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H.R. 2561, IMPROVING ACCESS TO WORKERS’

COMPENSATION FOR INJURED FEDERAL WORKERS

ACT AND H.R. 697, FEDERAL FIRE FIGHTERS

FAIRNESS ACT OF 2005

HEARING

BEFORE THE

SUBCOMMITTEE ON WORKFORCE PROTECTIONS

OF THE

COMMITTEE ON EDUCATION 

AND THE WORKFORCE 

U.S. HOUSE OF REPRESENTATIVES

ONE HUNDRED NINTH CONGRESS

FIRST SESSION

May 26, 2005

Serial No. 109–20

Printed for the use of the Committee on Education and the Workforce

(

Available via the World Wide Web: http://www.access.gpo.gov/congress/house 

or 

Committee address: http://edworkforce.house.gov 

(II)

COMMITTEE ON EDUCATION AND THE WORKFORCE 

JOHN A. BOEHNER, Ohio, Chairman

Thomas E. Petri, Wisconsin, Vice Chairman 

Howard P. ‘‘Buck’’ McKeon, California 

Michael N. Castle, Delaware 

Sam Johnson, Texas 

Mark E. Souder, Indiana 

Charlie Norwood, Georgia 

Vernon J. Ehlers, Michigan 

Judy Biggert, Illinois 

Todd Russell Platts, Pennsylvania 

Patrick J. Tiberi, Ohio 

Ric Keller, Florida 

Tom Osborne, Nebraska 

Joe Wilson, South Carolina 

Jon C. Porter, Nevada 

John Kline, Minnesota 

Marilyn N. Musgrave, Colorado 

Bob Inglis, South Carolina 

Cathy McMorris, Washington 

Kenny Marchant, Texas 

Tom Price, Georgia 

Luis G. Fortun ̃ o, Puerto Rico 

Bobby Jindal, Louisiana 

Charles W. Boustany, Jr., Louisiana 

Virginia Foxx, North Carolina 

Thelma D. Drake, Virginia 

John R. ‘‘Randy’’ Kuhl, Jr., New York 

George Miller, California 

Dale E. Kildee, Michigan 

Major R. Owens, New York 

Donald M. Payne, New Jersey 

Robert E. Andrews, New Jersey 

Robert C. Scott, Virginia 

Lynn C. Woolsey, California 

Rube ́n Hinojosa, Texas 

Carolyn McCarthy, New York 

John F. Tierney, Massachusetts 

Ron Kind, Wisconsin 

Dennis J. Kucinich, Ohio 

David Wu, Oregon 

Rush D. Holt, New Jersey 

Susan A. Davis, California 

Betty McCollum, Minnesota 

Danny K. Davis, Illinois 

Rau ́l M. Grijalva, Arizona 

Chris Van Hollen, Maryland 

Tim Ryan, Ohio 

Timothy H. Bishop, New York 

John Barrow, Georgia

Paula Nowakowski, Staff Director 

John Lawrence, Minority Staff Director 

SUBCOMMITTEE ON WORKFORCE PROTECTIONS 

CHARLIE NORWOOD, Georgia, Chairman

Judy Biggert, Illinois, Vice Chairman 

Ric Keller, Florida 

John Kline, Minnesota 

Kenny Marchant, Texas 

Tom Price, Georgia 

Thelma Drake, Virginia 

John A. Boehner, Ohio, ex officio 

Major R. Owens, New York 

Dennis J. Kucinich, Ohio 

Lynn C. Woolsey, California 

Timothy H. Bishop, New York 

John Barrow, Georgia 

George Miller, California, ex officio 

(III)

C O N T E N T S 

Page

Hearing held on May 26, 2005 ............................................................................... 1

Statement of Members: 

Bishop, Hon. Timothy H., a Representative in Congress from the State 

of New York, prepared statement of ........................................................... 44

Capps, Lois, a Representative in Congress from the State of California, 

prepared statement of ................................................................................... 43

Norwood, Hon. Charlie, Chairman, Subcommittee on Workforce Protections, Committee on Education and the Workforce ................................... 2

Prepared statement of ............................................................................... 2

Owens, Hon. Major R., Ranking Member, Subcommittee on Workforce 

Protections, Committee on Education and the Workforce ......................... 3

‘‘W. Plan Stiffs Heroes; Nixes WTC Comp Pay,’’ New York Post 

article ...................................................................................................... 48

Statement of Witnesses: 

Davis, Hon. Jo Ann, a Representative in Congress from the State of 

Virginia .......................................................................................................... 6

Prepared statement of ............................................................................... 8

Johnson, James B., 16th District Vice President, International Association of Fire Fighters, Washington, DC ........................................................ 9

Prepared statement of ............................................................................... 11

Kohlhepp, William C., MHA, PA-C, Assistant Professor and Associate 

Director, Physician Assistant Program, Quinnipiac University, Hamden, CT .......................................................................................................... 28

Prepared statement of ............................................................................... 30

Shufro, Joel, Executive Director, New York Committee for Occupational 

Safety and Health, New York, NY .............................................................. 15

Prepared statement of ............................................................................... 17

Towers, Jan, PhD, NP-C, CRNP, FAANP, Director of Health Policy, 

American Academy of Nurse Practitioners, Washington, DC ................... 36

Prepared statement of ............................................................................... 37

Additional Materials Supplied: 

American Nurses Association, statement submitted for the record ............. 45

(1)

H.R. 2561, IMPROVING ACCESS TO WORKERS’ 

COMPENSATION FOR INJURED FEDERAL 

WORKERS ACT AND H.R. 697, FEDERAL FIRE 

FIGHTERS FAIRNESS ACT OF 2005

Thursday, May 26, 2005

U.S. House of Representatives 

Subcommittee on Workforce Protections 

Committee on Education and the Workforce 

Washington, DC 

The Subcommittee met, pursuant to notice, at 10:33 a.m., in 

room 2175, Rayburn House Office Building, Hon. Charlie Norwood 

[Chairman of the Subcommittee] presiding. 

Present: Representatives Norwood, Kline, Marchant, Price, 

Drake, Owens, Kucinich, Woolsey, and Bishop. 

Staff present: Kevin Frank, Professional Staff Member; Ed 

Gilroy, Director of Workforce Policy; Donald McIntosh, Legislative 

Assistant; Jim Paretti, Workforce Policy Counsel; Molly 

McLaughlin Salmi, Deputy Director of Workforce Policy; Deborah 

L. Emerson Samantar, Committee Clerk/Intern Coordinator; Kevin 

Smith, Senior Communications Advisor; Margo Hennigan, Legislative Assistant/Labor; Marsha Renwanz, Legislative Associate/

Labor; Peter Rutledge, Senior Legislative Associate/Labor. 

Mr. NORWOOD. A quorum being present, the Subcommittee on 

Workforce Protections of the Committee on Education and the 

Workforce will now come to order. 

We are meeting today to hear testimony on H.R. 697, the Federal Fire Fighters Fairness Act of 2005, and H.R. 2561, the Improving Access to Workers Compensation for Injured Federal Employees Act. 

Under Committee Rule 12(b), opening statements are limited to 

the Chairman and Ranking Minority Member. If other Members 

have statements, they, of course, will be included in the record. 

With that, I ask unanimous consent for the hearing record to remain open for 14 days. 

This will allow Members’ statements and other extraneous material referenced during the hearing to be included in the hearing 

record. 

Without objection, so ordered. 

2

STATEMENT OF HON. CHARLIE NORWOOD, CHAIRMAN, SUBCOMMITTEE ON WORKFORCE PROTECTIONS, COMMITTEE 

ON EDUCATION AND THE WORKFORCE 

Both of these bills would amend the Federal Employees’ Compensation Act, otherwise known as FECA. FECA is the comprehensive workers’ compensation program for Federal employees. The 

program provides important benefits and services to Federal workers who have suffered economic hardship from a work-related injury or death. 

The Subcommittee has held a number of oversight hearings on 

the FECA program over the past several years. The last hearing, 

held in May of last year, provided a broad overview of the FECA 

program. 

We looked at what could be done to maximize the benefits for 

workers and improve the efficiency and effectiveness of the program. 

Today’s hearing reinforces those themes and will focus on two 

proposals that would increase access to the program for injured 

Federal workers. 

Our first panel of witnesses will testify on H.R. 697, a bipartisan 

bill introduced by Representative Jo Ann Davis. The bill would create a presumptive disability under the law such that certain diseases incurred by a Federal firefighter would be presumed to be 

work-related. 

Our second panel of witnesses will testify on H.R. 2561, a bipartisan bill that Rob Andrews, my colleague on the Full Committee, 

and I introduced earlier this week. H.R. 2561 would allow injured 

Federal workers to submit medical documentation signed by a physician assistant or a nurse practitioner in support of a claim for 

benefits. 

This is an important bill that would improve access to compensation benefits for injured Federal workers, especially those in rural 

areas with limited options for medical treatment. 

I would like to thank the witnesses for making themselves available to share their expertise with us today. We appreciate you taking time out of what we know is a busy schedule to appear before 

the Subcommittee, and we look very forward to your testimony. 

I now yield to the distinguished gentleman from New York, the 

Ranking Member on the Subcommittee, Major Owens, for his opening statement. 

[The prepared statement of Chairman Norwood follows:]

Statement of Hon. Charlie Norwood, Chairman, Subcommittee on 

Workforce Protections, Committee on Education and the Workforce 

The Subcommittee is meeting today to hear testimony on two bills: H.R. 697, the 

‘‘Federal Firefighters Fairness Act of 2005,’’ and H.R. 2561, the ‘‘Improving Access 

to Workers’ Compensation for Injured Federal Workers Act.’’

Both bills would amend the Federal Employees’ Compensation Act, otherwise 

known as ‘‘FECA.’’ FECA is the comprehensive workers’ compensation program for 

federal employees. The program provides important benefits and services to federal 

workers who have suffered economic hardship from a work-related injury or death. 

This Subcommittee has held a number of oversight hearings on the FECA program over the past several years. The most recent hearing, held in May of last year, 

provided a broad overview of the FECA program. We looked at what could be done 

to maximize the benefits for workers and improve the efficiency and effectiveness 

3

of the program. Today’s hearing reinforces those themes, and will focus on two proposals that would increase access to the program for injured federal workers. 

Our first panel of witnesses will testify on H.R. 697, a bipartisan bill introduced 

by Representative Jo Ann Davis. The bill would create a ‘‘presumptive disability’’ 

under the law, such that certain diseases incurred by a federal firefighter would be 

presumed to be work-related. 

Our second panel of witnesses will testify on H.R. 2561, a bipartisan bill that my 

colleague on the full committee, Rob Andrews, and I introduced earlier this week. 

H.R. 2561 would allow injured federal workers to submit medical documentation 

signed by a physician assistant or a nurse practitioner in support of a claim for benefits. This is an important bill that will improve access to compensation benefits for 

injured federal workers, especially those in rural areas with limited options for medical treatment. 

I would like to thank the witnesses for being available to share their expertise 

with us today. We appreciate you taking time out from your busy schedules to appear before the Subcommittee. We look forward to your testimony. 

I now recognize the gentleman from New York, the Ranking Member on the Subcommittee, Major Owens, for his opening statement. 

STATEMENT OF HON. MAJOR R. OWENS, RANKING MEMBER, 

SUBCOMMITTEE ON WORKFORCE PROTECTIONS, COMMITTEE ON EDUCATION AND THE WORKFORCE 

Mr. OWENS. Thank you very much, Mr. Chairman. I appreciate 

the fact that today the task before us is a bipartisan and positive 

one. 

As we approach Memorial Day, I really thought that we are 

going to do some positive things for working families. Working families, of course, bear the brunt of the sacrifices in the battlefields 

of the world for our nation. They are bearing that burden in Iraq 

now, and they did so in Vietnam and on D-Day and the Battle of 

the Bulge. Ninety-five percent of the people in the armed forces are 

from working families, and we look forward to the day when we 

have a Department of Labor and a government and administration 

which cares more for our working families. 

Certainly today is an unusual and very much appreciated step in 

the direction of trying to improve things for working families. 

I am very pleased that this hearing focuses on bills designed to 

strengthen protections for American workers, in contrast to legislation that we often have which subverts or undermines such safeguards. Both bills before us this morning would enhance worker 

protections afforded by the Federal Employees’ Compensation Act, 

FECA. 

The immediate aftermath of the devastating terrorist bombing 

attacks on the Murrah Federal Building in Oklahoma City and the 

World Trade Center in New York City remind us all of just how 

crucial the FECA program can prove to be. Services provided under 

FECA, for example, proved invaluable in assisting surviving family 

members of those killed in the Oklahoma City bombing. 

Likewise, medical care tied to the FECA program helped make 

the difference for some of the workers wounded during the tragic 

events of 9/11 between a faster recovery and a series of risky 

health setbacks. 

In addition to providing critical assistance in the case of national 

emergencies, over the years FECA has helped countless other Federal works injured or made ill in the course of carrying out their 

duties, as well as surviving family members in the event of worker 

deaths. 

4

Let me turn now to H.R. 697, the first bill before us at this 

morning’s hearing. 

This bill would give Federal firefighters the same presumptive 

disability protections already afforded firefighters in 40 states. In 

other words, the disability or death of Federal firefighters from a 

range of specified diseases would be presumed as a direct result of 

occupational exposure. 

The exposure of firefighters to certain infectious diseases include 

tuberculosis, HIV, hepatitis, rabies, has received more press attention that some of the other diseases specified in this bill. 

Yet, the connections between the day-to-day duties of fire protection personnel, including firefighters, paramedics, emergency medical technicians, rescue workers, as ambulance and hazardous materials workers, and there are increased risks of exposure to infectious illnesses, a range of cancers, and heart and lung diseases, 

have already been well documented. 

I understand that the lead sponsor of H.R. 697, Representative 

Jo Ann Davis, will testify on the first panel of witnesses, and I ask 

her to add me as a cosponsor to this important bill. The lead cosponsor of H.R. 697, Representative Lois Capps, also wanted to be 

here today to testify, but she had a scheduling conflict. 

Mr. Chairman, I ask that a written statement by Representative 

Capps be included in the record in its entirety. 

Mr. NORWOOD. So ordered. 

Mr. OWENS. At this juncture, I would like to acknowledge Mr. 

Joe Shufro, who is Mr. Occupational Health and Safety himself in 

New York State, Mr. Shufro of the New York Committee on Safety 

and Health, and I want to welcome him as an important witness 

to this hearing. 

Mr. Shufro and NYCOSH have played a pivotal role in addressing the critical health problems for workers and residents that 

emerge and are still emerging as a result of the devastation 

wrought by the attacked of 9/11. The clean-up workers of Ground 

Zero deserve the same presumptive disability protections that 

H.R. 697 would grant to Federal firefighters. 

We need to do much more than just wax eloquently about the 

debt we owe these brave workers, many of whom volunteered to 

clean up Ground Zero at great personal risk to themselves and 

their families. 

We need to provide these workers, a number of whom will never 

be able to work again, with real medical relief and wage replacement. 

It is absolutely unconscionable that the Bush administration in 

the fiscal 2006 budget request is attempting to rescind more than 

$120 million in workers compensation funds for the 9/11 workers. 

Furthermore, it is a disgrace that Governor Pataki, Governor of 

New York, is refusing to sign bills to afford presumptive disability 

protections to 9/11 workers. I do not know any issues that have 

more to do with morality than these. 

Until we address the critical needs of these brave workers, as 

well as all the residents of Manhattan, Brooklyn, and other New 

York City burroughs affected, we have failed to meet our moral responsibility. 

5

So, I commend Mr. Shufro and his great organization for remaining on the front lines of this important fight. 

I further ask, Mr. Chairman, that a New York Post article of 

May 8, 2005, which was posted on the NYCOSH website, be entered into the record its entirely. The article is entitled ‘‘W plan 

stiffs heros.’’

[The article referred to is on page 48 of this document.] 

Mr. NORWOOD. Do we get a chance to look that over? I am 

sure——

Mr. OWENS. Yes. 

Mr. NORWOOD [continuing]. That will not be any problem, just 

give us a chance to look it over. 

Mr. OWENS. It is from the New York Post. It’s a great paper. 

Mr. NORWOOD. I do not read any New York papers, you know. 

I have enough trouble with the Atlanta Journal. 

Mr. OWENS. My time is almost up, but I would like to make a 

few comments about H.R. 2561 before closing. 

Mr. Chairman, your bill is an important piece of legislation, as 

you know. I cosponsored it during the 108th Congress. 

However, the American Nurses Association and Service Employees International Union recently pointed out to me that the bill 

would be improved immeasurably by substituting a broader category of, quote ‘‘advanced practice registered nurses’’ for the narrow subset of nurse practitioners. 

For example, certified nurse anesthetists administer some 65 

percent of all anesthetics delivered to U.S. patients every year, but 

they are precluded from FECA coverage in your bill. 

Mr. Chairman, I request that a forthcoming written statement by 

the American Nurses Association about this issue be later included 

in the record. 

In closing, I applaud you for holding this hearing. 

I look forward to hearing the testimony of all the witnesses. 

Mr. NORWOOD. Thank you very much, Mr. Owens. 

I am, frankly, delighted that you approve of this hearing. 

I feel it incumbent upon me to make sure you got home for this 

vacation in a good mood, so maybe this will start us off. 

We, today, have two panels of witnesses. 

Our first panel will testify on H.R. 697. We will begin with testimony offered by the gentlelady from Virginia, the Honorable Jo 

Ann Davis, the first elected female Republican to the U.S. House 

of Representatives from the Commonwealth. 

Representative Davis has represented the First District of Virginia since she was elected in November of 2000. In addition to her 

Committee work on the House Armed Services Committee, International Relations, and the Permanent Select Committee on Intelligence, Representative Davis serves as Chair of the Intelligence 

Committee’s Subcommittee on Intelligence Policy. We look forward 

to hearing her insight, and as the sponsor of H.R. 697, on the need 

for this important legislation. 

Next, we will hear from Mr. James Johnson, 16th District Vice 

President of the International Association of Fire Fighters, located 

right here in Washington, D.C., and the final witness on our first 

panel is Mr. Joel Shufro, executive director of the New York Committee on Safety and Health. 

