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EXAMINING H.R. 1786, THE JAMES ZADROGA 

9/11 HEALTH AND COMPENSATION REAUTHORIZATION ACT 

HEARING 

BEFORE THE

SUBCOMMITTEE ON HEALTH 

OF THE

COMMITTEE ON ENERGY AND 

COMMERCE 

HOUSE OF REPRESENTATIVES 

ONE HUNDRED FOURTEENTH CONGRESS 

FIRST SESSION 

JUNE 11, 2015 

Serial No. 114–52 

( 

Printed for the use of the Committee on Energy and Commerce 

energycommerce.house.gov 

COMMITTEE ON ENERGY AND COMMERCE 

FRED UPTON, Michigan 

Chairman 

JOE BARTON, Texas 

Chairman Emeritus 

ED WHITFIELD, Kentucky 

JOHN SHIMKUS, Illinois 

JOSEPH R. PITTS, Pennsylvania 

GREG WALDEN, Oregon 

TIM MURPHY, Pennsylvania 

MICHAEL C. BURGESS, Texas 

MARSHA BLACKBURN, Tennessee 

Vice Chairman 

STEVE SCALISE, Louisiana 

ROBERT E. LATTA, Ohio 

CATHY MCMORRIS RODGERS, Washington 

GREGG HARPER, Mississippi 

LEONARD LANCE, New Jersey 

BRETT GUTHRIE, Kentucky 

PETE OLSON, Texas 

DAVID B. MCKINLEY, West Virginia 

MIKE POMPEO, Kansas 

ADAM KINZINGER, Illinois 

H. MORGAN GRIFFITH, Virginia 

GUS M. BILIRAKIS, Florida 

BILL JOHNSON, Ohio 

BILLY LONG, Missouri 

RENEE L. ELLMERS, North Carolina 

LARRY BUCSHON, Indiana 

BILL FLORES, Texas 

SUSAN W. BROOKS, Indiana 

MARKWAYNE MULLIN, Oklahoma 

RICHARD HUDSON, North Carolina 

CHRIS COLLINS, New York 

KEVIN CRAMER, North Dakota 

FRANK PALLONE, JR., New Jersey 

Ranking Member 

BOBBY L. RUSH, Illinois 

ANNA G. ESHOO, California 

ELIOT L. ENGEL, New York 

GENE GREEN, Texas 

DIANA DEGETTE, Colorado 

LOIS CAPPS, California 

MICHAEL F. DOYLE, Pennsylvania 

JANICE D. SCHAKOWSKY, Illinois 

G.K. BUTTERFIELD, North Carolina 

DORIS O. MATSUI, California 

KATHY CASTOR, Florida 

JOHN P. SARBANES, Maryland 

JERRY MCNERNEY, California 

PETER WELCH, Vermont 

BEN RAY LUJA ́ N, New Mexico 

PAUL TONKO, New York 

JOHN A. YARMUTH, Kentucky 

YVETTE D. CLARKE, New York 

DAVID LOEBSACK, Iowa 

KURT SCHRADER, Oregon 

JOSEPH P. KENNEDY, III, Massachusetts 

TONY CA ́ RDENAS, California 

SUBCOMMITTEE ON HEALTH

JOSEPH R. PITTS, Pennsylvania 

Chairman 

BRETT GUTHRIE, Kentucky 

Vice Chairman 

ED WHITFIELD, Kentucky 

JOHN SHIMKUS, Illinois 

TIM MURPHY, Pennsylvania 

MICHAEL C. BURGESS, Texas 

MARSHA BLACKBURN, Tennessee 

CATHY MCMORRIS RODGERS, Washington 

LEONARD LANCE, New Jersey 

H. MORGAN GRIFFITH, Virginia 

GUS M. BILIRAKIS, Florida 

BILLY LONG, Missouri 

RENEE L. ELLMERS, North Carolina 

LARRY BUCSHON, Indiana 

SUSAN W. BROOKS, Indiana 

CHRIS COLLINS, New York 

JOE BARTON, Texas 

FRED UPTON, Michigan (ex officio) 

