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PROGRESS SINCE SEPTEMBER 11TH: PROTECTING

PUBLIC HEALTH AND SAFETY AGAINST TERRORIST ATTACKS

HEARING

BEFORE THE

SUBCOMMITTEE ON NATIONAL SECURITY,

EMERGING THREATS, AND INTERNATIONAL

RELATIONS

OF THE

COMMITTEE ON

GOVERNMENT REFORM

HOUSE OF REPRESENTATIVES

ONE HUNDRED NINTH CONGRESS

SECOND SESSION

FEBRUARY 28, 2006

Serial No. 109–153

Printed for the use of the Committee on Government Reform

(

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

http://www.house.gov/reform

(II)

COMMITTEE ON GOVERNMENT REFORM

TOM DAVIS, Virginia, Chairman

CHRISTOPHER SHAYS, Connecticut

DAN BURTON, Indiana

ILEANA ROS-LEHTINEN, Florida

JOHN M. MCHUGH, New York

JOHN L. MICA, Florida

GIL GUTKNECHT, Minnesota

MARK E. SOUDER, Indiana

STEVEN C. LATOURETTE, Ohio

TODD RUSSELL PLATTS, Pennsylvania

CHRIS CANNON, Utah

JOHN J. DUNCAN, JR., Tennessee

CANDICE S. MILLER, Michigan

MICHAEL R. TURNER, Ohio

DARRELL E. ISSA, California

JON C. PORTER, Nevada

KENNY MARCHANT, Texas

LYNN A. WESTMORELAND, Georgia

PATRICK T. MCHENRY, North Carolina

CHARLES W. DENT, Pennsylvania

VIRGINIA FOXX, North Carolina

JEAN SCHMIDT, Ohio

——— ———

HENRY A. WAXMAN, California

TOM LANTOS, California

MAJOR R. OWENS, New York

EDOLPHUS TOWNS, New York

PAUL E. KANJORSKI, Pennsylvania

CAROLYN B. MALONEY, New York

ELIJAH E. CUMMINGS, Maryland

DENNIS J. KUCINICH, Ohio

DANNY K. DAVIS, Illinois

WM. LACY CLAY, Missouri

DIANE E. WATSON, California

STEPHEN F. LYNCH, Massachusetts

CHRIS VAN HOLLEN, Maryland

LINDA T. SANCHEZ, California

C.A. DUTCH RUPPERSBERGER, Maryland

BRIAN HIGGINS, New York

ELEANOR HOLMES NORTON, District of

Columbia

———

BERNARD SANDERS, Vermont

(Independent)

DAVID MARIN, Staff Director

ROB BORDEN, Parliamentarian

TERESA AUSTIN, Chief Clerk

PHIL BARNETT, Minority Chief of Staff/Chief Counsel

SUBCOMMITTEE ON NATIONAL SECURITY, EMERGING THREATS, AND INTERNATIONAL

RELATIONS

CHRISTOPHER SHAYS, Connecticut, Chairman

KENNY MARCHANT, Texas

DAN BURTON, Indiana

ILEANA ROS-LEHTINEN, Florida

JOHN M. MCHUGH, New York

STEVEN C. LATOURETTE, Ohio

TODD RUSSELL PLATTS, Pennsylvania

JOHN J. DUNCAN, JR., Tennessee

MICHAEL R. TURNER, Ohio

JON C. PORTER, Nevada

CHARLES W. DENT, Pennsylvania

DENNIS J. KUCINICH, Ohio

TOM LANTOS, California

BERNARD SANDERS, Vermont

CAROLYN B. MALONEY, New York

CHRIS VAN HOLLEN, Maryland

LINDA T. SANCHEZ, California

C.A. DUTCH RUPPERSBERGER, Maryland

STEPHEN F. LYNCH, Massachusetts

BRIAN HIGGINS, New York

EX OFFICIO

TOM DAVIS, Virginia HENRY A. WAXMAN, California

LAWRENCE J. HALLORAN, Staff Director and Counsel

KRISTINE FIORENTINO, Professional Staff Member

ROBERT A. BRIGGS, Clerk

ANDREW SU, Minority Professional Staff Member

(III)

C O N T E N T S

Page

Hearing held on February 28, 2006 ....................................................................... 1

Statement of:

Bascetta, Cynthia A., Director, Health Care, Government Accountability

Office; Ronaldo Vega, architect, city of New York, Department of Design and Construction; Marvin Bethea, paramedic, New York City;

Stephen M. Levin, M.D., co-director, World Trade Center Worker and

Volunteer Medical Screening Program, medical director, Mount Sinai

Center for Occupational and Environmental Medicine, New York, NY;

and Kerry J. Kelly, M.D. chief medical officer, Bureau of Health Services, FDNY, and co-director, FDNY-WTC Medical Program, New York,

NY .................................................................................................................. 11

Bascetta, Cynthia A. ................................................................................. 11

Bethea, Marvin .......................................................................................... 54

Kelly, Kerry J. ........................................................................................... 74

Levin, Stephen M. ..................................................................................... 59

Vega, Ronaldo ............................................................................................ 47

de Hernandez, Micki Siegel, Communications Workers of America, District 1, New York City; Lee Clarke, American Federation of State

County and Municipal Employees, District Council 37, New York City;

John Romanowich, New York City Department of Design and Construction; Michael Kenny, Local 375, District Council 37, New York City;

and Charles Kaczorowski, Local 375, District Council 37, New York

City ................................................................................................................. 159

Clarke, Lee ................................................................................................. 160

de Hernandez, Micki Siegel ...................................................................... 159

Kaczorowski, Charles ................................................................................ 163

Kenny, Michael .......................................................................................... 162

Romanowich, John .................................................................................... 161

Howard, John, M.D., M.P.H., Director, National Institute for Occupational Safety and Health [NIOSH], Centers for Disease Control and

Prevention, U.S. Department of Health and Human Services .................. 133

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

Bascetta, Cynthia A., Director, Health Care, Government Accountability

Office, prepared statement of ....................................................................... 14

Bethea, Marvin, paramedic, New York City, prepared statement of ........... 56

Howard, John, M.D., M.P.H., Director, National Institute for Occupational Safety and Health [NIOSH], Centers for Disease Control and

Prevention, U.S. Department of Health and Human Services, prepared

statement of ................................................................................................... 136

Kelly, Kerry J., M.D. chief medical officer, Bureau of Health Services,

FDNY, and co-director, FDNY-WTC Medical Program, New York, NY,

prepared statement of ................................................................................... 77

Levin, Stephen M., M.D., co-director, World Trade Center Worker and

Volunteer Medical Screening Program, medical director, Mount Sinai

Center for Occupational and Environmental Medicine, New York, NY,

prepared statement of ................................................................................... 63

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

of New York, information concerning findings and treatment for high

levels of mercury and lead toxicity .............................................................. 112

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

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

Vega, Ronaldo, architect, city of New York, Department of Design and

Construction, prepared statement of ........................................................... 49

(1)

PROGRESS SINCE September 11th: PROTECTING PUBLIC HEALTH AND SAFETY AGAINST

TERRORIST ATTACKS

TUESDAY, FEBRUARY 28, 2006

HOUSE OF REPRESENTATIVES,

SUBCOMMITTEE ON NATIONAL SECURITY, EMERGING

THREATS, AND INTERNATIONAL RELATIONS,

COMMITTEE ON GOVERNMENT REFORM,

Washington, DC.

The subcommittee met, pursuant to notice, at 2:06 p.m., in room

2154, Rayburn House Office Building, Hon. Chris Shays (chairman

of the subcommittee) presiding.

Present: Representatives Shays, Fossella, Maloney, and Van

Hollen.

Staff present: Lawrence Halloran, staff director and counsel;

Kristine Fiorentino, professional staff member; Robert A. Briggs,

clerk, and Marc LaRoche, intern; Andrew Su, minority professional

staff member; and Jean Gosa, minority assistant clerk.

Mr. SHAYS. A quorum being present, the Subcommittee on National Security, Emerging Threats, and International Relations

hearing entitled ‘‘Progress Since September 11th: Protecting Public

Health and Safety Against Terrorist Attacks’’ is called to order.

On September 11, 2001, the World Trade Center site became the

epicenter of seismic events still generating aftershocks across our

entire Nation.

We convene in remembrance of those lost and on behalf of those

still suffering and dying as a result of the toxic terrors unleashed

that day.

The unfinished work of protecting public health in this dangerous era came into painful focus again last year when Hurricane

Katrina washed away complacent assumptions about national readiness to deal with large-scale disasters.

So we also come together to commemorate our fellow citizens

who died in the storm and to ask, what more must be done to care

for those who live and work in the past of cataclysmic devastation.

An 18th century philosopher reached the sad conclusion, ‘‘We

learn from history only that we do not learn from history. We prefer to forget.’’

We want to get on with our lives as soon as possible to get back

to where we were before disaster struck.

But many suffering long-term effects from toxic exposures at

Ground Zero cannot forget, nor can they be forgotten.

2

Recent deaths and diagnosis of debilitating conditions among

September 11th first responders serve as painful reminders of the

enduring duty to acknowledge the wounded, ease their suffering,

and learn the lessons their hard history teach.

When the subcommittee convened in New York City in 2003, we

heard testimony about a disjointed patchwork of Federal, State,

and local health programs meant to address unique September

11th health impacts.

First responders and Federal employees who answered the call

were falling into bureaucratic crevices between those special programs and regular health care and workers’ compensation systems

ill equipped to diagnose, treat, or compensate the delayed casualties of the September 11th attacks.

Today, it appears the public health approach to lingering environmental hazards remains unfocused and halting.

The unquestionable need for long-term monitoring has been met

with only short-term commitments.

Screening and monitoring results have not been translated into

timely protocols that could be used by a broader universe of treating physicians.

Valuable data sets, compiled by competing programs, may atrophy as the money and vigilance to a September 11th health research wane.

This unhappy history warns we are not yet prepared to do essential public health assessments after mass casualty events, natural

or man-made.

More recently, the lack of any baseline measurement protocols in

the wake of Hurricane Katrina suggests the response to the next

disaster may be yet another ruddlerless, ad hoc scramble.

Last week, the White House Report on Hurricane Katrina recommended Federal agencies be prepared ‘‘to quickly gather environmental data and to provide the public and emergency responders the most accurate information available to determine whether

it is safe to operate in a disaster environment or to return after

evacuation.’’

Those charged with implementing that recommendation should

study the history of the September 11th programs as a cautionary

guide to lessons still unlearned and mistakes that should not be repeated.

We asked our witnesses to discuss how the Federal investment

in the World Trade Center Health Program has been used, how

those efforts can be better coordinated and more sharply focused.

We asked them to tell us what we have learned for good or ill

about responding to the health effects that sustain toxic terrorism.

We value their perspectives. We appreciate their expertise, and

we look forward to their testimony.

With that, the Chair now recognizes Mrs. Maloney, who has been

leading the charge in this area, with Mr. Vito Fossella, who I will

also ask at this moment for unanimous consent that he be allowed

to participate, only if he joins us a little closer. Come on up here,

Vito.

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

3

4

5

Mrs. MALONEY. Well, thank you, Mr. Chairman, and I really

thank you Chairman Shays for holding this hearing. This is the

third of its kind by the subcommittee, and, in fact, this subcommittee is the only Federal Committee to ever hold hearings on the

health impact of September 11th, which is an astonishing fact

when you consider the enormity of this problem.

I in particular want to welcome all of the panelists, but two of

my constituents are here—Mr. Ron Vega, Mr. Marvin Bethea. And

I also would like to recognize Ms. Lee Clark, another constituent

from D.C. 37 with Workers’ Comp, Micki de Hernandez from CWA,

who has been dedicated to this issue, and Barbara Coufel from

AFSCME. They have all worked selflessly on this issue.

We are joined today by other workers from Ground Zero. We

could not have everyone as panelists, but their constant attention,

their many visits to Washington, has contributed greatly to the

success that Vito Fossella and the chairman and myself are so

proud to learn on Monday that the administration has appointed

a health czar, a person who will be totally in charge in coordinating

response.

I also must mention that the Mayor’s Office is here, who has

been a partner in this effort in securing a health professional, and

also the restoration, which Vito and many others worked so hard

on to restore the $125 million to Workers’ Compensation and to

help the injured workers.

We have thousands of people that are sick and Vito has them

coming to his office. I have them to mine, and Chris has his. Many

people from Connecticut as well as across this country rushed to

Ground Zero, and many of them have not been treated. They have

not been monitored, and we hope to change that.

At the last hearing, I asked every witness if they could name

anyone in the Federal Government to whom they could turn to for

help. Was there anyone that they could go to to help them with

their health needs? Everyone called them a hero or a heroine, but

where were they to go when they were sick? And absolutely no one

could give me a name.

Well, today, we finally have a name—Dr. John Howard, the Director of NIOSH. He is a witness on our second panel. He is a seasoned health professional, and I know, Dr. Howard, that you were

just given this responsibility yesterday, but along with Vito and

Chris, I look very much forward to working with you, because we

have a great deal of work to do to help the men and women who

are heroes and heroines, such as Mrs. Bascetta who is here today

who was literally buried alive. Many others were buried alive, dug

their way out. They are sick now. They went back to the mound.

They worked to help others, and we need to be there to help them

now.

One of the first things I want to deal with, which I think is incredibly important, is the medical monitoring programs. One of our

witnesses, Dr. Levin, has been head of the Health Consortium and

has worked on this.

But these programs have documented that thousands of people

are still sick. They are sick from their exposure to a virtual cocktail

of poisonous asbestos, lead, mercury, powdered glass, pulverized cement, and other carcinogens at Ground Zero, and that many of

6

these individuals have a lack of access to sufficient medical care or

treatment.

The World Trade Center Monitoring Program alone has found

that roughly half of the 16,000 people they have screened have a

medical condition resulting from September 11th. Some have called

a condition called the ‘‘World Trade Center cough’’ that has

emerged from this impact of glass in the lungs.

What is worse is that we are now getting news that several responders may have died as the result of their service at Ground

Zero years after the attack. And it has been 41⁄2 years. We are coming up on the fifth anniversary, but since June of this year, we

have mourned the loss of three heroes of September 11th—EMTs

Felix Hernandez, at 31; Timothy Keller, at 41; and NYPD Detective

James Cedragu, 34.

These men were all in the prime of their life. Their loved ones

told me they would be alive today but for September 11th.

Tim Keller’s son says the night he died he was coughing up black

phlegm, and many tell me they could rub their loved ones arms

and little particles of glass would come out.

The frustrating thing to me is that even with this information,

eligibility for medical monitoring is all over the map, and it is more

dependent on who you are, what hat you wore, what department

you belonged in rather than what you were exposed to.

And with this appointment of a medical chief in charge, I would

hope that the debate moves to what you were exposed to as opposed to the various medical monitoring patchwork that has been

created across the region.

If you are a Federal employee, you are eligible now for a onetime screening from a program that has been shut down more than

it has been operating. The GAO report said that of the approximately 10,000 Federal employees and we are talking FBI, CIA,

IRS, FEMA, SEC—that were exposed, when they found—they only

monitored or screened 400 of them, and they closed down the program because they didn’t know what to do with them, because people were sick and there was no treatment program.

I have been told that there will be no followup exams for the

Federal program that is starting up now, and that this program is

a screening program, not a monitoring program.

If you are a former Federal employee, as of today, you are not

eligible for anything. If you are a New York State employee, you

used to be eligible for a one-time screening. But that program has

since shut down.

And our point today is that illnesses are not shutting down, and

we need to have the scientific instructions sent out to doctors. We

have heard stories of people who are coughing up—and very sick—

and they have glass in their lungs, and they are being treated for

asthma. They have World Trade Center cough.

The CDC has sent protocols to every single doctor in this country

for the SARS cough. Why aren’t we sending and developing protocol for the World Trade Center cough?

That needs to be done.

Now that you are eligible as New York State and Federal employee to be part of a medical monitoring program, but your first

exam is useless, because the New York State Screening Program

7

failed to coordinate their exam with the other existing monitoring

programs.

If you were a construction worker, a firefighter, a police officer,

or a volunteer and worked at Ground Zero, you are eligible to be

part of medical monitoring programs that we had to fight the administration to create.

If you are an area resident and breathed in this debris, you are

not eligible for any federally funded medical screening or monitoring program.

The same is true for area workers, many of whom were back on

the job the next day, and school children.

The only thing that everyone is eligible for is the World Trade

Center Registry. But let us be clear: Beyond the privacy concerns

that have been raised by a number of local unions, the Registry has

never conducted a single medical examination.

All it has ever done is conduct phone surveys, requiring individuals to self-report their health status.

I would like to hear from our witnesses any experiences that

they have had with this Registry. Specifically, I would like to hear

from the doctors on whether it has been of any use to them whatsoever, and it is amazing to me that the Federal Government has

found it necessary to include area residents—workers, school children, and others—in a health registry, but are prohibiting the

same from existing medical monitoring programs, even after illnesses and injuries are reported.

As we are working out the coordination of monitoring, we also

must work on providing actual medical treatment to those who are

sick, but lack access to sufficient medical care or treatment.

It is absolutely wrong, and I would say immoral, to find a medical condition and then do absolutely nothing about it. We have

made progress in this area and are on the verge of providing the

first Federal funding for treatment. That is amazing. It has been

41⁄2 years, and we are just now getting Federal funding for treatment.

But this only happened after a prolonged battle with the administration. There is no way that the funds appropriated will meet all

of the unmet needs of the September 11th responders. The funding

that I am talking about is the restoration, which my colleague,

Vito, worked so hard on with the New York delegation to restore

$125 million rescission of the September 11th funding, and I must

mention the workers who came up repeatedly to meet with the

leaders in Congress to make them aware that this money was

needed for their treatment.

Of this $125 million, $75 million will be used for existing monitoring programs and, for the first time, provide funding for treatment. This is indeed an important step forward.

We have here today two of the people who were great advocates

in this fight. I would say three. Mrs. Bascetta, Mr. Vega, and Mr.

Bethea.

Without their work, and the work of other September 11th responders, this funding would have never been returned to New

York.

Now that it has been returned, it is past time for the Federal

Government to come up with a comprehensive plan, not just on

8

how to spend this money, but develop a plan that looks to deal with

the unmet needs of everyone exposed to the toxins at Ground Zero.

To this end, I would like to hear from the doctors from the monitoring programs about the unmet needs of their patients. Maybe

I have this World Trade Center cough, too.

I would be specifically interested in hearing what you think it

will take to finally take care of these men and women. Too much

time has passed. The time to act is now. As the September 11th

responders will tell you, their life very well depends on it. Thank

you.

Mr. SHAYS. I thank the gentlelady. At this time, Mr. Van Hollen

has said that we could go to our invited member, Mr. Fossella for

a statement.

Mr. FOSSELLA. Well, thank you, Mrs. Maloney, and thank you,

Chairman Shays, for holding this I think is an important hearing,

and, of course, to my colleague, Carol Maloney. She has been very,

very helpful and we are doing what is right for the people who responded on September 11th.

As been mentioned, too many of the people I represent and others are living with severe health problems due to September 11th

and will continue to do so for years to come. I commend you, Mr.

Chairman, and others for the dedication to this topic.

We know now that when the terrorists flew two airplanes into

the Twin Towers on September 11, 2001, New York’s police officers,

firefighters, EMTs, and so many others put their own lives aside

in an heroic attempt to save others. Many did not return home. In

the attacks immediate aftermath, countless others flocked to

Ground Zero to help with recovery efforts. They spent several days

and hours working the pile of wreckage, holding on to the hope of

finding survivors. They worked tirelessly, driven by the somber reality that Ground Zero needed to be cleaned up quickly to bring

peace for those who lost loved ones and to help lower Manhattan

and America rise again.