6

Before the gentlelady from Virginia begins her testimony, I 

would like to remind our Members that we will impose a 5-minute 

limit on all questions. I understand Ms. Davis can only be with us 

for a limited time today and must excuse herself after offering her 

testimony. Therefore, if any of our Members have questions for her, 

we will forward them to her and include the answers and questions 

in the hearing record. 

I would like to point out the timer system up there. Red means 

time’s up. Green means it’s time to start. Yellow gives you a little 

notion that we are getting close. 

We all have a copy of your testimony. 

I would ask you to summarize in that 5-minute period so we can 

run a orderly hearing here. 

Representative Davis, you are recognized for 5 minutes. 

STATEMENT OF HON. JO ANN DAVIS, A REPRESENTATIVE IN 

CONGRESS FROM THE STATE OF VIRGINIA 

Ms. DAVIS. Thank you, Mr. Chairman, and Mr. Owens, we will 

make sure you are a cosponsor right away. 

Mr. Chairman and Members of the Subcommittee, I want to 

thank you for the opportunity to discuss with you an issue that is 

very important to me and even more important to the brave men 

and women who defend Federal installations around the country. 

As the wife of a now-retired municipal battalion fire chief, I know 

the dangerous work that our firefighters do, and we owe them a 

tremendous debt of gratitude. That is why I am proud to sponsor 

H.R. 697, the Federal Firefighters Fairness Act of 2005. 

Federal firefighters risk their lives protecting our nation’s most 

vital interest. 

They face some of the most difficult and hazardous working conditions in the country, guarding military installations, nuclear facilities, VA hospitals, and the like. 

As such, they are daily exposed to stress, smoke, heat, toxic substances that greatly increase their chances to contract heart disease, lung disease, and various types of cancer. May I point out 

that many times they do not even know when they are being exposed to these hazardous materials. 

A paper by the International Association of Fire Fighters states 

that during the latest 10-year period, professional firefighters experienced 342 line-of-duty deaths, 502 occupational disease deaths, 

343,861 injuries, and 6,632 forced retirements due to occupationally induced diseases or injuries, and almost monthly, my husband 

calls me to tell me about a young fellow or a young woman from 

our local fire department that has either contracted cancer or heart 

disease or some disease that they should not have contracted at an 

early age, and we are losing firefighters much more quickly than 

we should be. 

The IFF report continues that, of the injuries reported, approximately 80 percent occur while at the emergency scene. Data shows 

that more than 40 percent of all firefighters can be expected to be 

injured at least once during the course of the year. Occupational 

diseases such as heart disease and cancer constitute more than 90 

percent of all reported firefighter deaths when their occurrences 

are combined. Additionally, the IFF reports that technology has 

7

created a distinct difference in the modern firefighting environment. The report explains that firefighters are often exposed to extremely high concentrations of a large number of toxic and carcinogenic chemical compounds. 

Chemicals such as carbon monoxide and soot are natural products of combustion and have always been present at fires. However, 

the combustion of modern synthetic and plastic material produces 

many highly toxic and carcinogenic compounds that were not found 

in fires three or four decades ago. 

As a result, the modern firefighter faces a number of potentially 

serious new health threats, including many that can develop over 

several years of exposure. 

Currently, 40 states have presumptive disability laws that presume that cardiovascular diseases, certain cancers and infectious 

diseases are job-related for purposes of workers compensation and 

disability retirement unless proven otherwise, but our Federal firefighters’ compensation and retirement benefits are not provided 

with the same benefits that these 40 states provide. 

This requirement places a substantial burden on Federal firefighters who suffer from occupational diseases, because they have 

to, by Federal law, prove that they came into contact with these 

substances, which is—and specify where the precise cause of the 

injury or illness comes from. It is very hard to do, because firefighters do not know, many times, when they are exposed to these 

substances. 

To give you a for-instance, when I was pregnant with our first 

child, my husband contracted hepatitis. It has stayed with him forever, and it has caused a lot of problems for him, and he contracted 

it, we think, on an ambulance. We do not know from who, what, 

when, where. 

This happens even more so to our Federal firefighters because of 

the types of buildings and types of fires and incidences that they 

have to go on. 

The burden of proof is unacceptably high for firefighters to meet, 

because they are constantly exposed to a myriad of harmful substances and dangerous conditions. Working in such a hazardous environment, it is often impossible to precisely identify when and 

where a firefighter contracted a certain disease. 

My legislation, H.R. 697, simply creates the presumption that 

Federal firefighters who become disabled by heart and lung disease, certain cancers, and certain other infectious diseases contracted the illness on the job. Additionally, if a firefighter contracts 

an illness that is clearly not caused by his or her firefighting duties, my bill recognizes that the Federal Government should not be 

responsible for covering those costs, and I have much more to say 

here, Mr. Chairman, but I know how important and how vital the 

time is, and like you say, you have my written statement. 

I just cannot stress enough how important it is that our Federal 

firefighters get the same benefits that are offered to firefighters in 

40 other states. 

Our Federal firefighters, in my opinion, are put at much more 

risk, especially since 9/11, than many of our state and local firefighters. 

8

I hope that the Committee will read my complete statement, that 

you will listen carefully to the testimonies today, and that if you 

have any questions, you will contact me, and I may be a little prejudiced, because I’m married to a firefighter, but after 30 years of 

being married to him, I have seen what happens with our firefighters, and I just ask for your consideration of the bill. 

Thank you, Mr. Chairman. 

[The prepared statement of Hon. Davis follows:]

Statement of Hon. Jo Ann Davis, a Representative in Congress From the 

State of Virginia 

Mr. Chairman, and Members of the Subcommittee, I want to thank you for the 

opportunity to discuss with you an issue that is very important to me, and even 

more important to the brave men and women who defend federal installations 

around the country. As the wife of a now-retired municipal battalion fire chief, I 

know firsthand the vital and dangerous work that our nation’s firefighters perform 

every single day. We all owe them a tremendous debt of gratitude. That is why I 

am proud to sponsor H.R. 697, the Federal Firefighters Fairness Act of 2005. 

Federal firefighters risk their lives protecting our nation’s most vital interests. 

They face some of the most difficult and hazardous working conditions in the country guarding military installations, nuclear facilities, and VA hospitals. As such, 

they are daily exposed to stress, smoke, heat, and toxic substances that greatly increase their chances to contract heart disease, lung disease, and various types of 

cancer. 

A paper by the International Association of Fire Fighters (IAFF) states that during the latest ten year period, professional firefighters experienced 342 line-of-duty 

deaths, 502 occupational disease deaths, 343,861 injuries and 6,632 forced retirements due to occupationally induced diseases or injuries. The IAFF report continues 

that of the injuries reported, approximately 80 percent occur while at the emergency 

scene. Data shows that more than 40 percent of all firefighters can be expected to 

be injured at least once during the course of a year. Occupational diseases such as 

heart disease and cancer constitute more than 90 percent of all reported firefighter 

deaths when their occurrences are combined. 

Additionally, the IAFF reports that technology has created a distinct difference 

in the modern firefighting environment. The report explains that firefighters are 

often exposed to extremely high concentrations of a large number of toxic and carcinogenic chemical compounds. Chemicals such as carbon monoxide and soot are 

natural products of combustion and have always been present at fires. However, the 

combustion of modern synthetic and plastic materials produces many highly toxic 

and carcinogenic compounds that were not found in fires even three or four decades 

ago. As a result, the modern firefighter faces a number of potentially serious new 

health threats, including many that can develop over several years of exposure. 

Currently, 40 states have presumptive disability laws that presume that cardiovascular diseases, certain cancers and infectious diseases are job-related for purposes of workers compensation and disability retirement unless proven otherwise. 

However, under federal law, compensation and retirement benefits are not provided 

to federal employees who suffer from occupational illnesses unless they can specify 

the precise cause of their illness. This requirement places a substantial burden on 

federal firefighters who suffer from occupational diseases, to receive fair and just 

compensation or retirement benefits. Federal firefighters currently must identify the 

precise cause of a disease in order for it to be considered job-related. This burden 

of proof is unacceptably high for firefighters to meet because they are constantly exposed to a myriad of harmful substances, and dangerous conditions. Working in 

such a hazardous environment, it is often impossible to precisely identify when and 

where a firefighter contracted a certain disease. 

My legislation, H.R. 697, simply creates the presumption that federal firefighters 

who become disabled by heart and lung disease, certain cancers, and certain other 

infectious diseases contracted the illness on the job. Additionally, if a firefighter contracts an illness that is clearly not caused by his or her firefighting duties, my bill 

recognizes that the federal government should not be responsible for covering those 

costs. However, in the case of the vast majority of federal firefighters who contract 

certain illnesses, it should be presumed that their illness is a result of their service 

to our country by running into burning buildings while others are running out of 

them. 

9

The Federal Firefighters Fairness Act will bring federal law in line with state 

laws that afford a majority of municipal firefighters a presumptive disability benefit. 

This bill will help our nation’s federal firefighters receive fair and equitable compensation or retirement benefits as a result of workplace illnesses. There is no reason why the federal government cannot treat its firefighters with the same respect 

as 40 states now treat their municipal firefighters. We owe our federal first responders the same occupational safeguards and benefits our civilian firefighters enjoy. 

Mr. Chairman, thank you for holding this hearing today on legislation pertaining 

to compensation for injured federal workers, and for including the Federal Firefighters Fairness Act of 2005. As I have stated before, the unique hazards associated 

with firefighting demand that federal firefighters are afforded a presumptive disability benefit similar to laws already on the books in 40 states. As you consider 

these issues, I urge you and your fellow Committee Members to act on H.R. 697, 

in order to provide our brave federal firefighters with the support that they deserve. 

Thank you again for including this important issue with today’s hearing. 

Mr. NORWOOD. Thank you, Ms. Davis. 

It is all right for you to be prejudiced if you are married to a firefighter. 

I think that makes sense. 

We appreciate your coming this morning, and you are now excused. 

Ms. DAVIS. Thank you. 

Mr. NORWOOD. Mr. Johnson, you are now recognized for 5 minutes. 

STATEMENT OF JAMES B. JOHNSON, 16TH DISTRICT VICE 

PRESIDENT, INTERNATIONAL ASSOCIATION OF FIRE FIGHTERS, WASHINGTON, DC 

Mr. JOHNSON. Thank you, Mr. Chairman, Ranking Member, 

Members of the Committee. 

I am James Johnson, and I am the 16th District vice president 

of the International Association of Fire Fighters. I represent the 

Federal firefighters for the IFF. On behalf of General President 

Jake Berger and the 267,000 men and women of the IFF, it is my 

honor to testify before you today regarding H.R. 697, a bipartisan 

bill which was introduced by Representatives Jo Ann Davis and 

Lois Capps. This bill would bring a much needed benefit to the firefighters that I represent in the Federal sector. 

Federal firefighters, although not as visible to the public eye as 

their counterparts in the municipal sector, play an essential role in 

protecting the vital interests of the United States. 

Over 15,000 Federal firefighters face some of the most difficult 

and hazardous working conditions in the country guarding military 

installations, VA hospitals, and other Federal assets and lands. 

Without their dedicated service, our nation would be less secure. 

The job of a Federal firefighter is unique in many ways. When 

compared to other occupations in the Federal civil service, they are 

routinely exposed to carcinogens, infectious diseases, and other occupational hazards. Federal firefighters respond to all the same 

types of emergencies as their counterparts in the cities, including 

medical emergencies, hazardous materials incidents, structural 

fires, and aircraft emergencies, but they also face unique hazards 

involving incidents at weapons depots, facilities that conduct classified work and research, and emergencies aboard naval vessels. 

They respond to these incidents often without adequate information about the dangers they may encounter. For instance, an EMS 

10

call can involve a chemical spill, and a structural fire can actually 

be the result of an ammunition test failure. Although firefighters 

take precautions and wear protective gear, as with all aspects involving occupational hazards, exposures do and can happen. As a 

result, they are far more likely to suffer from heart disease, lung 

disease, and cancer than other workers, and as firefighters, increasingly assume the role of the nation’s leading providers of 

emergency medical services, they are also exposed to infectious diseases. These illnesses are now among the leading causes of death 

and disability for firefighters. 

Mr. Chairman, in the interest of time, I will not go into great detail, but as my written testimony will indicate, there is an abundance of medical reasons why firefighters acquire these illnesses 

and diseases at a higher level and a higher rate than the average 

person. 

It is important, however, to note that, under the Federal Employees’ Compensation Act, compensation and/or retirement benefits 

are not provided to Federal employees who suffer from occupational 

illnesses unless they can specify the conditions and the exact situation in their employment to which the disease is attributed. 

In order to qualify for these benefits under current law, Federal 

firefighters must be able to pinpoint the precise incident or exposure that caused the disease in order for it to be determined jobrelated. 

This burden of proof is extraordinarily difficult for firefighters to 

meet, because they respond to a variety of emergency calls, constantly working in different environments under varied conditions. 

H.R. 697 was named the Federal Firefighter Fairness Act because the main reason for the legislation is to treat Federal firefighters fairly. 

H.R. 697 would create a presumption that firefighters who become disabled because of heart or lung disease or certain cancers 

or infectious diseases contracted their illness on the job. H.R. 697 

would shift the burden of proof from the employee to the employer 

to prove that the illness was caused by some factor other than the 

duties of a firefighter. 

It is important also to note that Congress has enacted legislation 

with presumptive benefits in the past. The 108th Congress passed 

the Hometown Heroes Act, and under this law, the public safety officers benefit is paid to families of firefighters who died as a result 

of a heart attack or a stroke while they are on duty. 

So, we are assuming that the death was a direct and proximate 

result of their duties. 

However, currently, if a firefighter does not succumb to a heart 

or stroke on duty, it is presumed not to be job-related. 

In conclusion, Mr. Chairman, while we believe the merits of 

H.R. 697 warrant Congressional action, we are also mindful that, 

in this tight budget environment, we must be sensitive to the cost 

of even the most compelling initiatives. Although no formal cost estimate has been done by the Congressional Budget Office, we believe the cost of implementing H.R. 697 will be minimal. 

Mr. Chairman, that concludes my statement, and I would like to 

thank you and the Committee for the opportunity to be here today, 

and would welcome any questions you may have. 

11

[The prepared statement of Mr. Johnson follows:]

Statement of James B. Johnson, 16th District Vice President, International 

Association of Fire Fighters, Washington, DC 

Mr. Chairman, Ranking member and members of the committee, my name is 

James Johnson, and I am the 16th District Vice–President of the International Association of Fire Fighters (IAFF), representing federal fire fighters. 

On behalf of General President Harold A. Schaitberger and the 267,000 men and 

women of the IAFF it his my honor to testify before you today on H.R. 697, The 

Federal Fire Fighters Fairness Act, a bipartisan bill introduced by Representatives 

Joann Davis and Lois Capps. The bill would bring a much-needed benefit to the fire 

fighters that I represent in the federal sector. 

Introduction 

Since the events of September 11, 2001, Americans have become increasingly 

aware of the role that fire fighters serve as our nation’s domestic defenders. These 

courageous men and women protect the lives and property of their neighbors in 

communities throughout the country. 

Federal fire fighters, although not as well known as their counterparts in the municipal sector, play an essential role in protecting the vital interests of the United 

States. The over 15,000 federal fire fighters face some of the most difficult and hazardous working conditions in the country guarding military installations, nuclear facilities, and VA hospitals. And their 72 hour work week is unparalleled. Without 

their dedicated service, our nation would be less secure. 

The job of federal fire fighters is unique in many ways. Far more often than other 

occupations within the federal sector, they are routinely exposed to carcinogens, infectious diseases, and other occupational hazards. 

Federal fire fighters respond to all of the same types of emergencies as their counterparts in the municipal sector including medical emergencies, hazardous material 

incidents, structural fires, and aircraft emergencies. But they also face unique hazards involving incidents at weapons depots, facilities conducting classified work and 

research, and emergencies aboard naval vessels. 

And they respond to these incidents often without adequate information about the 

dangers they may encounter. An EMS call can actually turn out to involve a chemical spill, and a structural fire can be the result of a research or ammunition test 

failure. Although fire fighters take precautions and wear protective gear, as with all 

aspects involving occupational protection, exposures happen. 

Fire fighters are exposed on an almost daily basis to stress, smoke, heat and various toxic substances. As a result, they are far more likely to contract heart disease, 

lung disease and cancer than other workers. And as fire fighters increasingly assume the role of the nation’s leading providers of emergency medical services, they 

are also exposed to infectious diseases. 

Heart disease, lung disease, cancer, and infectious disease are now among the 

leading causes of death and disability for fire fighters, and numerous studies have 

found that these illnesses are occupational hazards of fire fighting. 

Under the Federal Employees’ Compensation Act (FECA), compensation and/or retirement benefits are not provided to federal employees who suffer from occupational illnesses unless they can specify the conditions of employment to which the 

disease is attributed. In order to qualify for these benefits under current law, federal fire fighters must be able to pinpoint the precise incident or exposure that 

caused a disease in order for it to be determined job-related. 

As I will explain further in my testimony, this burden of proof is extraordinarily 

difficult for fire fighters to meet because they respond to a wide variety of emergency calls, constantly working in different environments under varied conditions. 

As a result, very few cases of occupational disease contracted by fire fighters have 

been deemed to be service connected. 

State Laws 

In recognition of the linkage between firefighting and certain diseases, 40 states 

have enacted some sort of ‘‘presumptive disability’’ laws, which presume that cardiovascular diseases, certain cancers and infectious diseases are job-related for purposes of workers compensation and disability retirement unless it can be shown otherwise. 

For example, Mr. Chairman, in your home state of Georgia fire fighters are protected by a presumptive disability law that covers heart disease, lung disease, and 

certain infectious diseases. 

12

Many of the illnesses covered by state presumptive disability laws are debilitating 

and often fatal. They place a great strain on the fire fighter and his/her family. 

Knowing that they will not have to fight their state Worker’s Compensation offices 

during trying times for them and their families provides a degree of security for 

those who place themselves in harm’s way to protect the rest of us. 

While presumptive laws are now the norm for municipal fire fighters, no such protection exists for fire fighters employed by the federal government. 