GENE GREEN, Texas 

Ranking Member 

ELIOT L. ENGEL, New York 

LOIS CAPPS, California 

JANICE D. SCHAKOWSKY, Illinois 

G.K. BUTTERFIELD, North Carolina 

KATHY CASTOR, Florida 

JOHN P. SARBANES, Maryland 

DORIS O. MATSUI, California 

BEN RAY LUJA ́ N, New Mexico 

KURT SCHRADER, Oregon 

JOSEPH P. KENNEDY, III, Massachusetts 

TONY CA ́ RDENAS, California 

FRANK PALLONE, JR., New Jersey (ex 

officio) 

(II) 

(III) 

C O N T E N T S 

Page 

Hon. Joseph R. Pitts, a Representative in Congress from the Commonwealth 

of Pennsylvania, opening statement ................................................................... 1 

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

Hon. Gene Green, a Representative in Congress from the State of Texas, 

opening statement ................................................................................................ 4 

Prepared statement .......................................................................................... 5 

Hon. Fred Upton, a Representative in Congress from the State of Michigan, 

opening statement ................................................................................................ 6 

Prepared statement .......................................................................................... 7 

Hon. Frank Pallone, Jr., a Representative in Congress from the State of 

New Jersey, opening statement .......................................................................... 8 

Prepared statement .......................................................................................... 10 

WITNESSES

John Howard, M.D., Director, National Institute for Occupational Safety and 

Health ................................................................................................................... 11 

Prepared statement .......................................................................................... 13 

Answers to submitted questions 1 ................................................................... 101 

Iris G. Udasin, M.D., Director, Environmental and Occupational Health 

Sciences Institute, Robert Wood Johnson Medical School ................................ 39 

Prepared statement .......................................................................................... 42 

David G. Howley, Retired Police Officer, New York City Police Department .... 48 

Prepared statement .......................................................................................... 49 

Barbara Burnette, Former Detective, New York City Police Department ......... 54 

Prepared statement .......................................................................................... 56 

SUBMITTED MATERIAL

H.R. 1786, the James Zadroga 9/11 Health and Compensation Reauthorization Act, submitted by Mr. Pitts ......................................................................... 68 

Statement of Hon. Peter T. King, a Representative in Congress from the 

State of New York, submitted by Mr. Pitts ....................................................... 79 

Statement of Harold A. Schaitberger, General President, InterNational Association of Fire Fighters, June 11, 2015, submitted by Mr. Pitts ...................... 80 

Statement of Ed Mullins, President, Sergeants Benevolent Association of 

the New York City Police Department, June 11, 2015, submitted by Mr. 

Pitts ....................................................................................................................... 82

Letter of June 9, 2015, from William J. Johnson, Executive Director, National 

Association of Police Organizations, Inc., to Mr. Pitts and Mr. Green, submitted by Mr. Pitts .............................................................................................. 91 

Article, ‘‘The Forgotten Victims,’’ PBA Magazine, submitted by Mr. Pitts ......... 93 

Statement of Hon. Daniel M. Donovan, Jr., a Representative in Congress 

from the State of New York, submitted by Mr. Lance ...................................... 96 

Letter of June 11, 2015, from Mr. Lance, et al., to House Speaker John 

A. Boehner and Minority Leader Nancy Pelosi, submitted by Mr. Lance ....... 97 

1Dr. Howard did not answer submitted questions for the record by the time 

of printing. 

(1) 

EXAMINING H.R. 1786, THE JAMES ZADROGA 

9/11 HEALTH AND COMPENSATION REAUTHORIZATION ACT 

THURSDAY, JUNE 11, 2015 

HOUSE OF REPRESENTATIVES, 

SUBCOMMITTEE ON HEALTH, 

COMMITTEE ON ENERGY AND COMMERCE, 

Washington, DC. 

The subcommittee met, pursuant to call, at 10:17 a.m., in Room 

2123 of the Rayburn House Office Building, Hon. Joseph R. Pitts 

(chairman of the subcommittee) presiding. 