Many first responders and volunteers hoped the pain would

eventually pass, but many continue suffering today. It has been revealed that tens of thousands of first responders, Federal employees, and lower Manhattan residents and workers are suffering from

health problems likely caused by exposure to toxins at or near the

World Trade Center site. They inhaled asbestos, lead, mercury,

powdered glass, and other carcinogens stagnating in the air.

According to a federally funded World Trade Center Medical

Screening Program, approximately half of the 16,000 September

11th responders that they have screened continued to need physical and or mental health treatment. In many cases, they need further testing as well.

Our New York City Fire Department I believe we will hear shortly study reported similar findings: Thousands of other responders

eligible for medical screening are still left in need.

After a long fight, our Federal Government is now on its way toward providing a better response to this problem. This past year

has been mentioned. My colleague, Congresswoman Maloney, and

I came together with our other New York colleagues and successfully reversed the rescission of $125 million for September 11th

first responders and workers.

9

We were also successful at freeing up this funding to be used for

treatment for the first time ever. Thanks to these victories, many

will continue receiving the treatment they need to live more normal

lives. Those not currently served can also now live with the hope

there is help out there, and America has not forgotten their sacrifice.

Unfortunately, tragedy has come in the wake of these successes.

We have heard in the past 9 months three of these responders lost

their lives from what are believed to be sicknesses incurred during

the heroic rescue and recovery efforts. Their names have been mentioned, but bear repeating—the EMTs Timothy Keller, Felix Hernandez, and Police Detective James Cedragu, now counted among

the victims of September 11th.

Thousands of others are living with persistent health problems

believed to be associated with their September 11th response. One

medic I talked to is no longer able to work due to severe respiratory illnesses and vision problems doctors feel all relate to his

efforts on September 11th.

Another individual suffers from respiratory problems caused by

severe internal chemical burns from toxins inhaled at Ground Zero.

One of the witnesses today, Mr. Vega, will testify about high levels

of mercury and arsenic in his blood. These toxins will affect his

liver and brain cells. He has also been diagnosed with restrictive

lung diseases and post-traumatic stress disorder associated with

September 11th.

Other common conditions are heart disease, bronchitis, and emphysema.

Many of our September 11th responders are facing dire circumstances. Some have tragically passed away. However, today offers others like him will not suffer a similar fate and those living

with September 11th health problems as they will in the future.

After requests from Congresswoman Maloney and I, I am very

pleased to, as she has mentioned Health & Human Services Secretary Michael Leavitt, who we met with earlier today, with Mayor

Blumberg, has been a strong advocate in this cause, has chosen, as

been mentioned, Dr. John Howard as the Federal Government’s

September 11th Health Coordinator. Dr. Howard, we look forward

to your efforts in helping those in need.

I welcome Dr. Howard here again and look forward to working

with all of us and many—I can’t bear repeating enough for the last

41⁄2 years, there have been many on the ground back in New York

who have dedicated their lives to helping those in need—many of

the not-for-profit, fundraisers, etc., in the health community, and

one person in particular I would like to acknowledge is Dr. Kelly,

most important a Staten Island resident, who is here today, a

Grimes Hill resident and a graduate of Notre Dame Academy on

Grimes Hill. Doctor, thank you for what you have been doing for

these last several years especially.

With that, Mr. Chairman, I want to thank you and let us hope

that not just the witnesses here, but, as we know, there are thousands of people who are not here. They need to know one thing:

that September 11th may have been a very bad day and a tragic

one in this country’s history, and there are many people who responded heroically, and they need to know that this Congress and

10

this country will never forget their sacrifice and will stand by

them. And I think this hearing helps to underscore that commitment.

Thank you very much.

Mr. SHAYS. I thank the gentleman. Mr. Van Hollen. Thank you

for your patience.

Mr. VAN HOLLEN. Well, no, thank you, Mr. Chairman. Thank you

for holding a hearing on this very important issue, and I commend

my colleagues from New York, Mrs. Maloney and Mr. Fossella, for

their leadership in this area. And I will be brief in my remarks.

As you said, Mr. Chairman, in your opening remarks, we have

an obligation as a country to learn from tragedies that strike us as

a Nation. On September 11th, we had a tragedy that struck all

Americans, but, of course, particularly people in New York City, in

the Washington area, and, of course, on the plane that crashed in

Pennsylvania.

And we have had a lot of opportunities as a country to learn from

those disasters and try to determine what we can do to prevent and

respond to other disasters. We saw in the case of Hurricane

Katrina that unfortunately the Federal Government did not learn

its lessons. We were not adequately prepared, and there is much

unfinished business we can do to prevent future tragedies, whether

they are man-made or whether they are from natural causes, and

to respond and be prepared to respond to those tragedies.

But in the process of learning lessons from the tragedy of September 11th and lessons from Katrina, it is important that we not

forget the people who were victims in those tragedies and those

who put their lives on the line, and nevertheless continue to suffer

from the long-term health effects of exposure to toxics and other

environmental conditions.

And so I hope as we learn the lessons from those tragedies to

avoid future tragedies and decide how to best respond to them, we

do not forget those heroes who were part of responding, and that

is what today is all about is trying to find a way to make sure that

those people who put their lives on the line that they have their

health care needs addressed. And I thank you, Mr. Chairman,

again my colleagues from New York for your work in this area.

Mr. SHAYS. I thank the gentleman. Before I recognize the witnesses, I ask unanimous consent that all members of the subcommittee be permitted and those have been given unanimous consent to participate be permitted to place an opening statement in

the record, and the record will remain open for 3 days for that purpose. Without objection, so ordered.

I ask further unanimous consent that all witnesses be permitted

to include their written statement in the record. And without objection, so ordered.

Recognizing our panel, we have Ms. Cynthia Bascetta, Director

of Health Care, Government Accountability Office; Mr. Ronald

Vega, architect, city of New York, Department of Design and Construction; Mr. Marvin Bethea, New York City paramedic; Dr. Stephen M. Levin, co-director of the World Trade Center Work and

Volunteer Medical Screening Program, medical director of the

Mount Sinai Center for Occupational and Environmental Medicine;

and Dr. Kerry J. Kelly, Fire Department of New York, chief mediVerDate 11-MAY-2000 09:29 Aug 03, 2006 Jkt 000000 PO 00000 Frm 00014 Fmt 6633 Sfmt 6633 D:\DOCS\28531.TXT HGOVREF1 PsN: HGOVREF1
11

cal officer, Bureau of Health Services co-director of the Fire Department of New York WTC Medical Program—Fire Department of

New York? Yes. OK. You get the Fire Department of New York in

there a lot.

Please, if you would stand and raise your right hands.

[Witnesses sworn.]

Mr. SHAYS. Note for the record our witnesses have responded in

the affirmative, and two others who may provide testimony will

provide that to you, Mr. Transcriber, if they testify. But they have

been sworn in.

You may begin.

STATEMENTS OF CYNTHIA A. BASCETTA, DIRECTOR, HEALTH

CARE, GOVERNMENT ACCOUNTABILITY OFFICE; RONALDO

VEGA, ARCHITECT, CITY OF NEW YORK, DEPARTMENT OF

DESIGN AND CONSTRUCTION; MARVIN BETHEA, PARAMEDIC, NEW YORK CITY; STEPHEN M. LEVIN, M.D., CO-DIRECTOR, WORLD TRADE CENTER WORKER AND VOLUNTEER

MEDICAL SCREENING PROGRAM, MEDICAL DIRECTOR,

MOUNT SINAI CENTER FOR OCCUPATIONAL AND ENVIRONMENTAL MEDICINE, NEW YORK, NY; AND KERRY J. KELLY,

M.D. CHIEF MEDICAL OFFICER, BUREAU OF HEALTH SERVICES, FDNY, AND CO-DIRECTOR, FDNY-WTC MEDICAL PROGRAM, NEW YORK, NY

STATEMENT OF CYNTHIA BASCETTA

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

subcommittee.

I am pleased to be here today to update you on the progress of

programs established to monitor adverse health effects in the aftermath of the World Trade Center attack.

As you know, up to 400,000 people living, working, and attending

school in the vicinity were affected, and thousands of responders

were exposed to many physical and environmental toxins as they

took part in rescue, recovery, and clean up activities.

The magnitude and unprecedented nature of this event also

caused significant psychological trauma for responders and many

other people.

More than 4 years later, the long-term effects on physical and

mental health are still of great concern.

In my remarks today, I will first discuss the four federally funded programs that are implemented by State and local government

agencies or private organizations to serve State and local workers

as well as the general population.

Then I will share our findings about the program established to

monitor the health of Federal workers who responded to the disaster in an official capacity.

For State and local workers, the New York City Fire Department’s program and the Worker and Volunteer Program, have provided medical examinations to more than 15,000 and 14,000 people,

respectively, and are also tracking their health over time. Both programs are accepting new enrollees for initial screening, have begun

to conduct followup examinations, and provide referrals for participants who require treatment.

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A third program, the New York State Responder Screening Program, offered one-time examinations to State employees, including

the National Guard.

After screening about 1,700 of the estimated 9,800 stated responders, this program stopped in November 2003, in part because

the number of responders requesting examinations was dwindling

and no followup was planned.

State responders were allowed to participate in the Worker and

Volunteer Program beginning in February 2004.

The fourth program, the World Trade Center Registry, is designed for research on long-term health effects through 2023, and

has collected health information through interviews with over

71,000 responders and others exposed to the hazards caused by the

collapse of the Towers.

Officials from the Registry, as well as the other programs doing

long-term monitoring, expressed concerns that the duration of Federal funding arrangements may be too short to identify all health

effects that may develop over time.

For Federal workers who are not eligible for other monitoring

programs, a few hundred were screened by Federal agencies within

the Army and the Justice Department. But for the vast majority,

HHS’ program lagged behind by about a year, accomplished little,

and was dormant between March 2004 and December 2005.

Of the estimated 10,000 Federal workers who were sent by their

agencies to respond, only about 500 have received screening examinations.

HHS officials told us that three operational issues contributed to

their decision to suspend the program. First, they could not inform

all eligible Federal responders because they didn’t have a comprehensive list of their names. HHS is now spending about $500,000 to develop the list and to

recruit enrollees.

Second, officials reported that clinicians were concerned about

providing screening examinations to the many participants who

need additional testing and followup care, especially for respiratory

and mental health problems.

This issue was resolved in July 2005 by a new interagency agreement that provided directions for how to handle further diagnostic

tests, treatment, or referral. Five months later, HHS resumed the

program and decided how to resolve its third issue, dealing with its

authority to provide examinations for former Federal employees.

Mr. Chairman, we believe that Federal, State, and local government officials who are responsible for planning and implementing

health monitoring in the aftermath of any disaster could improve

their effectiveness by applying the lessons learned from the World

Trade Center experience.

For example, officials emphasized how time is of the essence in

identifying and contacting affected people, because the passage of

time erodes their memories and reduces the likelihood of collecting

accurate information.

Using the Rapid Response Registry could reduce delays in collecting time-sensitive data.

Another lesson is the value of centrally coordinated planning,

which could improve the underlying data base for research and

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eliminate the need for separate and sometimes incompatible programs for different populations.

Finally, officials stress that it will be time consuming to identify

providers available to treat participants, especially those without

health insurance.

This may be especially important for mental health care needs,

which are often less obvious initially, but which take on greater

significance over time.

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

questions that you or the other subcommittee members might have.

[The prepared statement of Ms. Bascetta follows:]

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Mr. SHAYS. Thank you very much. Mr. Vega.

STATEMENT OF RONALDO VEGA

Mr. VEGA. Good afternoon, Chairman Shays, and members of the

subcommittee.

I wish to thank you, and especially thank my Congresswoman,

Carolyn Maloney, for inviting me here today.

My name is Ronaldo Vega. I am a registered architect, employed

by the city of New York, Department of Design and Construction

[DDC].

DDC was the city agency tasked by the Mayor to manage the

rescue and recovery effort at Ground Zero. I am also a union official of AFSCME D.C. 37’s local 375, the Civil Service Technical

Guild. Our members have served in the rescue-recovery at Ground

Zero since day one, and continue, even today, at the Medical Examiner’s office.

Along with everyone else who served at Ground Zero, my story

is but one of thousands.

Four and a half years ago, all the world was right. American

families went about their business in blissful ignorance. By this

time on September 11th, the unimaginable death and destruction

had already taken place. Our way of life changed forever.

The general population became paralyzed by grief and horror,

and yet our response was immediate, overwhelming, and fearless.

We went in blindly, first to save whomever we could, and then to

recover as many remains as there were to be recovered.

A byproduct of that search was the clean up of the site. The two

operations went hand in hand. They were inseparable. Human remains and debris had become one. We accomplished both efforts in

9 months, but we left knowing our job was unfinished.

You have no idea how sensitive we were about the lives that

were lost that day. We saw Ground Zero as a mass grave where

a senseless massacre took place. We did all we could to bring them

all home, but the fact that we failed weighs heavily on our minds

still today.

Needless to say, every day offered a new traumatic experience.

For many, just 1 minute at Ground Zero scarred them for life.

How many scars do you suppose we carry, we who worked there

10 hours a day, 7 days a week for 10 months?

Some of these scars reveal themselves when you least expect

them. A few weeks ago, while I was at home, I got up from my

chair and went to the kitchen to get a soda. While I was in there,

my little grandniece, Kayla, decided to play a joke on me by placing

her foot in the opening between the seat cushion and the back rest

of my chair so that by sitting on her foot she could kick me in the

butt.

Well, when I saw that seemingly disembodied foot on the chair,

it triggered a memory. My heart stopped. I held my breath and

shouted, ‘‘oh, no.’’ I caught myself before I broke down in tears.

My daughter, Amanda, noticed my strange behavior and asked,

‘‘what is wrong, dad; are you all right?’’ I answered, ‘‘yeah; yeah,

I am all right. It is nothing.’’

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I hope I never have to tell anyone about the carnage that I witnessed at Ground Zero. It will remain buried in my memory until

it is time to let it go.

In July 2002, after 300 days of service, I left Ground Zero for

what was the last day of the rescue and recovery effort. But before

we left, we sat around the table at the last debriefing meeting, and

everyone said their goodbyes. When my turn came around, all I

could offer was the song ‘‘Danny Boy.’’ I don’t know how it sounded,

but it really didn’t matter. We all cried together for the first and

last time.

We had combed through every inch of that 16-acre site until

there was nothing left. The real last truck left at 10:30 p.m. with

the contents of what was brushed off the windowsills of 1010 Firehouse. It was only then that I turned my attention to my own physical and mental wellbeing.

For the record, I have no doubt in my mind that my exposure

to poisonous toxins at Ground Zero will eventually kill me. The

rule of medicine that toxins wash out of your body 90 days after

exposure does not apply to an environment that contaminates you

continuously over a 10-month period. And post-traumatic stress

disorder will not go away by itself.

There is an overwhelming need for more mental health services.

The WTC Registry, while well meaning, is not an accurate gauge

of the real effects of working at Ground Zero. The Mount Sinai

Monitoring Program monitors the health, but funds are needed to

provide treatment, too.

Today, after much effort and the help of caring organizations like

the New York Rescue Workers Detox Project and Serving Those

Who Serve, the poisons that resided in my body seem to have finally washed out. But it is their path through my body and what

damage they may have caused on their way out that concerns me.

My examination results confirm that 11 months after I began

working on the site, I still had high levels of mercury and arsenic

in my blood. These toxins affect your liver and brain cells. All the

dust and pulverized toxic powder that I inhaled affected my breathing.

My diminished lung capacity will continue to worsen over time,

and if asthma doesn’t get me, then liver disease probably will.

There have been times since Ground Zero that my breathing has

been so labored, I have felt close to death, close to being reunited

with my first-born son, Justin, who died in 1997 from an asthma

attack.

He died praying for one more breath. Working at Ground Zero

was indeed worth dying for. But when the next attack comes, as

we all know it will, you are going to want us there. You are going

to need us there. Whether we will be healthy enough to answer the

call is up to you. The death toll from Ground Zero is still being

counted. What number will I be?

If you let the best trained, most dedicated responders in the

world die from neglect, then the terrorists truly win.

All that I can ask of you is to give us one more breath. Thank

you.

[The prepared statement of Mr. Vega follows:]

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Mr. SHAYS. Thank you, Mr. Vega. Mr. Bethea.

STATEMENT OF MARVIN BETHEA

Mr. BETHEA. Yes. Chairman Shays and distinguished Members

of Congress, thank you for giving me an opportunity to testify here

today.

My name is Marvin Bethea, and I used to be a New York City

paramedic; and I am disabled due to the results of September 11th.

My partner, James Dobson, and myself were assigned to the Trade

Center after the first plane struck.

In the 23 years I was on the job, I have had a gun put to my

head twice. I had been shot at once, and nothing could compare to

what we went through on that day. People ask me what was it like.

Again, I tell people think of going from day to night in no time, and

you are completely blind, and you couldn’t see at all. And at the

same token, you had a big bucket of toxic dirt that was being

thrown down your throat.

We were literally blowing out small pieces of concrete out of our

nose on that day.

Five weeks to the day of September 11th, I suffered a significant

stroke, at which I did recover, and went back to work to only develop asthma, post-traumatic stress disorder, as well as sinusitis

and major depression. January 8, 2004 was the last day I actually

worked.

Why are we here today? We are here today because we have a

major, major health crisis going on. What people failed to realize

is Ron, as well as a lot of other people here, we had very physical

jobs, in which we had to take physicals to get those jobs, and once

we got the jobs, every year we were required to take a yearly physical, in which we passed those physicals so we were allowed to continue to work.

So the question now becomes if all these people were healthy,

why now is everybody sick, and the common denominator is, once

again, it is September 11th. And the numbers are just simply mind

boggling.

We were told that the air was safe, which we all know now is

simply not true. Again, it is a disgrace. I would like to honor Tim

Keller, who was a 41-year-old EOT from New York City EMS, as

well as Mike Kendrick, a 53-year-old, who just died 2 weeks ago,

who was an iron worker with five children, as well as Detective

James Zadroga, 34. And the list goes on.

We basically have been given a slow death sentence, and we all

got to say who is next? Who is the next person to go? That is something that is constantly in our mind.

What has the government done or hasn’t done? I mean the government failed. The September 11th Fund was ideal. It was a great

intention. Execution of it was poorly done.

Again, the parameters of this that were set up was simply totally

unfair, and the people got lost in the system.

If something happens until you wait the first 96 hours, it was

OK. But you take a man like John Feal, for instance, a construction worker, who had half of his left foot amputated about the 17th

day of September 11th. He received nothing from the September

11th Fund, because it didn’t happen within the first 96 hours; and,

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yet the man has had 30 different operations, and he goes back into

the hospital this week for a 33rd operation. Again, the government

gave him zero when it came to the September 11th Fund.

I mean how do we do that?

Also for the fact that fire burned for over 3 months, so all the

people who were down there were being exposed on a continuous

basis. So if you were not there within 96 hours, you got nothing.

If you were there for 3 months, maybe after the fact so you were

still inhaling deadly toxins, but yet nothing was being done, and

you weren’t entitled to anything. That is simply not right.

I have to say thank you to Congresswoman Maloney, Congressman Fossella, and the other elected officials who did help us get

back that $125 million.

Something needs to be looked into with New York State, because

people are unaware of the fact that workers’ comp situation is so

complicated that the workers’ comp claims are being denied five

times greater with September 11th, and something needs to be

done about that as well.

I mean these people are already on edge, and they don’t want to

go through the New York State harassment with the New York

State workers’ comp.