Fairness 

HR 697 was named the Federal Fire Fighters Fairness Act because the main impetus for the legislation is to treat federal fire fighters fairly. It is simply not right 

that federal fire fighters are denied an important workplace protection that is routinely provided in the municipal sector. This inequity is especially egregious in communities where federal fire departments maintain a mutual aid agreement with a 

neighboring municipality. 

In such instances, federal fire fighters work side-by-side with municipal fire fighters during mutual aid responses and are subject to the same occupational hazards 

as the municipal fire fighter. However, if two fire fighters both contract an illness 

due to their mutual exposure at an incident, the municipal fire fighter in most instances would be covered by workers compensation but the federal fire fighter would 

not. 

There simply is no valid justification for denying federal fire fighters comparable 

protections. 

Recruitment and Retention 

In order for the federal government to adequately protect our nation’s domestic 

military installations, nuclear facilities and other sensitive agencies, the government 

must offer fire fighters benefits that are competitive with those that are provided 

by municipalities. Often, federal fire fighters leave the federal service for work in 

a municipal department because the benefits are superior. For those same reasons, 

municipal departments also have a competitive advantage over the federals in the 

recruitment of new hires. 

Being at a competitive disadvantage to recruit and retain fire fighters harms the 

federal government in two ways. First, it makes it more difficult to recruit and keep 

the very best our profession has to offer. Considering the vital national security role 

played by the nation’s fire fighters, it is important that the federal government is 

able to recruit and retain the elite of the firefighting world. 

Second, the federal government invests a significant amount of money to uniquely 

train federal fire fighters, and it costs taxpayer dollars each time a federal fire fighter leaves for the municipal sector. High turnover is costly and wasteful. 

In order to address these problems, the federal government must offer a competitive benefits package, and that includes having occupational illness covered by 

workers compensation. 

Case Studies 

Admittedly, there are few examples of the Department of Labor’s Office of Worker’s Compensation (OWCP) rejecting applications for occupational illnesses, but that 

is due to the fact that fire fighters simply do not apply for benefits they have been 

told are not available to them. 

When a fire fighter contracts a career-ending illness, they are given paperwork 

by their local personnel office and told what benefits they are or are not eligible to 

receive. Those who are suffering from diseases that have been linked to fire fighting 

are informed that such illnesses are not considered duty-related for Workers Comp 

purposes. 

For example, Fire Fighter Leon Tukes of Warner Robins Air Force Base in your 

home state of Georgia suffered a heart attack while on duty. After his heart attack, 

Fire Fighter Tukes went to the Personnel Office at Warner Robins to enquire about 

receiving a presumptive disability retirement. He was told to not even bother because no claim has ever been granted for a heart attack. He never filed a claim and 

accepted the retirement benefits provided to people who retire for non-work related 

reasons. Unable to work and with no protection under FECA, Fire Fighter Tukes had to 

rely on his fellow fire fighters to donate leave to him so he could retire with a full 

pension. He was lucky to be near retirement age; most are not when they are stricken with these occupational illnesses. 

Occasionally an instance occurs in which the service connection is so apparent 

that OWCP has little choice but to award benefits. But the absence of a presumptive 

disability law means that in even these cases the fire fighter must spend years 

fighting the bureaucracy to get what they are rightfully entitled to. 

13

Fire Fighter Rick LeClair provides a tragic example of this delay. LeClair spent 

his career protecting the critical naval facility in San Diego, California until he was 

diagnosed with lung cancer. Doctors discovered that his cancer was caused by 

mesothilioma, which was attributed to the asbestos suits that fire fighters once 

wore. Fire Fighter Leclair filed a claim with the Office of Workers’ Compensation. 

Before the claim was decided fire fighter LeClair succumbed to the cancer that was 

ruled to be caused by an occupational hazard. If this law would have been in place 

for fire fighter Leclair, his illness would have been presumed and he would have 

received the benefit he died waiting years to receive. 

It is for fire fighters Tukes, LeClair, and many others whose names we don’t 

know, that we urge passage of the Federal Fire Fighters Fairness Act. 

Firefighter Health and Safety 

The IAFF has been actively involved in the health and safety of fire fighters for 

more than seventy years. Each year the IAFF conducts an annual death and injury 

survey with the cooperation and participation of various fire department administrators. This survey has shown that fire fighting is the most hazardous occupation 

in the United States. During the latest ten-year period (1990–2000), the Death and 

Injury Survey has found that professional fire fighters experienced 342 traumaticinjury deaths, 502 occupational disease deaths, 343,861 injuries and 6,632 forced retirements due to occupationally induced diseases or injuries. 

Occupational diseases such as heart disease and cancer constitute a majority of 

all reported fire fighter deaths. 

Heart Disease 

The very nature of firefighting places extraordinary strain on cardiovascular systems. Fire fighters are constantly making transitions from the calm, peaceful environment of the firehouse to the hostility presented by fire. Within 15–30 seconds 

after the fire alarm sounds, research studies have found that a fire fighter’s heart 

rate can increase by as much as 117 beats per minute. In addition, a fire fighter’s 

heart can beat at twice its normal rate throughout the entire fire fighting operation. 

These extreme physiological stresses lead to severe coronary problems, which have 

been documented by numerous authorities. 

Fire fighting involves stressful and strenuous physical activity that is made more 

burdensome by the fact that the protective clothing and breathing apparatus a fire 

fighter wears adds 45 to 65 pounds. The working environment can also mean a transition from below freezing temperatures to temperatures between 100 degrees and 

500 degrees Fahrenheit at the fire itself. 

The strain placed on the heart by this unique combination of factors is unlike that 

of any other occupation, and leads to heightened risk of heart disease. 

Cancer 

Technology has created a distinct difference in the modern fire environment. Fire 

fighters are exposed in their work to extremely high concentrations of a large number of toxic and carcinogenic chemical compounds. 

Some of these chemicals—for example, carbon monoxide and soot containing 

polycyclic aromatic hydrocarbons—are natural products of combustion and have always been present at fires. However, the combustion of modern synthetic and plastic materials produces many highly toxic and carcinogenic compounds that were not 

found in fires even three or four decades ago. Exposures today commonly include 

benzene, formaldehyde, polycyclic aromatic hydrocarbons (PAH), asbestos and the 

complex mix of carcinogenic products that arise from combustion of synthetic and 

plastic materials. 

These chemical compounds are commonplace ingredients in our environment as 

components of household furniture, plastic pipes, wall coverings, automobiles, buses, 

airplanes, and coverings for electrical and other insulation materials. 

While the initial health effects of such exposures can be short-term or even nonexistent, these exposures can and do result in long-term illnesses involving the cardiovascular system, the respiratory system, the central nervous system and other 

body organs. 

Practically every emergency situation encountered by a fire fighter has the potential for exposure to carcinogenic agents. However, fire fighters can also be exposed 

to carcinogenic agents when the protective clothing they wear is exposed to high 

heat or burns. Fire fighters have even been exposed to carcinogens through the fireextinguishing agents they utilize. The list of potential carcinogenic agents that fire 

fighters can be exposed to is almost as long as the list of all known or suspected 

carcinogens. Nevertheless, fire fighters constantly enter potential toxic atmospheres 

without adequate protection or knowledge of the environment. 

14

Research has clearly shown the following specific linkages established between 

cancer and chemicals encountered in fire fighting: 

• Leukemia is caused by benzene and 1,3-butadiene. 

• Lymphoma and multiple myeloma are caused by benzene and 1,3-butadiene. 

• Skin cancer is caused by soot containing PAH. 

• Genitourinary tract cancer is caused by gasoline and PAH. 

• Gastrointestinal cancer is caused by PCBs and dioxins. 

• Angiosarcoma of the liver and brain cancer are caused by vinyl chloride. 

Leukemia, lymphoma, multiple myeloma, cancer of genitourinary tract, prostate 

cancer, gastrointestinal cancer, brain cancer and malignant melanoma are among 

the cancers that have been observed consistently with increased frequency in epidemiologic studies of fire fighters. It is likely that additional associations will be 

identified between chemicals encountered in the fire environment and cancer in fire 

fighters. Nevertheless, the available data are sufficient to conclude that excess risk 

of cancer is a distinct hazard of fire fighting. 

Lung Disease 

In the course of their work, fire fighters are exposed to numerous substances that 

irritate the respiratory tract–ammonia, chlorine, formaldehyde, hydrogen sulfide 

and hydrogen chloride to name just a few. Toxic substances can cause acute (immediate) effects, chronic effects noted months or years afterwards, or both. The acute 

effects of inhaling smoke are familiar to every fire fighter. Some of these agents may 

not cause immediate irritation, but instead, cause damage that doesn’t become apparent until years later when it may be difficult to prove cause and effect. 

Infectious Diseases 

Infectious diseases have become a hazard to fire fighters too big to ignore. Fire 

fighters and emergency medical responders can be exposed during motor vehicle accidents in which blood and sharp surfaces often are present, by rescuing burn victims, and through the administration of emergency care. The victim may require extrication from a difficult-to-access accident scene, such as a motor vehicle accident 

or poorly accessible building. There may be broken glass or other sharp objects at 

the scene that are poorly visualized, and the lighting at the scene may be minimal. 

In addition, if the victim is exsanguinating and needs to be extricated quickly to 

save his life, the emergency provider may act in haste, with disregard for his or her 

own safety. Fire fighters are also involved in emergency medical treatment at the 

scene, including intravenous line insertion and blood drawing. The fire fighter almost never knows the infectious disease status of the victim while he or she is rendering emergency services. All of these factors combine to place the fire fighter at 

increased risk of contracting a blood borne contagious disease through a puncture 

wound, skin abrasion or laceration that becomes contaminated with infected blood 

from the victim. 

Every fire fighter’s education now includes use of Universal Precautions, such as 

the wearing of protective gloves, safety glasses, and masks. But in the chaotic environment of an emergency scene, these precautions can and do fail. Exposures happen. A government study conducted during the development of the federal OSHA 

Blood borne Pathogen Standard found that 98 % of EMT’s and 80% of fire fighters 

are exposed to blood borne diseases on the job. 

Next Steps 

Mr. Chairman, as I have previously stated, nearly 40 states have some form of 

a presumptive disability law on the books. There is no such law for federal fire 

fighters. 

In order to qualify for a disability retirement, a fire fighter who suffers from an 

occupational illness must specify the precise exposure that caused their illness. As 

my testimony indicates those are nearly insurmountable odds. 

H.R. 697, The Federal Fire Fighters Fairness Act would create a rebuttable presumption that fire fighters who become disabled by heart and lung disease, certain 

cancers and infectious diseases contracted the illnesses on the job. H.R. 697 would 

shift the burden of proof to the employer to prove that the illness was caused by 

some factor other than the duties of the fire fighter. 

This does not mean that every fire fighter who contracts a disease named in the 

legislation automatically would qualify for benefits under FECA. For example, lung 

cancer is unlikely to be determined to be occupational if it is contracted by a fire 

fighter who was also a long-term smoker. But the burden of proof would no longer 

be placed on the fire fighter to prove the cause of the disease. 

15

Precedent 

Although FECA currently does not provide presumptive disability benefits, Congress has enacted such presumptions in other benefit programs. Peace Corps volunteers, military veterans, and public safety officers who die in the line of duty are 

all covered by presumptive laws. 

Service-connected disability is provided to Vietnam veterans whose cancers are 

presumed to be caused by herbicide exposure. Like fire fighters, Vietnam Veterans 

found it extremely difficult to pinpoint precise exposures, and as a result, thousand 

of veterans were denied a benefit to which they were entitled. After years of lobbying by veteran groups, Congress responded by enacting a law that established a 

presumption of service-connection for certain diseases. 

More recently, the Congress passed and President Bush signed into law the 

Hometown Heroes Act (PL 108–182). Under the new law, Public Safety Officer Benefit (PSOB) will be paid to the families of fire fighters and police officers who die 

as a result of heart attack or stroke suffered within twenty-four hours of responding 

to an emergency call or participating in a training exercise involving ‘‘unusual physical exertion.’’ It is now presumed that the death was ‘‘a direct and proximate result’’ of the emergency response. 

Cost 

While we believe that the merits of the Federal Fire Fighters Fairness Act warrant congressional action, we are mindful that in this tight budget environment we 

must be sensitive to the cost of even the most compelling initiatives. Although no 

formal cost estimate has been done by the Congressional Budget Office, we believe 

the cost of implementing H.R. 697 will be minimal. 

The number of federal fire fighters is relatively small compared with other occupations in the federal sector, and the vast majority do not retire due to an illness. 

Based on the experience of states with similar presumptive disability laws, as few 

as 15–20 people are likely to qualify for the benefit each year. 

Moreover, because fire fighters are generally on the lower end of the GS pay scale, 

benefits based on their salary would not have a significant impact on FECA’s balance sheet. 

In short, an important protection can be provided to the nation’s federal fire fighters at little expense to the federal treasury. 

In conclusion, Mr. Chairman, I would like to thank you and the Committee for 

holding this hearing today. I look forward to working with the committee to see this 

legislation move forward. 

Mr. NORWOOD. Thank you very much, Mr. Johnson, and now, 

Mr. Shufro, you are recognized for 5 minutes. 

STATEMENT OF JOEL A. SHUFRO, EXECUTIVE DIRECTOR, NEW 

YORK COMMITTEE FOR OCCUPATIONAL SAFETY AND 

HEALTH (NYCOSH), NEW YORK, NY 

Mr. SHUFRO. Thank you very much. I appreciate the opportunity 

to testify. 

The New York Committee for Occupational Safety and Health is 

a nonprofit educational organization composed of 200 local unions 

and 300 individual members dedicated to promoting every worker’s 

right to a safe and healthful work place. 

I am here to support H.R. 697, which creates the legal presumption that certain diseases are considered work-related when they 

cause the disability or death of Federal fire protection employees. 

Many states, including New York, have created such presumptions as a reasonable and rational method of providing those workers who are routinely exposed to hazardous substances and conditions at work and who are disabled as a result with medical and 

financial benefits. 

This year, the New York State legislature, in its current session, 

passed legislation establishing presumptions that disability is 

work-related among certain public employees who were exposed to 

16

hazardous conditions in connection with the World Trade Center 

tragedy of September 11, 2001. The bill, which provides disability 

retirement, is currently sitting on Governor Pataki’s desk, and we 

are hoping that he will sign the bill this year. The need, however, 

goes far beyond public sector workers and disability retirements. 

It is estimated that 30 to 35 thousand workers worked directly 

on the pile at Ground Zero. Countless others worked to clean up 

the buildings of lower Manhattan and Brooklyn. 

Six thousand of the 12,000 workers who have been seen at the 

World Trade Center worker and volunteer medical screening program at Mt. Sinai Medical Center have respiratory symptoms that 

require medical treatment. 

For some, symptoms have abated. Others have symptoms that 

have reemerged after abating, and still others have symptoms that 

are appearing only now, nearly 4 years after exposure. 

Similar numbers of workers have been diagnosed with mental 

problems requiring psychological counseling, and of course, it is too 

early to know how many workers will develop diseases such as cancers with latency periods as long as 40 years. 

To receive medical treatment, workers and volunteers must 

apply for workers compensation. In the aftermath of 9/11, Congress allocated $175 million over 4 

years to assist New York State’s workers compensation board. In his latest budget proposal, the President eliminates $125 million which has not yet been spent. If the funding is not restored, 

there will be no source of funds to pay future claims of volunteers 

and uninsured workers who have been made ill as a result of their 

exposure at Ground Zero, as well as the ongoing claims of those 

workers who have already been able to establish them. 

This is extremely unfortunate. 

While we do not know how many workers are eligible for benefits, we do know that there are many impediments for workers to 

file and that large numbers of individuals who should receive medical attention and possibly wage replacement are not receiving 

them. 

For example, many immigrant workers and volunteers who participated in the rescue efforts and cleanup of office buildings in 

lower Manhattan were never informed of their right to access the 

New York State workers compensation program. 

My organization, through funding from the Red Cross and the 

United Church of Christ World Services, has been reaching out to 

the immigrant organizations and has begun to identify large numbers of workers who are sick and have not received any benefits. 

In addition, we have a case known as medical-only cases, claims 

where workers need medical treatment but have not lost time at 

work, and they cannot get legal representation. Lawyers do not get 

paid in this process, and so, our system, which is very arcane and 

complicated, especially for immigrant workers, to navigate without 

a lawyer—many of the workers just drop out. 

Many workers’ compensation claims have been contested and remain unresolved. 

Many workers who participated in the rescue and clean-up at the 

World Trade Center site, who have experienced the onset of respiratory illness and other diseases, have not been able to establish 

17

claims, thereby preventing them from receiving timely medical 

treatment and medication, as well as receiving wage replacement 

benefits. This has meant real hardship for the many who heroically 

attempted to rescue those who were buried in the rubble of the collapse or who worked in the vicinity of Ground Zero. 

There are many reasons workers have not received benefits. In 

part, the difficulty has arisen because there are no presumptions 

in the law. 

In the remaining time, I would just like to say that we urge that 

the Congress restore the funding for workers’ compensation payments to workers who were made ill in New York City. 

[The prepared statement of Mr. Shufro follows:]

Statement of Joel A. Shufro, Executive Director, New York Committee for 

Occupational Safety and Health, New York, NY 

My name is Joel Shufro. I am the executive director of the New York Committee 

for Occupational Safety and Health, a non-profit educational organization. We are 

a coalition of 200 local unions and 300 individual members dedicated to promoting 

every worker’s right to a safe and healthful workplace. We have a twenty-six year 

history of providing safety and health training and technical assistance to working 

people, community organizations and employers in the New York Metropolitan area. 

I am here to support H.R. 697, which creates the legal presumption that certain 

diseases are considered work-related when they cause the disability or death of federal fire protection employees. Many states, including New York, have created such 

presumptions to as a reasonable and rational method of provide those engaged in 

hazardous activities with medical and financial benefits to workers who are routinely exposed to hazardous substances and conditions at work and who are disabled 

as a result. 

