, people that worked in

other areas in ways that are not currently eligible for the program.

Again, that would be done through a public process, in a timely

fashion, so that people would be able to receive treatment, but will

be treated for World Trade Center-related conditions.

Mr. TOWNS. All right.

Mrs. MALONEY. I thank the Doctor, and my time has expired.

Mr. TOWNS. Yes.

Mrs. MALONEY. Thank you, all the panelists.

Mr. TOWNS. Right. Let me yield now to Congressman Nadler.

Mr. NADLER. Thank you, thank you, Mr. Chairman.

Let me begin by following up on the first question that Congresswoman Maloney asked. This morning’s New York Post says the following: ‘‘a searing New York Times piece suggests that an activist

clinic’’—meaning Mount Sinai—‘‘egged on by opportunistic pols and

naive (at best) journalists, has blown health fears way out of proportion. Bottom line: There is scant reliable scientific evidence to

link 9/11’s toxic plume to any serious, chronic health problems. . . .

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It casts doubt on the severity of even the short-term fallout. . . .

There is scant evidence that any lives were endangered.’’

Ms. Bascetta and then Dr. Thorpe, could you comment on those

assertions?

Ms. BASCETTA. It is a shame that was published. You know, as

I said, I——

Mr. NADLER. Well, it is in the Post, so—[laughter.]

Ms. BASCETTA. Well, even the New York Times article, if you

read it closely, didn’t say there were no health effects. There was

more argument around the aims of——

Mr. NADLER. Well, that is my next question, on the New York

Times article.

Ms. BASCETTA. OK.

Mr. NADLER. I will come to that.

Dr. Thorpe, do you have any comment on this? I mean, on the

observation that there were no long-term health effects, no evidence of long-term health effects, scant evidence of short-term

health effects.

Dr. THORPE. I think the consistent—one of the things that epidemiologists look for by trying to understand the exposure, causes

of disease, is the consistency of the literature. And, there is growing consistency of literature across the studies, from the medical

monitoring programs, from the World Trade Center Health Registry, and elsewhere, on physical health effects and mental health

effects among the rescue and recovery workers.

Mr. NADLER. So, would you both agree or disagree than any competent, honest epidemiologist would say this is nonsense?

Ms. BASCETTA. Yes, I would agree.

Dr. THORPE. I think that would be different scientists who analyze data differently, but I think most scientists would look at the

growing literature and say that there are clear health ramifications

from 9/11.

Mr. NADLER. Thank you. Now, as we said that, I read—and obviously you have read the New York Times article, since you just referred to it—I was going to ask you if you had. I read that article

very carefully on Friday.

Would it be fair to say, because this is what I found there, that

one of the key points, really, is that to the extent that there is

some doubt in the literature, or doubt as to control groups, it is because nobody—neither the Federal, State, or city governments—did

adequate studies in the first 9 months, so you don’t have a base

control, and that is the real problem, to the extent there is a real

problem.

Ms. BASCETTA. Well, it is a contributing factor to the difficulties

in doing the research. But, you know, I have a different response.

One of the—the Fire Department is really the gold standard.

They have baseline data on their workers, and it is absolutely clear

from their studies that the health effects are simply not questioned.

Second, as Dr. Thorpe has said, there are well-accepted epidemiological dictates that involve looking for excess rates of disease in

populations where, you know, we don’t have very good medical

records, you don’t know what their baseline health was before, so

it is more complicated. But, you can certainly document, and it has

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been documented, that respiratory effects, asthma, PTSD, you

know, do appear to be diagnosed at rates that are higher than we

would expect.

Mr. NADLER. And, are you familiar with the Mount Sinai study?

Ms. BASCETTA. I am.

Mr. NADLER. Would you say that is a good, competent study?

Ms. BASCETTA. It was published in a well-thought-of peer-reviewed journal. I would have no reason to doubt that their techniques were in question.

Mr. NADLER. So that the aspersions, the comments, and the

loathage of the Mount Sinai researchers here would have no foundation, in your opinion.

Ms. BASCETTA. I wouldn’t weigh them in my assessment of the

literature. I would certainly include some in any view of it.

Mr. NADLER. Thank you.

Dr. Thorpe, in your testimony—first of all, you say, ‘‘We estimate

that it requires at least $4.5 million per year to maintain the Registry for the remainder of its 20-year life.’’

Why only 20 years? Shouldn’t we maintain this Registry for the

balance of the lives of all of the people involved in it.

Dr. THORPE. Twenty years is the commitment that we gave to

participants who enrolled. That does not in any way negate the potential need for this Registry to move forward beyond 20 years, if

we are looking at long-term health ramifications, development of

cancers with long latency periods, or mortality. There are many

reasons why it may——

Mr. NADLER. And it——

Dr. THORPE [continuing]. Serve for a longer period.

Mr. NADLER. And, since the basic purpose of the Registry is for

research and for knowledge, as you said a few minutes ago, that

would seem to indicate that we should keep the Registry open

much longer.

Dr. THORPE. Yes, depending on the findings of the first run of the

Registry, yes.

Mr. NADLER. OK, thank you.

I have a second question. You referred in your testimony quite

often to the asthma study found that 3.6 percent of previous asthma-free rescue and recovery workers reporting asthma as 12 times

the normal rate in the general population. Further on, you refer to

findings in the Fire Department, showing a higher than normal—

the problem of health problems. These studies demonstrate the

need for continued monitoring and care of exposed workers, etc.