September 11th was the most significant event that happened in

American history today. People often say, where were you when

Kennedy got shot? I remember, because I was 4-years-old. I remember it like it was yesterday, and now people say well, what

about September 11th. Well, you know, September 11th we will

never forget what happened on that day. And you know, it gets

back to the words of John F. Kennedy, who said, you know, ‘‘my

fellow Americans, ask not what your country can do for you. Ask

what you can do for your country.’’

And I would be curious what would President Kennedy say today

about the way in which the heroes and the survivors of September

11th are being treated? It is simply totally un-American that this

is going on.

To the elected officials who made all these promises that we will

never forget you, we will take care of you, I want to know what

has changed now that all of a sudden, we are being forgotten. Do

I need to pull your sound byte and remind you of what you did say

on September 11th? It is an absolute disgrace.

And to the President, Bush, I would say show us some of the

same compassion that I personally showed one of your family members as a patient in my ambulance.

Thank you.

[The prepared statement of Mr. Bethea follows:]

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Mr. SHAYS. Thank you, Mr. Bethea. Dr. Levin.

STATEMENT OF DR. STEPHEN M. LEVIN

Dr. LEVIN. Thank you for letting me testify today.

Mr. SHAYS. Is your mic on, sir?

Dr. LEVIN. Is that working? Is that better?

Mr. SHAYS. I usually find it is the doctors that don’t know how

to do it. I am totally teasing—totally teasing. I don’t get it right.

Dr. LEVIN. Thank you for asking me to testify today. I have been

asked to talk about the unmet health needs in the aftermath of the

September 11th attacks on the World Trade Center. And I hope

that my comments and those of my fellow panelists can draw attention to the widespread and persistent health impacts of such

disasters.

There are thousands of men and women who are still ill and suffering as the result of their heroic rescue and recovery efforts after

the World Trade Center was hit. The horrifying human suffering

and loss of life caused by Hurricane Katrina has again showed the

clear need for our Nation to improve its planning, and implementation of effective public health responses to man-made and natural

disasters.

A public health response should always include protecting the

health of rescue and recovery workers, as well as saving the lives

and protecting disaster victims.

In the heat of the effort to save the lives of victims, we have to

minimize disability and illness among the rescue and recovery

workers and those who bring such devastated areas back to life.

Now, nearly 41⁄2 years after the attacks on the World Trade Center, the men and women who worked in the rescue and recovery

and clean up efforts are still suffering. Respiratory illness, psychological distress, and financial worries have reshaped the lives of

many of these responders.

It is important to note that the World Trade Center responders

were provided with important medical programs that I will talk

about in just a moment. The many thousands of residents of lower

Manhattan and the thousands of workers who returned to the area

within days and weeks of September 11th had no federally funded

services available to them to assess effects on their health. That is

a public health need that remains unmet.

I would like to talk just for a moment about the medical screening and monitoring programs, and they exist, in large part, because

of the efforts of New York’s organized labor community and the

clinical experience accumulated by our Center for Occupational and

environmental medicine and the Medical Department of the Fire

Department of New York City.

Because of their efforts, the Federal Government came to recognize that evaluating and monitoring the health consequences of the

September 11th attacks was important to the health of rescue and

recovery workers.

It was clear also that we had to learn all we could about the

health consequences of this horrific disaster. In June 2002, Mount

Sinai received $11.8 million in Federal funding from NIOSH to design a medical screening program and to organize and coordinate

a consortium of health care centers in New York and nationwide

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to provide free medical screening exams for responders who were

involved in the rescue and recovery efforts, the removal of debris,

the restoration of vital services, and the clean up of the buildings

around Ground Zero, and those who worked at the Staten Island

landfill.

From its inception, in April 2002, to its end, in 2004, the clinical

centers of this program saw nearly 12,000 people. This was an economically and socially diverse group of individuals. And of that

group, nearly 9,000 were seen by Mount Sinai physicians.

We published the results of a 10 percent sample of the people we

saw in that program. They have been discussed before. The real

point is that very high rates of upper respiratory problems like sinusitis, laryngitis, persistent sore throats were reported when people were down at Ground Zero, but also up to the month prior to

their examination in our screening program.

Similarly, very high rates of lung symptoms, chest tightness,

wheezing, shortness of breath, cough were reported among people

who were seen in our program—reported about their experiences

when they were down at Ground Zero, but also up to the month

prior to the time that we saw them.

Approximately 40 percent had persistent psychological distress at

the time that we examined them, and what is very important is

that we did objective pulmonary function testing, not just asked

people about their symptoms, but examined them and did special

pulmonary function testing, and the rates of abnormality were

some two to three times what would be expected in the general

population.

Now, it is important to note that these effects were still occurring

on average 8 months after people had left the Ground Zero site or

their World Trade Center efforts. These were not just brief and

transient problems.

What we are seeing in our clinical settings today are very similar. We are still seeing persistent respiratory problems, psychological problems, and gastrointestinal problems.

Now, Mount Sinai received Federal funding through NIOSH and

the CDC to serve as a clinical center and as a data and coordination center for the World Trade Center Medical Monitoring Program. That is to provide followup examinations every year and half

for 5 years to responders who were seen in the screening program,

and it is also set up to see people for the first time for first examinations among those responders who couldn’t get into the screening

program when it existed.

We began seeing responders in 2004, and we are presently conducting followup examinations, as well as providing initial examinations. And we have seen an additional nearly 2,500 people for

the first time, and nearly 4,000 for repeat examinations.

People are still coming for the first time now 41⁄2 years after September 11th, because of their concerns about either persistent current symptoms or because they are worried about what is going to

happen to their health in the long term.

For many coming to our program, fears of future catastrophic illnesses like cancer, which can take 20 to 30 years to show up, looms

large or larger than their current illnesses, because many responders sustained unprecedented exposures, of which the long-term conVerDate 11-MAY-2000 09:29 Aug 03, 2006 Jkt 000000 PO 00000 Frm 00064 Fmt 6633 Sfmt 6633 D:\DOCS\28531.TXT HGOVREF1 PsN: HGOVREF1
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sequences are unknown. This population should be under medical

surveillance with periodic medical examinations, not just telephone

interviews, for another 30 years, not because we want to count how

many illnesses they develop and whether it is unusual, but because

it is important to detect as early as possible diseases like cancer

that develop years after exposure and that are much more effectively treated if we find them early.

There are new approaches to early detection being developed

every day in research laboratories across the United States and

worldwide. It is important that we use the best tools we have to

protect the health of this remarkable group of men and women,

given what they have done.

We estimate that current funding will permit the World Trade

Center Medical Monitoring Program to conduct examinations of

some 12,000 responders once every year and a half for the next 5

years only, lasting only through 2009.

Let me speak just for a moment about treatment. One of the

greatest concerns in my responders and those of us who are trying

to provide their care——

Mr. SHAYS. Doctor, if you could please summarize.

Dr. LEVIN [continuing]. Is the need for treatment. It is an excellent thing that we were provided with funding to monitor and

evaluate. It is absolutely key that treatment resources be made

available. We were able to obtain some philanthropic funding to set

up a health effects treatment program. We have seen some 1,900

responders in that program. They are persistently ill despite the

best care that we are able to offer them, and the need for care will

not end when that funding runs out in approximately a year and

a half.

It is not enough to tell a person who has done what these responders have done that, yes, you have asthma. Now, go find a way

to get treated.

The data that we have accumulated makes clear that we need to

provide treatment resources for these people. The workers’ compensation system in New York has presented nothing but insults

and frustration for those workers who have attempted to get access

to benefits. A small proportion of claimants have gotten their cases

accepted expeditiously. The majority filed claims that were fought

tooth and nail by workers’ comp insurance companies or self-insured employers, including unfortunately New York City, with genuine heroes being accused of lying and malingering, and their testing and treatment delayed for months and even years.

This is a fragmented health care system in the United States. It

is seen all too clearly in the challenges these heroes have had to

face simply to get treatment for their World Trade Center related

illnesses, and it is important now that we go ahead and provide

mental and medical health care for all who sustained health consequences as a result of this disaster, and that means the residents

in lower Manhattan, as well as all those workers who returned prematurely to that dangerous site.

And it seems that we have to do better if there are going to be

disasters in the future in establishing an infrastructure and a response that truly is public health in its orientation and in its nature.

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We have to provide information to treating physicians, which

didn’t happen in the case of the September 11th disaster, and it is

important that we develop programs to provide early diagnosis and

treatment. These heroes deserve no less, and the people who live

in this the wealthiest of nations have reason to expect that in the

face of disaster, their health needs will be our country’s top priority.

[The prepared statement of Dr. Levin follows:]

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Mr. SHAYS. Thank you, doctor. Dr. Kelly.

STATEMENT OF DR. KERRY J. KELLY

Dr. KELLY. Good afternoon, Chairman Shays, Congresswoman

Maloney, and Congressman Fossella. My name is Dr. Kerry Kelly,

and I am the chief medical officer for the New York City Fire Department.

I would like to thank you for the opportunity to testify today. I

would also like to thank you for the restoration of the $125 million

in September 11th funds, particularly for the $75 million that will

be available to local agencies providing health and mental health

services and monitoring.

On September 11, 2001, the FDNY responded to the World Trade

Center prepared to save lives. That is what they do every single

day. Fire Department members continued their rescue and recovery

efforts at the World Trade Center site for the weeks and months

that followed. Nearly 14,000 of our personnel from every rank took

part in the rescue, recovery, and clean up efforts at the World

Trade Center site. Our first responders were the first in and the

last out.

During the initial recovery and evacuation and later during the

extended recovery that followed, our first responders were exposed

to the physical hazards of the World Trade Center site.

No less significant is that our members were also exposed to the

emotional trauma. Very soon after September 11th, we began to

see medical symptoms, particularly that of respiratory complaints.

In recognition of those exposers, the FDNY initiated the World

Trade Center Medical Screening Program in October 2001, just 4

weeks after September 11th.

The Bureau of Health Services partnered with the CDC and

NIOSH to implement medical screening for the exposed FDNY first

responders. More than 10,000 of our responders were evaluated in

the first 6 months following September 11th, and in collaboration

with NIOSH, we started our medical monitoring followup program.

To date, we have seen over 4,000 of our FDNY exposed first responders in this second visit evaluation. It is our goal to continue

to evaluate 13,700 first responders over the next several years, but

our goal really has to be to take people beyond the 2009 cutoff that

we currently face.

This extended medical monitoring is critical to the early detection and treatment of diseases, such as cancer, heart and lung disease. We know that asbestos-related illness data from prior occupational exposures show that cancer is detected 15 to 30 years after

exposure.

Because HHS had a medical infrastructure in place prior to September 11th that included annual medical examinations for all of

our first responders, we are able to compare pre-September 11th

data to post-September 11th data. What we have seen on a significant basis is a drop in pulmonary function tests. In this healthy,

athletic work population, we have seen a significant decline that

correlates well to the members’ initial time of arrival at Ground

Zero. This pulmonary function decline is 11 times greater than the

average decline you would ordinarily see with aging.

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In the first 6 months following September 11th, 332 of our firefighters required extended medical leave for what has been called

the World Trade Center cough.

Now, 41⁄2 years later, over 25 percent of the FDNY members are

still reporting respiratory symptoms, and 2,000 have received extensive evaluation and treatment for respiratory disease. Nearly all

of these symptoms have been due to asthma or rads. Unfortunately, symptoms persist, and many of our first responders still

need multiple expensive medications.

More than 540 of our fire department firefighters have qualified

for permanent lung disability, a four to five times annual increase

compared to pre-September 11th.

Our counseling service unit responded to the new needs of this

department after September 11th, expanding from a single counseling unit in Manhattan to multiple locations in the communities

where our first responders live.

Partnering with multiple resources, we secured critical funding

to provide needed counseling services. More than 12,000 people

have sought mental health services through our CSU. Are those

needs still there? The answer is yes.

Before September 11th, we treated about 50 new clients a month.

Currently, our 6 locations now average around 260 new intakes a

month. More than 85 percent of our clients are active members

who remain on full duty while seeking assistance.

The city’s Department of Health and Mental Health World Trade

Center Health Registry provides essential tracking of short and

long-term health effects for more than 71,000 enrollees. It is the

only resource designed to track and maintain contact with a diverse group of people most highly affected by exposure to the

events of September 11th.

More than 3,500 of our first responders had to retire sooner than

expected; some with health issues; all with health concerns. These

dedicated first responders would have fallen off our health track

radar were it not for our intensive followup medical and mental

health monitoring program.

Fortunately, with the efforts of the Senators and Members of

Congress, we will receive the additional funding for the Medical

Monitoring Program for another 31⁄2 years, through July 2009.

This monitoring program allows us to monitor and identify early

trends of patterns of illness or wellness.

But as I noted earlier, it will not help us follow for the long term.

We need to continue this monitoring program for 20 to 30 years if

we are to see the long-term consequences of this environmental disaster.

The current Medical Monitoring Program also does not address

treatment. That is one of the many reasons why we need a rapid

disbursement of the $125 million Federal World Trade Center aid

to our treatment centers.

We thank you for the reinstatement of the funds, and we again

hope for that quick reimbursement of funding so that we can provide the needed clinical services.

The FDNY takes great pride in responding to the health and

safety needs of the residents of our city. When the call is sounded,

the FDNY arrives to help, well aware that the threat of terrorism

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remains, our first responders provide security for our homeland

every day. But we have concerns about the health and safety of our

rescue workers.

We have an obligation to make sure that no member is left behind. We lost too many on September 11th. Early diagnosis and

treatment is effective. We can only prevent more loss of life

through sufficient, continued funding to provide long-term monitoring and treatment. Thank you for the opportunity to speak to you

today.

[The prepared statement of Dr. Kelly follows:]

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Mr. SHAYS. Thank you all for your testimony. I will give my time

and take his time and allow Mr. Vito Fossella to ask the first

round. And, Vito, we go 10 minutes.

Mr. FOSSELLA. Thank you very much, Mr. Chairman. I will be

very brief. For Dr. Kelly, and then thank the whole panel for their

testimony in coming here today.

Dr. Kelly, CDC is currently working out the distribution of the

funding that we all mentioned has been restored for treatment.

Now, do you have any projections on the long-term funding needs

for the Medical Monitoring and treatment of, in your case, firefighters?

Dr. KELLY. We would project with additional funding, we would

need about $10 million per year, and again that funding would

ideally take us for the next 3 years, through the year 2009.

That would allow us to do treatment that will supplement what

the American Red Cross has given us. That particular funding is

going to be ending within the 2006–2007 timeframe, as well as to

continue and add to our monitoring program.

Mr. FOSSELLA. Are there any projections beyond 2009?

Dr. KELLY. Again, our minimum would be at least that much,

and we would need to continue that program beyond 2009. It is

very important that we look at the long-term monitoring and treatment. Two thousand and nine, although it sounds far in the future,

really isn’t very far in the timeframe that we are thinking about

if we are going to look at long-term patterns of illness, given the

exposures that we saw in our department.

Mr. FOSSELLA. So we are saying long term. I mean I know you

reference in the testimony upwards of 30 years. Is that to you longterm or is 20 years long-term in your opinion? How do you define

it?

Dr. KELLY. I think 20 to 30 years would be the timeframe we

would be looking at to see the kinds of outcomes that we have seen

in the past from exposures to something just of asbestos, there are

other exposures at that site that we probably don’t even know all

of the different substances and what those long-term outcomes may

be.

Mr. FOSSELLA. OK. For both you and Dr. Levin, funding aside,

are there policies at the Federal level you feel would be helpful or

now a hindrance to assist you in not only, you know, ongoing and

long-term medical monitoring and treatments, but that can better

prepare and help address the needs of firefighters and first responders for a, God forbid, future attack?

Dr. KELLY. I think we were very fortunate that we had a preexisting medical office, and we were there on the ground ready to

start our work. We were able to recognize patterns of illness, because we have a centralized medical office. I think we worked very

well collaborating with fellow medical institutions, such as Mount

Sinai, and we have also worked with CDC and NIOSH so that we

could develop programs that brought thought and balance into

these programs. I think we play a critical role because of the cohort

size we see. We see over 10,000 to 15,000 members. Mount Sinai

sees about the same amount of people. The larger the groups that

you can evaluate and see, the better you are able to see patterns

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of illness, and you can really appreciate the development of treatments and understand how to take care of people.

Dr. LEVIN. If I can just add to what Dr. Kelly has said. It was

clear in the wake of the September 11th disaster that there was

not a coordinated response at any governmental level to the health

concerns. It was rapidly clear to those of us who practice occupational medicine that the likelihood of respiratory problems and psychological distress was very high, given what we saw on television

people being dragged off the pile choking, you know, for breath and

at no point did any level of government issue an advisory to the

treating medical community on how to understand the exposures,

how to understand the illnesses that might develop from those exposures, how to evaluate such individuals, and how to treat them.

We do that for many other illnesses. It is a normal public health

response. It didn’t happen here. And in any disaster situation, it

is the most important thing that physicians and other practitioners

who are going to see such individuals have some idea of how to understand what they are going to be evaluating and treating.

We don’t train our physicians in this country in occupational and

environmental medicine, so the best intentioned of physicians

treated many of our patients with antibiotic after antibiotic for

things that were not infections, but rather chemical burns.

In the situation following September 11th, there never was assembled a panel of people with expertise in public health, in understanding environmental exposures and their consequences, to make

an assessment of what were the exposures and what were the consequences. There was a considerable amount of political and economic influence on policy shaping. It seems to us that a public

health response requires that experts in understanding the health

effects of such exposures have to be isolated from those influences

for at least a period of time so an accurate assessment can be developed and appropriate attempts to control the illnesses among responders and other victims can be developed.

The issue of a failure to develop treatment resources and the

slowness of developing a screening program and monitoring program for other than the fire department, it was a wonderful thing

that they had an infrastructure in place. There was no such infrastructure in place for the other responders other than New York

State’s Occupational Health Clinic Network Centers, which we are

one of. And it was a good thing that we were there.

Nevertheless, the failure to develop a treatment response, we are

still seeing the consequences of because treatment delayed for

many meant a greater severity and longer persistence of their illness.

Mr. FOSSELLA. Is there a time period in which there should be

this treatment response or this group to sit down, as you say, a

panel of experts to assess the nature of the problem and then to

issue the advisories accordingly?

Dr. LEVIN. Three weeks before the disaster and that means now

we should be thinking about what sort of panels are appropriate

to pull together for this purpose. But certainly after a disaster,

within a day, it is possible to gather people with relevant expertise

to assess the situation and develop proposals as to how to mount

a public health response.

96

We are an advanced technological society. We are capable of

doing this sort of thing, and it requires the political will to make

sure that it happens, because technically it is possible to do it.

Mr. FOSSELLA. Finally, doctor, and it is more of I guess procedural—I know there was many—and we have received some calls

from some former New York City Police Department officers who

are now retired and living in other States. My understanding is

Mount Sinai contracts with the clinics outside of New York, so September 11th responders living in those areas have a place to go for

exams. Can you elaborate on that, and if there are those officers

who are not near one of these clinics, are there plans in the works

to identify clinics that are better prepared to handle that population?

Dr. LEVIN. Under the auspices of our screening program, from

2002 through 2004, we saw nearly 700 responders from around the

country outside of the New York Metropolitan Area, who had come

to New York and done their significant rescue and recovery efforts

and then returned home.

We were able to work with an association of occupational medicine clinics that exists throughout the United States during that

time to provide screening examinations. No treatment resources

were available for that group as well.

In the monitoring program, we are now in the process of setting

up exactly that sort of network around the country to provide a second round of examinations and ongoing examinations to those responders from around the country.

Again, the issue of treatment resources for them will be a problem. There are some responders from areas of the country where

there is no local expertise in occupational or environmental medicine. There isn’t an occupational medicine center nearby.