Members present: Representatives Pitts, Guthrie, Whitfield, 

Shimkus, Burgess, Lance, Griffith, Bilirakis, Long, Ellmers, 

Bucshon, Brooks, Collins, Upton (ex officio), Green, Engel, 

Schakowsky, Castor, Sarbanes, Luja ́n, Schrader, Kennedy, 

Ca ́ rdenas, and Pallone (ex officio). 

Also present: Representatives King, Maloney, Nadler, Donovan, 

and Clarke. 

Staff present: Clay Alspach, Chief Counsel, Health; Gary Andres, 

Staff Director; Leighton Brown, Press Assistant; Karen Christian, 

General Counsel; Noelle Clemente, Press Secretary; Paul Edattel, 

Professional Staff Member, Health; Carly McWilliams, Professional 

Staff Member, Health; Katie Noraria, Professional Staff Member, 

Health; Tim Pataki, Professional Staff Member; Graham Pittman, 

Legislative Clerk; Adrianna Simonelli, Legislative Associate, 

Health; Heidi Stirrup, Health Policy Coordinator; Greg Watson, 

Staff Assistant; Christine Brennan, Democratic Press Secretary; 

Jeff Carroll, Democratic Staff Director; Waverly Gordon, Democratic Professional Staff Member; Tiffany Guarascio, Democratic 

Deputy Staff Director and Chief Health Advisor; Ashley Jones, 

Democratic Director of Communications, Member Services and 

Outreach; Tim Robinson, Democratic Chief Counsel; and Samantha 

Satchell, Democratic Policy Analyst. 

Mr. PITTS. Ladies and gentlemen, if you will, if you will take 

your seats, we will begin. I would like to ask all of our guests today 

to please take their seats. The subcommittee will come to order. 

The Chair will recognize himself for an opening statement. 

OPENING STATEMENT OF HON. JOSEPH R. PITTS, A REPRESENTATIVE IN CONGRESS FROM THE COMMONWEALTH 

OF PENNSYLVANIA 

Today’s Health Subcommittee hearing will examine the World 

Trade Center (WTC) Health Program that was created in the 

2 

James Zadroga 9/11 Health and Compensation Act enacted in 2011. 

The Act allocated $4.2 billion to create the Health Program, which 

provides monitoring, testing, and treatment for people who worked 

in response and recovery operations, as well as for other survivors 

of the 9/11 attacks. The authorization of the Health Program ends 

on September 30, 2015. Another part of the law, the September 

11th Victim Compensation Fund, is under the jurisdiction of the 

Judiciary Committee. It will continue to accept applications until 

October 3, 2016, over a year after the Health Program authorization ends. 

The WTC Health Program funds networks of specialized medical 

programs, and these programs are designed to monitor and treat 

those with 9/11-related conditions. For responders, The World 

Trade Center Medical Monitoring and Treatment Program; for survivors, the NYC Health and Hospitals Corporation WTC Environmental Health Center; for NYFD personnel, the Fire Department 

of New York Responder Health Program; the National Program, 

the WTC Health Program has a nationwide network of clinics with 

providers across the country for responders and survivors who live 

outside the New York City metropolitan area. These programs provide free medical services by health care professionals who specialize in 9/11-related conditions. 

Our colleagues, Representatives Carolyn Maloney, Peter King, 

and Jerrold Nadler, have jointly introduced legislation, H.R. 1786, 

the James Zadroga 9/11 Health and Compensation Reauthorization 

Act, which reauthorizes the Act. This legislation has begun an important conversation that will lead to a timely and fully offset reauthorization of the Health Program. 

Today’s hearing will allow us to learn more about how the program is working and whether changes are needed. We will hear 

from the Director of the National Institute for Occupational Safety 

and Health, who is responsible for administering the program, as 

well as from the medical director of the Robert Wood Johnson Medical School, and 2 first responders who are enrolled in the World 

Trade Center Health Program. 

Mr. PITTS. I look forward to the testimony today. 