This year the New York state legislature, in its current session passed legislation 

establishing the presumption that disability is work-related among certain public 

employees who were exposed to hazardous materials presumptive accidental disability in connection with the World Trade Center tragedy of September 11, 2001. 

The legislature passed the same bill last year and the year before that, but the first 

two times it was vetoed by Governor Pataki. In so doing, the legislature recognized 

that public employees including police, fire, correction and sanitation rendered rescue, recovery and clean up at and around the World Trade Center site and were 

exposed to numerous hazards which may have, and may, impact their health in 

years to come. 

The bill is currently sitting on Governor Pataki’s desk. We are hoping that he will 

not veto the bill for the third time. 

The need, however, goes far beyond public sector workers and disability retirements. It is estimated that 30–45,000 workers worked directly on the pile at Ground 

Zero; countless others worked to clean up the buildings of Lower Manhattan. Still 

others returned to work and live in buildings which were either not or inadequately 

cleaned up and still contaminated after the EPA and OSHA assured the public that 

the air was safe. The consequence has been that workers and community residents 

are sick—and in large numbers. 

Six thousand of the 12,000 workers who have been seen at the World Trade Center Worker and Volunteer Medical Screening Program at Mt. Sinai Medical Center 

have respiratory symptoms that require medical treatment. For some, symptoms 

have abated; others have symptoms that re-emerge after abating and still others 

have symptoms that are appearing only now, nearly four years after exposure. Similar numbers of workers have been diagnosed with mental problems requiring psychological counseling. Many of the workers will never be able to work again; others 

will not be able to pursue their chosen careers. And, it is, of course, too early to 

know whether and how many workers will develop diseases such as cancers with 

latency periods as long as 40 years. 

To receive medical treatment workers and volunteers must apply for workers’ 

compensation. In the aftermath of 9/11, Congress allocated a total of $175 million 

over four years to the New York State Workers’ Compensation Board. Of the money 

allocated, $125 million was earmarked for the processing of claims; $50 million to 

reimburse the state Uninsured Employers Fund for benefits paid to volunteers and 

to employees of companies that did not have workers’ compensation insurance. 

18

According to a recent GAO report (GAO–04–1013T) entitled ‘‘September 11, Federal Assistance for New York Workers’ Compensation Costs,’’ the New York State 

Workers’ Compensation Board has spent $50 million of the $175 million that has 

been provided by the federal government. In his latest budge proposal, the President 

calls for taking back the remaining $125 million. If the president’s proposal is 

agreed to there will be no source of funds to pay future claims of volunteers and 

uninsured workers who have been made ill as a result of exposure to toxic substances during the September 11th cleanup. 

This is extremely unfortunate. While we do not know how many workers are eligible for benefits, we do know that there are many impediments for workers to file 

and that large numbers of individuals who should receive medical attention and possibly wage replacement are not receiving them. 

For example, many immigrant workers and volunteers who participated in the 

rescue efforts and cleanup of office buildings in Lower Manhattan were never informed of their right to access the New York State Workers’ Compensation System. 

NYCOSH has recently received grants from the Red Cross and the United Church 

of Christ World Services to inform organizations that are active in the immigrant 

community about the eligibility of workers who have developed occupational disease 

related to work at the World Trade Center. 

In addition, many workers have what are known as ‘‘medical-only cases’’—claims 

where the worker needs medical treatment but has not lost time at work. In these 

cases, lawyers in New York State most lawyers are unwilling to take medical-only 

cases, because there is no mechanism to pay lawyers for work on such cases. The 

Workers’ Compensation System in New York State is too complicated and arcane 

for any worker, but especially an immigrant worker, to navigate workers’ compensation system without a lawyer. As a result, far too many workers who would be entitled to medical treatment do not pursue their cases. 

Many workers’ compensation claims have been contested and remain unresolved. 

Despite a request from the then chair of the New York State Workers’ Compensation Board, Robert Snashall, that claims for workers’ compensation arising out of 

the World Trade Center tragedy be expedited, many workers who participated in 

the rescue and cleanup at the World Trade Center site and have experienced the 

onset of respiratory illness and other diseases have been unable to establish claims 

thereby preventing them from receiving timely medical treatment and medication 

as well as receiving wage replacement benefits. This has meant real hardship for 

many who heroically attempted to rescue those who were buried in the rubble of 

the collapse or who worked in the vicinity of Ground Zero cleaning up the toxic dust 

which covered Lower Manhattan. 

There are many reasons workers have not received benefits. In part, the difficulty 

has arisen because there are no presumptions in our workers’ compensation law 

that associate the adverse health effects that workers at the Trade Center experienced with their exposure to the toxic substances. Given the witches brew of toxic 

substances and chemicals to which workers were exposed, it is virtually impossible 

for a worker to prove the onset of symptoms was caused by any given chemical or 

combination of chemicals. However, there is evidence that insurance companies are 

contesting claims of 9/11 victims, according to some sources, at a rate ten times 

greater than that of the normal population of injured workers. This has led programs that have provided needed medicines to injured workers while their cases are 

being adjudicated, to stop providing assistance until workers claims have been established, leaving workers without access to prescribed medications while they 

await a determination. 

Consequently, we are here to urge Congress should restore funding to cover the 

future workers’ compensation costs associated with illnesses arising out of the rescue, cleanup of Ground Zero and return to workers to workplaces throughout Lower 

Manhattan. This is particularly important since we have do not know whether additional workers will develop illnesses in years to come nor do we know how long the 

symptoms workers are currently experiencing will persist. The funding should be 

used to: 

1) create a medical trust fund so workers can get needed medical treatment while 

they are waiting for their claims to be established; 

2) finance a outreach campaign to special populations such as immigrant workers 

and volunteers to inform them of their rights to benefits under New York 

State’s Workers’ Compensation Law. 

3) fund Medical Centers of Excellence which would develop expertise in dealing 

with the complex, multiple medical issues which workers who worked at the 

World Trade Center site are experiencing. 

As our state legislature noted in passing its bill for disability retirements for public-sector workers who participated in the rescue and clean up at the World Trade 

19

Center, ‘‘It is beyond question that the State must recognize the services that these 

individuals provided not only to the victims and their families, but to all citizens 

of the City and the State of New York and the United States of America.’’ We believe that all workers who participated in the rescue and clean up or have become 

ill as a result of exposure to the toxic substances from the collapse of the World 

Trade Center should receive appropriate benefits and that the funding should be restored to the President’s budget. 

Mr. NORWOOD. Thank you, Mr. Shufro. 

I recognize Mr. Kline for 5 minutes. 

Mr. KLINE. Thank you, Mr. Chairman. 

Thank you, gentlemen, for being here today. 

I want to try to get a better handle in my own mind on the scope 

of the problem in terms of numbers, and I know, Mr. Johnson, you 

mentioned the number of Federal firefighters. Could you give that 

to us again and tell us what percentage of that that your union 

represents? 

Mr. JOHNSON. Overall, there are approximately—depending on at 

which time you actually work, because of the hiring processes, between—approximately 15,000 Federal firefighters. 

That includes overseas sites, Guam, Puerto Rico, and throughout 

the continental United States. 

A portion of those Federal firefighters are also—are military, 

however. 

My understanding is there’s about 4,000 military firefighters between the different agencies, and then the remainder are civilians. 

Mr. KLINE. How many of those are in the union? 

Mr. JOHNSON. The IFF represents approximately 4,000 Federal 

firefighters. 

There are several other unions that represent a number of firefighters, also. 

Mr. KLINE. OK. Thank you very much. 

Continuing on the—getting a handle on the scope of the problem, 

the—looking at my notes here, the FECA is set up as a non-adversarial program, and according to my notes here, the Department of 

Labor has told us that approximately 65 percent of all claims for 

occupational diseases are ultimately approved. 

Is the issue with firefighters out of proportion with that, or is 

there a higher number approved or disapproved? Do you know? 

Mr. JOHNSON. We feel that there are a higher number disapproved. 

As an example, I will use hepatitis exposures, which Jo Ann 

Davis mentioned. 

The problem that we’re seeing specifically with those type of exposures, infectious diseases, is the employees are being told that 

unless they can specifically point out the patient that they acquired 

the disease from, they are not going to be covered, their claims are 

denied, and basically—it comes down to basically a blood test issue, 

and OWCP is looking for something that they can actually sink 

their teeth into and say, OK, you acquired this infectious disease 

from this person, and it’s nearly impossible for a firefighter to be 

able to pin that down, because a firefighter may go on 25 or 30 

calls a month, medical calls, and—and obviously we do not know 

who is carrying those diseases when they respond. 

Mr. KLINE. OK. 

20

One final question, then I will yield back, but along the same 

lines as trying to get a feel for the difference between the firefighters population and the general population, obviously in the 

general population, people die from cancer and heart disease and 

so forth. On an age-equal basis, could you give me a sense of the 

percentage or number of deaths from heart disease, for example, 

for firefighters versus the general population, say, for 45-year-olds? 

Mr. JOHNSON. I believe we have that data in the full testimony 

that we submitted, and I cannot recall it off the top of my head, 

but it is in the report that we submitted. Overall, from my experience working in the Federal sector for 27 years, there is, I believe, 

a higher rate of heart attack and strokes specifically with Federal 

firefighters because of the exposures and the stress in the job. 

There are also—I’ve been actually witness to several instances with 

employees I have worked with where they have tried to file claims 

through OWCP related to these incidences, and they have been denied. 

Mr. KLINE. I see, and those numbers are in the testimony? 

Mr. JOHNSON. Yes. 

Mr. KLINE. OK. 

Thank you very much. 

Mr. Chairman, I yield back. 

Mr. NORWOOD. The gentleman yields back. 

Mr. Bishop, you are recognized for questioning for 5 minutes. 

Mr. BISHOP. Thank you, Mr. Chairman, and thank you for holding this hearing. 

I have a written statement, and I would ask unanimous consent 

that it be inserted into the record. 

Thank you, Mr. Chairman. 

First, let me start by commending Representatives Davis and 

Capps for filing this legislation. 

I think it is very good and very important legislation. I am proud 

to be a cosponsor of it, and I hope that we can see that this legislation becomes law. 

Mr. Johnson, several states already have the presumption of disability, and my question is, what experiences can you cite for us 

that would help inform the Federal Government with respect to 

how that presumption has worked? For example, how often is the 

presumption challenged? How often is that challenge successful? 

Mr. JOHNSON. From the data that we reviewed involving the separate states that have presumptive-type disability for firefighters, 

we actually find that there are relatively few firefighters that actually apply for disability under the presumption. 

So, I do not think the numbers are really that great for us to actually look at. 

Most of the instances that we see are related to heart attack and 

stroke issues, and I think a lot of that was channeled into the Public Safety Officers Death Benefit, which was a lot of the impetus 

behind that. 

Mr. BISHOP. If we are successful in passing this law, do you have 

any sense of what its impact would be on the ability to both recruit 

or retain Federal firefighters? Is this something that would be attractive? 

21

Mr. JOHNSON. It would definitely be a benefit. As we see right 

now, we have a lot of problems in the Federal sector as far as Federal firefighters currently, as far as recruiting new hires and retaining those individuals throughout their career. Obviously, when 

the cities are offering better pay and better benefits, better compensation, and better health care and this presumptive disability 

that most of them offer, it becomes a challenge for the Federal sector to recruit and retain employees through an entire career. We 

do experience, as I have seen, employees coming into the system, 

gaining experience, and then seeing an opportunity to move to the 

municipal sector, and they definitely will take that road if they get 

the opportunity. So, improving the benefits within the Federal sector, I think, would be a great help. 

Mr. BISHOP. One more question for Mr. Shufro. You cited that at 

least $125 million that is proposed to be cut from workers’ compensation claims. Can you walk us through the human implications 

of that if we are unsuccessful in having that money restored? How 

many people are we talking about? What types of disabilities would 

go uncompensated? 

Mr. SHUFRO. Well, workers who worked on the pile are suffering 

from respiratory problems, many of whom are no longer able to 

work at all, many of whom go in and out of experiencing symptoms. 

We have large numbers of workers who worked on the pile who 

currently are not able to work. 

To eliminate this funding will mean that workers who are currently collecting will not be able to collect, and in New York, the 

maximum benefit level is the lowest of any state in the country, 

$400 a week, and—but more importantly—and I guess as importantly, I would say—workers who will become ill—there will be no 

funding for them, and especially for those people who are—were 

volunteered to work on the pile, for whom our workers compensation system has no provision. So, this will mean very real hardship 

for workers. 

It is hardship enough to live on $400 a week, let alone if there 

is no funding at all. 

Mr. BISHOP. Thank you very much. 

Thank you, Mr. Chairman. I yield back. 

Mr. NORWOOD. Thank you very much. The gentleman yields 

back. 

Dr. Price of Georgia, you are recognized for 5 minutes for questioning. 

Dr. PRICE. Thank you, Mr. Chairman. 

I, too, want to thank you all for coming and giving your testimony today, and just simply want to echo what others have said, 

and that is that we certainly, all of us, appreciate the work that 

firefighters do, our Federal firefighters, and want to recognize that 

and recognize that they are true heroes on the front lines. 

As a physician, I know that firefighters are oftentimes the first 

folks there on medical tragedies and crises when, in fact, there is 

no fire around. They get involved in many medical emergencies. 

So, I appreciate the work that they do. 

I would like to ask a couple specific questions. I am interested 

in the list in the bill of diseases, and understand through your 

22

statement, Mr. Johnson, about some of the correlation of exposure 

to certain chemicals and the like. 

How did you all come up with this list? 

Mr. JOHNSON. The data that is included in the report is obviously 

the result of years and years of research and statistical studies 

that the IFF and medical professionals have developed over a period of time. The IFF itself conducts annual surveys regarding 

deaths and injury for firefighters, and we tried to delve in detail 

into what the causes of injuries in firefighters are, and based on 

that data, we maintain a reporting system that we can extract that 

data from and come up with the diseases and specific illnesses that 

are affecting firefighters. 

Dr. PRICE. That gets to, I think, the crux of the issue that I think 

Mr. Kline tried to touch on, and that is whether the actuarial data 

will give any difference—show any difference between firefighters 

and the general public, and you mentioned that the numbers were 

in your testimony, and I may have missed it, but I did not see it. 

Mr. JOHNSON. I will check to see. If it is not, then we will make 

sure that that is provided to you. 

Dr. PRICE. I think that would be of great help to all Members of 

the Committee to see that. 

I also wanted to just point out one item in your—and ask you 

to comment on it, one item in your—in your written testimony, Mr. 

Johnson. That is in the area of cancer, and it lists the exposure and 

the—and how certain leukemias and lymphomas and skin cancers 

can be a result of certain exposure, but the final line in this paragraph here is that, ‘‘Nevertheless, the available data are sufficient 

to conclude that the excess risk of cancer is a distinct hazard of 

firefighting,’’ and that is the kind of data that I think we are interested in, and I do not see that here. 

Finally, I would like to have each of you comment on the cost. 

Your summary says that this would probably affect 15 to 20 people a year. 

So, I am curious about that, given the scope of what you all seem 

to say today is much larger than that, but your written testimony 

is 15 to 20 a year. 

So, would you comment on the cost—I know CBO has not scored 

it, but what you all believe is the cost? 

Mr. JOHNSON. Just briefly to try to summarize that, I think what 

we were looking at is what we actually see from the states currently that have this type of presumption, and we tried to look at 

how many claims are actually filed and go through the system successfully, because it is still important to remember that, even in 

the states that have a presumptive disability, there is still the ability on the states’ part, or the employer, to controvert that claim. 

So, it is not a given that just because the presumption is there initially that the employee is going to receive the benefit permanently. 

So, we looked at those numbers, and based off those numbers 

from the states, we tried to equate what we thought is a best estimate. 

Dr. PRICE. Have you got a guess? 

Mr. JOHNSON. Pardon me? 

Dr. PRICE. Do you have a guess? 

Mr. JOHNSON. Within the Federal sector? 

23

Dr. PRICE. Yes. 

Mr. JOHNSON. My best guess would probably be 30 to 40 employees a year. 

We really do not see that many——

Dr. PRICE. In a line item per——

Mr. JOHNSON. Well, it is also important to remember that this 

is broken down into different categories. 

Some employees may acquire a disease that only requires two or 

3 months of treatment and they are back on the job, and that is 

what we see the majority of the time, are limited illnesses to where 

the employee is off for a short duration. 

Occasionally there will be—obviously there is occasions when an 

employee’s illness requires a disability retirement. 

Dr. PRICE. If I may, Mr. Chair, do Federal firefighters have access to any other disability that they can purchase on their own for 

those kinds of instances? 

Mr. JOHNSON. There are private avenues that—obviously, they 

could pursue private disability-type insurance or something of that 

nature. 

The only other compensation that they can receive is directly 

through OWCP. 

Dr. PRICE. Thank you, Mr. Chairman. 

Mr. NORWOOD. Thank you very much. The gentleman’s time is 

expired. 

Ms. Woolsey, you are now recognized for 5 minutes for questioning. 

Ms. WOOLSEY. Thank you, Mr. Chairman, and this is a great bipartisan bill. It is good to be working on something like this. 

I was a city council member in Petaluma, California, for 8 years, 

and the mayor used to say, oh, do not even ask Woolsey about her 

vote on the—for our local firemen, because she is always going to 

say yes, because you are absolutely my heroes, and he is right, I 

always did say yes, and the same thing goes here. 

So, I do not understand why we have left the firefighters out of 

this disability coverage, and if you have some—you know, if you 

want to tell us why you think that happened, that is fine, that and 

I would like you both to look at both of these ideas. 

You know, your list of dangerous chemicals and all that, which 

is important to have, but we are finding that our world changes so 

quickly, and we manufacture new products, and we do not even 

have any idea what is in the product, like in our carpeting, where 

you go—you know, when it starts burning, and then our furniture, 

and you are in there saving people, and the furniture is setting off 

gases and things. Whoever knew that that is what we would be up 

against? 

I hope, in your lists, that it is not all inclusive. You have got to 

leave room for what is coming up next, because you know, we 

sometimes react backwards and get rid of things that are toxic, but 

we are always adding more. So, please—OK. 

Mr. JOHNSON. I think that is also important to remember. 