We will work with local physicians, providing them with basic

training materials on how to do the assessments that we do here

in our programs in the New York Metropolitan Area, and how to

make appropriate referrals with guidance sheets as to how to understand these illnesses and how to manage them and treat them

so that local physicians, even if they don’t have expertise in occupational medicine and unfortunately too many don’t, will at least

have the guidance of our experience that we have accumulated over

the last 41⁄2 years.

Mr. FOSSELLA. So it is up to, say, in this case, an individual to

see if there is a local physician willing to assume that responsibility and willingness to learn from you how to handle——

Dr. LEVIN. We will try to identify such physicians in any geographical area where responders are. If they are unable to travel

to get to a clinical center with real expertise, we will try to identify

local practitioners, physicians with whom we can work to provide

these examinations.

Mr. FOSSELLA. Thank you very much. Thank you.

Mr. SHAYS. I thank the gentleman. Mrs. Maloney, you have the

floor.

Mrs. MALONEY. Thank you. First of all, I would like to thank all

of the witnesses today for their excellent testimony, especially our

two September 11th responders, Ron Vega, who is a constituent of

mine, and Marvin Bethea, who is a founding member of the UnVerDate 11-MAY-2000 09:29 Aug 03, 2006 Jkt 000000 PO 00000 Frm 00100 Fmt 6633 Sfmt 6633 D:\DOCS\28531.TXT HGOVREF1 PsN: HGOVREF1
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sung Heroes Helping Heroes, a group that I am always proud to

stand with in our fight for September 11th issues. And they are

representative of thousands more workers, and they have led efforts to bring their concerns to Congress. They have been here

many times, and I thank them for their work.

I would like to ask Ron Vega. It is my understanding that you

are a participant in both the World Trade Center Monitoring Program and the World Trade Center Health Registry.

Can you tell me about your experiences with each, and were they

helpful to you?

Mr. VEGA. Thank you for your help. I have to say that the Registry, which I participated in, as I have said, probably a month

after I left the site in 2002, I have to be apologetic. It had so little

significance to me that I forgot that I even participated in it.

I remember that we were forced by our agencies and nagged and

nagged and nagged to make that call, and then, when we made the

call, we were very frustrated by the questions that were being

asked of us. It was actually kind of consultant service that was

hired. These people really had no idea what we had been through.

The presentation of the questions were very insulting in many

ways. The questions that we were being asked were like don’t you

know what we have been through? Why are you asking us that?

So I have to say it reminded me of when I was a young teenager

and I got a survey about somebody doing a sex survey and how active I was in my teens sexually. I have to say I lied a lot on that

survey.

And I had the same reaction on this survey. I didn’t really know

how to answer it, because I knew that the questions did not allow

the proper answer that I wanted to give.

So I do appreciate the attempt that was made, but I didn’t really

appreciate the questionnaire or the people that were asking. I was

pretty frustrated when I got off that phone. I think I needed therapy when I got off the phone, and there was nothing there. So that

is why when the WTC Mount Sinai Program started, at least it

was something that said look you go into a hospital. You are going

to a hospital environment. You are going to go see nurses, doctors.

People are going to look at your health. They are going to give you

an examination. Even that in a sense is frustrating, because you

feel like OK, you are going to watch me die, and you are going to

watch me die over 20 years. And you are going to confirm that I

died out of something I got at Ground Zero. But maybe that will

help other people.

See you keep talking about long-term monitoring. I don’t think

I have 10 more years. I am pretty sure I don’t. I don’t think Marvin

thinks he has it, either. Not that we are going to see 10 more

years. We are going to make these good 10 years, and no doubt if

the country calls upon us again, we will go. But I am pretty sure

I don’t have it. So just monitor us until it makes a difference.

Mrs. MALONEY. Have you received treatment from the Monitoring Program?

Mr. VEGA. No. No, I have not.

Mrs. MALONEY. Have you received treatment for your condition

anywhere?

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Mr. VEGA. Here is the problem: the problem is if we are working

city workers, we can’t take the time off to prove we are disabled.

I am an architect. So what if I can’t walk up 5 flights of stairs anymore. Take the elevator. You can still do some design, can’t you?

But the problem is I can’t. I can’t even function half as much as

I did before. When you can’t breathe, when you think you don’t

have much life left, guess what? It affects the way you work mentally also.

So we are at a high level of mental—I mean I always thought

that I was a pretty good architect.

Mr. SHAYS. Could the gentlelady yield for a second?

Mrs. MALONEY. I yield to the chairman.

Mr. VAN HOLLEN. Yes.

Mr. SHAYS. You know, this is very sensitive, but I find myself reacting to what you are saying in one way impress that you have

an attitude, but feeling like you need to think differently. And I

really believe that do you do things like exercise? Do you do things

to compensate or—I mean maybe this isn’t part of the hearing, but

it strikes me that when we talk about mental health issues, this

is as much a mental health as a physical issue for you. And I am

thinking that the system is broken down more than I even thought,

if you are allowed to think that without at least being confronted.

So I want to confront you with it as——

Mr. VEGA. No, you are right on target. You are right on target.

They are interchangeable. They are intermixed.

Mr. SHAYS. Do you have kids?

Mr. VEGA. Yes, I do.

Mr. SHAYS. How old are they?

Mr. VEGA. My oldest now is 25.

Mr. SHAYS. Right.

Mr. VEGA. No. 2 is 20, and No. 3 will turn 18 this Friday, God

help me.

Mr. SHAYS. OK.

Mr. VEGA. So——

Mr. SHAYS. You need a 5-year-old that makes you want to live

for more than 10 years.

Mr. VEGA. No, I have a grandniece, who makes me want to live,

and she makes me want to live every minute that I live.

Mr. SHAYS. Right.

Mr. VEGA. When you know what it is like to be without air, and

you get that feeling constantly, when you have to walk all around

your life with one of these—it goes to a nebulizer——

Mr. SHAYS. Has the medical community told you have 10 years

to live?

Mr. VEGA. No. No, no, no.

Mr. SHAYS. Yes.

Mr. VEGA. You know, as I said in my testimony——

Mr. SHAYS. You know what I would—we don’t have the 10-

minute rule with the——

Mr. VEGA. Oh, OK.

Mr. SHAYS [continuing]. Gentlelady from New York and I when

there is just two of us left. So I will give her back the floor.

Mr. VEGA. OK.

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Mr. SHAYS. I just needed to tell you that I couldn’t lead this

hearing and hear you say what you are saying without wondering

a bit about whether that is to your advantage to feel that way. And

I wish there was some doctors that could comment about it.

Mr. VEGA. I appreciate what you are saying. I really do.

Mr. SHAYS. Where is Dr. Fleming when we need him?

Mr. VEGA. I hope I am wrong, believe me. I hope I am wrong,

too.

Mr. SHAYS. I mean, Dr. Levin, maybe you could just respond in

general about the attitude that says you are—I mean should we

make an assumption that people can’t be helped, that they can’t

find healings? I mean tell me. Help me out. Dr. Kelly.

Dr. KELLY. When we did questionnaires right after September

11th, we asked people about health concerns. Even those who

didn’t have an active problem truly believed their lives would be

shortened by their exposures. The feeling that you had when all of

that dust and debris were falling down on you was that this can’t

be good for my health. And for the people who continued to have

respiratory symptoms, particularly in a group who was in good

health before that, this was a group who was very athletic, very

physical. They sought our department work, because they liked

that hands on. They had no problem running up and down buildings with equipment on.

When you suddenly can’t do what you could do before, life, as you

know it, changes.

Mr. SHAYS. Right.

Dr. KELLY. You know he brings up the point that someone says

you can take an elevator, but that is not what you planned on

doing with your life, so people have a changed image of their own

health, their wellbeing, and what their future holds.

Mr. SHAYS. I guess I am reminded of Congressman Dingel, who

told a whole group of us his father was a rather crusty guy, and

the doctor told him he only had 5 more years to live, and he said,

the hell with that. He said, I am going to piss on your grave. And

that is Congressman Dingel’s father, and he lived many, many

years, and I am just responding to that.

Dr. LEVIN. Well, let me comment on this because our clinical experience tells us that many of our patients who have been given

the best of care we know how to give are improving but very few

are feeling the way they did before September 11th.

Mr. SHAYS. But that is a different issue. Yes.

Dr. LEVIN. And the issue of whether, in fact, people’s lives will

be shortened by this experience is not something that we can answer with any certainty——

Mr. SHAYS. True.

Dr. LEVIN [continuing]. At this point. And unfortunately, the recent deaths in New York have provoked lots of words among World

Trade Center responders as well as community residents and everyone who came back to work in lower Manhattan.

Mr. SHAYS. I just don’t like the idea that we are going to pay

money to monitor their death. I want to monitor their life, and I

want to find ways to help them live.

Dr. LEVIN. I think the last point that you made is the most important point.

100

We are interested in learning what we can about the consequences of this disaster. We are much more interested in trying

to intervene so that people’s health can be protected, improved, and

that unnecessary death can be prevented. That is the purpose of

the monitoring program, not to gather statistics.

Dr. KELLY. And the other thing is that this is health and mental

health, and we know that those two go together, and that your

mindset affects how you feel physically.

Mr. SHAYS. Right.

Dr. KELLY. And attention to the mental health aspect is critical

in this monitoring program. We know that the full effect from a

mental health perspective is not always felt, a week or two after

the event. It is felt later. And addressing that issue is a critical

part of what this program is all about.

Mr. SHAYS. Well, the bottom line is, Mr. Vega, I like you a lot.

I want you to live a long life.

Mr. VEGA. I just hope that you understand I am about the most

positive person on Earth.

Mr. SHAYS. I know.

Mr. VEGA. So when I say that, it carries a little more weight.

Mr. SHAYS. Well, you are a beautiful man, and——

Mr. VEGA. Thank you so much.

Mr. SHAYS [continuing]. Mr. Bethea.

Mrs. MALONEY. OK. Thank you, Mr. Chairman. I would like to

ask Marvin Bethea if he would share with us his chart on the

medicines that tells a huge story in itself. And I would also like you

to share some of your experiences and specifically do you believe

or think it is the responsibility of the Federal Government to fully

monitor and treat the sick and injured September 11th responders?

Mr. BETHEA. Absolutely. Again, I would like to draw and say now

being sick changes your life. I mean I was very athletic, and I took

great pride in the fact that at 38, I could hit the boys’ ball to the

second baseman, and still beat the ball to first. I mean that is how

fast I was. They had to go up two flights of stairs of huffing and

puffing. I played tennis. I rode bicycles. I was very athletic. But

again, being a paramedic, we had to climb up and down stairs. You

carry a patient, so with September 11th we went. We served. We

did what we had to do on that day, not realizing that this is going

to be a slow death sentence. And as much as you try to think positive, you do think about death. And I mean I am very grateful for

the Mount Sinai program, and my psychiatrist, Dr. Laurie Malkoff,

because without her, I don’t know if I would be here today. The

tests might mean I will never be the same. I am very, very emotional. You know being on all this medicine, it is very hard.

For instance, before September 11th, I was taking two medicines

for colitis. And now, because of September 11th, here is all the

medicine I have to take.

Mrs. MALONEY. How are you treated? Are you a part of the Monitoring Program, on the Registry?

Mr. BETHEA. Right. I was very—I am sorry.

Mrs. MALONEY. What are your experiences with the Monitoring

Program and the Registry?

Mr. BETHEA. The Monitoring Program at Mount Sinai has been

absolutely wonderful. I was very fortunate that I got into the proVerDate 11-MAY-2000 09:29 Aug 03, 2006 Jkt 000000 PO 00000 Frm 00104 Fmt 6633 Sfmt 6633 D:\DOCS\28531.TXT HGOVREF1 PsN: HGOVREF1
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gram early enough not only to get monitoring, but I also get the

treatment. And so I was one of the lucky guys—myself as well as

my partner. But there is, you know, like a 3-month waiting list to

get treatment. So again, is it is nice that the government can tell

you OK, you can go here. You will get monitoring. We will do some

screening. But as far as your asthma, post-traumatic stress disorder or any other problem you have, well, you are on your own,

and come back in another 5 months, and we will tell you whether

or not you still have these problems, but yet, we are still not going

to give you treatment, because of the thing is diagnosing, recognizing what you do have and then on top of it is then making sure

the person gets the treatment. And unfortunately, too many people

are not getting the treatment, and the Federal Government needs

to have—I mean we see this also go down with Katrina—a Federal

health care insurance where that if anyone responds to a manmade or a natural disaster that and you respond in an official capacity, and, God forbid, you get injured or hurt, that you will have

Federal health care coverage as well as receive some type of financial compensation, because now they tell everybody about COBRA.

Oh, go out and get COBRA.

Well, COBRA is nice, but if you aren’t working and have no

money, COBRA costs money, so you don’t have health care. All of

this is a real wakeup call for me, because I have always had health

care insurance. And all of a sudden, when I stopped working and

I lost my benefits, it was like, oh, my God, I am one of those 43

million plus people who don’t have health care. And that was a real

wakeup call.

Fortunately now, since I do receive Social Security, I now have

my health care back through my union, but for a while there, I did

not have health care, and you don’t realize how important it is

until you don’t have it. And, you know, we all went out to do our

jobs that day. I mean you look at a lot of these young people who

were so affected by September 11th that they turned around and

they joined the military. They got into the Armed Forces, because

everybody felt they had to do something to support this country,

and that is what we did.

And it is a shame now again and I get back to President Kennedy. I always admired President Kennedy that, you know, what

would President Kennedy say to what the U.S. Government is

doing today about the treatment of heroes and survivors. It is totally un-American, and we are a better Nation than that, and we

can do better than that. It doesn’t make any difference whether you

are a Democrat, Republican, or an Independent or whether you are

a Catholic, Jewish, Protestant, Muslim. You know, we are a better

country. I mean you cut me. I bleed red. You bleed red. And it is

just a shame that we have somehow lost sight of all this. I was

very touched and moved by especially New York City, as well as

the country right after September 11th how we all became one.

And it wasn’t this or that. We were all united together, and unfortunately, as the years have passed now, we started to lose that,

and we are quickly forgetting what brought us all together again.

And some people say it is almost as if we need another attack

to wake us up again, and we don’t want that to happen, but, you

know, we could do a lot better than that, because why should any

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rescue people respond to anything knowing that, God forbid, I get

hurt or I get sick that I won’t be able to take care of myself or my

family. I mean these people—I know guys that are losing their

families, losing their homes, because there is no money, and every

time they go and try to get help, it is like, well, you don’t qualify

for this. You didn’t fill out the paperwork soon enough. And I

know, yes, we are a better country than that. We truly are, and we

need to take care of the people, because you can pay me now or

you can pay me later. And we need to pay the people and do it

now, so we don’t wind up paying a big price down the road.

Mrs. MALONEY. Well, I think you raised a lot of important points

and that we need to, God forbid, we have another September 11th,

but we have to learn from this experience for future disasters and

future emergencies.

I want to compliment Dr. Kelly on your testimony. The fire department really is the symbol of the strength and resilience of New

York. You lost so many people. They performed so bravely, and I

know I join Congressman Fossella in supporting his line of questioning on what it is you need to continue your work and just ask

that request be placed in writing to our committee so we can continue to work with you and the administration on meeting your

needs.

I would like to pose the same question to Dr. Levin that Congressman Fossella posed to Dr. Kelly, which is, what do you feel

you need to complete your work in terms of resource and length of

time, and I—what do you feel that you as a consortium need to continue to complete the work of helping the September 11th responders?

Dr. LEVIN. About a year or a year and a half ago, we were asked

to come up with an estimate of what would be needed to follow this

group of responders out over the next 20 years, not just for screening evaluations and monitoring examinations, but for treatment as

well.

Dr. Prezant, Dr. Kelly’s colleague, and I sat down and quickly

made an assessment of well, what were our current levels of funding, what were we not able to do with that funding, and what

would be needed.

And over the next 20 years, we made an estimate of about $315 million to $320 million to provide monitoring as well as treatment

resources over this next 20-year period. If this population——

Mrs. MALONEY. And that is with the fire department and Mount

Sinai or just the Mount Sinai consortium?

Dr. LEVIN. At that time, it was the two programs combined.

Mrs. MALONEY. The two programs together.

Dr. LEVIN. We have learned some now that we didn’t know when

we made that first estimate of what it really costs to provide especially mental health services, how commonly these mental health

problems are experienced by our responder populations, and how

severe they are.

And I think that initial estimate was probably something of an

underestimate, but it is a reasonable approximation.

The problem is that following people for only 20 years means

that some people will go ahead and develop cancers as a consequence of their exposures at Ground Zero or at that Staten IsVerDate 11-MAY-2000 09:29 Aug 03, 2006 Jkt 000000 PO 00000 Frm 00106 Fmt 6633 Sfmt 6633 D:\DOCS\28531.TXT HGOVREF1 PsN: HGOVREF1
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land landfill, who will not develop those diseases within 20 years

time. We know the experience of occupational groups and how long

it takes for them to get their cancers after exposures.

So a period of at least 30 years is warranted, which means that

some additional money would be needed to follow them for another

10 years.

Mrs. MALONEY. Thank you, and I join Fossella in hoping you will

get that to us in writing.

And GAO, you haven’t had a question yet, so I thank you for

your testimony and the many research papers that have done on

the September 11th response and what is needed.

And I would like to ask isn’t it likely that the variation in the

current array of monitoring programs—I believe you mentioned

four in your testimony—will lead to many situations in which people will have the same exposure, but may not have their needs met

because they will have unequal access to exams, unequal followup

and unequal treatment.

Ms. BASCETTA. Yes, that is certainly the case. I think that Dr.

Levin characterized our health care system as fragmented and

that, in combination, with a rather haphazard approach to monitoring as the situation evolved over the last several years, you know,

creates, as we have stated, some people who get only a one-time

exam; others who get an examination with followup. Those examinations are not necessarily consistent across the programs, and

they are certainly not needs-based. They are not based on the exposure that the individual experienced. They are based on what program the person is eligible for, so that certainly creates inequities

across the programs if you are looking from a needs-based perspective.

We would also about the differences in referral patterns and how

consistently those might be occurring. So you are correct in your

characterization.

Mrs. MALONEY. So it what hat you wore, not what dirty air you

breathed in?

Ms. BASCETTA. That is right.

Mrs. MALONEY. In terms of what you are confronted with treatment. It should be the same. If you breathe the same dirty air, got

the same exposure, you should get the same treatment, is that basically what you are saying?

Ms. BASCETTA. From a medical perspective, that is what you

would need.

Mrs. MALONEY. Thank you. My time is up, but I have one last

question. I would like to ask Dr. Kelly and Dr. Levin, I would like

to ask you about the World Trade Center Registry, and has this

Registry ever provided you with any information that you have

found valuable in conducting your medical monitoring programs?

Dr. LEVIN. Well, I will take a first crack at that. They did release

interim reports based on their telephone surveys, and what it did

was confirm what we were seeing among our responder populations—fairly high rates of respiratory symptoms being reported

and some psychological distress, as well as gastrointestinal problems.

I can’t say that anything has been learned that is new that we

didn’t already know from our examination programs. And it is

104

probably too early for a registry of that sort to be able to identify

problems since many of the diseases that presumably the registry

was set up to identify aren’t going to appear for another 20, 25

years.

The real problem that I have with the Registry, and this is something of a technical matter, is whether it has the statistical power,

enough people in its enrollment, to be able to detect increases in

some of the diseases that we are concerned may result from these

exposures. The epidemiological method that it uses and this is by

their own calculations indicates that they may not have numbers

sufficient to be able to answer important questions like are lung

cancers going to be increased in this population.

So registries are valuable and important if they have the technical capacity to answer the questions they are set up to answer.