[The prepared statement of Mr. Pitts follows:] 

PREPARED STATEMENT OF HON. JOSEPH R. PITTS

Today’s Health Subcommittee hearing will examine the World TradeCenter (WTC) 

Health Program that was created in the James Zadroga 9/11 Health and Compensation Act enacted in 2011. 

The Act allocated $4.2 billion to create the Health Program, which provides monitoring, testing, and treatment for people who worked in response and recovery operations as well as for other survivors of the 9/11 attacks. The authorization of the 

Health Program ends on September 30, 2015. Another part of the law, the September 11th Victim Compensation Fund, is under the jurisdiction of the Judiciary 

Committee. It will continue to accept applications until October 3, 2016, over a year 

after the Health Program authorization ends. 

The WTC Health Program funds networks of specialized medical programs. These 

programs are designed to monitor and treat those with 9/11-related conditions. 

• For responders—The World Trade Center Medical Monitoring and Treatment 

Program; 

• For survivors—NYC Health and Hospitals Corporation WTC Environmental 

Health Center; 

• For NYFD Personnel—The Fire Department of New York (FDNY) Responder 

Health Program; 

3 

• The National Program—The WTC Health Program has a nationwide network 

of clinics with providers across the country for responders and survivors who live 

outside the New York City metropolitan area. 

These programs provide free medical services by health care professionals who 

specialize in 9/11-related conditions. 

Our colleagues, Reps. Carolyn Maloney (NY), Peter King (NY) and Jerrold Nadler 

(NY), have jointly introduced legislation, H.R. 1786—the ‘‘James Zadroga 9/11 

Health and Compensation Reauthorization Act’’—which reauthorizes the Act. This 

legislation has begun an important conversation that will lead to a timely and fully 

offset reauthorization of the Health Program. 

Today’s hearing will allow us to learn more about how the program is working 

and whether changes are needed. We will hear from the Director of the National 

Institute for Occupational Safety and Health who is responsible for administering 

the program, as well as from the medical director of the Robert Wood Johnson Medical School and two first responders who are enrolled in the World Trade Center 

Health Program. 

I look forward to the testimony today and yield the balance of my time to the gentleman from New Jersey, Rep. Leonard Lance. 

[Bill H.R. 1786 appears at the conclusion of the hearing.] 

Mr. PITTS. And I would like to yield the balance of my time to 

the gentleman from New Jersey, Representative Lance. 

Mr. LANCE. Thank you, Mr. Chairman. It is my honor to welcome 

David Howley, a constituent of mine in New Jersey’s seventh congressional district, to the committee this morning. 

David, thank you for making the trip from New Jersey to share 

your story, and advocate for those who cannot be with us today. We 

look forward to your testimony. 

I first met David several months ago when he came into my office in Westfield, New Jersey, to discuss the bill before us today. 

And this Reauthorization Act is, I think, critically important. David 

has been a tremendous advocate for the legislation because, as he 

will detail in his testimony, he knows firsthand the importance of 

these programs for him and his fellow first responders and survivors. 

David joined the New York Police Department in 1985, and 

served in various departments over his 21-year tenure. He is a 

third generation law enforcement official; following the tradition of 

his father and grandfather. He was serving in the NYPD Operations Division on September 11, 2001, and spent the next several 

months in the dust and rubble of Ground Zero. 

I am proud to have David here with us today, and I am proud 

to be a cosponsor of this critical legislation. 

It is my hope, Mr. Chairman, that we can work in a bipartisan 

fashion to move this legislation forward quickly, and I look forward 

to voting for it not only here and in full committee, but on the floor 

of the House of Representatives. 

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

Mr. PITTS. The Chair thanks the gentleman. And I also would 

note that some of our colleagues from the New York delegation who 

are not on the committee, but very concerned of this issue and 

sponsors of the legislation, have requested to sit on the dais, and 

we welcome them this morning. 

At this point, the Chair recognizes the ranking member of the 

subcommittee, Mr. Green, 5 minutes for an opening statement. 