The list is as concise as it can be at this point in time, because 

it basically covers those incidences or those diseases that we see affecting firefighters the majority of the time. 

24

There are always unknowns out there that we do not know 

about, and they will continue, and the firefighters respond to 

incidences, especially on Federal installations, and I think that is 

important to point out, because you clued in on some of the hazards that are out there that we know about. The Federal firefighters on some of these Federal installations get involved in 

things that they have no idea what it is, and in some cases, they 

will not be told what it is, because it is classified, and I have personally been in incidences that involve classified issues and materials, and it is really an unknown, and it is an unknown that you 

will never get any information on, and that is, you know, important 

to note. 

Ms. WOOLSEY. Joel, do you want to respond? 

Mr. SHUFRO. No. 

Ms. WOOLSEY. OK. 

You know, in private—as long as I have a couple of seconds left, 

in private industry—I was a human resources professional, and we 

have our protocols in manufacturing. We knew what—our local 

firefighters knew if they came into our plant—it was an electronics 

company—and there was a fire, which we never had one, but if 

there was, they would know what they were looking for. You do not 

have that, do you, in Federal buildings. 

Mr. JOHNSON. Most of the Federal installations have inspection 

procedures and parameters, and inspections are conducted. 

So, in most of your administrative-type buildings, the firefighters 

are well aware of what are in those buildings, the office-type buildings and things of that nature. When you get into the facilities that 

are involved in research and depot work and things of that nature, 

there are a lot of instances where we are prohibited from actually 

even touring the building or having any idea whatsoever what is 

in there. 

So, when you show up, if there is an incident on the scene, you 

really are at peril, because you have no idea whatsoever what 

you’re getting into or what is in the building or what is involved. 

Ms. WOOLSEY. Well, we ought not to be treating you as our stepchildren because you are Federal, and I think this bill is a step in 

the right direction, Mr. Chairman. 

Mr. NORWOOD. The gentlelady’s time is expired. 

Mrs. Drake, you are recognize for 5 minutes for questioning. 

Mrs. DRAKE. Thank you, Mr. Chairman. 

First of all, I would like to thank both of you for being here. 

I think this is an important discussion, and we certainly are very 

grateful for the work of our firefighters. 

I have many friends who are firefighters, and I did serve in the 

Virginia legislature when we passed what we called the heart-lung 

bill to deal with what you have just mentioned about heart and 

lung diseases, and in Virginia, we have a much more limited list 

of cancers that are covered with a presumption. We cover no infectious diseases, and a big part of my concern is how we determine 

where they actually got exposed to that disease. 

I have family members who have died of meningitis. I have family members who have had hepatitis that had nothing to do with 

any occupation at all. What I wonder is, when you treat someone 

who might have a disease—hepatitis, HIV, any of the diseases—is 

25

there any reporting system back to you that you would know you 

had had that exposure, or is that allowed to take place? 

Mr. JOHNSON. Well, the first step is that you would have to be 

aware that the patient you were treating was infected. 

In some instances, the patient may state to the responder that 

they are carrying an illness or a disease such as hepatitis or something of that nature. In most cases, they do not state that, or they 

may not even be aware themselves. 

Mrs. DRAKE. I mean from the medical facility that you are transporting them to, is there a reporting back to you that there may 

have been an exposure? 

Mr. JOHNSON. Normally not. Because of patient privacy issues, 

normally the firefighters themselves will not get any type of notification back from a medical facility that a patient was or was not 

carrying an infectious disease. 

Mrs. DRAKE. I mean I think you can understand the concern that 

we may giving someone a presumption that, by their own particular lifestyle, has caused themselves to be exposed to certain diseases, and maybe that is an avenue we need to look at for these 

infectious diseases, is some sort of reporting requirement. 

Mr. JOHNSON. I would say that is a possibility. I think from my 

position, I think because of the nature of the job and the work that 

the firefighters are doing, that at the very least they deserve the 

benefit of the doubt. 

Mrs. DRAKE. OK. I would like to thank you. I know we have to 

go vote. 

Thank you, Mr. Chairman. I yield back my time. 

Mr. NORWOOD. Thank you. The gentlelady yields back. 

Mr. Owens, you are now recognized. 

Mr. OWENS. That last questions—have any patterns been established showing that firefighters do come down with an appreciable 

number of infectious diseases, any kind of research done to document that, more so than other occupations, you have a pattern 

where large numbers of firefighters have some of these infectious 

diseases? 

Mr. JOHNSON. Yes, we do. 

Mr. OWENS. Documented? 

Mr. JOHNSON. Yes. 

Mr. OWENS. Mr. Shufro, thank you again for being here, Joel. 

The Mount Sinai Medical Center study was financed by the Federal Government, right? 

Mr. SHUFRO. Yes, that is correct. It financed screening but not 

medical treatment. All the workers who are going through the program were screened, but they rely on workers’ compensation for 

treatment. There is no treatment funded by the Federal Government. 

Mr. OWENS. You say 6,000 of 12,000 who were screened were 

found to have problems related to 9/11. 

Mr. SHUFRO. That is correct. 

Mr. OWENS. That is 50 percent, a pretty high rate. 

Mr. SHUFRO. It is a very high rate. 

Mr. OWENS. Then the old moribund inefficient workers’ compensation board was given the money, Federal money, also, right, 

to deal with the problems of individual workers, correct? 

26

Mr. SHUFRO. The workers’ compensation board is giving Mount 

Sinai money? 

Mr. OWENS. No. 

Mr. SHUFRO. I am sorry. 

Mr. OWENS. The Federal Government gave $175 million, and 

part of that went to the New York State workers’ compensation 

board. 

Mr. SHUFRO. Yes, that is correct. The Federal Government——

Mr. OWENS. That is the money that the President, the administration is seeking to take back, is money that that workers’ compensation board did not spend, correct? 

Mr. SHUFRO. That is correct. 

Mr. OWENS. So, we are penalizing future workers because of the 

lack of efficiency of that board. I mean they have a reputation for 

being slow, and they have a mind-set of sort of suspecting workers 

and safeguarding employers, and all that went into play, I am sure, 

and so, you have unspent $120 million. 

Mr. SHUFRO. Unspent $120 million. Some of it I would not lay 

totally at the foot of the board. I think that the board worked to 

try and deal with many cases that came in front of it. 

The Chairman of the workers’ compensation board at that time, 

Robert Snashall, put out a statement urging that the insurance 

carriers expedite all the cases, but really, what has happened has 

been that the carriers have treated this as business as usual and 

contested an extremely high rate of—high number of the cases. 

In fact, one of the companies, called IWP, has been providing free 

medicine to workers while their cases have been adjudicated in 

front of the board, because workers were not entitled to medication 

until their cases were established. 

That company has just written a letter deciding not to provide 

anymore medicine, because the—it has not been—they have found 

that the cases that are being contested are contested at a rate 10 

times higher than the normal rate of contest for other workers. 

So, it may not be the board’s fault here but the insurance companies’ fault. 

Mr. OWENS. Are we getting any help from OSHA and EPA in 

terms of scientific technical assistance? That 9/11 situation produced something that never existed before, ashes which consist of 

glass, lead, metal. All kinds of things were in that toxic brew that 

the workers were breathing. Are we getting any kind of help to pinpoint the fact that, you know, this is an ongoing mystery, they are 

still trying to sort it out, and not enough time has passed for us 

to be dismissing workers as having no relationship between what 

happened. 

Mr. SHUFRO. The EPA is yet to finalize a sampling program for—

to determine the extent and scope of contamination of lower Manhattan. That battle is still going on, and they put forth one plan 

which was found totally inadequate, and now they have proposed 

a second, which members of the community and many of the 

unions representing workers in lower Manhattan have criticized, 

also. 

So, we are still not at a point where the dust—the toxic nature 

of that dust has been characterized, and so, we do not know the 

exposures of all that people were subjected to. 

27

Mr. OWENS. Thank you. 

Mr. NORWOOD. Well, I think everybody has asked questions but 

the Chairman. 

I would like to ask a few and then put a number of them in writing. 

Mr. Johnson, you mentioned that 40 states, which I find very interesting, have enacted presumptive disability laws. 

Can you provide the Subcommittee with a list of those states? 

Mr. JOHNSON. Absolutely, yes. 

[The information referred to appears on page 35 of this document.] 

Mr. NORWOOD. Can you clarify for me whether these presumptive disability laws have been added to the various state workers’ 

compensation systems, or are these presumptive disability laws 

that is part of a separate disability and retirement program for 

firefighters, or are there states out there, for example, that have 

multi-purpose broad disability retirement programs that are specific to firefighters? 

Mr. JOHNSON. My understanding is that it varies, that some 

states have included the presumptive issue for firefighters into 

their current programs and that there are also states that have 

created a separate program just for public safety or firefighters. 

So, there is both. 

Mr. NORWOOD. So, like in so many other things, states do things 

separately. 

I guess that would—the presumptive disability provisions would 

vary, you know, the types of illnesses or disease. 

I guess that would vary state by state, too? 

Mr. JOHNSON. It is my understanding, yes, it does. 

Mr. NORWOOD. Well, one more little question about that. 

These disability—presumptive disability laws have been added to 

various state workers’ compensation systems, or are these presumptive disability laws part of a separate disability? 

You are telling me that all the states do this differently in so 

many different ways. 

Mr. JOHNSON. There are differences out there, yes. I think the 

norm is for them to be included in the current programs, but 

there—there are also states that have created a separate program 

just for firefighters that covers just workman’s comp for firefighter 

issues. 

Mr. NORWOOD. I presume that information or, certainly, we could 

get that information. 

Mr. JOHNSON. We can get that information, yes, sir. 

Mr. NORWOOD. Yes. We would love to take a really good look at 

that. 

I thank both of you for your time and your valuable testimony, 

and we will dismiss you as a panel, and I will ask that the second 

panel of witnesses come forward and take your seats at the table. 

Mr. JOHNSON. Thank you. 

Mr. NORWOOD. Thank you very much. 

The second panel will address H.R. 2561, the Improving Access 

to Workers’ Compensation for Injured Federal Workers Act. 

Our first witness today will be Professor William Kohlhepp, associate director of the physician assistant program at Quinnipiac 

28

University in Hamden, Connecticut. Professor Kohlhepp is testifying on behalf of the American Academy of Physician Assistants. 

Our final witness today is Dr. Jan Towers. Dr. Towers is the director of health policy at the American Academy of Nurse Practitioners, located right here in Washington, D.C. 

I would like for you both to know we truly appreciate you taking 

the time and coming to help teach us something. 

With that, Mr. Kohlhepp, I will recognize you for 5 minutes. 

STATEMENT OF WILLIAM C. KOHLHEPP, MHA, PA-C, ASSISTANT PROFESSOR AND ASSOCIATE DIRECTOR, PHYSICIAN ASSISTANT PROGRAM, QUINNIPIAC UNIVERSITY, HAMDEN, CT 

Mr. KOHLHEPP. Good morning. Thank you, Chairman Norwood, 

for the opportunity to present testimony this morning on behalf of 

the American Academy of Physician Assistants. 

I am here to discuss the need to update the Federal Employees’ 

Compensation Act to allow PAs to diagnose and treat Federal 

workers who are injured on the job. 

I request that my written statement be included in the hearing 

record. 

Mr. NORWOOD. So ordered. 

Mr. KOHLHEPP. My name is Bill Kohlhepp, as you said, and I 

have been a physician assistant for 25 years. As you said, I am the 

associate director of the Quinnipiac University physician assistant 

program. 

For the past 15 years, I have continued my clinical practice at 

Saint Raphael’s Occupational Health Plus in New Haven, Connecticut. 

I am a past president of the AAPA and current chair of the National Commission on Certification of PAs, which is the certifying 

body for PAs. 

What I would like to do this morning is to provide a brief overview of PA education, and I would like to share our perspective on 

why it is important to update FECA to allow PAs to diagnose and 

treat Federal employees who are injured on the job. 

PA programs are located at schools of medicine or health 

sciences, universities, teaching hospitals, and the armed services. 

All PA programs are accredited by the Accreditation Review 

Commission on Education for the Physician Assistant, an organization composed of representatives from national physician groups 

and PAs. 

The average PA program is 26 months and is characterized by 

a rigorous competency-based curriculum with both didactic and 

clinical components. 

The first phase of the program consists of an intensive classroom 

and laboratory study providing students with an in-depth understanding of the medical sciences. 

The second year of PA education consists of clinical rotations. 

On average, PAs devote more than 50 to 55 weeks to clinical education. 

The overwhelming majority of PA programs offer master degrees. 

After graduation, PAs must pass a national certifying exam. 

PAs maintain their certification through required CME and recertification by exam every 6 years. 

29

PAs are licensed health-care professionals who practice medicine, 

as delegated by and with the supervision of a physician. 

PAs are legally regulated in all states. 

Forty-eight states, the District of Columbia, and Guam authorize 

physicians to delegate prescriptive privileges to PAs. 

In 2004, an estimated 206 million patient visits were made to the 

55,000 PAs in clinical practice. Approximately 250 million medications were prescribed or recommended by those PAs. 

PAs always work with physicians. However, this does not mean 

that the physician is necessarily onsite, nor does it suggest that 

PAs do not make autonomous medical decisions. For example, PAs 

employed by the State Department may be—may work with a physician who is a continent away and available for consultation by 

telecommunication. 

It has been said that every workers’ compensation case is a failure of prevention, and PAs as a profession have a particular focus 

in prevention. PAs’ versatility, competencies, and interpersonal 

skills are well suited to the demands of occupational medicine. 

PAs participate in the promotion of employee health, including 

the treatment of occupational injuries and illnesses, preventive and 

pre-placement exams, health maintenance activities, immunization 

programs, Department of Transportation exams, workers’ compensation case management follow-up, and health and safety education. 

What does it mean for my practice that I cannot sign FECA 

claim forms as a PA? The bottom is that, unless the physician signs 

the form, the claim is not paid. 

In letters responding to Congressional inquiries on PAs and 

FECA, the DOL’s Office of Workers’ Compensation has taken the 

position that claims or reports are not acceptable if they have been 

signed by a PA, because PAs are not included in the FECA’s definition of physician. 

PAs currently jump through hoops to ensure that physicians sign 

the workers’ compensation claims in order to make the system 

work for the injured employee and the practice. 

Waiting for a physician’s signature is not the best use of the physician’s time, my time, or the time of the injured worker, and physicians are not always available, particularly in rural and urban 

medically under-served communities where PAs may be the only licensed health care professionals serving the community or in clinics staffed by PAs that provide care during evenings and weekends 

or at other times without a physician present. 

We believe that it makes good sense and good public policy to update FECA to allow PAs to diagnose and treat Federal employees 

who are injured on the job. The current restriction limiting PAs’ 

abilities to provide care to Federal workers adds unnecessary cost 

to the system, limits Federal workers’ access to quality medical 

care, restricts Federal workers’ choice of a preferred health care 

professional, and may result in problems related to continuity of 

care. 

There is another good reason to update FECA to allow PAs the 

ability to diagnose and treat injured workers, the shortage of physicians in occupational medicine. The 1,500 to 1,800 occupational 

medicine physicians in practice today falls far below the need. 

30

We believe these are compelling reasons to update FECA to recognize PAs. 

Thank you for the opportunity to present testimony before the 

Subcommittee. I look forward to responding to your questions. 

[The prepared statement of Mr. Kohlhepp follows:]

Statement of William C. Kohlhepp, MHA, PA–C, Assistant Professor and Associate Director, Physician Assistant Program, Quinnipiac, University, 

Hamden, CT 

Good Morning. Thank you, Chairman Norwood and Representative Owens, for the 

opportunity to present testimony this morning before the Subcommittee on Workforce Protections. On behalf of the American Academy of Physician Assistants 

(AAPA), I also wish to thank you for your interest and leadership in updating the 

Federal Employees’ Compensation Act (FECA) to allow PAs to diagnose and treat 

federal workers who are injured on the job. 

My name is Bill Kohlhepp. I am a graduate of the University of Medicine and 

Dentistry of New Jersey’s PA Program, and I have been a physician assistant for 

the past 25 years. I hold a master’s degree in health administration and am currently enrolled in a doctoral program in health science. 

I am the Associate Director of the Quinnipiac University Physician Assistant Program, where I am also a professor. For the past 15 years, I have practiced clinically 

on a part-time basis for Saint Raphael’s Occupational Health Plus, which is an occupational medicine practice affiliated with Saint Raphael’s Hospital in New Haven, 

Connecticut. I was the founding Administrative Director of the practice. I am also 

a co-author of an article on the role of PAs in occupational medicine that was published in the Journal of the American Academy of Physician Assistants. 

I am a member of the AAPA and the American Academy of Physician Assistants 

in Occupational Medicine (AAPA–OM). I am a former president of AAPA, as well 

as a former Speaker of the AAPA’s House of Delegates. I am the current Chair of 

the National Commission on Certification of Physician Assistants (NCCPA), which 

is the certifying organization for PAs in the United States. 

On behalf of the more than 55,000 clinically practicing physician assistants in the 

United States who are represented by the American Academy of Physician Assistants, I am pleased to submit comments on the need to update the Federal Employees Compensation Act (FECA) to allow PAs to diagnose and treat federal workers 

who are injured on the job. 

Overview of Physician Assistant Education 

Physician assistant programs provide students with a primary care education that 

prepares them to practice medicine with physician supervision. PA programs are located at schools of medicine or health sciences, universities, teaching hospitals, and 

the Armed Services. All PA educational programs are accredited by the Accreditation Review Commission on Education for the Physician Assistant, an organization 

composed of representatives from national physician groups and PAs. 

The average PA program is 26 months and is characterized by a rigorous, competency-based curriculum with both didactic and clinical components. The first 

phase of the program consists of intensive classroom and laboratory study, providing 

students with an in-depth understanding of the medical sciences. More than 400 

hours in classroom and laboratory instruction are devoted to the basic sciences, with 

over 70 hours in pharmacology, more than 149 hours in behavioral sciences, and 

more than 535 hours of clinical medicine. 