I am not confident that this registry can do that, and that is a real

concern. We have not learned anything new from them thus far.

Mrs. MALONEY. To followup, in reading your papers and others,

the ‘‘World Trade Center cough’’ is usually described as a respiratory problem, a breathing problem. Many of the people who

come to me have rashes and breathing problems.

You mentioned gastrointestinal problems, and is this something

that is new coming out years later, but in the first research I

wasn’t gastrointestinal. And is that as prevalent as the cough pattern? When you have the cough, do you have the related gastro—

I think the point that you made on having medical protocol like we

have for SARS is very, very important so that we know what to

look at, and I have many people call me on their concerns, and this

is the first time I have heard gastrointestinal. Is that as prevalent

as the breathing?

Dr. LEVIN. We reported on it early, in September 2004, and we

began seeing it as soon as we began seeing patients that people

were experiencing acid reflux problems, very severe heartburn,

chest discomfort with acid secretions backing up into their throats.

People had never had this problem before September 11th.

Then we talked to our colleagues at the fire department, and

they were seeing this very frequently among the firefighter responders. And it is quite clear that in our treatment program, not

the monitoring program, a very high proportion of our patients

have this reflux problem. That is what we mean by the gastrointestinal problem, and it complicates asthma and sinusitis. Those

people who have acid reflux, who also have sinusitis and asthma,

we find very much more difficult to manage medically because the

reflux itself makes those other conditions much worse.

Mr. SHAYS. Why is that?

Dr. LEVIN. We don’t have a full understanding, but clearly the

acid, when it backs up to the throat, some of it is inhaled, and that

acid is a very strong irritant to the respiratory tract, whether we

are talking about sinuses or whether we are talking about the airways in the lungs. And we know that acid mist can provoke asthma and cause it and make it much worse.

Maybe Dr. Kelly has some new understanding of how the acid

reflux makes conditions worse, but certainly we observe that those

patients who have this problem, especially if it is uncontrolled, find

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that their asthma and their sinusitis is much more difficult to take

care of.

Dr. KELLY. I don’t begin to have the answers, but we have seen

that same increase in GI-type symptoms. It can even be a reason

for a cough. It can certainly affect some of the voice changes that

people have, because as that acid refluxes back, it can affect the

vocal chords, so that a lot of the upper symptoms can be influenced

and the cough with the GI symptoms.

But, you know, getting back to the Registry, I think the Registry

serves a different purpose than the monitoring program. It is not

a substitute for a monitoring program, and I think the problem always is if there is X amount of money, none of us should be in a

position where we are competing with the Registry for money. They

are separate programs. They serve separate needs.

But to look at the overall pattern of the people who were there

and to see trends it serves a purpose in that regard. And I think

it also serves as a unified presence so that people who are looking

to do research and looking to develop programs about other aspects. You know, we just talked about a fragmented medical program. There are specific groups of people that may have been at

the September 11th situation whose conditions or problems are

similar to hurricane victims in Florida, and if there is someone in

that medical community who is studying the effects on a group of

school-aged children, you have the ability through the Registry to

look at a comparison in that group.

Therefore, people who are outside of that mainstream that we

are looking at might be able to be looked at through the Registry.

So it does serve a purpose. It is not the same as a monitoring

program. We can’t look at it to provide the same sets of information, but it is another tool to help us look at long-term patterns.

Mrs. MALONEY. As a followup to you and Dr. Levin, all of these

individuals, all individuals are eligible to be part of the Registry,

but area residents and school children are not allowed to be part

of the Federal monitoring program. Does that make sense to you?

Do you believe access to medical monitoring should be based on

who you are or what you were exposed to? And I open it up to Dr.

Kelly and Dr. Levin for any comments.

Who you are or what you are exposed to, because you have all

these programs, and they are limited. This is for this group of people. This is for that group of people. At the very least, the Registry

is open to everyone, and again I just ask do you believe access to

medical monitoring and treatment should be based on who you are

or what you were exposed to?

Dr. LEVIN. Well, I think it is clear that the exposures should be

the key aspect of this, and I say that on the basis of real clinical

experience. We have in our Center for Occupational and Environmental Medicine many patients who were not eligible for the monitoring program or the screening program, because they weren’t responders. They were people who were required to come back to

their employment in lower Manhattan sometimes within a week of

September 11th, in part because the EPA said that air quality was

safe, the employer said you have to come back to work or you don’t

have a job. I have patients who never had asthma before, who

came back to office space within a week of September 11th that

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was 4 or 5 blocks southeast of Ground Zero. Each day they would

go from subway to their offices, walking through that cloud of dust

and smoke and developed asthma, developed sinusitis, the same

conditions that the responders developed.

There is no access to a program for such individuals, and the

same can be said of some of the community residents, who returned to their homes, their apartments; found themselves exposed;

found their children developing asthma for the first time. Some of

them had adequate insurance. Many did not. Many found it difficult to get health care. And it seems to me a public health response that is comprehensive, especially in a country that can afford to do this sort of thing, would entail making sure that all the

affected people had an opportunity to be evaluated and taken care

of.

Mrs. MALONEY. Any comment, Dr. Kelly?

Dr. KELLY. Well, our particular group has always taken care of

our fire department, so that has been our avenue of concern, and

I suppose our exposure has placed us in the forefront of this event,

because we again were the first there and the last to leave.

So looking at our health patterns, I think helps other people see

what their exposures were, because there were none in my mind

greater than ours.

And certainly the mental health, we have seen the trickle down

effect not only to our first responders, but their families, so that

it is clear that these effects were felt across the board, not just by

the people there, but the people in that surrounding area.

Mrs. MALONEY. Thank you for your testimony.

Mr. SHAYS. Thank you. Mr. Bethea and Mr. Vega, when you were

working at Ground Zero, were you paid employees or were you volunteers?

Mr. VEGA. I worked for the city of New York, but I volunteered

for that detail.

Mr. SHAYS. So they were asking for volunteers, but you were

being paid as a city employee.

Mr. VEGA. In lieu of going to our regular city job——

Mr. SHAYS. Exactly.

Mr. VEGA [continuing]. That became our city job. Yes.

Mr. SHAYS. Mr. Bethea.

Mr. BETHEA. I am a 911 paramedic, and in New York City half

of the EMS system is run by the city fire department providing

hospitals like Saint Vincent’s——

Mr. SHAYS. Well, let me ask you how long were you at the site?

Mr. BETHEA. I was there that day. I got buried by both towers

that day, and then I went back on the 14th, the day the President

came, and dug all day.

Mr. SHAYS. So you were only the——

Mr. BETHEA. Two days.

Mr. SHAYS. Just 2 days.

Mr. BETHEA. Two days. I got buried the first day, and then on

the 14th. And you can hear this——

Mr. SHAYS. And you, Mr. Vega, were there for 10——

Mr. VEGA. Ten months.

Mr. SHAYS [continuing]. Yes 10 months. It is interesting for me

to kind of sort how some people can be there for, you know, 10

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months and be healthy and others 10 months and not, and then

someone 2 days and not be healthy with just 2 days——

Mr. VEGA. If you had seen that site, you would understand. That

site gave up plumes of toxic fumes from unpredictable spots. If you

wound up being in that wind stream, you inhaled about 10 months

worth. Or if you worked there 10 months and you were able to

avoid the blue-greenish smoke as it came out of the hole, you were

OK.

Mr. SHAYS. Would you. Yes?

Mr. BETHEA. Again, it is just like, you know, in medicine, we

have different routes at which you give medicine. And like take it—

and given intravenously, that is the quickest way to get medicine.

But if I take the medicine and rub a cream on you and it is absorbed through the skin, it will take an effect, but it takes longer.

So you have to understand on that first day, when those towers

came down, we got a massive dose of all the toxins that was in the

air, because you got to remember, I mean I was literally white from

head to toe——

Mr. SHAYS. OK. So——

Mr. BETHEA [continuing]. And I was literally blowing out pieces

of concrete out of my nose that day, so I inhaled a major—it was

like—the best way to describe it was a big bucket of toxic dirt that

I swallowed, and so that is why a lot of us who were there that

first day got sick, because we were there when the towers came

down.

Mr. SHAYS. Well, which was leading into my first question I

looked to my left. I looked to my right. I see this unbelievable picture of just, you know, 90 plus stories two times, plus another

building, all in total debris next to the Statue of Liberty. There is

something incredibly poetic or striking about that. But I have empathy for government officials that allowed you to be there the first

day because you were hoping to save lives that day. But once it

began that we were looking for body parts, I am just wrestling with

how it is that we allowed this to happen. That is what I wrestle

with and others. As eager as you are to get in there, you know we

should have held you back. I am talking to Mr. Vega. We should

have held you back.

Mr. VEGA. I thought that same thing many times. After the first

2 weeks, there should have been a stop, hold, let us rethink this.

I understand what it was like to go in there looking for bodies and

try to save people. A lot of the engineering feats we did on that site

were to save people. But after 2 or 3 weeks, pretty much all hope

was lost, and there should have been a step back. Let us look at

this.

Mr. SHAYS. But then I am struck by that fact that in 10 months,

you all did what some people said was going to take 2 years. And

you got that out of the downtown Manhattan and out of the center,

so, in a sense, lots of lives were saved, because we could have just

let that thing smolder for years, and it would have just been spewing out all the caustic things it did.

Ms. Bascetta, as Director of Health Care, tell me your background, your expertise?

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Ms. BASCETTA. My expertise is in public health. And before I

worked in this area, I spent about 8 years looking at veterans’

health care and disability compensation.

Mr. SHAYS. So I guess as you are doing this study, I am curious

if you said, my God, how is it that we allowed this to happen? I

mean I am in the outside looking in. I am not a medical professional, but I know we would never have allowed in downtown Manhattan to have a landfill, a burning landfill. I mean so and we

wouldn’t, because it would be highly dangerous.

So this thing is highly dangerous, and it was highly dangerous

for nearly 10 months. But what I am wrestling with is why we

didn’t tell people they had to go in in suits and total protective

gear, and if you couldn’t work in that condition for 8 hours, maybe

you worked for 2, and we just kept bringing new people in, and you

had 2 hours on, 2 hours off, and so on.

Tell me if you had any of these emotions when you were doing

this study? Or in thinking about it now?

Ms. BASCETTA. Well, I used to work for the Occupational Safety

and Health Administration.

Mr. SHAYS. Pardon me?

Ms. BASCETTA. I worked for the Occupational Safety and Health

Administration, and so as a person with that background when I

was watching as a citizen, I was very concerned about the exposures of people who would be engaged in recovery operations. But

I have to say I mean I think everyone was overcome by the emotion

of the time. It was unprecedented. You know there are lots of problems fitting personal protective equipment, particularly on a scene

like that. It would have absolutely slowed things way down, perhaps appropriately.

You know I think we need to step back for a moment and ask

why our preparedness overall is a problem, and I think that part

of it is that we don’t think before an event about what we need to

do and what we need to be concerned about. We didn’t think, you

know, from the first day about what we needed to do to prevent

the people who were going to go in and do the recovery operations.

We didn’t think about——

Mr. SHAYS. But there wasn’t even one person?

Ms. BASCETTA. Well, we didn’t think systematically. I mean we

had——

Mr. SHAYS. Yes. I guess what I would be interested is I would

love to have a hearing with that person who said, you know, I was

saying this and no one was listening. Then I would like to know

why no one was listening. It had to have been somebody who said

this is about the craziest thing in the world.

Ms. BASCETTA. Yeah.

Mr. SHAYS. And, you know, the Congress included. Me included.

Ms. BASCETTA. Well, I am asking.

Mr. SHAYS. All of us. I mean I think about it now, and I just—

well——

Ms. BASCETTA. Well, I am asking myself now whether we are repeating something in a different situation in New Orleans, where

we have workers engaged in recovery operations there who, you

know, under the National Response Plan, OSHA has an obligation

to assure that they are provided with equipment to make that job

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as safe as possible, and EPA has done some amount of monitoring.

I hear anecdotally that, you know, there are disputes about the

EPA measurements.

I mean it seems to me that several years from now, we could be

in a similar situation were we have some other kind of Katrina-related health effects, and we haven’t proactively dealt with that either.

Mr. SHAYS. Help me, Dr. Levin, Dr. Kelly, wrestle with the issue

of Mr. Vega and this is a hearing from the people at the front here,

sir. You can speak to any Member afterwards. We would be happy

to talk with you. Thank you.

Let me ask you is there anyone in this audience that was involved in the clean up site, if you would raise your hand, is anybody here?

[Show of hands.]

Mr. SHAYS. OK. We may invite one or two of you to come up

afterwards, so we will see about that. All right?

What is the point of monitoring for monitoring’s sake? Let me

ask you this, Mr. Vega: what kind of health care are you getting

right now?

Mr. VEGA. Whatever my city health insurance can offer me. It is

almost like a catch 22. You can’t claim you were hurt at Ground

Zero, otherwise you got to go to workers’ comp, and otherwise you

have to take time off from work. I can’t afford any of those.

So now, you wind up going to your regular doctor who has no

training in this kind of toxic exposure. When I give him my test

results and show the high mercury and the high arsenic, he had

no idea what to do. There was not any doctor in his whole service,

provider service, that could deal with this. I just had to sit back

and get a bunch of these. And this is what I am on—albutyrol and

nebulizers.

Mr. SHAYS. But that may not be helping you.

Mr. VEGA. This is all I have. This is all I have. I hear now——

Mr. SHAYS. I mean I don’t want to continue a program that is

going to continue with what you are doing. I want you to get help.

Mr. VEGA. Well, that is what we are asking you to do, to continue

a program and offer some treatment component with the Mount

Sinai situation. That would be the best thing.

I mean I am a city worker recovering from Ground Zero contamination, but I am using my regular city services. It is crazy. There

should be some kind of like medical consortium saying let us attack

what happened at Ground Zero. Let us put all these people together and find out how to help them, like we just came out of

some toxic disaster, and you want to make sure we don’t contaminate anybody else. There should have been some way to say look,

let us take care of these people, not because they are nice people,

but because you are probably going to need them tomorrow.

I mean we really feel like we have been abandoned here. We

were sent back to our city jobs. Go back and design your libraries

and your churches and your firehouses and go back to your life as

normal. It was us being proactive that said, no, we need debriefing.

We need mental health services. We need you to put everybody

that came back. I mean 1 day coming back from that site, you just

can’t go back to your regular job. You can’t think of anything. You

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are frozen. Really, your mind is still not opened up yet. So we had

to be proactive. We had to beg people to send therapists and counselors to our office sites so that when 60 guys came back, they sat

at a lunch period, and everybody got kind of debriefed a little bit,

and were reached out to. And there are still members of my—in my

agency that have not had one ounce of therapy. And they are hurting, and I can see it in their faces, and they are just trying to go

on blindly day by day. They look like they are lost souls. I can’t

reach them yet. But maybe if we start talking about the fact that

it is really out there, and we really reach out to Mount Sinai and

say Mount Sinai instead of you asking me how many body parts

did I see in the 10 months I was there, 10 seconds after that send

me to a therapist; that will work.

I tell you sometimes I go through those questionnaires, and I

need more therapy than when I went in. It is amazing. It is amazing. It is sort of like anecdotally, well, you know, the first 10 days

how many body parts did you see. OK. About the next 10 days. It

was like that. Those are the questions that are in these programs,

and I help as much as I can. I answer everything honestly, but

don’t ask, well, you know, can you have me talk to somebody now.

He said, well, we will make an appointment for you. We have a

whole set of services here we can provide for you, but you know you

need the help right then and there when you open up those

wounds.

These are the kinds of things that we are dealing with. And we

are going about our business. We are doing our city work. I mean

when the wall collapsed on the Henry Hudson Parkway, we were

there. OK. The blackout in New York, we were there.

We are still jumping to the call. We are still answering the call.

We are just maybe taking a step longer to get there.

Dr. LEVIN. I think what Mr. Vega is talking about points to some

of the very real problems of setting up a monitoring program without a treatment program aspect to it, because we found ourselves

in the situation until we got some philanthropic funding of identifying people who really needed care desperately and having no resources available to provide that care. And the point that he makes

about the workers’ comp system, and it is not just taking off from

work. It is also then finding the New York City Law Department,

because the New York City is a self-insured entity, fighting these

cases tooth and nail, and every city worker who has gone through

this workers’ compensation process knows just how difficult it is

made for them and how insulting a process it is and people talk

to each other. And so what Mr. Vega does is what so many workers

have done and said, I am not going into that system, even though

it is set up presumably to take care of people for that purpose, because it is too difficult. It is too insulting, and the end process is

too far away for me to get care.

For claims that are filed in workers’ comp for World Trade Center-related illness, we have seen people wait 21⁄2 and 3 years before

their claims are resolved. During that period of time, who’s providing the medications? Who is providing the support for additional

testing that is necessary? The workers’ comp carriers, the insurance companies, and in this case the city of New York was not, so

people were left to their own devices. We did get some philanVerDate 11-MAY-2000 09:29 Aug 03, 2006 Jkt 000000 PO 00000 Frm 00114 Fmt 6633 Sfmt 6633 D:\DOCS\28531.TXT HGOVREF1 PsN: HGOVREF1
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thropic funding. That made it possible for us to take care of some

of the people that we identified through our screening program who

needed care. Marvin is an example of that.

Those funds we had to go hat in hand to those philanthropic organizations and say please we have people who are sick. Can you

give us funding so that we can take care of them, because there

was nothing systematic set up to make sure that they were cared

for.

It is good to hear that $125 million is now restored to New York.

But frankly, even though the efforts were successful and we are

deeply grateful that it is happening, it is a backdoor way of taking

care of what should have been a governmental response to a public

health problem that was caused by an attack on this country that

these people responded to. There has never been up to this time

a systematic and comprehensive approach to how to take care of

people like Mr. Vega, who desperately need care, and some of his

concerns about what his life is going to be like might be helped by

such care, but, in fact, no programs have been funded by the Federal Government or any other level of government to make sure

that people are taken care of.

Mrs. MALONEY. I thank the chairman for yielding, and request

permission to place in the record the ‘‘Findings and Treatment for

High Levels of Mercury and Lead Toxicity.’’ This is a paper put

forth by Dr. KOKi and Claire Haaga Altman, who is president of

the project Olive Relief, and I request to place it in the record.

Mr. SHAYS. Without objection.

[The information referred to follows:]

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Mrs. MALONEY. Many people wanted to testify today. We did not

have room for the panel, but I would like to ask a question to Drs.

Levin and Kelly about my constituent, Mr. Vega.

He just mentioned he has high levels of mercury and lead. What

is the treatment, if any, to remove these terrible items from his

body? What is the treatment to remove mercury and lead from our

firefighters and our Mr. Vegas and our Marvin Betheas?

Dr. KELLY. One of the issues is that you have to test the correct

way. If you do blood testing for mercury, you may get a false elevation. You need to check urinary mercury, again because we had

been doing this beforehand with our HAZMAT units, we had

known this fact so that when we set up our medical monitoring, we

set up our program so that we did test that way, and we worked

with NIOSH and CDC to send off for many of the unusual heavy

metal and toxins that might be seen at the site so that in our overall numbers, we had very, very few people that had high mercury,

because we did that the correct way.

At one point, there was a problem because they had been done

incorrectly and there was a concern raised about mercury at the

site, but then when the retesting was done correctly using urine

mercury, it was realized that was sort of a false positive. So that

we did not run into that type of a heavy metal problem with our

particular group.

Mrs. MALONEY. But if you did, Mr. Vega has tested high in mercury and lead and others have, and assuming that they have been

tested——

Mr. SHAYS. Just lead. Just take lead.

Mrs. MALONEY. Take lead.