4 

OPENING STATEMENT OF HON. GENE GREEN, A 

REPRESENTATIVE IN CONGRESS FROM THE STATE OF TEXAS 

Mr. GREEN. Thank you, Mr. Chairman, for holding the hearing 

on this important program. I thank the witnesses today, and for 

the first responders in the audience who—for their bravery and 

service both on and after the tragic day of 9/11. Thank you for coming today to share your personal experiences and shed light on the 

significance of the World Trade Center Health Programs. 

No one here can forget the horrific attacks perpetrated upon our 

country at the World Trade Center in New York, the Pentagon, and 

Washington, and at the field in Shanksville, Pennsylvania. During 

and after the attacks, tens of thousands of first responders, including police, firefighters, emergency medical workers, jumped into action to assist in rescue, recovery, and cleanup. As a result of their 

service, these responders were exposed to dust, smoke, toxins, such 

as pulverized concrete, fibrosis, glass, particulate matter, and asbestos. This exposure caused many of them to develop a spectrum 

of debilitating diseases, including respiratory disorders like asthma, skin, prostate, and lymphedema cancers. A GAO report on the 

9/11 Health Program suggested that firefighters who responded to 

the attack ‘‘experienced a decline in lung function equivalent to 

that of which produced by 12 years of aging.’’ 

In addition to the physical ailments these heroes now have, 

many have suffered post-traumatic stress syndrome, PTSD, depression, anxiety stemming from psychological trauma they experienced 

in the aftermath of the attack. 

Nearly 1 decade after the September 11 terrorist attacks, the 

James Zadroga 9/11 Health and Compensation Act was signed into 

law in 2010. The Zadroga Act created the World Trade Center 

Health Program within the Department of Health and Human 

Services. The program provided evaluation, monitoring, and medical necessary physical and mental health treatments to first responders and certified eligible survivors of the World Trade Centerrelated illnesses. It has also established a network of Clinical Centers of Excellence and data centers. For these responders and survivors who reside outside the New York area, the Act created a national network of health providers who provide the same types of 

services for World Trade Center-related illnesses. While cancer was 

not originally listed among the statutory WTC-related health conditions, 60 types of cancer were added in 2012, after a petition by 

Members of Congress. As of May the 5th of this year, 37,000 members of the health program had cancer. 

The Act also established the Victim Compensation Fund that 

provides compensation for harm suffered as a result of debris removal. Without action by Congress, funding for the current Health 

Program will terminate on September of 2016. The James Zadroga 

9/11 Health and Compensation Reauthorization will reauthorize 

the critical World Trade Center Health Program and the Victim 

Compensation Fund. 

As requires under the current program, New York City will continue to pay 10 percent of the total cost. It is important to note that 

WTC Health Program serves our heroes nationwide, and extends 

far beyond the New York area. Both these and currently enrolled 

and future enrollees live in all areas of the country. In fact, as of 

5 

August 2014, 429 of the 435 congressional districts were home to 

at least 1 9/11 responder or survivor. 

We must not abandon those who bravely sacrificed their own 

wellbeing on behalf of the country in the wake of terrible attacks. 

We have a duty to serve our first responders and survivors and heroes with complex healthcare from 9/11. It is critically important 

that we support the James Zadroga 9/11 Health Compensation Reauthorization Act. 

I would like to thank the first responders for their gallant and 

selfless service on and after 9/11. I would also like to thank the 

doctors and administrators of the program for their efforts to treat 

the complex illnesses afflicted on our first responders, and continued research on the impact of exposure to toxins and psychological 

trauma. 

[The prepared statement of Mr. Green follows:] 

PREPARED STATEMENT OF HON. GENE GREEN

Thank you, Mr. Chairman, for holding a hearing on this important program. I 

thank the witnesses today, and to the First Responders in the audience, for their 

bravery and service, both on and after, the tragic day of 9/11. 

Thank you for coming today to share your personal experiences with the committee and shed light on the significance of the World Trade Center Health Programs. No one here can forget the horrific attacks perpetrated upon our country at 

the World Trade Center in New York, the Pentagon in Washington, and at a field 

in Shanksville, Pennsylvania. 