So clearly you and Ms. Bascetta, both, and Dr. Eth, with respect

to mental health conditions, you say clearly that there is more than

ample evidence of heightened rates of all kinds of pathologies, as

a result of the exposure to these toxins.

Dr. THORPE. There is a lot of evidence on the widespread experience of respiratory symptoms among the people who responded to

the World Trade Center site as a volunteer or a worker. There is

widespread evidence of long-term mental health implications. And,

I think there are still a lot of unknowns.

Mr. NADLER. OK.

Dr. THORPE. It is still unknown——

Mr. NADLER. There is a lot of evidence for what you said.

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Now, the State and the city and the Port Authority, as we have

heard from Mr. McHale and others, have been contesting causation

on all kinds of Workers Comp and other claims. Now, I observed

before that we know that, as a result of Hiroshima and Nagasaki,

there were wildly increased incidents of cancer in the exposed population. But, you couldn’t prove that an individual case of leukemia

would not have otherwise occurred, even if it is 90 percent would

not otherwise have occurred—even if 90 percent of the people who

came down with leukemia in Hiroshima would not have done so

but for the atomic bomb, and 10 percent would have, the statistic

is, you couldn’t prove which was which.

So, is it fair, is it proper for these government agencies to be denying claims on the basis that you can’t prove that your case of

asthma, your case of sarcoidosis, was caused by this, even though

we know that 98 percent would not have occurred but for this.

Dr. THORPE. I can’t speak to these individual cases. What I can

speak to is the difficulty and the importance of understanding the

relationships between the level of exposure and the development of

a disease. Heart disease and cancer are common conditions that

are going to exist and that are going to occur, independent of

whether or not the World Trade Center attack——

Mr. NADLER. Occurred.

Dr. THORPE [continuing]. Has resulted.

Now, the difficulty in identifying whether or not cancers or heart

disease deaths are occurring at a greater rate as a result of these

events——

Mr. NADLER. Or asthma or sarcoidosis or——

Dr. THORPE [continuing]. Is a very important endeavor, but it

is—and because there are so many background cases——

Mr. NADLER. But my question——

Dr. THORPE [continuing]. It is a challenge.

Mr. NADLER. It is a challenge, but is there any way—well, my

real question is, is government asking something impossible and

unfair, when it says to a firefighter who was in the peak of condition and suddenly can’t breathe any more, prove this was World

Trade Center-related.

Dr. THORPE. I can’t speak to these single conditions, Again, what

I can speak to is——

Mr. NADLER. I mean, a health condition. Can you assume that

most of these cases are because that—is it unfair ethically, never

mind legally, is it not fair, the requirement to ask that kind of

proof? Is it not realistic to require it, knowing that most—let me

re-phrase the question.

Is it the case that most with sarcoidosis, these lung diseases,

most people who are coming down with it who were exposed probably would not have, and therefore, it is unfair to ask the specific

proof in each case.

Dr. THORPE. I am having a difficult time answering your

question——

Mr. NADLER. OK.

Dr. THORPE [continuing]. Because you are talking about many

different conditions together in one, and I think each condition

merits its own individual evaluation.

Mr. NADLER. Thank you.

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Ms. Bascetta, have you seen any evidence that the Federal Government is doing anything to expand the services that it provides

beyond responders to residents, office workers, school children,

other people who were exposed and who, as a result of that exposure, are sick or may get sick in the future.

Ms. BASCETTA. I have not looked into that. There is another team

at GAO that has done work on ambient air. They have responsibility for EPA, and I could take a look at that report and have it submitted to the record.

Mr. NADLER. I would——

Ms. BASCETTA. I don’t believe that it specifically addresses the

problems of those groups.

Mr. NADLER. Well, I would appreciate if you would, because I

have seen no evidence that the Federal Government has done anything with response to anybody other than the specific first responders.

I think my time has almost expired. Let me just thank all of you

for your services in various lines, in particular Dr. Melius, for your

help in developing the legislation which we are introducing.

I just want to say that I wasn’t aware that quote that I always

use from President Lincoln was the motto for the Veterans Administration. But, it is fitting that it is. And, I think that this Federal

Government, State government, city government have been incredibly deficient, incredibly guilty in not meeting the moral debt that

we all owe to the first responders and to the other victims of this

terrorist attack on the United States.

Mr. TOWNS. Thank you, very much, Congressman. And, let me

just say that I will thank all of you for your testimony.

But, I cannot let this moment pass without saying that, when

you look at the clinics, look at the Borough of Brooklyn, which has

2.5 million people in it. And, as I remember that day, as I saw the

second plane hit, standing over by the Navy Yard, that I saw that

dark cloud coming over. And of course, I am sure that it affected

people in Brooklyn. And, there are no ifs, ands, and buts about it.

So, I am hoping that somewhere along the line, that Brooklyn

would get one of these clinics. And the reason I say that is I really,

really mean it, that there are people in Brooklyn that have never

been to Manhattan, have never been to Manhattan. So, it points

out how serious it is to get a clinic in Brooklyn. You know, I have

had the opportunity to talk to people over the years, who have said

to me—I am talking about adults—that I have never gone to Manhattan. So which means that we need to establish something in

Brooklyn where those 2.5 million people reside.

So, thank you, again, all of you, for your testimony, because as

you know, as we look at the first responders, we also have to look

at the residents, as well. So, thank you for your testimony. We look

forward to working very closely with you in the days and months

ahead.

You can see we are rushing to get to another meeting, and that

is the reason why we are sort of being brief here. So, thank you,

again, for your testimony.

The hearing is now adjourned.

[Whereupon, at 12:30 p.m., the subcommittee was adjourned.]

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