Mr. SHAYS. How do you get it out?

Mrs. MALONEY. How do you get it out of their bodies? How do

you treat them if they have these particles in them?

Dr. LEVIN. There is a standard treatment for lead poisoning, and

it involves what are known as chelating agents. We have a long

history in occupational medicine of taking care of individuals who

have lead toxicity, ranging from iron workers to people who are exposed to lead in paint, in battery manufacturing. So we have very

well standardized approaches for testing for lead poisoning, as Dr.

Kelly mentions, as well as the treatment of it, and there used to

be an intravenous treatment with what is known as EDTA. Now

we can use an oral agent, known as Succimer, or DMSA. These are

compounds that bind to the metals and enable them to be cleared

in the urine by the kidneys. That is true of mercury as well. There

are particular treatment agents that can remove inorganic mercury, not the kind of mercury that is present in fish, but the kind

that comes from exposure in industrial circumstances or other environmental circumstances. When these levels are genuinely elevated

in the body, we do have treatments that can be effective.

The question that I have, and I don’t know about Mr. Vega’s individual case, and maybe we will have an opportunity to talk after

here.

Mrs. MALONEY. Let us ask him right now. Mr. Vega, have you

gotten any of those treatments?

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Mr. VEGA. As I have stated, once I went to my primary care giver

through the city agencies. They had no professional provider to

deal with this issue.

Mrs. MALONEY. You have gotten no treatment for your high levels of lead.

Mr. VEGA. No, we did everything we could. We went to the Indian herbal treatments—Ayurveda, 2000-year-old treatments. We

have taken herbs. We have been taking—we have been going to—

I am just——

Mrs. MALONEY. But you never had the treatments that Dr. Levin

just described?

Mr. VEGA. No. No medical treatment. Any person who wanted to

help us, try to get us healthy any way they can, we tried. And some

of them are not as present as others, and we have tried everything

we can, because there is nothing else out there. We are that desperate.

So we have been proactive. We have been proactive medically

and proactive with mental health issues, but we were told pretty

much there was nothing else out there, even at Mount Sinai. We

just had monitoring, and no treatment, so what else could we do?

Dr. LEVIN. I make an open offer. All right. That you and your

colleagues might bring the medical records to us. Let us have an

opportunity to take a look. See if we are in agreement with whether the right testing has been done. If, in fact, we find elevations

of metals among any of your colleagues, we would be pleased to

offer the best that we know how to offer in the way of treatment,

if, in fact, there are problems along these lines.

Mr. SHAYS. Yes, I mean with all due respect, I mean monitoring

is OK, but I would rather you put your resources here.

Well, let me do this: I just want to make sure the professional

staff covers one or two issues that we need to just put on the record

for our report.

Ms. FIORENTINO. Ms. Bascetta, your testimony talked about the

lessons learned in the aftermath of 9//11, including the need to

quickly identify and contact people, the value of a coordinated approach, the importance of monitoring both physical and mental

health and the need to plan for providing referrals for treatment.

In the work that you have done and the work you are currently

doing on Hurricane Katrina, have you seen any steps the government has taken to apply the health monitoring lessons learned

from September 11th? And then second, do you feel that health

monitoring programs are being included in disaster planning?

Ms. BASCETTA. Unfortunately, I have to say that we are not

aware of any of these lessons learned being applied in New Orleans

or in the other Gulf Coast States.

With regard—your second question again? I am sorry.

Ms. FIORENTINO. Are health monitoring programs being included

in disaster planning as far as you know?

Ms. BASCETTA. Again, you know, we are engaged in a review now

of the NRP and other preparedness plans, and we are not aware

of a proactive approach to health monitoring.

We are aware that under the NRP, OSHA has an obligation to

protect first responders. We are aware that, EPA has a role in

measuring the levels of toxic exposures that first responders may

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experience, but we don’t see any mindset to set up—to have a plan

in advance for who will be accountable for establishing and following through with medical monitoring if it is needed.

Dr. KELLY. When we sent firefighters to Katrina, we had volunteers that went in cycles of every 2 weeks. We ensured that before

they went, everyone had the protective vaccinations that they needed, including tetanus, Hep-A, and our members are already protected against Hep-B; therefore, we didn’t let anyone go unless we

had proven record that they had received their shots and that it

had taken. We made sure that they brought their PPE with them,

and when they returned, we made sure they all had a followup

medical evaluation. We have marked their charts to recognize that

they had that Katrina exposure, and we will continue to monitor

them when they come for their annual exam with that set of information. So as an agency, we are able to do that based on our prior

exposure at September 11th and as a proactive effort as they went

out to Katrina.

Ms. FIORENTINO. Thank you very much.

Mr. SHAYS. Is there anything that any of you would like to put

on the record before we get to our next panel? Any last comment?

Yes, Mr. Bethea?

Mr. BETHEA. You really need to look at the workers’ comp. It is

totally out of control. Case in point: my hospital statements since—

in 2002, every year you have EMS physicals in May. The hospital

gave myself and the five others who were down at Ground Zero, we

all received plaques as well as we got a citation from the New York

City Council.

The event was on television. It was in the hospital newsletter.

They made a whole big to do about it.

Last year, at a workers’ comp hearing, the lawyers representing

the hospitals got up in court and said to the judge, Your Honor,

nothing for nothing. How do we know Mr. Bethea was actually

down there? And if he was down there, what was he doing down

there?

Now, they inquired to me in the hospital. It was already acknowledged that I was there. They gave me an award, but yet they

were allowed to go into court and argue or raised this issue on

whether or not I was down there. We all know it was a lie.

Mr. SHAYS. Mr. Bethea, that is not a racist issue. I mean that

was——

Mr. VEGA. Raised this issue.

Mr. BETHEA. Raised. Raised. Raised. Raised. Raised.

Mr. SHAYS. Raise the issue. Oh I am sorry.

Mr. BETHEA. I am sorry. I said raised the issue. Oh, I am sorry.

Mr. SHAYS. Yes.

Mr. BETHEA. Oh, I am sorry. So I got the sinusitis. I am all

stuffed up now. I apologize.

Mr. SHAYS. I apologize. I heard you incorrectly.

Mr. BETHEA. Yes, it was a raised issue, and now, it is totally

nonsense. I mean you have a right to defend your client, but to

make a blatant lie like this, as Dr. Levin has said, you know, they

harass you so much and humiliate you, people don’t want to go

through that. And so this $125 million, if the workers’ comp system

was better that money would have never gotten taken away from

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us, because we would have had access to it. You can’t penalize us

for money that we don’t have access to. I can’t get money if you

never give me a chance to get that money. So what they should do

is seriously look into the workers’ comp system and what is going

on with it, because it is an absolute disgrace. And people just don’t

want to be humiliated anymore, and they are constantly denying

claims. Well, that was just one example. There are hundreds of stories, of horror stories, and that needs to be addressed. And I got

to commend you for taking the time to listen to us about what we

have to say and what is really going on with September 11th, and

they should use this as a model to not to make the same mistakes

down in Katrina, but unfortunately, they will.

Mr. SHAYS. Thank you. Thank you for your comment and thank

you for being here. Anyone else?

Ms. BASCETTA. I would just like to add that I think that Dr.

Kelly’s comment is illustrative of the facts that we do have very

different organizations that respond very differently, and if we can

learn from those who are better positioned and who do take a

proactive stance, and include some of those principles in planning

and our various government levels—Federal, State, and local—we

will all be better off.

Mr. SHAYS. OK. I wanted to close this, but I am going to ask you

to react to what I am going to say.

And I am going to leave a lot out. But, first, I am going to ask

this question: Was this the responsibility of the State health department, the local health department, the local environmental

protection folks, the State, or the Federal health and environmental to have basically taken control of the site and looked out

to protect the workers? Which level of government should have

been the one taking charge? Dr. Levin.

Dr. LEVIN. I think the primary responsibility is with the Federal

Government because it has the greatest resources available to it to

develop a comprehensive public health response. I don’t mean by

that the State agencies, the public health agencies at the State

level and city levels shouldn’t be integrated into such a response.

But the Federal Government has the greatest capacity to do monitoring and to set up the kind of programs that do early detection

of health problems that might result from such disasters.

The lack of that kind of overall coordination had real consequences for what happened at this site and during the ensuing

really year and a half up to the present time. And it seems to me

that the Federal Government is the site where the resources are

greatest and the best opportunity exists for setting up a comprehensive plan.

Mr. SHAYS. Anybody disagree with that? OK. Let me ask you

this, though: Isn’t it true that any one of the three could have shut

the site down and said you can’t go in here until you have proper

protection of the workers?

Dr. LEVIN. I don’t know what the legalities of that may be as to

where that power really resides within the law. I know certainly

the Federal Government could have declared this a site that was

hazardous waste site, for example.

Mr. SHAYS. Well, the State could have as well. Ms. Bascetta? You

don’t know?

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Ms. BASCETTA. I don’t know. I mean I think when it was the first

battle in a war, and for those of us who were there, that was our

feeling, that this was a war. And it was a war zone that held the

remains of people that were beloved by all of those who had suffered losses. And when there are any attempts to even close down

the site for a night, there was a protest by our members because

they felt an obligation to be there to remove those who were missing, and those who had died.

There was active fire at the scene until mid-December.

Mr. SHAYS. OK. If health care folks who had the expertise had

an obligation as well. They had an obligation, and I want to know

where they were? You know. They had an obligation on the local,

State, and Federal level. They had the expertise. They were down

there, and it is pretty amazing to me.

In a perfect world, react to this—I guess what I am trying to—

we are going to try to come out with recommendations as a subcommittee, and I am just wanting to understand. It seems to me

you have the event. You were going to have a few days of just rescuing the workers. You are just going to do everything—of rescuing

people that possibly someone might be alive, even though I think

there was a feeling, you know, that was very unlikely, but you just

keep at it until you are pretty convinced that there is no one alive.

But at that point, it seems to me there should have been the

Federal Government, the State government, and local government,

the health people should have basically shut the site down. They

should have then made a determination who could work in there

and on what conditions. And I can see that there are tradeoffs between the health of the workers and the health of the entire city

in terms of it being a condition that you needed to clean up as

quickly as possible. So you were going to have some tradeoffs. But

I am struck by the fact that in terms of some kind of model, someone takes control, someone tells the workers in going, someone decides what kind of equipment, how long they should be there;

maybe they should only be there for a few weeks, and then you

bring in another group.

I mean it strikes me that is the kind of process that should take

place, and I don’t have any conviction that is happening.

So what I am going to probably do for this hearing is we are

going to bring in the folks that can explain what you do in an

emergency and what we should do. And maybe since then, there

are people who put their heads together and figured this out, and

we just don’t know about it. So. Thank you all very much, and we

will get to next here.

I said that I would maybe consider having a third panel. So this

panel is adjourned. Thank you very much.

Raise the hands of the people who would like to address this subcommittee? You have one, two people. OK. We will have you both

address the subcommittee after the third and fourth. No more than

five, but we will allow a third panel. We will swear you in. We will

sign you up, but not right now. We will go to our second panel. And

that is Dr. John Howard, Director, National Institute of Occupational Health, Centers for Disease Control and Prevention, Department of Health and Human Services. You can stay standing, Dr.

Howard.

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Do you have anybody else, Dr. Howard, that might be responding

to questions with you?

Dr. HOWARD. No.

[Witness sworn.]

Mr. SHAYS. Thank you very much for your response, which was

in the affirmative. And, Dr. Howard, we welcome your testimony.

I am going to ask that you go down and sign up in the back. I

am going to ask our staff to go to that table over there and anyone

who wants to address this subcommittee can go over there, and we

will fill out your names and address and so on.

Actually, Bob, I am going to have you do that. Right over there.

So this gentleman here, if anyone wants to address the subcommittee on the third panel that we will—do know that you will be

sworn in and anything you say before the subcommittee will have

to be the truth.

Dr. Howard, what would you like to tell us?

STATEMENT OF JOHN HOWARD, M.D., M.P.H., DIRECTOR, NATIONAL INSTITUTE FOR OCCUPATIONAL SAFETY AND

HEALTH [NIOSH], CENTERS FOR DISEASE CONTROL AND

PREVENTION, U.S. DEPARTMENT OF HEALTH AND HUMAN

SERVICES

Dr. HOWARD. Good afternoon, Mr. Chairman, and members of the

subcommittee.

My name is John Howard. I am the Director of the National Institute for Occupational Safety and Health, part of the Centers for

Disease Control and Prevention within the Department of Health

and Human Services.

I am pleased to report on the screening and medical monitoring

of World Trade Center responders, development of a new treatment

program for responders, and to give you a brief report on the World

Trade Center Health Registry.

In 2002, as you know, Congress provided funding through FEMA

for baseline health monitoring of responders. CDC partnered with

the New York City Fire Department, the New York State Department of Health, and the Mount Sinai School of Medicine to conduct

baseline medical screenings.

The symptoms identified in these screenings, such as the ‘‘World

Trade Center cough,’’ as we have heard about, prompted the development of a medical monitoring program to assess long-term health

effects.

This program consists of a consortium of clinical centers, together with data and coordination centers, to provide standardized

clinical and mental health screening, patient management data,

and clinical referral services.

One center is operated by the New York City Fire Department

for firefighter responders, and the others are operated by Mount

Sinai for responders within and outside the New York Metropolitan

Area.

All these responders receive the same examination utilizing a

standardized protocol.

Since 2002, the Monitoring Program has served more than

30,000 responders, and as of February 2006, the Fire Department

and Mount Sinai both have conducted nearly 19,000 screenings, apVerDate 11-MAY-2000 09:29 Aug 03, 2006 Jkt 000000 PO 00000 Frm 00137 Fmt 6633 Sfmt 6633 D:\DOCS\28531.TXT HGOVREF1 PsN: HGOVREF1
134

proximately 75 percent of them being initial examinations and 25

percent being followup.

The clinical data is analyzed regularly, and in September 2004,

the program published data showing that the majority of screen responders reported experiencing upper and lower respiratory symptoms, along with musculoskeletal and gastrointestinal symptoms.

These clinical findings, I stress, that are the same clinical findings we saw in the early program are being seen in 2005 and 2006,

and highlight the need for a long-term medical monitoring and

treatment program.

In March 2003, FEMA and HHS completed an interagency agreement allocating $3.7 million to have the Federal Occupational

Health Service conduct baseline medical screening for Federal responders. The program began in June 2003, but by January 2004,

as has been reported, FOH halted the screening process, because

they too identified the need for more robust mental health screening protocols, the need for other diagnostic tests, and the need to

have a referral mechanism for health concerns identified during

the screening.

In addition, it also became necessary to identify the administrative authority to provide services to former Federal employees, including retirees and those were Federalized for the time of the

World Trade Center experience.

The agreement was modified in July 2005 to address these mental health diagnostic testing and referral concerns and the screening resumed in December 2005.

However, since the FOH mission precludes them from conducting

screening for former Federal workers, a decision was made to contract with NIOSH World Trade Center program to provide a single

baseline screening for former Federal workers.

To date, of the $3.7 million allocated for this program, $2.2 million has been obligated to Federal Occupational Health for the purpose of screening current Federal employees and for outreach and

registration management. The remainder of this fund will be allocated to the NIOSH program for the purpose of screening former

Federal employees.

Since restarting the program for Federal workers, 135 Federal

agencies have been contacted, and approximately 1,700 individual

Federal responders have been identified out of an estimated population we believe of around 5,000.

Of those responders identified, 423 current, 40 former, and 12 retired Federal employees have registered for screening and of these

registered responders, 166 have been screened; 250 are awaiting

screening.

To ensure the continued screening and treatment of World Trade

Center responders, Congress recently appropriated $75 million to

CDC for treatment; $50 million was appropriated for the Uninsured Employers Fund. A portion of these funds will be used to establish a World Trade Center Responder Treatment Program to

support existing monitoring programs and to fund program needs

identified by the World Trade Center responder community such as

the New York City Police Foundation Project Cope, as well as the

police organization providing peer assistance.

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Also appropriated funds will be directed to support the World

Trade Center Health Registry, which began baseline data collection

September 5, 2003, and finished 71,437 interviews on November

20, 2004.

Registrants will be interviewed periodically through the use of a

comprehensive and confidential physical and mental health survey.

The first followup interviews are scheduled to begin next month,

and will last approximately 6 months. Information about the Registry’s finding is posted quarterly on their site at

www.wtcregistry.org.

Thank you very much, Mr. Chairman. I would be happy to answer any questions.

[The prepared statement of Dr. Howard follows:]

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Mr. SHAYS. Thank you. Mrs. Maloney.

Mrs. MALONEY. Thank you very much, Dr. Howard, for your testimony today. A great number of us have waited a long time to

have one particular person in the Federal Government to direct our

questions about September 11th health emergency, and we are

thrilled with your designation, and I join my colleagues, Mr.

Fossella and Mr. Shays, in congratulating you on your new job.

But I do have a series of questions, and first of all, do I have

your word that we will finally have a coordinated Federal response

to the September 11th health emergency, including a plan from

your office on how to fully monitor and treat everyone affected and

sick?

Dr. HOWARD. I am certainly going to try to bring consistency

across, as you have said and several others today, for all exposed

workers. That is my first priority, based on their exposure, not

based on the particular system that they happen to be receiving

there—either screening, monitoring, or in the future treatment care

from.

Mrs. MALONEY. And when can we expect to see your recommendations and plan of how you are going to run this new outreach in response to injured workers and responders?

Dr. HOWARD. Well, I hope very soon. In fact, I have already contacted the acting director of the Federal Occupational Health Service. She and I will be meeting to look at that issue, which has, I

know, as GAO reported and as you and the committee have pointed

out, is an issue that we need to address.

Mrs. MALONEY. And in your testimony, your testimony reports

that the majority of World Trade Center responders participating

in the World Trade Center Medical Monitoring Program have experienced health problems that have continued until today. And you

go on to say that these trends highlight the need for a long-term

health monitoring program. And how many years are you talking

about for a health monitoring program?

Dr. HOWARD. I think I would agree with Drs. Kelly and Levin.

Our experience as occupational physicians teach us that many conditions—dust diseases of the lung, which were referred to already

this afternoon, like asbestos exposure—have significantly long latent periods.

So I think even though we have been doing incremental budgeting for these types of programs, and we are very happy to be able

to be in a position now to administer a treatment program that will

get at that issue and also continue our monitoring program, I think

we have to look seriously at our vision for the future in terms of

looking at that kind of timeline.

Mrs. MALONEY. Could you give me a specific number of years. We

are funded for 5 years. Do you think this monitoring should be 20

years or, as Dr. Kelly and Levin said, it should be 30 years?

How many years are you talking about?

Dr. HOWARD. Well, I certainly agree from the medical standpoint

that these long latent diseases require us to think in that kind of

timeframe. At the present time, I think we have to look at all of

our findings, both from our monitoring program, as well as from

our registry program, and titrate, if you will, those needs based on

time as we go through the next 4 to 5 years.

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I think we are at the point of producing significant data. Our

clinical data management centers have that job. And I hope within

the next 12 to 24 months that we see good statistically valid studies on these issues so that we are able to plan for these long-term

periods of time that you and others have talked about—the 10, 20,

and 30-year timeframes.

Mrs. MALONEY. I am glad you are thinking about 10, 20, 30-year

timeframes.

Mr. SHAYS. Would the gentlelady yield 1 second?

Mrs. MALONEY. Yes. But may I ask one question real quick to followup? What I think is very interesting is that the statistics that

are coming from the World Trade Center Consortium, the fire

fighters and fire fighters and officers research, and others, they are

consistently the same: half the people they are looking at are sick.

For some reason, half are immune to the problems, in all of these

studies, if you look at them, half of the people that they looked at

are sick.