During and after the attacks, tens of thousands of first responders—including police, firefighters, and emergency medical workers—jumped into action to assist in 

rescue, recovery, and clean up. As a result of their service, these responders were 

exposed to dust, smoke, and toxins, such as ‘‘pulverized concrete, fibrous glass, particulate matter, and asbestos.’’ 

This exposure caused many of them to develop a spectrum of debilitating diseases, 

including respiratory disorders like asthma, and skin, prostate. and lymphedema 

cancers. A GAO report on the 9/11 Health program suggested that firefighters who responded to the attack quote ‘‘experienced a decline in lung function equivalent to 

that which would be produced by 12 years of aging.’’ In addition to the physical ailments these heroes now have, many also suffer from Post-Traumatic Stress Disorder 

or ‘‘PTSD,’’ depression, and anxiety stemming from the psychological trauma they 

experienced in the aftermath of the attack. Nearly one decade after the September 

11 terrorist attacks, the James Zadroga 9/11 Health and Compensation Act was 

signed into law in 2010. The Zadroga Act created the World Trade Center Health 

Program within the Department of Health & Human Services. 

The Program provides evaluation, monitoring, and medically necessary physical 

and mental healthtreatments to first responders and certified-eligible survivors for 

World Trade Center-related illnesses. 

It also established a network of Clinical Centers of Excellence and Data Centers. 

For those responders and survivors who reside outside the New York City area, the 

Act created a national network of health care providers, who provide the same types 

of services for World Trade Center-related illnesses. While cancer was not originally 

listed among the statutory WTC-related health conditions, 60 types of cancer were 

added in 2012 after a petition by members of Congress. 

As of May 5 of this year, 3,700 members of the Health Program had cancer. The 

Act also established the Victim Compensation Fund to provide compensation for 

harm suffered as a result of debris removal. Without action by Congress, funding 

for the current Health Program will terminate in September 2016. The James 

Zadroga 9/11 Health and Compensation Reauthorization Act will reauthorize the 

critical WCT Health Program and VCF. 

As required under the current program, New York City would continue to pay for 

10 percent of the total program costs. 

It is important to note that the WTC Health Program serves our heroes nationwide. It extends far beyond the New York area. 

Both those currently enrolled and future enrollees live in all areas of the country. 

In fact, as of August 2014, 429 of the 435 Congressional Districts were home to at 

6 

least one 9/11 responder or survivor. We must not abandon those who bravely sacrificed their own well-being on behalf of country in the wake of the terrible attacks. 

We have a duty to serve our first responders, survivors, and heroes with complex 

health needs from 9/11. 

It is critically important that we support the James Zadroga 9/11 Health and 

Compensation Reauthorization Act. I thank the first responders for their gallant 

and selflessservice on and after 9/11. I also want to thank the doctors and administrators of the program for their efforts to treat the complex illnesses afflicting our 

first responders, and continued research on the impact of exposure to toxins and 

psychological trauma. 

Thank you, Mr. Chairman. I yield back. 

Mr. GREEN. Mr. Chairman, if someone on our side of the aisle 

would like a minute, I would be glad to yield to them. I would like 

to yield to my colleague from New York. 

Ms. CLARKE. I thank the ranking member of the subcommittee, 

as well as the chairman. And welcome our witnesses here today. 

While not a member of this subcommittee, I am a member of the 

full Committee on Energy and Commerce. I am Congresswoman 

Clarke of New York. And I wanted to thank Chairman Pitts and 

Ranking Member Green for holding this hearing, and allowing me 

to sit in this very important hearing. Also want to thank our panelists. It is a—good that you have shared your experiences and remind America of the importance of renewing this very important 

program. This is a great first step toward reauthorization, in a 

time when the American people are skeptical about the work of 

Congress, so I am happy that this committee is working in a bipartisan fashion to move expeditiously to renew these important 

health programs. Congress must move forward to ensure first responders and survivors of the 9/11 terrorist attacks on the World 

Trade Center, the Pentagon, and Shanksville, Pennsylvania, continue to receive the care they deserve and they so sorely need. 

With that, Mr. Chairman, Mr. Ranking Member, I yield back the 

time. 