The second year of PA education consists of clinical rotations. On average, students devote more than 2,000 hours or 50–55 weeks to clinical education, divided 

between primary care medicine and various specialties, including family medicine, 

internal medicine, pediatrics, obstetrics and gynecology, surgery and surgical specialties, internal medicine subspecialties, emergency medicine, and psychiatry. During clinical rotations, PA students work directly under the supervision of physician 

preceptors, participating in the full range of patient care activities, including patient 

assessment and diagnosis, development of treatment plans, patient education, and 

counseling. 

After graduation from an accredited PA program, the physician assistant must 

pass a national certifying examination jointly developed by the National Board of 

Medical Examiners and the independent National Commission on Certification of 

Physician Assistants. To maintain certification, PAs must log 100 continuing medical education credits over a two-year cycle and reregister every two years. Also to 

maintain certification, PAs must take a recertification exam every six years. 

31

A growing number of PAs possess master’s degrees, and the majority of PA educational programs now offer master’s degrees. According to data collected by the 

AAPA, 61.7 percent of PAs graduating from a PA educational program in 2004 received a master’s degree. Approximately 80 percent of the 137 PA educational programs currently offer master’s degrees. 

Physician Assistant Practice 

Physician assistants are licensed health care professionals educated to practice 

medicine as delegated by and with the supervision of a physician. In all states, physicians may delegate to PAs those medical duties that are within the physician’s 

scope of practice and the PA’s training and experience, and are allowed by law. 

Forty-eight states, the District of Columbia, and Guam authorize physicians to delegate prescriptive privileges to the PAs they supervise. 

PAs always work with physicians. However, this does not mean that the physician 

is necessarily on site, nor does it suggest that PAs do not make autonomous medical 

decisions. PAs employed by the State Department, for example, may work with a 

physician who is a continent away and available for consultation by telecommunication. 

PAs are located in almost all health care settings and in every medical and surgical specialty. Nineteen percent of all PAs practice in non-metropolitan areas where 

they may be the only full-time providers of care (state laws stipulate the conditions 

for remote supervision by a physician). Approximately 41 percent of PAs work in 

urban and inner city areas. Approximately 44 percent of PAs are in primary care. 

Nearly one-quarter practice in surgical specialties. Roughly 80 percent of PAs practice in outpatient settings. In 2004, an estimated 206 million patient visits were 

made to PAs and approximately 250 million medications were prescribed or recommended by PAs. 

PAs are covered providers within Medicare, Medicaid, Tri–Care, and most private 

insurance plans. Additionally, PAs are employed by the federal government to provide medical care, including the Department of Defense, the Department of Veterans Affairs, the Public and Indian Health Services, the State Department, and the 

Peace Corps. PAs are designated as covered providers in the overwhelming majority 

of State workers’ compensation programs. (A chart is attached to the testimony, 

summarizing coverage of medical services provided by PAs in the State workers’ 

compensation programs.) 

Physician Assistants in Occupational Medicine 

Physician assistant versatility and interpersonal skills are well suited to the demands of occupational medicine. Working as part of a medical team, physician assistants participate in the promotion of employee health, including the treatment of 

occupational injuries and illnesses, preventive and pre-placement examinations, 

health maintenance activities, immunization programs, Department of Transportation exams, workers’ compensation case management follow-up, and health and 

safety education. 

PAs deliver employee health services in diverse settings—corporate medical offices, occupational medicine clinics, private physician offices, hospital employee 

health departments, clinics for production plants or mines, remote pipeline locations, aboard ship, on military bases, and on the White House medical staff. 

The US Department of Transportation allows PAs to perform and sign truck driver physicals. The regulations identify the responsibilities of the medical examiner 

in performing and recording the physical examination (49 CFR, Part 391.43) and define physician assistants as medical examiners. PAs are employed in occupational 

medicine roles by numerous federal agencies, including the Department of Veterans 

Affairs and the Department of Defense. OSHA recognizes PAs as qualified occupational medicine providers able to ‘‘perform physical examinations, identify health 

problems, and plan therapeutic interventions.’’

Following are a few examples of PAs who practice in occupational medicine. 

PA Fills Diverse Role with Occupational Med Company 

A PA working for Mercy Occupational Health—a clinic providing occupational 

medicine services to a diverse range of employers including General Motors, Wal–

Mart, Lear Jet, local school districts, and service industry employers—treats patients with a wide range of work-related injuries, including strains, lacerations, and 

repetitive stress ailments. After diagnosis, she equips employees with detailed written instructions concerning all aspects of their recovery, including the use of prescribed medications and how to best protect injured areas against further damage. 

She consults with managers about lighter duty assignments during employee recovery. Follow-up visits help to ensure a full and well-coordinated recovery. 

32

The PA administers a range of pre-placement physicals for employers, including 

fitness tests and drug screenings tailored to reflect the physical demands of the 

work to be performed. In addition, she performs DOT physicals for employers including the local school district and Federal Express. 

This physician–PA team effectively increases patient access to care by sending the 

PA off-site to provide care at a laboratory equipment factory four hours a week. The 

physician is available for consultation by phone if necessary while the PA sees the 

workers, many of whom have no other medical provider. By answering their medical 

questions and providing general health education, the PA helps keep the factory 

workers well and able to work in a physically demanding setting. 

PA Care at Los Alamos 

The workers and researchers of Los Alamos Nuclear Laboratory receive their occupational health services from a physician assistant. This PA specializes in the prevention, diagnosis, and referral of radiation-related conditions. To help Los Alamos 

fulfill strict Occupational Safety and Health Administration (OSHA) regulations 

concerning radiation exposure, he conducts rigorous medical exams for employees on 

a yearly basis. The PA also treats the researchers employed by the facility who travel to remote locations and return with ailments related not only to radiation exposure but also more mundane problems such as stomach ailments. A physician is always on-site at the facility and coordinates care with the PA. 

PA Versatility Shows at New York Presbyterian Hospital 

A PA employed by New York Presbyterian Hospital treats a diverse population 

of hospital employees and Cornell University researchers. Her versatility is impressive, ranging from pre-placement exams to developing preventive worker safety 

measures. In conducting pre-placement examinations for candidates offered employment by the hospital, she tests for TB, illegal substances, and HIV, and gauges applicants’ physical fitness to perform job duties. This PA also serves as a main contact person for impaired employees, making referrals to drug and alcohol treatment 

centers. 

As a certified New York state HIV educator, the PA at New York Presbyterian 

Hospital conducts employee safety training for hospital employees at risk for HIV 

exposure through blood or body fluid exposure. This PA also oversees a program addressing the special health needs of Cornell researchers working in a Biosafety 

Level 3 Lab. Here researchers are exposed to a variety of health risks through their 

contact with lab animals, including rare viruses. To protect against these hazards, 

the PA has devised and implemented lab safety measures in cooperation with the 

New York State Department of Health and laboratory and hospital officials. 

CDC Employs Occupational Medicine PAs 

At the federal Centers for Disease Control and Prevention (CDC), a PA cares for 

researchers who typically spend a month at a time in ‘‘hot spots’’ or disease outbreak areas around the world. His practice combines travel medicine with infectious 

disease medicine. Researchers generally return with at least one ailment, ranging 

in seriousness from digestive problems to malaria. One of the PA’s specialty areas 

is the testing of researchers’ fitness for the use of physically demanding protective 

gear. Cardiopulmonary tests gauge employees’ fitness for use of protective gear used 

in highly toxic environments. Working closely with his supervising physician, he coordinates the annual bioterrorism fitness exams required of CDC researchers. 

His other large patient base consists of CDC office workers who typically suffer 

from carpal-tunnel syndrome and similar repetitive stress injuries. In these cases, 

the PA collaborates with the CDC’s industrial hygienist to restructure employees’ 

workstations along ergonomic standards and trains employees in preventive measures against repetitive stress. 

State Department Counts on Versatility 

The U.S. Department of State employs occupational medicine PAs to provide medical care to State Department employees and their families overseas. For example, 

a PA working for the State Department manages family medicine as well as emergency medical crises. In addition, he serves as the medical liaison between employees and host country medical personnel and facilities, inspecting local hospitals to 

determine their quality of care. In countries where acceptable inpatient care is not 

available, he has developed alternative sites where patients can be stabilized prior 

to airlift to hospital. This PA’s work epitomizes the clinical range and organizational 

versatility of PAs in occupational medicine. 

33

PA Practice at Saint Raphael’s Occupational Health Plus 

The hospital-based occupational medicine practice where I work has 300 clients. 

For our federal clients, like the FBI and the Post Office, we perform pre-employment physicals and treat injuries that are covered by FECA. With respect to the 

workers on the merchant ships arriving in New Haven Harbor, virtually all illnesses 

and injuries are covered under workers’ compensation. We do a lot of work with employees who have back, shoulder, and knee injuries. In order to be most effective 

as a clinician, it is important for me to be familiar with the workplace and know 

about the workers’ compensation system so that informed decisions can be made 

about returning employees to work. 

My day at Saint Raphael’s Occupational Health Plus is typically divided between 

seeing employees with work-related injuries and doing examinations on individuals 

who are being hired or employees who need periodic screening. Injuries are generally musculoskeletal sprains and strains, but may also involve lacerations, burns, 

fractures, or eye injuries. Evaluating and treating employee exposures to infectious 

agents like tuberculosis or bloodborne pathogens (i.e., Hepatitis B or HIV) may also 

be involved. Pre-placement examinations are performed immediately before the employee is hired. Periodic examinations are performed to evaluate potential health effects of exposures to chemicals or other things in the worker’s environment. They 

are also completed to evaluate the worker’s continuing ability to safely perform their 

jobs, such as DOT physicals for truck drivers or respirator examinations for firefighters. 

What does it mean for my practice that I can not sign FECA claims forms as a 

PA? The bottom line is that unless the physician signs the form, the DOL’s Office 

of Workers’ Compensation will not honor the FECA claim. At a minimum, this 

means that the physician can not make the maximum use of my skills and must 

sign every workers’ compensation form. Quite frankly, this is not the best use of the 

physician’s time and expertise. The problem is exacerbated when I’m performing oncall services for the practice or if I’m providing after-hours care at the practice. Physicians hire PAs to extend their reach and to extend access to care. Many physicians 

also hire PAs to make life a little easier for them—to share on-call duties and to 

provide after-hour care. 

The Problem with the Federal Employees Compensation Act 

In letters responding to congressional inquiries on PAs and FECA, the Office of 

Workers’ Compensation has taken the position that claims or reports are not acceptable if they have been signed by a PA, because PAs are not included in FECA’s definition of ‘‘physician’’ (section 8101 (2)). 

In a December 2001 letter to Senator Gramm, the Director of the Office of Workers’ Compensation Program wrote: 

OWCP is responsible for the administration of the Federal Employees’ Compensation Act (FECA). In Section 8101(2) of this Act, physicians are defined as 

surgeons, podiatrists, dentists, clinical psychologists, optometrists, chiropractors, and osteopathic practitioners within the scope of their practice as 

defined by State law. 

Since Physician’s [sic] Assistants are not included in this definition, we are unable 

to accept their clinical reports as medical evidence unless these reports are 

countersigned by a physician. 

Why It Makes Good Sense and Good Public Policy to Update FECA to Allow 

PAs to Diagnose and Treat Federal Employees who are Injured on the Job 

Simply put, the current restriction limiting PAs ability to provide care to federal 

workers who are injured on the job results in added costs to the system, unnecessarily limits federal workers’ access to quality medical care, restricts federal workers’ choice of preferred health care professional, and may result in problems related 

to continuity of care. 

PAs currently jump through hoops to ensure that physicians sign the workers’ 

compensation claim in order to make the system work for the injured employee and 

the practice. However, physicians aren’t always available—particularly in rural and 

urban medically underserved communities where PAs may be the only health care 

professional serving the community or in clinics staffed by PAs that provide care 

during evenings and weekends. Following are a few of the personal examples that 

we’ve heard from PAs regarding the FECA problem. 

• A PA in Georgia informed us that federal workers were advised to use hospital 

emergency rooms for non-emergency care, rather than receiving care after-hours 

at local clinics where PAs were the only health care professional on-site. Ironically, the care provided in the emergency room could be provided by a PA—

at 4–5 times the cost. 

34

• A federal worker in Massachusetts recently asked a PA in a surgical practice 

where he had undergone surgery to suture a laceration on his leg that occurred 

while on the job. The physician was not in the office that day, and the PA had 

two choices—to send her patient to the emergency room or to provide the care, 

knowing that the practice wouldn’t be reimbursed. She chose continuity of care 

and sutured his leg. 

• Every rural community in the nation has at least one employee of the U.S. Postal Service. A PA from Iowa commented that it made no sense that she could 

provide medical care to this employee on an ongoing basis, but not be able to 

collect reimbursement for attending to a dog bite or other injury that occurred 

on the job. 

We also understand that the FECA issue is particularly troublesome in the Peace 

Corps and State Department where many injuries and illnesses are covered under 

the Federal Workers’ Compensation Program. 

As federal employees, Subcommittee Members and staff have the option of seeing 

a PA through your Federal Employee Health Benefit Plan. But, you may not be able 

to see the PA if you’re injured during working hours. 

There is also another very good reason to update FECA to allow PAs the ability 

to diagnose and treat injured workers—the shortage of physicians in occupational 

medicine. According to the American Board of Preventive Medicine, only 3,332 physicians have been certified in occupational medicine since 1955, and only 1,500 

–1,800 of these physicians are actually in practice today. This number falls far 

below the Bureau of Health Professions’ estimated need of 4,830 physicians certified 

in occupation medicine or the Institute of Medicine’s need estimate of 3,100 –5,500 

occupational medicine physicians. 

We believe that expanded access to care and continuity of care for federal workers 

are compelling reasons to update FECA to recognize PAs, as are potential cost savings and meeting the need that is created by the physician workforce shortage in 

occupational medicine. After all, that’s why the physician–PA team concept was created—to expand the physician’s ability to provide care. 

Thank you for the opportunity to present testimony before the Subcommittee. I 

look forward to responding to your questions.

[An attachment to Mr. Kohlhepp’s statement follows:]

35

Mr. NORWOOD. Thank you very much. 

Having spent 45 days in the hospital last year, I got to know 

your crowd pretty well. 


21548.001
36

I know what you guys do. 

Mr. KOHLHEPP. I am happy to hear that we played an important 

role in your recovery. 

Mr. NORWOOD. They did, indeed. 

Dr. Towers, you are now recognized for 5 minutes for testimony. 

STATEMENT OF JAN TOWERS, PhD, NP-C, CRNP, FAANP, DIRECTOR OF HEALTH POLICY, AMERICAN ACADEMY OF 

NURSE PRACTITIONERS, WASHINGTON, DC 

Dr. TOWERS. I am here representing the American Academy of 

Nurse Practitioners, which is the full-service organization that represents over 90,000 nurse practitioners of all specialties throughout 

the United States. I am the director of health policy, but I am also 

a family nurse practitioner, and I am here to speak to the proposed 

amendment to the Federal Employees’ Compensation Act. 

Certified registered nurses are advanced practice nurses who 

have completed a formal nurse practitioner program culminating in 

a minimum of a Master’s education beyond their 4-year baccalaureate education in professional nursing. This means they have 

a total of 6 years of preparation in the medical and health care 

field. 

Most, in addition, are seasoned nurses before they go back for 

their graduate degree to become a nurse practitioner, and we then 

become educated by specialty, and our specialties follow along the 

same lines as the physician specialties, with family, internal medicine, pediatrics, gerontology, etcetera. 

Nurse practitioners are prepared to be primary care providers in 

today’s health care arena, and they have been recognized as medical providers in the Federal employee health insurance program 

since the 1980’s. 

As the Committee knows, nurse practitioners are highly qualified 

health care providers who have demonstrated their skill in providing primary care to individuals in both rural and urban settings, 

regardless of age, occupation, or income. The quality of their care 

has been well documented over the years. 

With their advanced preparation, they are able to manage the 

medical and health problems seen in the primary care and acute 

care settings in which they work. 

Nurse practitioners constitute an effective body of health care 

providers that may be utilized as a cost savings in both fee-forservice and managed care arenas in the country. 

Recent managed care data reports an aggregate patient-permonth cost savings of over 50 percent among patients seen by 

nurse practitioners when compared to similar patients being seen 

by physicians, and I did bring a document here that has a number 

of citations that speaks to similar kinds of findings and studies. 

Other cost savings realized when nurse practitioners are properly 

utilized include savings due to reductions in emergency room visits 

and hospitalizations. 

In relation to cost, not recognizing nurse practitioners as attending providers for Federal employees in the Federal employees compensation program actually creates a cost for the Federal Government, because the patient is required to see a physician for any 

work related to a work-related medical problem. 

37

This potentially increases the number of medical encounters incurred by patients who will continue to see their regular health 

care provider for other medical problems while seeing the required 

physician provider for the problem coming under the aegis of the 

Federal employees compensation program. 

Nurse practitioners diagnose and treat patients of all ages and 

walks of life. This includes taking patient histories, conducting 

physical examinations, ordering and interpreting their diagnostic 

tests, and prescribing medications and other treatments for their 

medical problems. 

Nurse practitioners are often the only provider in a particular 

health care setting. In rural areas, it means that patient have to 

travel distances to see other providers when that is required. 

The inability of nurse practitioners to serve their patients when 

an occupationally related injury or illness occurs not only creates 

additional cost by forcing patients to go elsewhere for the care of 

these conditions, often to the more expensive emergency rooms, but 

also creates fragmentation of care that can have implications for 

other health care outcomes. 

Nurse practitioners are covered medical providers in Medicare, 

Medicaid, Tricare, and private insurance plans, as well as the Federal employees health insurance program. They serve as medical 

providers in the VA, the Department of Defense, and the Indian 

Health Service. 

They are capable of performing services for workman’s compensation patients in state programs but are still excluded from doing 

the same for Federal employees who are under their care. 

Nurse practitioners are licensed to practice in all 50 states and 

the District of Columbia. 

They are authorized to diagnose, treat, and prescribe medications 

under their own signatures. 

They are board-certified. 

They carry malpractice insurance. 

They are capable of making medical judgments related to occupational hazards, diseases, and injuries. 

They have an outstanding record for providing high-quality care, 

and they are cost-effective. 