And in a sense, I don’t think we need to reinvent the data that

you talk about, because that is what they have been releasing, and

I monitor this very carefully. This is the third hearing that we

have had. Consistently, they are showing half the people are sick,

and I yield to my colleague, the chairman.

Mr. SHAYS. I just want to be clear as to what is the point of monitoring someone for 20 or 30 years? What is the point? Tell me the

point.

Dr. HOWARD. Well, I would say the simplest point is that some

conditions take time to show themselves clinically.

Mr. SHAYS. Then what?

Dr. HOWARD. In terms of the condition or?

Mr. SHAYS. So we have this great graph of how people got sick

20 years later from some disease, I want to know what is the point.

Dr. HOWARD. I would approach it from the population that was

originally exposed, which we know to number some 30,000 to

40,000 people, whatever category they are in, whether they are responders or residents.

Mr. SHAYS. You need to say it differently. I already know the answer to how I would answer the question. I am interested to know

how you will answer the question. What is the point of monitoring

someone for 20 or 30 years.

Dr. HOWARD. I think in terms of a registry, where you are monitoring a large population, one answer is to get at the prevalence

of a particular condition in that population. So population monitoring I think I would contrast with individual monitoring. The registry is doing population monitoring. The screening and monitoring

program——

Mr. SHAYS. What is the point of monitoring someone?

Dr. HOWARD. To look for conditions and also the knowledge that

we accumulate day by day, month by month, in terms of those aspects that Dr. Levin talked about of prevention so that we could

detect at the earliest possible stage, the existence of a condition

and intervene as early as possible——

Mr. SHAYS. Yes.

Dr. HOWARD [continuing]. To prevent the condition from worsening or manifesting itself and harming the individual.

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Mr. SHAYS. Right. Well that is, to me, the bottom line, the key

in the whole reason why we would do this. And what I leave this

hearing is feeling like we have done a lot of monitoring haphazardly, but not a lot of intervention, and certainly not very helpful intervention.

Do you view it as your job to be in charge of the monitoring and

in charge of making sure that there is intervention?

Dr. HOWARD. I think the real value that we are approaching

right now, with $75 million, able to develop treatment programs I

think is really crucial to that question. And I think we are at a

very important time in the development of these programs.

Mr. SHAYS. So is the answer yes?

Dr. HOWARD. Yes.

Mr. SHAYS. Thank you.

Mrs. MALONEY. Thank you, Mr. Chairman, and, Dr. Howard, I

was pleased with your statement that you believe that medical

monitoring should be based on exposure and should include residents, school children, whoever breathed the debris, not on what

hat you were wearing, whether you were the police or the fire, but

whether you breathed the items or not. Is that clear? Do you think

it should?

Dr. HOWARD. Well, it may not be absolutely what I meant. What

I meant to do is to suggest in terms of the most exposed population, which were responders at Ground Zero, many of whom

spent months and months at Ground Zero, the most exposed population I think from 2002 to the present we have developed screening programs, monitoring programs, and now treatment programs

for that population. The Registry was set up in order to look at

that population. The greatest majority of those 71,000 interviews

have been done in residents of the lower Manhattan area and other

areas of New York City—school children, office employees who

work there, but were not residents, or responders. So the information that we are going to get from the Registry I think would go

to that latter issue that you just raised with regard to the need for

screening and or monitoring for residential exposure, if you will, in

lower Manhattan. So I just wanted to make that clearer.

Mrs. MALONEY. Well, personally, I think everyone should be included, but going back to your statement and pleasure with the $75

million, and we are thrilled. That was a long effort by the workers,

the unions, and Members of Congress to get that funding in the

budget, and we are thrilled that it is now going to provide some

treatment. But do you believe that it will provide for all of the

unmet needs of individuals who are still sick from September 11th?

We heard from two of them today. And will you make recommendations within your budget for adequate funding? Up until this hearing, the initiative has come from Congress to ask the administration, and we are grateful for your appointment today. We are grateful for the $90 million that has been allocated for the Consortium

monitoring. We are grateful for the money for the fire monitoring

and treatment. We are grateful for all this, but what many of us

would like to see is your department requesting the money and the

proper funding for the treatment and the long-term monitoring. I

believe Drs. Kelly and Levin testified $305 million.

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My question is, how are we going to fund this? Will you be requesting it in the administration budget? Will you be pushing for

this funding from your side of the aisle? We are pushing with you.

Let me tell you.

Dr. HOWARD. I think in answer to your first question is no.

Based on what I have heard, what I have seen the last few years

participating in the NIOSH program at the World Trade Center

and Mount Sinai and with the Fire Department of New York City,

no. There appears to be quite a number of unmet needs.

In regard to your second part of the question relative to budget

recommendations, you know I won’t hesitate based on my job of

looking at where coordination is best, where unmet needs need to

be met within the budget structure that I operate on in the executive branch, I would not hesitate to make those needs known.

I would add just parenthetically that I think it is important to

build on some of the ad hoc budgetary work that Dr. Levin referred

to. I think it is important for us to do a more formalistic evaluation

so that we are able to succeed within a budget process in the executive branch. And I hope to be able to do that, and my job now is

to pull those people together and do a more formalistic look at that

question.

Mrs. MALONEY. There was some questions about Katrina, and I

would like to ask in a general way if there were another September

11th, if we were to have another September 11th, would you recommend the patchwork of medical monitoring that we currently

have or would you recommend a coordinated response that monitors and treats all who are affected?

Dr. HOWARD. I would say no, I wouldn’t recommend it. We are

all sort of prisoners of our various systems that we operate on. I

think the challenge that we have—and throughout CDC and HHS

this is one that we are actively working on and that we actively

believe in—we need coordination across partnerships, multiple levels of government, and with non-governmental organizations. So I

would say that, no. This wouldn’t be the route that I would take

if we had to do this again.

Mrs. MALONEY. And a very important point that was raised by

Drs. Kelly and Levin and others was the need for protocol and

treatment to be developed, really learning from all the many different programs that were out there, trying to treat and trying to

help, and do you see your department coming forward with a

SARS-type of advisory that would go to the medical community on

what to look for and how to treat those that have the World Trade

Center cough?

Dr. HOWARD. I say yes. And I was very impressed by the fact

that we haven’t done that yet. We need better communications in

the medical community, and I hope to be able to work with Mount

Sinai at the Fire Department, the FOH, to look at the protocols,

to make that information known to any physician who may encounter a responder in his or her practice. That is critical communications information.

Mrs. MALONEY. And basically how long, not trying to tie you to

any date, because I believe in your sincerity, how long do you think

it will take to develop this protocol and get it out to the medical

community? And I might add it is not just New York and ConnectiVerDate 11-MAY-2000 09:29 Aug 03, 2006 Jkt 000000 PO 00000 Frm 00156 Fmt 6633 Sfmt 6633 D:\DOCS\28531.TXT HGOVREF1 PsN: HGOVREF1
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cut and New Jersey. We had people from California, divisions from

Wisconsin. My office gets calls from all across the country of people

who are sick. Now, I can refer them to your office. So this protocol

is needed really not just for our region, but for the whole country,

because many, many people rushed to respond and volunteered.

Dr. HOWARD. Well, my answer to your question is much sooner

than it has been done. I think we have an excellent protocol available at Mount Sinai. We are very proud at NIOSH that Mount

Sinai is our partner in this.

We need to get that information that has been developed over

the last 4 years with excellent medical input, both from Mount

Sinai as well as the New York City Fire Department, Dr. Kelly, Dr.

Prezant, and others. We need to get that information out so that

we are able to empower physicians who may see these responders,

whether they be, as you say, in California, Wisconsin, or New York.

Mrs. MALONEY. As one who represents Mount Sinai, if you will

allow me to be personal for a moment, I am very proud of their

record in environmental health care. They pioneered in this years

before anyone thought about environmental causes causing severe

health problems, and they are still building on the environmental

disaster that impacted so many of our residents and my neighbors

and friends.

I have great respect for all workers, and I am very disturbed at

how the Federal employees were treated in the monitoring. They

began the monitoring. They estimated 10,000 were involved. They

stopped after 400. I hear you are going to activate the response

here, but as I understand your testimony, you report that Federal

employees who worked alongside the heroes and heroines, the responders, and they also the FBI, the CIA, FEMA, all these Federal

workers, they breathed in the same toxic air, and as I understand

it, they are only eligible for a one-time screening; is that correct at

this point?

Dr. HOWARD. That is correct. But we hope to use the treatment

program to allow them to enter. It is my intention that they would

enter the treatment program so that they would be eligible for followup monitoring as well as treatment within that program so that

gap is not created.

Mrs. MALONEY. Well, I am very, very glad to hear that they will

be eligible for treatment and long-term monitoring. All of these

people should be eligible. Those that rushed down there to help

others, if they are volunteers, Red Cross, Federal, State, city

should be helped in my opinion.

Now, the one part of your testimony that does not—I would like

you to elaborate on is the Health Registry. You testify that the

Registry has conducted more than 70,000 interviews, and this includes area workers, residents, and school children. And this group

of exposed individuals, according to your testimony, are having

similar health problems as the September 11th responders. But

this group of people are barred from any of the federally funded

medical monitoring and treatment programs; is that correct?

Dr. HOWARD. It is largely true. I believe out of the 70,000 registrants, about 30,000 are in the responder category, if you will, so

that they would be eligible for screening and monitoring. But that

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would leave about 40,000 in the category of residents of lower Manhattan that did not respond, nor were sent to the site.

Mrs. MALONEY. OK. Last, because my colleague and great leader

on this, Mr. Fossella, has a series of questions, but can you explain

to me why these individuals should be left out? They were exposed

to toxins. Our government said it was safe. These are people who

would lose their job if they didn’t return to work. The SEC offices

are there. The FEMA offices are there. These are Federal workers

that had to return to their jobs and others. Why should they be left

out of the monitoring and treatment?

Dr. HOWARD. I can say that I don’t see that reason either other

than if you go back to the origin of how these programs were structured in 2002 we as an occupational safety and health agency, with

statutory responsibility for workers receiving money from FEMA,

we had limitations ourselves on monitoring, on screening programs,

so it is unsatisfactory. I realize that, but I hope that as we work

on the issue of the Registry, and they are just beginning their second interview schedule, I am hoping we can use the data from the

registry, based on their subgrouping of school children and residents and others, I am hoping that we will get that positive information that we need out of the Registry to build on that need that

you have identified.

Mrs. MALONEY. Thank you so much for your testimony, and as

one who was there on September 12th, I was in meetings with the

State and city government where the estimates of the dead were

25,000, 30,000. It was a time of great crisis and because of heroic

actions by many, we lost 3,000. But those early days we had no feel

for how many people had perished, and it was truly a trying experience for all of us.

So I thank you for all of your help, and I yield back.

Dr. HOWARD. Thank you.

Mr. SHAYS. I thank the gentlelady, and this time the Chair

would recognize Mr. Fossella.

Mr. FOSSELLA. Thank you, Mr. Chairman. Dr. Howard, thank

you for being here and thank you for your assignment of your duties you are about to assume in addition to what you have done already. I appreciate it.

And just an overall observation, and it bears again to be underscored. September 11th was, in a way, an act of war in this country. Seventy-one thousand people, as you say, have gone through

the Registry, which is when you think about it in perspective, it is

about the size of if not larger than many cities in this country.

And, you know I guess by the way of example, Pearl Harbor, 65

or so years ago, if somebody is a survivor of Pearl Harbor, they are

treated with reverence and I think every ounce of the Federal Government is there to help an individual who survived Pearl Harbor

60 plus years later.

And you know and you have been listening to the testimony of

the doctors here before you that we are looking at another 20, 30,

if not more years ahead of us. Many of the people who responded

were in their 20’s and 30’s, so they weren’t people in their 50’s or

60’s or 70’s. They were in their 20’s or 30’s. The three individuals

who died from apparently exposure to September 11th were very

young.

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And it just strikes us as I hope what you take back because any

responsibility borne by the Federal Government, any obligations

that we believe—at least I believe—we should have to those who

responded is going to far outlive us in your professional capacity

and my professional capacity.

So the sooner we get our arms around the entire situation, the

sooner we work—as I think you have just said, you want to work

with the Mount Sinais, the fire department, the non-governmental

agencies, organizations—the better, because this is an obligation

that is going to have to exist for decades to come.

And it is not going to be fair to those individuals to have a—I

believe a—in the words that I guess of my colleague, Mrs. Maloney,

a legislative undertaking every year to be lobbying for funding.

It should be coming from I believe almost it was part of the executive budget within HHS to step forward and say this is going to

be our obligation with respect to these individuals. And it is going

to be an obligation that is going to be, you know, for a time to

come.

And I say that just as a general observation because I sure

would—hopefully for the next several weeks and several months,

as you continue to put your arms around this issue, which is a

heavy undertaking, and I just hope you keep that in mind.

With respect to some of the things that I have heard regarding

NIOSH’s partnering with—NIOSH I should say partnering with

the Red Cross to establish in a new outpatient treatment program

that will serve as an extension of the existing WTC Medical Monitoring Program, this is a nice effort. I was just curious was—does

this mean that NIOSH’s point on directing some of the $75 million

recently secured to the Red Cross or is this a separate?

Dr. HOWARD. No.

Mr. FOSSELLA. No?

Dr. HOWARD. I think it is a misstatement in our testimony. What

we meant to say was we are meeting with the Red Cross——

Mr. FOSSELLA. OK.

Dr. HOWARD [continuing]. Trying to look at their program and

see what they have learned from running a treatment program, the

lessons they have learned and how they may be applied to our

structuring of a treatment program. But our money, the $75 million to the extent for the treatment program would go directly to—

through our extramural grant program to the New York Fire Department as well as Mount Sinai.

Mr. FOSSELLA. Well, that is good. That is what I was hoping to

hear.

In discussing that money, I think in the testimony you also say

you increased costs ‘‘resulting from the recent expansion of the protocol to include a comprehensive mental health assessment, and

the increase in outreach efforts necessary to inform participants of

the services provided by the program may make it necessary to use

a portion of these funds to supplement the World Trade Center

Medical Monitoring Program. The funds, initially appropriated for

this program in 2003, are available through 2009.’’

Out of curiosity, what portion of the newly appropriated funding

do you think should be used for such initiatives?

156

Dr. HOWARD. Our understanding right now that would probably

be 10 percent or less. It is a small amount of funding. It is largely,

as we point out in the testimony, for cost increases associated with

a robust mental health screening. We have encouraged some debt

on that side of the program. But it would be a small portion of the

$75 million. The bulk of the $75 million would go to treatment.

Mr. FOSSELLA. OK. And finally, we are seeing as a Nation involved in the last several years, especially in responding and being

prepared for disasters of different forms, natural or obviously in

this case September 11th, do you see, as I asked before the doctors

anything legislatively that Congress needs to be doing that would

allow you to better do your job, either now or prospectively?

Dr. HOWARD. Well, I believe that throughout the last couple

years, the Congress and the Department of Health and Human

Services, through our office of Public Health and Emergency Preparedness, the Centers for Disease Control, etc., have worked hard

on this issue to look at the needs as we prepare for pandemic flu,

for instance.

I think with regard to this program, it is important that we look,

as I said, to Representative Maloney—it is important that we in

the program, working with our partners, develop the justification

for others to act on, both within my department as well as the appropriators in Congress.

So hopefully, my job will be to make sure that we have that justification done so that we can tell our department, through our

processes and the appropriators, here is what we need to make this

program work better.

Mr. FOSSELLA. OK. Well, that sort of concludes it, and let me just

again thank you, Dr. Howard. I know you are very well respected,

as I mentioned earlier. We have met with Secretary Levitt before—

very well respected both inside and outside of government. You

know, but the injuries, the illnesses are staggering. Dr. Kelly

talked about four to five times the personnel who have had to leave

the fire department due to permanent lung disability. A number of

pulmonary problems. 12,000 individuals who have to seek mental

health already. So these are staggering numbers. You have a tough

task ahead of you, and I just hope that you keep us in mind to the

degree that we can help, and help those who truly need it.

So thank you very much.

Dr. HOWARD. Thank you.

Mr. SHAYS. Dr. Howard, we are going to complete. I want to have

professional staff, Kristina Fiorentino, just ask you a question so

we can have it for the record.

Ms. FIORENTINO. Dr. Howard, what steps have been taken to ensure health monitoring programs are included in disaster planning?

Dr. HOWARD. Disaster planning in the Department of Health and

Human Services?

Ms. FIORENTINO. Right.

Dr. HOWARD. Yes. I would say that we work constantly on this

issue, and we have talked this afternoon about the Katrina response. Our department, the agency I work for, the Centers for

Disease Control and Prevention, was very much involved. We at

NIOSH were involved and actually are doing a health hazard evalVerDate 11-MAY-2000 09:29 Aug 03, 2006 Jkt 000000 PO 00000 Frm 00160 Fmt 6633 Sfmt 6633 D:\DOCS\28531.TXT HGOVREF1 PsN: HGOVREF1
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uation study on New York—on New Orleans Police Department individuals.

So we are actively and I know this is an issue for this committee

as well as for many others, we are actively looking at the lessons

that we have learned from New York to apply them to Katrina, the

lessons we are learning from Katrina to apply them to the future.

So I would say that we are always trying to sharpen our tools for

any other future disaster planning.

Ms. FIORENTINO. And is there a recommended protocol for health

monitoring after a terrorist event? Are we just doing a wait and see

approach and then tailoring it after an event happens?

Dr. HOWARD. Well, I hope not. I think that is really where we

have to look at the lessons that we have learned in New York, because I think that is really for disaster planning in terms of health

monitoring for these large events that is a very important issue.

We at NIOSH commissioned 3 reports that RAND Corp. did for

us, and I would be happy to provide the committee copies of those

three reports that really get at much of the detail of this issue.

So certainly, we at NIOSH, we at CDC, we at HHS think this

is an extremely important issue, so we hope to be able to—and it

is difficult because the exposures differ depending on the disaster.

The exposures are a little different in New York than they were in

New Orleans, so one has to be able to modulate this.

But we certainly hope to be able to have a health monitoring outcome, if you will, so that we can quickly adapt to whatever situation is out there.

As you may know, I will just tell the subcommittee about the development of the Agency for Toxic Substances Disease Registry’s

Rapid Response Registry Survey Form, which is designed to be

used quickly in these types of events. So we are constantly trying

to fill our tool bag with these sorts of things.

Ms. FIORENTINO. Thank you very much.

Mr. SHAYS. Dr. Howard, just quickly. Should it be you and your

office that ultimately takes control of a site like this? Which, first,

should it be Federal, State, and local within the Federal? Who

would be the one to basically stop workers from going in there?

It strikes me that it would be you that would have that responsibility?

Dr. HOWARD. Well, I actually think probably not. These sites are

quite complex. This site was owned by the Port Authority. It was

in the city of New York, in the State of New York. Under the Occupational Safety and Health Act, New York has a program for public

sector workers, but the Federal Occupational Safety and Health

Administration is responsible for other workers, so it is a complex

matrix, and I would defer to the Occupational Safety and Health

Administration on the issue with regard to who has jurisdiction

over the workers.

Mr. SHAYS. Yes. It just strikes me, though, that if you are going

to design a protocol, we had better know who is in charge.

Dr. HOWARD. Yes. For the health monitoring issues, there is no

doubt about that.

Mr. SHAYS. No doubt about what?

Dr. HOWARD. There is no doubt that our department, Health and

Human Services, CDC, and NIOSH that is the job that we do to

158

make sure that the health of the workers in terms of the screening

programs, the monitoring programs. OSHA does not do that. They

do the immediate protection of the employees.

Mr. SHAYS. Well, then did you all drop the ball in not taking

charge of this early on?