Mr. GREEN. Mr. Chairman, I yield back. 

Mr. PITTS. The Chair thanks the gentleman. 

Now recognize the chair of the full committee, Mr. Upton, 5 minutes for an opening statement. 

OPENING STATEMENT OF HON. FRED UPTON, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF MICHIGAN 

Mr. UPTON. Well, thank you, Mr. Chairman. 

Now, back on September 11, ’01, the world as we knew it was 

turned upside down by unthinkable acts of terrorism, which took 

the lives of nearly 3,000 individuals in New York, Pennsylvania, 

and Virginia, left a mark on every American. Every one of us was 

impacted. From the smoldering ruins of the Twin Towers and the 

Pentagon to the wreckage of United Airlines Flight 93, the painful 

images and heartbreaking personal stories of that day, every 

minute, will not be forgotten. 

We remember the thousands of innocent lives lost and the communities of loved ones they left behind, and many of us met with 

those. We also honor the countless acts of heroism and leadership 

shown by brave American men and women in those hours of pandemonium and in the days, weeks, months, and now years that have 

followed. Then, for me, as chair of the Telecom Subcommittee on 

7 

this committee, I led a bipartisan delegation, both to New York and 

to the Pentagon, where we witnessed firsthand the valiant efforts 

of our first responders who were certainly exhausted, overwhelmed, 

but still working 24/7. First responders spent hours, days in air 

that was thick with dust and smoke, digging through the rubble, 

searching for survivors. 

When I visited Ground Zero, New York’s finest were still working 

round the clock in impossible conditions for the recovery efforts. 

Their selfless work took a toll on their health. We know that. The 

Federal Government provided aid to those individuals who were injured and the families of those who were killed in the attacks 

through a discretionary grant program, as we should. 

In 2011, the Zadroga 9/11 Health and Compensation Act established the World Trade Center Health Program and the Victim 

Compensation Fund. Our ranking member, Frank Pallone, and our 

New York colleagues Representatives Carolyn Maloney, Peter King, 

and Jerry Nadler, have jointly introduced now H.R. 1786, the 

James Zadroga 9/11 Health and Compensation Reauthorization 

Act, which would reauthorize both of these programs. 

At today’s hearing, we are going to focus on the World Trade 

Center Health Program as it is the program that falls in this committee’s jurisdiction. The authorization for the World Trade Center 

Health Program ends at the end of September, just a few months 

from now, while the Victim Compensation Fund remains open to 

applicants into October of 2016. 

The WTC Health Program funds networks of specialized medical 

programs designed to monitor and treat those with 9/11-related 

conditions. The members enrolled in the program are not just from 

the greater New York area. In 2014, there were 71,942 individuals 

in the World Trade Center Health Program from 429 of the 435 

congressional districts. In fact, there are 75 Michigan residents currently enrolled in the WTC Health Program. Today’s hearing is, 

yes, an important opportunity to learn more about how the World 

Trade Center Health Program has operated since its authorization 

in, and what is needed for it to successfully operate and meet the 

needs of its members in the future. 

I want to thank all of the witnesses today for taking the time to 

be here, especially thank Officer Howley and Detective Burnette for 

their service to our great country, and for sharing their personal 

stories and struggles with this subcommittee. The bill needs to be 

passed, and I will look to consider every effort to make sure that 

we get it to the House Floor prior to its—prior to the end of September so that we will have an opportunity to make sure that 

these victims are taken care of. 

And I yield back the balance of my time. 

[The prepared statement of Mr. Upton follows:] 

PREPARED STATEMENT OF HON. FRED UPTON

On September 11, 2001 the world as we know it was turned upside down by unthinkable acts of violent extremism, which took the lives of nearly 3,000 individuals 

in New York, Pennsylvania, and Virginia—leaving a mark on every American. From 

the smoldering ruins of the Twin Towers and the Pentagon to the wreckage of 

United Airlines Flight 93, the painful images and heartbreaking personal stories of 

that day will not be forgotten. We remember the thousands of innocent lives lost 

and the communities of loved ones they left behind. We also honor the countless 

8 

acts of heroism and leadership shown by brave American men and women in those 

hours of pandemonium and in the days, weeks, and months that followed. 