According to the current statute, Federal employees come under 

the jurisdiction of the Federal Employees’ Compensation Act, have 

the right to choose their own health care provider for the treatment 

of their condition. Yet if their health care provider is a nurse practitioner, they are forced to go elsewhere for that part of their medical care, even though the nurse practitioner is perfectly qualified 

to provide the care they need. 

It is for this reason that we are asking the Federal Employees’ 

Compensation Act be amended to include nurse practitioners as 

medical providers in that act, and we thank you for the opportunity 

to speak with you, and I will be glad to answer any questions. 

[The prepared statement of Dr. Towers follows:]

Statement of Jan Towers, PhD, NP–C, CRNP, FAANP, Director of Health 

Policy, American Academy of Nurse Practitioners, Washington, DC 

My name is Jan Towers. I am here representing the American Academy of Nurse 

Practitioners, the full service organization representing over 90,000 nurse practitioners of all specialties throughout the United Sates. I am the Director of Health 

38

Policy and a family nurse practitioner. I am here to speak to the proposed amendment to the Federal Employees’ Compensation Act that would allow nurse practitioners and physician assistants to be covered providers under that act. 

Certified registered nurse practitioners are advanced practice nurses who have 

completed a formal nurse practitioner program culminating in a minimum of a Master’s education beyond their four-year baccalaureate education in professional nursing. They are prepared to be primary care providers in today’s health care arena. 

As the committee knows, nurse practitioners are highly qualified health care providers who have demonstrated their skills in providing primary care to individuals 

in both rural and urban settings regardless of age, occupation or income. The quality of their care has been well documented over the years. With their advanced 

preparation, they are able to manage the medial and health problems seen in the 

primary care and acute care settings in which they work. 

Nurse practitioners constitute an effective body of health care providers that may 

be utilized at a cost savings in both fee for service and managed care arenas in this 

country. Recent managed care data reports an aggregate patient per month cost savings of over 50% among patients seen by nurse practitioners when compared to 

similar patients being seen by physicians. Other cost savings realized when nurse 

practitioners are properly utilized include savings due to reductions in emergency 

room visits and hospitalizations. 

Not recognizing nurse practitioners as attending providers for federal employees 

in the Federal Employees’ Compensation Program actually creates a cost for the federal government because the patient is required to see a physician for any work related medical problem. This potentially increases the numbers of medical encounters 

incurred by patients who will continue to see their regular health care provider for 

other medical problems while seeing the required physician provider for the problem 

coming under the aegis of the Federal Employees’ Compensation Program. 

Nurse practitioners diagnose and treat patients of all ages and walks of life. This 

includes taking patient histories, conducting physical examinations, ordering and interpreting their diagnostic tests and prescribing medications and other treatments 

for their medical problems. Nurse practitioners are often the only provider in a particular health care setting. In rural areas this means that patients have to travel 

distances to see other providers. The inability of nurse practitioners to serve their 

patients when an occupationally related injury or illness occurs, not only creates additional costs by forcing patients to go elsewhere for the care of theses conditions 

(often to more expensive emergency rooms), but also creates fragmentation of care 

that can have implications for other health care outcomes. 

Nurse practitioners are covered medical providers in Medicare, Medicaid, Tri-care 

and private insurance plans. They serve as medical providers in the Veterans Administration, the Department of Defense and the Indian Health Service. They are 

capable of performing services for worker’s compensation patients in state programs, 

but are still excluded from doing the same for federal employees who are under 

their care. 

Nurse practitioners are licensed to practice in all fifty states and the District of 

Columbia. They are authorized to diagnose, treat and prescribe medications under 

their own signature. They are Board certified. They carry malpractice insurance. 

They are capable of making medical judgments related to occupational hazards, diseases and injuries. They have an outstanding record for providing high quality care. 

According to the current statute, federal employees coming under the jurisdiction 

of the Federal Employees’ Compensation Act, have the right to choose their own 

health care provider for the treatment of their condition. Yet, if their health care 

provider is a nurse practitioner, they are forced to go elsewhere for that part of their 

medical care, even though the nurse practitioner is perfectly qualified to provide the 

care they need. It is for this reason that we are asking the Federal Employees Compensation Act be amended to include nurse practitioners as medial providers in the 

act. 

We thank you for the opportunity to discuss this issue with you. I will be glad 

to answer questions or provide you with further information that you may need. 

Mr. NORWOOD. Thank you, Dr. Towers. 

Mr. Kline, you are recognized for 5 minutes for questions. 

Mr. KLINE. Thank you, Mr. Chairman. 

I would like to thank the witnesses for being here today. 

We discovered in the earlier panel that the occupation of one’s 

spouse may sometimes indicate a level of interest. I would have to 

39

admit that my spouse has spent 30 years as a registered nurse, so 

I have been following the testimony of Dr. Towers very closely, and 

it does seem to me we have a serious disconnect here. I have got 

a couple of notes here, and some questions, and I will direct them 

to you, if I could, Dr. Towers. 

You mention that the nurse practitioners are board certified and 

carry liability insurance. Is there a difference in that insurance between a nurse practitioner and a physician both in coverage and 

cost? 

Dr. TOWERS. In coverage, we cover 1 million/3 million, generally, 

which is about the same as a physician, and the cost right now is 

considerably less than a physician. We still pay less than $1,000 

a year for malpractice insurance. So, we have been very well protected. 

Our malpractice rate is quite low, less than 1 percent, and that 

has not changed. 

We did studies in 1989 and in 1999 and just completed another 

study, national study, last year, and that rate is just about the 

same as where it was in 1989. 

Mr. KLINE. Thank you. 

You also mentioned that nurse practitioners are covered medical 

providers under Medicare, Medicaid, Tricare, I think you said, and 

some others. Do you know—are nurse practitioners and physicians 

treated the same, exactly the same, in those programs, and if not, 

what the differences might be? 

Dr. TOWERS. The difference in some of the programs, such as 

Medicare, is a difference in reimbursement. For every 100 percent 

of the physician payment, where you have $100, the nurse practitioner’s reimbursement would be 85. It’s 85 percent of the physician cost. The activities are the same within the primary care 

piece. Nurse practitioners are not in surgery, but they do work in 

sub-specialties in relation to things like orthopedics. 

Mr. KLINE. OK. Thank you. 

I will ask one more question and yield back. 

Do you know, yourself, if state workers’ compensation programs 

allow nurse practitioners to be designated as medical providers? 

Dr. TOWERS. Yes, they do, and this is not 100 percent at this 

point, but I think one of the reasons this came to the surface, because we were doing workman’s comp for other things in the state, 

and then you would get a Federal employee in your practice come 

to you, and suddenly you could not sign something that you have 

been signing for everybody else, and that is how we became aware 

that we were beginning to have a problem with this. 

Mr. KLINE. That there was a discrepancy? 

Dr. TOWERS. Yes. 

Mr. KLINE. Would you say that was true in most of the states? 

Dr. TOWERS. I would say, at this point, we are probably around 

half or over half. 

We are doing it—it is something that has grown over the past 

several years. 

More and more states are recognizing nurse practitioners to do 

this. 

I certainly do it in Maryland. 

40

Mr. KLINE. Well, thank you for the questions. I do see a very serious disconnect here, and I was interested in your testimony talking about how you have someone whose primary care provider is 

a nurse practitioner, they are injured, and suddenly they have to 

go someplace else, and it looks like we ought to be able to fix that. 

Thank you, Mr. Chairman. 

I yield back. 

Mr. NORWOOD. The gentleman yields back. 

Dr. Price, you are recognized. 

Dr. PRICE. Thank you, Mr. Chairman, and I want to thank you 

all for coming, as well. I am sorry that I was not here for your testimony. We had a vote on the floor, and I apologize. 

As you may know, I am an orthopedic surgeon from Georgia, and 

we have some interesting scope-of-practice issues in that state, as 

you know. It is always a challenge, and the challenge that we have 

as policymakers is to make certain that patients are provided quality care, and I know that you concur with that. 

Dr. TOWERS. That is correct. 

Dr. PRICE. That is your goal, as well. 

Professor, I am interested in—and I am sorry I did not hear your 

testimony, but I am interested in kind of the history of PAs and 

how they relate to physicians and how you see that relationship 

changing, if at all, if we were to adopt this legislation. 

Mr. KOHLHEPP. Well, thank you very much for that question. 

Certainly, the history of the physician assistant profession started in the mid-1960’s at a time of significant shortage of particularly 

primary care physicians, was the specialty that was really lacking, 

and physician assistants that came out of the Duke University system—Dr. Eugene Stead started the profession, and it started with 

three Navy corpsmen. 

So, it has a long history both with physician education, physician 

educators, a commitment to the physician-PA team, and I do not 

see that commitment ever changing, and certainly, this legislation 

will allow physicians to better use PAs and to more efficiently and 

seamlessly see a series of patients in their practice, rather than 

trying to say which patient has what kind of insurance when they 

are coming in the door. That makes a great deal of difficulty for 

a practice. 

Dr. PRICE. As a physician extender, if you will? Is that fair to 

say? 

Mr. KOHLHEPP. Personally, I like to refer to both professions as 

physician assistants and advanced practice registered nurses and 

nurse practitioners, whatever they prefer, but it certainly is a role 

that we play, where we extend the ability of physicians to provide 

access, quality of care, and cost-effective care. 

Dr. PRICE. How close is the physician physically to PAs when 

they are practicing? 

Mr. KOHLHEPP. As I mentioned in my testimony——

Dr. PRICE. I am sorry. 

Mr. KOHLHEPP. I recognize that you needed to vote. 

PAs are in a variety of settings, and the presumption is that supervision is active and that the physician is supervising the PA, 

providing conversations before patient care, quality checks after patient care, and availability during patient care, but availability can 

41

be via telecommunication, particularly in rural sites or inner city 

communities, was the two examples I used in my testimony, where 

a physician may not be physically present. That does not mean 

that supervision is not effective. 

Dr. PRICE. I understand. 

Dr. Towers—and again, I am sorry, I missed the beginning of 

your statement, but tell me about the numbers of APNs across the 

nation. 

Dr. TOWERS. There are 106,000 nurse practitioners at this point 

in time in the United States. 

Dr. PRICE. Is there any evidence that they practice in settings—

any objective evidence where—that they practice in settings where 

physicians do not? 

Dr. TOWERS. Oh, yes. 

Dr. PRICE. Is that in your testimony? 

Dr. TOWERS. I do not know that we put it quite that way, but 

nurse practitioners are often utilized in areas, and your state is one 

of them, where there are no physicians available, and you have got 

one of the most interesting states in terms of how they manage to 

function with some of the things they have to deal with in the state 

as far as statute and regulation is concerned, but nurse practitioners will be sole providers in consultation with other health care 

providers, including physicians in many areas, and in our rural 

areas, it is particularly prevalent. 

Dr. PRICE. I suspect you all have data on that, do you not? 

Dr. TOWERS. Yes, we do. 

Dr. PRICE. Would you be able to provide that? 

Dr. TOWERS. We certainly can, and we can tell you there are 

some states that do not have requirements for physicians to be 

hooked into—for them to be hooked into a physician in a formal 

manner. 

That does not mean that they do not consult and that they do 

not have their network of health care providers, which include physicians, that they utilize regularly, and so, we have about 13 states 

that—where nurse practitioners actually function that way at this 

point in time. 

Dr. PRICE. Do you see this legislation resulting in a collaborative 

relationship between APNs and physicians in a structured way or 

just——

Dr. TOWERS. I think it would be according to how the state laws 

establish the relationship. What would be required of them in the 

state in terms of their license and how they function under their 

license would be the way that—it would be consistent with this. In 

terms of collaborating with physicians—if you are thinking about 

are there things that get out of their scope, every nurse practitioner has to have a way to deal with things that are outside their 

scope, and so, you have a referral network that you utilize, or consulting network. That is what the collaboration word means for us. 

Dr. PRICE. Us, as well. 

Thank you so much. 

I yield back. 

Mr. NORWOOD. The gentleman yields back. 

Mr. Owens, you are recognized. 

42

Mr. OWENS. Mr. Chairman, I just have one brief question, and 

that is for Dr. Towers. 

Would you agree that nurse anesthetists should be able to provide services under FECA as part of an advanced practice category? 

Dr. TOWERS. Yes. We do not see any problem with that. The reason this became—was a nurse practitioner issue is because we are 

the ones that are generally hit with not being able to function with 

our patients in relation to this. When a patient can choose a—their 

attending provider, why that attending provider is generally not 

going to be an anesthetist or, you know, some of the other advanced practice groups. 

The nurse practitioners are the ones that are sitting in the position where, when it comes to documenting and recognizing that 

someone has a problem and determining what needs to be done 

about it, they are the ones that are finding that they cannot provide that service, unless they want to do it free, and even then it 

does not work, even if they do it for free, because you have to have 

that physician’s signature on these documents, which means you 

have to go find a physician to do it. 

So, that is why this has been focused mainly on nurse practitioners, but we have no problems with other kinds of advanced 

practice nurses being included. We need to look and see how they 

would fit into the pattern. 

Mr. OWENS. I have no further questions, Mr. Chairman. 

I want to thank the witnesses and apologize for the fact that we 

had to go to vote, but I have your written testimony. Thank you. 

Mr. NORWOOD. Thank you, Mr. Owens. 

I will just quickly follow up. Is there anybody who opposes that, 

that Mr. Owens just suggested? 

Dr. TOWERS. I do not think so. 

Mr. NORWOOD. Mrs. Drake, I think you are recognized next. 

Mrs. DRAKE. Thank you, Mr. Chairman, and again, thank you for 

being here. 

I am just trying to understand the issue in my mind, because in 

Virginia, nurse practitioners do work under a physician, and I have 

used a nurse practitioner. It was a wonderful person, did a good 

job. 

I am not familiar with physician assistants personally, but when 

you reference these 13 states that—where nurse practitioners can 

work, do you mean they are completely on their own? 

There is no physician overseeing them in any form at all? 

Dr. TOWERS. According to state statute, that is correct, yes, and 

they function in rural areas. They are in rural health clinics, and 

if you have Federal clinics—I mean there is always a physician 

around some way, but not in a formalized manner, and in those 

states, they could have their own practices, and they do. 

Mr. OWENS. Medicaid/Medicare would pay them directly with no 

physician in the middle. 

Dr. TOWERS. Right. 

Mr. OWENS. I had wondered if part of the reason that their liability insurance was so low was because there was a physician also 

responsible, but the answer to that would be no. 

Dr. TOWERS. No. That is right. 

43

Mr. OWENS. All right. Well, thank you very much. 

I yield back, Mr. Chairman. 

Mr. NORWOOD. The lady yields back. 

I have a question for one of the Members. 

Dr. Price, do physicians usually only cover themselves up to a 

million dollars in malpractice? 

Dr. TOWERS. 1 million/3 million. 

Dr. PRICE. It depends on the state or the hospital in which they 

practice. Many hospitals have their own levels. 

1/3 is customary, 2/6 in some areas, but depending on your style 

of practice——

Mr. NORWOOD. Surgeons get it up as high as they can. 

Dr. PRICE. We, at one point, had 15 million/30 million, because 

we had a fellow who was taking care of professional athletes. 

Mr. NORWOOD. Would any Members like to ask additional questions? 

We thank you very much for the time that you have given us and 

your expertise on this subject. You have done very well, and we appreciate it. We may follow up with some written questions, if that 

is all right, that we would like to put in the record, and with that, 

this hearing is now adjourned. 

[Whereupon, at 11:55 a.m., the Subcommittee was adjourned.] 

[Additional material submitted for the record follows:] 

[The prepared statement of Mrs. Capps follows:]

Prepared Statement of Hon. Lois Capps, a Representative in Congress 

From the State of California 

Thank you for holding this hearing. 

Mr. Chairman, America’s fire fighters are the best trained and best equipped in 

the world. And they provide unparalleled service to our communities. 

They do their job as well in large part because of their bravery and skill. And, 

they are helped along in this job by some of the prevention measures for which they 

have tirelessly advocated. With the help of better safety equipment, such as flame 

retardant suits, fire fighters can get to the heart of fires quicker and pull more victims to safety. 

All Americans benefit from that. 

But I don’t need to tell anyone that fire fighting continues to be extremely dangerous. More than ever, fire fighters are working longer, harder hours, uncertain of 

what dangers lay ahead. 

After September 11th, America needs its firefighters to be better prepared to respond to deliberate acts of terror and destruction. The fire service needs to be better 

prepared to deal with bioterrorism and it needs to be prepared to help save people 

who have been attacked with toxic chemical weapons. 

In short, America’s fire departments need to be prepared for what once seemed 

unthinkable. 

I think most people don’t understand—until they go through a fire or an emergency—exactly how many roles firefighters play, and how dangerous there job often 

is. 

As a public health nurse, I know it is critical to provide adequate presumptive 

disease coverage, especially coverage that extends beyond respiratory disease. 

Science tells us that when we combine high levels of stress with environmental 

exposure to toxins, serious ailments can result. Fire fighting is hazardous enough—

the least we can do is to extend presumptive coverage to these work-related illnesses. 

For that reason, my colleague Jo Ann Davis and I have introduced H.R. 697, the 

Federal Fire Fighters Fairness Act of 2005. 

This legislation creates a presumptive disability for Federal fire fighters who become disabled by heart or lung disease, cancers such as leukemia or lymphoma, and 

infectious diseases like tuberculosis and hepatitis. 

We introduced this bipartisan legislation on behalf of thousands of Federal fire 

fighters. 

44

At great personal risk, these men and women protect America’s defense installations, our veterans, Federal wild lands, and other national treasures. Yet when they 

present with work-related illnesses, Federal law denies them compensation and retirement benefits unless they can point to the specific conditions that caused their 

disease. 

This onerous requirement makes it nearly impossible for Federal fire fighters to 

receive fair and just compensation or retirement benefits. The bureaucratic nightmare they must endure is burdensome, unnecessary, and in many cases, overwhelming. 

It’s ironic and unjust that the very people we call on to protect us are not afforded 

the health care and retirement protection that they deserve. 

Too frequently, the poisonous gases, asbestos and other hazardous substances that 

Federal fire fighters and emergency response personnel come in contact with, rob 

them of their health, livelihood, and professional careers. 