Dr. HOWARD. Well, we don’t have that jurisdiction. We are a research agency at NIOSH. OSHA is the enforcement agency for Occupational Safety and Health.

Mr. SHAYS. Right. So I am sorry—that OSHA should have taken

charge. I said it incorrectly, so you answered——

Dr. HOWARD. I am sorry.

Mr. SHAYS. No. You don’t need to apologize. I need to apologize

to you. Not you, but should it have been OSHA that should have

been——

Dr. HOWARD. I would defer that answer to the Occupational Safety and Health Administration.

Mr. SHAYS. In other words, don’t put you in the spot of having

to answer the question?

Dr. HOWARD. I have a big enough job as it is.

Mr. SHAYS. OK. Fair enough. I won’t make your job more difficult.

All right. Thank you, Dr. Howard. Is there anything you want to

put on the record before we get to a third panel that we will be

having of people I have never met before and have no idea what

they are going to say?

Dr. HOWARD. No, sir. Thank you.

Mr. SHAYS. You might want to stay and listen. Thank you.

We are going to call our third panel. We have done this once before in my 19 years, and this may be the last time I ever do it. We

have Ms. Micki Siegel de Hernandez, Communications Workers of

America; Sister Ms. Lee Clarke, American Federation of State

County and Municipal Employees, District Council 37; Mr. John

Ramanowich, who is New York City Department of Design and

Construction; Mr. Michael Kenny, Local 375, District Council 37;

and Mr. Charles Kaczorowski.

Now, let me explain the rules. We never have people here who

aren’t sworn in, so you will be sworn in. Being sworn in means if

you have not told the truth, you could be prosecuted. If you are

saying something to which you just made a mistake, that is one

issue. But if you knowingly say something false, then you are

breaking your oath. And let me say that I will give each of you 2

minutes to make any comment you would like to make, and so I

am going to ask you to stand up, and I will swear you each in.

[Witnesses sworn.]

Mr. SHAYS. Note for the record our witnesses have responded in

the affirmative. It is frankly nice to have you all here. I am going

to in the order I called you—Ms. Micki Siegel de Hernandez.

Thank you. You can go first. There is a button on there that you

hit.

Ms. DE HERNANDEZ. Got it.

Mr. SHAYS. Maybe describe who you are and why you want to

testify before you start.

Ms. DE HERNANDEZ. Sure. My name is Micki Siegel de Hernandez, and I run the Health and Safety Program for the CommunicaVerDate 11-MAY-2000 09:29 Aug 03, 2006 Jkt 000000 PO 00000 Frm 00162 Fmt 6633 Sfmt 6633 D:\DOCS\28531.TXT HGOVREF1 PsN: HGOVREF1
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tions Workers of America in New York in District 1. I also sit on

the Executive Committee for the Medical Monitoring Program and

was also the labor liaison on the EPA Expert Technical Review

Panel.

Mr. SHAYS. OK.

STATEMENTS OF MICKI SIEGEL DE HERNANDEZ, COMMUNICATIONS WORKERS OF AMERICA, DISTRICT 1, NEW YORK CITY;

LEE CLARKE, AMERICAN FEDERATION OF STATE COUNTY

AND MUNICIPAL EMPLOYEES, DISTRICT COUNCIL 37, NEW

YORK CITY; JOHN ROMANOWICH, NEW YORK CITY DEPARTMENT OF DESIGN AND CONSTRUCTION; MICHAEL KENNY,

LOCAL 375, DISTRICT COUNCIL 37, NEW YORK CITY; AND

CHARLES KACZOROWSKI, LOCAL 375, DISTRICT COUNCIL 37,

NEW YORK CITY

STATEMENT OF MICKI SIEGEL DE HERNANDEZ

Ms. DE HERNANDEZ. I have been struck by so many things while

the hearing was going on, and I was particularly struck by your

question, Congressman Shays, as you looked at the picture with

amazement on your face and asked the question of Ron Vega how

could nobody have stopped what was going on. How come people

weren’t protected?

We are still asking that question. And there are still huge—there

aren’t gaps in the response. There aren’t gaps in what has happened. There are huge chasms that still remain, and until we fix

those problems, at the response of September 11th the rebuilding

after September 11th, there will be no lessons learned. We will continue to make the same mistakes.

There were a couple of comments made about OSHA and whose

responsibility this was. We do believe that it was the primary responsibility of the Federal Government, the National Response

Plan. There were parts of that Response Plan, many parts, that

were not followed, but what has happened onsite and since September 11th is I think what you just saw: There were different agencies pointing different fingers at each other every time we talked

to them.

OSHA was onsite, and they decided that they would not be onsite

and do compliance with the standards that they had. They were

going to be there just to help——

Mr. SHAYS. Is it possible they did that because it was such a

dirty site that they were afraid that they wouldn’t be allowed to

allow anything to happen; is that?

Ms. DE HERNANDEZ. I can’t speak for what their reasons were.

Mr. SHAYS. OK.

Ms. DE HERNANDEZ. But they are now deciding. They are talking

about doing that at every future response.

Mr. SHAYS. Right. OK.

Ms. DE HERNANDEZ. But part of the problem with OSHA taking

control over all these situations that there are gaps in the laws

that exist. There aren’t laws to cover a situation like September

11th that would protect workers, that would protect the

community——

Mr. SHAYS. OK. Let me do this.

160

Ms. DE HERNANDEZ. Sure.

Mr. SHAYS. Your contribution is outstanding. Speak to Kristine

afterwards and walk through some of what you think needs to happen. We might be able to come back to you, but let me stick with

the 2-minute rule for now, and I gather you are Ms. Lee Clarke.

STATEMENT OF LEE CLARKE

Ms. CLARKE. Yes. Thank you, Congressman. Thank you for letting us address you.

I too was struck by your question, and the answer that you did

not get. Let me say I am from District Council 37 of the American

Federation of State, County, and Municipal Employees.

We represent 120,000 New York City government workers in

New York City. We had thousands of our members down there

from day one to the day Ground Zero was no longer a rescue or recovery area.

Micki talked about OSHA not enforcing the law. It was not only

OSHA. In New York State, we have the Public Employee Occupational Safety and Health Bureau that abdicated their responsibility

to Federal OSHA, and it was a domino effect. Everybody threw

their hands up, and nobody protected the workers.

Early on and about a week after the Trade Center fell, we sat

down as union representatives with the city of New York to talk

to them about documenting the presence of our members down

there, providing medical monitoring for them, providing medical

treatment for them. Dr. Steve Levin from Mount Sinai accompanied me to those meetings, and to this day we still do not have

treatment for city workers.

I have a tremendous amount of respect for Dr. Kelly and the fire

department, and Dr. Prezant. They are running a fabulous program; so is Mount Sinai and the other clinics.

However, the city workers that go to the Mount Sinai program

have to go on their own time. When the Fire Department workers

go on work time, that is important to point out.

As Ron Vega said to you, point blank, I don’t have any more time

to take from work. This is costing me a lot of money out of my

pocket. We have thousands of city workers who are not getting

treated.

This is an important point to raise: why? When we talk about the

$75 million and how it is being divvied up or who is holding their

hand out for some of that money, I am concerned about the Registry also standing in that line.

I don’t want to see—the Registry serves some purpose, and not

a good scientific purpose in my mind.

But I don’t want to see money go to the Registry and not going

to treatment of these workers who are sitting here today. And

these are my members from the Department of Design and Construction.

Mr. SHAYS. Thank you.

Ms. CLARKE. Who could give you first hand information of their

problems with the system.

Mr. SHAYS. Well, let me go to Mr. John Romanowich.

161

STATEMENT OF JOHN ROMANOWICH

Mr. ROMANOWICH. Well, good afternoon.

Mr. SHAYS. So you are the guy that started this. You rose your

hand in a hearing? It has never been done before.

Mr. ROMANOWICH. I have been held accountable for a lot of

things.

I think I do have the answer. I can’t address the medical questions that the other experts have addressed, but I can answer the

question that you posed to Mr. Vega. How was he and all of us allowed to dive into that mess? And the answer is that the business

of America is business, and that was not just the New York financial center. That was the financial center of the world. Because of

all of our efforts, the police to secure the site, the fire department

to put out the fires, the sanitation, the transportation, DDC to organize all of the other people, business was restored to lower Manhattan and to the rest of the world.

Mr. SHAYS. Right.

Mr. ROMANOWICH. The stock market reopened within 10 days.

Telephone service initially was knocked out on all of lower Manhattan. That was restored block by block, bit by bit. A lot of people

don’t realize that the Federal Reserve Bank is only 3 blocks from

that site, just across Broadway and down the hill is the New York

Branch of the Federal Reserve Bank.

Something like $200 billion of gold bullion was safely and orderly

removed from the vaults below the World Trade Center. A lot of

people don’t even know that, but for 24 hours armored trucks had

a steady stream of gold bullion leaving that place.

They were able to leave because we got the streets cleared. They

were able to leave because the police department held back with

the National Guard—held back the onlookers. It was all organized

by DDC. We orchestrated everything there. The police department

has credit coming. The fire department certainly has credit coming.

The sanitation, the transportation people, everybody.

There was urgency in that the entire site was in danger of flooding by the New York Bay, which was just a couple of hundred feet

to the west—the Hudson River and all of the Atlantic Ocean.

That site, if it had flooded, would have flooded the entire subway

system of New York and probably you would still be pumping it out

today, not just pumping out New Orleans, but pumping out the entire subway of New York.

We stopped the bleeding. We restored the breath. We cleaned the

wound. We pulled the edges together. Day by day, that site grew

smaller. Streets were opened and put back into service. The whole

thing was shrunk down, shrunk down. Life continued. Life restarted and continued around it, until eventually you have a nice

clean wound that anyone could look at.

Mr. SHAYS. So the question is could we have done that and protected the workers at the same time?

Mr. ROMANOWICH. No.

Mr. SHAYS. No?

Mr. ROMANOWICH. No, because the time someone had developed

the proper training, got all the protocols in order, the subway system may have been flooded. There was a real hustle in the initial

days to stop that site from——

162

Mr. SHAYS. OK. I am going to buy into the first week, the second

week, the third week, the fourth week. There was a point, and

what you said makes me very proud of what took place, because

it is pretty extraordinary, and it is wonderful to have you put on

the record these urgencies. But there was a point, and at the very

least, every worker should have been, you know, someone should

have looked in their face, held their head and said, you may become sick doing this. Do you volunteer to do this? So there are

things we could have done. Let me get to the next person.

Mr. ROMANOWICH. Yes. As individuals, we were aware of the

dangers. But just like the people who walked into Chernobyl to secure that atomic energy disaster, they sacrificed their lives for their

country, we threw ourselves on the fire.

Mr. SHAYS. Right. You know, I think you did in one sense. But

there was a point where they left Chernobyl the way it was, and

didn’t ask people to go in after everybody was dead and the emergency. For 10 months, this happened.

Mr. ROMANOWICH. As the urgency lessened there, the training increased.

Mr. SHAYS. Yes.

Mr. ROMANOWICH. There was a definite relationship.

Mr. SHAYS. Let me hear from somebody—I think what you have

made is on the record, and it is important to be on the record. Let

me get to the next. And the next person is Mr. Mickey Kennedy—

Michael Kennedy.

STATEMENT OF MICHAEL KENNY

Mr. KENNY. Thank you. I am Mike Kenny.

Mr. SHAYS. I am going to have you start over again. Hold it.

Mr. KENNY. OK. Hello. I am Mike Kenny, and thank you for having me down here.

Mr. SHAYS. Nice to have you here, sir.

Mr. KENNY. And it is an unexpected surprise, but a good one.

I am Local 375, Civil Service Technical Field, health and safety

officer, but I also spent 7 months at the site. Actually, it was 6

weeks before I was tested for PPE, because that is how crazy it was

down there, to find the time to get. So until after 6 weeks went by,

I really didn’t have the right PPE, because I was taking whatever

I could find when I went down there. And then I was tested, fitted,

and I knew which one to take.

After 7 months being at the site, I was injured. I broke my collar

bone, and I left the site. And to go to through the workers’ comp

system and to try to get treatment with an injury from the site and

to be contested from the city at the same time was very derogatory,

because once you filled out the paperwork saying you were hurt at

the site, and you go to the doctor, the doctor wouldn’t take you

until you got a workers’ comp number from the city. And I was out

of work for 40 weeks.

Mr. SHAYS. Wow.

Mr. KENNY. And when I went back to work, I was so depressed,

I couldn’t even walk up a flight of steps at that time.

There was nothing there. Mental health was through Project Liberty. I was able to find mental health. I went through the mental

health division, and then after that Red Cross gave me a grant to

163

go to more mental help. And I am still going to mental help from

what happened down at the site to me.

But even after going through the workers’ comp, 3 years before

my case was finally—we went right to the day of trial when the

city backed up and said OK you were injured at the city, they gave

me back—out of 200 days I was out, they gave me back 80 days.

That is all they gave me back, and they said thank you, you know.

I am in the treatment program right now at Mount Sinai. I have

major health concerns that I am actively going to. But I have

missed deadlines to reapply for mental health workers’ comp, because there is only a 2-year window. I never thought I would still

be in the situation I am in now. I have many members come to me,

and they don’t want to take on the fight with the city, because of

the way you are handled. If you—you try to go to work every day,

and then you try to go—I go to counseling. I give up one Saturday

every 2 weeks with family to go into the city for counseling.

Mr. SHAYS. Thank you. Thank you for your testimony. Mr.

Kaczorowski.

STATEMENT OF CHARLIE KACZOROWSKI

Mr. KACZOROWSKI. My name is Charlie Kaczorowski. I am District 37, Local 375. I was there the morning of September 11th, and

I was there for the next 10 months as the site supervisor to the

midnight to 8 a.m. shift.

Mostly I am going to speak about my concerns for my fellow coworkers, Ron and Mike and John and Marvin back there. Thirtyseven years ago, I spent a tour in Vietnam. I was exposed to Agent

Orange. In 1980, I had a liver two and half times the size and inflamed and enlarged. The doctors figured this came from Agent Orange.

Like Ron Vega said earlier, it depends where you stood on the

site, where the wind was blowing. It was night in December, I

spent 3 hours with two battalion chiefs, where we were trying to

watch the firemen go down to the boys to look for body parts or

victims, where the iron workers were cutting down the sticks of the

Trade Center facade. When the sticks fell, it caused a ripple effect

across the site, and the chiefs were concerned about losing more

men. So in order to be in contact with the chiefs and 10/10 and the

iron workers, I had my mask off for that long time, and during

those 3 hours, the clouds were coming up out of the ground from

the fumes, and it ripples. And 3 months later on, I had the ‘‘World

Trade Center cough.’’

Today, I now have—my wife says I don’t sneeze like I did before

September 11th. It is loud and it is unbelievable. I have rashes

now on my arms. I have a loss of breathing. I get tired quickly, and

my concerns are of my fellow co-workers about what they are going

through right now for what I experienced 37 years ago.

Mr. SHAYS. Thank you very much. Let me just turn to Mrs.

Maloney for any comment or questions you might want to ask.

Mrs. MALONEY. Well, first, I would like to thank the chairman

really for holding the only three Federal hearings on the health

needs of the Federal workers and for inviting the workers and

union leaders to come to the table. I think that is an extraordinary

164

expression of concern. It is the only time I have ever seen that happen since I have been in Congress, to bring up a group of people.

Charlie, what is Local 375? What was your job down at the site?

Mr. KACZOROWSKI. I was a site supervisor.

Mrs. MALONEY. You were a site supervisor for what? For what

agency?

Mr. KACZOROWSKI. DDC.

Mrs. MALONEY. DDC.

Mr. KACZOROWSKI. I am construction project manager.

Mrs. MALONEY. Construction project. I want to say that your testimony and John’s and Michael Kenny’s I think that there are so

many stories of unsung heroes and heroines, and the one that you

shared of coming down there and securing the site, of stopping the

flooding, of getting the treasure of the United States removed,

there are so many people who did extraordinary things with the police and the fire, but not everybody knows the story of what the

construction workers did and the iron workers and all of you. And

I think that one thing I would like to propose with my colleague,

Christopher Shays, and we have had a lot of successes together legislatively. We passed the intelligence reform bill, which I think is

probably the most important bill that has come before this Congress since I have been elected to office. It will hopefully make all

of us safer with the sharing of intelligence.

I would like to propose that we put forward a piece of legislation,

not just on rotating workers, which we are going to have to do

when we talk to Micki and to Lee about that aspect of the holes

in the whole OSHA deal.

But I would like to propose that we fund an oral history now that

we have people still alive that is part of the Library of Congress

that shares the incredible stories of the men and women that were

at Ground Zero. And what has struck me so much from Mr. Vega’s

testimony and John’s and Michael’s and Charlie’s is that you know

that you were making yourself when you went down there. I knew

I was making myself sick when I was down there. Yet, you felt like

this was a responsibility to protect our government, protect our

people, and to really respond and help people.

And what I found the most astonishing really and made the biggest impression on me—and I hear September 11th stories all the

time, and your stories today, to me, were very moving—is that

what is the most irritating to you is the way that the government

response has treated you. How dare they say to you you were not

down on the site. How dare they say to me you were not there trying to keep the subways from being flooded. How dare they say to

you that you weren’t there when the Towers fell, when the iron

workers brought back the skeletons down and the fumes came up.

How dare they question your integrity that you were there when

you selflessly went down there.

And what I hear is such an outrage and disappointment really

from workers that the Federal Government did not—and the State

and the city—did not respect their work and respect their valiant

actions really for the whole country. That seems to be more disturbing to people than anything else. I talked to one guy, he said

he found the flag. He has a picture of himself—the flag that went

165

all over the country and all over the United States and Europe and

Iraq, and they questioned that he was on the site.

We have people who have testified they have lost their limbs,

and they question they were on the site.

And so I hope that with this new appointment, which I consider

a real milestone—I am absolutely thrilled with this appointment—

that we have someone who can listen to their voices, hear their

concern, and respond hopefully to it.

But, as always, the response of the people who lived through it—

the union representatives, the workers, the police, the fire, the volunteers, the residents—I think we should have an oral history that

we begin now before we lose more of the people that were involved

with it that hopefully we learn from their experiences. And I say

to you and me, Chris, how dare we not have a policy that workers

are rotated in and off after the first crisis week or two. I mean that

should have been a given that we should want to get people in and

out and into fresh air for their health care.

I wanted to thank Charlie for your service to our Nation in Vietnam.

Mr. KACZOROWSKI. Thank you.

Mrs. MALONEY. I feel that the Vietnamese war heroes were not

treated with the proper respect by our country, and I really vow

to you and hopefully with the help of Chris and Vito Fossella that

we make sure that our heroes of September 11th are treated with

the respect that they deserve starting with absolute adequate, unquestioned health care. You were there for us. We need to be there

for you. End of story.

Mr. KACZOROWSKI. Thank you.

Mrs. MALONEY. And I say it has to be a city and State and Federal responsibility. I am surprised at the city’s response that I am

hearing from you today. Thank you.

Mr. KACZOROWSKI. Thank you.

Mr. SHAYS. Thank you all.

Mr. KACZOROWSKI. Thank you.

Ms. DE HERNANDEZ. Thank you.

Mr. SHAYS. Thank you all very much and just for the record, we

are having these hearings at the request of Mrs. Maloney. She is

the one who asked the committee to have these hearings, and so

I thank the gentlelady for making sure that we focus on this issue,

and we will continue. Thank you very much. I appreciate all of

your testimony.

Ms. DE HERNANDEZ. Thank you, Mr. Chairman. Thank you, Congresswoman Maloney.

[Whereupon, at 5:18 p.m., the subcommittee was adjourned.]

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