The Federal Government should not rob them of necessary benefits. 

The Federal Fire Fighters Fairness Act will help protect the lives of our fire fighters and it will provide them with a vehicle to secure their health and safety. 

In recent years, there has been a greater appreciation for the risks fire fighters 

and emergency response personnel face every day. Thirty-eight states have already 

enacted similar disability presumption laws for state and local fire fighters. It’s time 

to provide the same protection for Federal fire fighters. 

Recently, I learned of a case involving one of the Federal fire fighters in my district at Vandenberg Air Force Base. He’s been fighting brain cancer for the past six 

months and continues radiation treatment. This father of three is responsible for 

$14,000 in co-pays for his treatment. 

Without presumptive care protection he has only limited Federal insurance coverage and must rely on the support of his fellow firefighters. I applaud his fellow 

firefighters for stepping up to the challenge—but it’s the Federal government’s responsibility. 

We need to secure presumptive rights for Federal Firefighters now. 

This bill is the right thing to do and we should make every effort to pass it. 

Thank you again for having this hearing, and I wish to thank all of our nation’s 

firefighters and emergency response personnel for everything they do. 

[The prepared statement of Mr. Bishop follows:] 

Prepared Statement of the Hon. Timothy H. Bishop, a Representative in 

Congress From the State of New York 

Mr. Chairman, thank you for calling this important hearing to examine how we 

can make the Federal Employees’ Compensation Act a better law. 

In particular, I think it’s important that we are taking this opportunity to acknowledge how fire fighters who have sustained injuries or illnesses in the line of 

duty—while protecting federal property—have experienced difficulty receiving disability benefits. 

Federal fire fighters have some of the most dangerous responsibilities in the country. Protecting our national interests on military bases, nuclear plants, and other 

federal facilities often expose them to toxic substances, temperature extremes and 

stress. 

Since September 11, they have assumed a greater responsibility to prepare for 

emergencies and stand ready to place their lives on the line to protect our families 

and our communities. 

It’s regrettable that while 38 states have passed laws shifting the burden to the 

government to disprove a fire fighter’s claim that he or she was disabled on the job, 

this same standard does not apply to claims filed by federal fire fighters. 

Cutting through the red tape in order to receive the compensation they deserve 

is a tremendous burden, unnecessary, and in many cases, overwhelming. 

It’s ironic that the very people we call on to protect our Nation’s interests are not 

afforded the very best health care and retirement benefits our government has to 

offer. 

That is why yesterday I cosponsored the legislation introduced by our colleague 

from Virginia, Mrs. Davis (H.R. 697, the Federal Fire Fighters Fairness Act)—to 

shift the burden of proof in disability claims to the federal government and make 

it easier for our brave fire fighters to claim the fair and just compensation they deserve. 

I am very pleased to add my name to H.R. 697, and once again thank our fire 

fighters for their courage and service to our country. 

45

[The American Nurses Association statement follows:]

Advanced Practice Registered Nursing: A Solution for FECA 

Thank you for the opportunity to provide a statement for the record regarding the 

Federal Employees Compensation Act (FECA). ANA is the only full-service national 

association representing registered nurses (RNs). Through our 54 constituent nursing associations, we represent RNs across the nation in all practice settings. Our 

membership includes advanced practice registered nurses who have been unable to 

treat patients covered by FECA. 

The mission of American College of Nurse-Midwives is to promote the health and 

well-being of women and infants within their families and communities through the 

development and support of the profession of midwifery as practiced by certified 

nurse-midwives, and certified midwives. 

The American Psychiatric Nurses Association (APNA) represents approximately 

4900 psychiatric nurses in 50 states, with one international chapter. Our mission 

is to promote psychiatric-mental health nursing, improve mental health care for individuals, families and communities, and to inform health policy for the delivery of 

mental health services. APNA represents the largest group of psychiatric nurses 

serving as direct care providers, researchers, educators, and administrators. Our 

members specialize in the full range of mental health care and substance abuse 

treatment to adults, children, adolescents, and the elderly in rural and urban 

healthcare settings. 

The National Association of Clinical Nurse Specialists, founded in 1995, exists to 

enhance and promote the unique, high value contribution of the clinical nurse specialist to the health and well-being of individuals, families, groups, and communities, and to promote and advance the practice of nursing. Members of NACNS 

benefits from national, regional, and local efforts of the Association to make the contributions of CNSs more visible. 

Innovative advances in health care make frequent headlines, but there is an 

equally innovative, if somewhat misunderstood, treatment for the cost and accessibility woes plaguing the Federal Employees Compensation Program. The Health Resources and Services Administration reports that 196,279 advanced practice registered nurses (APRNs) are prepared to serve the American populace. These APRNs 

are carving out a new role in delivering timely, cost-effective, quality health care, 

especially to chronically underserved populations such as the elderly, the poor, and 

those in rural areas. 

Some 60 to 80 percent of primary and preventive care traditionally done by doctors can be done by a nurse for less money. This is not to say nurses work cheaper, 

but their cost-effectiveness reflects a variety of factors related to the employment 

setting, liability insurance, and the cost of education. 

With an emphasis on health promotion and disease prevention and a proven 

record of providing excellent primary care in diverse settings, advanced practice 

nurses form a critical link in the solution to America’s health care crisis. Removing 

the barriers to APRNs would pay a healthy dividend now and in the future. 

Who Are APRNs? 

The advanced practice registered nurse (APRN) is an umbrella term given to a 

registered nurse (RN) who has attained advanced expertise in the clinical management of health problems. Typically, an APRN holds a master(s degree with advanced didactic and clinical preparation beyond that of the RN. Most APRNs have 

extensive practice experience as RNs prior to entering graduate school. Practice 

areas include, but are not limited to: family, gerontology, pediatrics, women’s and 

adult health, neonatology, mental health, midwifery, and anesthesiology. Beginning 

in 2003, APRNs must hold a master’s degree to bill Medicare for their services. 

Under this umbrella fall four principal types of APRNs. 

Nurse Practitioner (NP) 

• Number: 102,829; of which 14,643 are also trained as CNSs. 

• Education: According to the American Association of Colleges of Nursing, there 

are 329 schools in the US offering a master’s or post-master’s level NP programs. 

• What they do: Working in clinics, nursing homes, hospitals, or their own offices, 

NPs are qualified to handle a wide range of basic health problems. Most have a specialty—for example, adult, family, pediatric, psychiatric health care. NPs conduct 

physical exams, take medical histories, diagnose and treat common acute minor illnesses or injuries, order and interpret lab tests and X-rays, and counsel and educate 

clients. In all 50 states, and D.C., they may prescribe medication according to state 

law. Some work as independent practitioners and can be reimbursed by Medicare 

46

or Medicaid for services rendered. Others work for hospitals, health maintenance organizations (HMOs), or private industry. 

Certified Nurse Midwife (CNM) 

• Number: 9,232. 

• Education: An average one and one-half years of specialized education beyond 

nursing school, either in an accredited certificate program, or like NPs, increasingly 

at the master’s level. There are currently 43 nurse-midwifery programs in the U.S 

accredited by the American College of Nurse Midwives. Four of these are post-baccalaureate certificate programs and 39 are graduate programs. • What they do: CNMs provide well-woman gynecological and low-risk obstetrical 

care including prenatal, labor and delivery, and post-partum care. In 2002, the most 

current year which data is available from the National Center for Health Statistics, 

there were 307,527 CNM-attended births in the U.S. This accounts for over 10 percent of all vaginal births that year. An ANA meta-analysis of CNM care found that 

nurse-midwives performed fewer fetal monitors, episiotomies, and forceps deliveries, 

administered fewer IVs, delivered fewer low birth weight and premature infants, 

and had shorter patient hospital stays. CNMs have prescriptive authority in 48 

states, D.C., American Samoa, and Guam. 

Clinical Nurse Specialist (CNS) 

• Number: 69,017; of which 14,643 are also prepared as NPs. 

• Education: Registered nurses with advanced nursing degrees—master’s or doctoral—who are experts in a specialized area of clinical practice defined in terms of 

population (e.g.pediatrics, geriatrics, womens health), type of problem (e.g. pain, 

wound management, stress), setting (e.g. critical care unit, operating room, community clinic, emergency room) type of care (e.g. rehabilitation, end-of-life) or disease 

(e.g. diabetes, oncology, psychiatry). There are 218 U.S. schools offering master’s or 

post-master’s degrees for CNSs. 

• What they do: CNSs practice in hospitals, clinics, nursing homes, their own offices, and other community-based settings, such as industry, home care and HMOs. 

CNSs have clinical nursing expertise in diagnosis and treatment to prevent, remediate or alleviate illness and promote health within a defined specialty population. 

Besides delivering direct patient care, CNSs work in consultation, research, education, and administration. Some work independently or in private practice and can 

be reimbursed by Medicare, Medicaid, Tri-Care, and private insurers. 

Certified Registered Nurse Anesthetist (CRNA) 

• Number: 29,844. 

• Education: Registered nurses who complete 2-3 years higher education beyond 

the required four-year bachelor’s degree, as well as meeting national certification 

and recertification requirements. 

• What they do: In this oldest of the advanced nursing specialties, CRNAs administer more than 65 percent of all anesthetics given to patients each year, and are 

the sole providers of anesthetics in 85 percent of rural hospitals. Working sometimes 

with an MD anesthesiologist, but frequently independently, these nurse specialists 

work in almost every setting in which anesthesia is given operating rooms, dentist’s 

offices, and ambulatory surgical settings. 

APRNs Are Accessible 

They provide pre-employment physicals for employers, home health care to the elderly, health education in hospitals, schools, and community clinics, geriatric care 

in nursing homes, infectious disease control in prisons, pre- and post-natal care in 

inner-city and rural clinics, and psychotherapy in public and private practices. A 

study published in the July/August 2003 issue of the Annals of Family Medicine 

found that physician assistants, nurse practitioners and nurse midwives are more 

likely to work in underserved communities than are general internists, pediatricians, and obstetricians. This held true in both rural and inner city areas. 

APRNs Deliver High Quality Health Care 

All advanced practice registered nurses must meet rigorous education, certification, and continuing education requirements. Standards of practice are set and 

monitored by nursing professional organizations. APRNs work collaboratively with 

physicians and other health professionals to coordinate health services for the best 

outcome for the patient. 

More than three decades of research have documented the high quality of care 

provided by APRNs. In 1986, The Congressional Office of Technology Assessment 

released a report requested by the Senate Appropriations Committee. This report, 

‘‘Nurse Practitioners, Physician Assistants, and Certified Nurse Midwives: A Policy 

47

Analysis,’’ stated that NPs are ‘‘especially valuable in improving access to primary 

care and supplementary care in rural areas and in health programs for the poor, 

minorities and people without health insurance.’’ OTA found the quality of NP care 

to be ‘‘as good as or better than care provided by physicians,’’ and found NPs had 

‘‘better communication, counseling and interviewing skills than physicians have.’’

A study published in the January 5, 2000 Journal of the American Medical Association attests to the high quality services provided by APRNs. This study, entitled 

‘‘Primary Care Outcomes in Patients Treated by Nurse Practitioners or Physicians,’’ 

compared the outcomes of patients randomly assigned to MDs and NPs within the 

same managed care organization. The authors found that patient outcomes and satisfaction were equivalent for NPs and MDs. 

A large-group study of patients seeking care for minor emergencies was published 

in the Lancet in 1999. The study compared the outcomes of patient’s whose care was 

managed by NPs and physicians. The authors found that NPs were better than MDs 

in recording medical histories and that fewer patients seen by an NP sought unplanned follow-up for advice about their injury. There were no significant differences 

between NPs and MDs in the accuracy of examinations, adequacy of treatment, 

planned follow-up or requests for medical imaging. 

In June of 2002, the Medicare Payment Advisory Committee (MedPAC’s) issued 

a report titled ‘‘Medicare Payment to Advanced Practice Nurses and Physician Assistants.’’ In its recommendation to Congress, MedPAC’s reported that, ‘‘.research 

studies show quality and outcomes of care [provided by CNMs] at least comparable 

to obstetricians and gynecologists.’’

A case in point is a May 1998 study from the National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention (CDC) that was published 

in the Journal of Epidemiology and Community Health. It examined all single, vaginal births in the United States in 1991 delivered at 35-43 weeks of gestation by 

either physicians or CNMs. After controlling for a wide variety of social and medical 

risk factors, the risk of experiencing an infant death was 19 percent lower for births 

attended by CNMs than for births attended by physicians. The risk of neonatal mortality (an infant death occurring in the first 28 days of life) was 33 percent lower, 

and the risk of delivering a low birth weight infant was 31 percent lower. Mean 

birth weight was 37 grams heavier for the CNM attended than for the physicianattended births. Low birth weight is a major predictor of infant mortality, subsequent disease, or developmental disabilities. 

The study also found that CNMs attended a greater proportion of women who are 

at higher risk for poor birth outcome: African Americans, American Indians, teenagers, unmarried women, and those with less than a high school education. Physicians attended a slightly higher proportion of births with medical complications. 

However, birth outcomes for CNMs were better even after socio-demographic and 

medical risk factors were controlled for in statistical analyses. 

APRNs Are Cost-Effective 

Advanced practice nurses aren’t low-priced doctor substitutes. They are first and 

foremost registered nurses, a profession with its own educational and licensing requirements, overseen by boards of nursing in all 50 states, that meet competency 

standards and continuing education requirements. APRNs are skilled in performing 

a wide range of health services, especially screening and preventive services, that 

if ignored, can lead to far more serious and costly health problems. 

A seminal study published in the Yale Journal on Regulation in 1992 reviewed 

two decades of research on APRN services. The author found that the evidence is 

clear that APRNs provide care of comparable quality and lower cost than physicians. The study asserts that APRNs tend to prescribe fewer drugs, use less expensive tests, and select lower-cost treatments than MDs. 

In 1995, the Journal of the American Academy of Nurse Practitioners published 

the results of a year-long study that compared a family physician’s managed practice with an NP’s practice within the same managed care organization. The authors 

found that the NP’s total annualized per member cost was approximately 50 percent 

less than the physician’s. The NP practice resulted in far fewer emergency room visits and inpatient days. 

A study published in the June, 2003 issue of the American Journal of Public 

Health contained the results of a two and one-half year cohort study funded by the 

Agency for Health Care Research and Quality (AHRQ). The AHRQ researchers 

found that low-risk patients receiving midwifery care had birth success rates comparable to those who saw only physicians. In addition, the patients who received 

midwifery care experienced fewer cesarean sections, spent fewer days in the birth 

center/hospital, experienced less induction of labor, and received less technical interVerDate 0ct 09 2002 12:50 Aug 31, 2006 Jkt 000000 PO 00000 Frm 00051 Fmt 6633 Sfmt 6621 H:\DOCS\WP\5-26-05\21548 HOME PsN: DICK
48

vention. The study also revealed similar morbidity, preterm birth, and low-birth 

weights among women receiving midwifery care and those seeing physicians. 

Based on a comparison of 1988 data from St. Paul Fire and Marine Insurance 

Company (then the country’s largest provider of liability insurance for CRNAs), and 

2004 data from CNA Insurance Company (currently the largest insurer of CRNAs) 

insurance premiums for nurse anesthetists have decreased nationally a total of 39 

percent in the 88-’04 time span. The decrease in CRNA malpractice insurance premium rates demonstrates the superb anesthesia care that CRNAs provide. The rate 

drop is particularly impressive considering inflation, an increasingly combative legal 

system, and generally higher jury awards. 

Conclusion 

The Federal Employees Compensation Program is one of the last major health 

care programs to deny patients’ access to APRNs. APRNs are covered medical providers in Medicare, Medicaid, Tri-Care and private insurance plans. They serve as 

medical providers in the Veterans Administration, the Department of Defense and 

the Indian Health Service. In fact, most federal employees have access to APRNs 

through their federal employee health benefit plan. 

Decades of research have shown that APRNs provide high quality services that 

often incur fewer costs than care provided by physicians alone. In addition, APRNs 

are more likely to provide services in medically underserved areas. 

For these reasons, the undersigned organizations urge the Committee to support 

efforts to provide Federal workers full access to the wide compliment of services provided by APRNs. 

American College of Nurse-Midwives. 

American Nurses Association. 

American Psychiatric Nurses Association. 

National Association of Clinical Nurse Specialists. 

[From the New York Post, May 8, 2005]

W. Plan Stiffs Heroes; Nixes WTC Comp Pay

By SAM SMITH

The Bush administration is reneging on its pledge of $175 million to fund workers’ compensation claims for uninsured Ground Zero responders, The Post has 

learned. 

In its proposed 2006 budget, the administration says it will take back $120 million in funds granted in 2002 that have yet to be spent. 

‘‘These particular funds were set aside for workers’ compensation needs that have 

not turned out to be as large as expected,’’ said federal Office of Management and 

Budget spokesman Scott Milburn. ‘‘The initial need for the funds has been met.’’

But advocates say the federal decision will leave workers in the lurch as they continue to get sick from their time at Ground Zero, and that the money may well be 

needed to pay future claims. 

‘‘I’m disgusted,’’ said Joseph Pecuro, 38, of Toms River, N.J., a Ground Zero volunteer who filed for workers’ compensation last August and is worried that the Bush 

administration’s proposal will leave him without benefits. 

‘‘I can’t even believe they would actually do that. They should be ashamed,’’ he 

said. 

Pecuro, an ironworker, says his ailments forced him to quit working two years 

ago. ‘‘I can’t afford to buy my groceries,’’ he said. 

Health professionals were concerned about the government’s decision. 

‘‘We don’t know what the long-term health effects will be,’’ said Dr. Robin Herbert, 

director of Mount Sinai hospital’s World Trade Center health-monitoring program. 

So far, the New York Workers’ Compensation Board has paid out roughly $52 million in benefits to 113 claimants from the federal funding. Of those, 37 are receiving 

biweekly payments because of the severity of their injuries. 

All those payments—along with 94 claims currently being processed, another 400 

filed with the state in anticipation of future health problems, and any future complaints—are jeopardized by the Bush administration’s proposal.

Æ