First responders spent countless hours in air that was thick with dust and smoke 

digging through the rubble, and searching for survivors. The conditions were very 

difficult and took a toll on their health. Because of this the Federal Government provided aid to those individuals who were injured or killed in the attacks through a 

discretionary grant program. In 2010 the Zadroga 9/11 Health and Compensation 

Act was signed into law which established the World Trade Center Health Program 

(WTCHP) and the Victim Compensation Fund (VCF). Our New York colleagues 

Reps. Carolyn Maloney, Peter King, and Jerrold Nadler have jointly introduced H.R. 

1786, the ‘‘James Zadroga 9/11 Health and Compensation Reauthorization Act’’ 

which reauthorizes both of these programs. 

At today’s hearing we will focus on the World Trade Center Health Program as 

it is the program that falls in our committee’s jurisdiction. The WTC Health program funds networks of specialized medical programs that are designed to monitor 

and treat those with 9/11-related conditions. The members enrolled in the program 

are not only from the greater New York area, but in 2014 71,942 members enrolled 

in the World Trade Center Health Program from 429 out of 435 congressional districts. 

Today’s hearing gives us an opportunity to learn more about how the WTC Health 

Program has operated since its authorization in 2010 and what is needed for it to 

successfully operate and meet the needs of its members in the future. I would like 

to thank all of the witnesses for taking the time to be here today to discuss the 

WTC Health Program and I would like to specifically thank Officer Howley and Detective Burnette for their service to our great country and for sharing their personal 

stories and struggles with the subcommittee. 

Thank you, Mr. Chairman, and I yield back the balance of my time. 

Mr. PITTS. The Chair thanks the gentleman. 

And now the Chair is pleased to recognize the ranking member 

of the full committee, a gentleman who has many constituents impacted by this issue, Mr. Pallone, 5 minutes for an opening statement. 

OPENING STATEMENT OF HON. FRANK PALLONE, JR., A REPRESENTATIVE IN CONGRESS FROM THE STATE OF NEW JERSEY 

Mr. PALLONE. Thank you, Chairman Pitts, and also Chairman 

Upton. And I particularly want to thank Chairman Upton for the 

comments he just made, you know, highlighting how we need to 

perceive this as a national program, and impacting people who 

came and helped out on 9/11 and the aftermath from all parts of 

the country. 

My staff probably is tired of my telling this story, but I remember within a few days after the attack, we went up to New York 

City with President Bush, and I was standing next to this big yellow fire engine that said Hialeah, Florida. And I said, what is this 

truck doing from Hialeah, because I think it was only 1 or 2 days 

after, and I wondered how it even got there so quickly. And I 

talked to the firemen from Hialeah, Florida, and they said, oh, we 

just—as soon as this happened, we just got in our fire truck and 

we drove up from Florida because we wanted to help. And it just 

struck me at the time about how so many people responded from 

all over the country, and so many people were injured because of 

the fact that they were there for a few days or a few weeks or a 

few months even. 

So this bill is a critical first step in ensuring that the 9/11 Health 

Program is extended as soon as possible. As you both already 

know, this is one of my top priorities for 2015, and I am grateful 

9 

for Chairman Pitts and Upton for your willingness to work with us 

to ensure the timely passage of this bill. 

I have to recognize all the first responders who are here, and to 

whom we owe a depth of gratitude. I also want to acknowledge Dr. 

Iris Udasin, who runs the New Jersey 9/11 Health Clinic. Thank 

you for being here to share your expertise and experience with us 

today. And let me also mention all the New Yorkers, Representative Maloney, the sponsor of the bill. I don’t know if Representative 

Nadler is here, but certainly he has been involved from the beginning. Representative King I see, who joined the committee today, 

as well as our representatives, Yvette Clarke, Eliot Engel, and also 

my colleague from New Jersey, Leonard Lance, who is the cosponsor. Since day 1, you have all fought tirelessly to ensure that our 

Nation’s 9/11 responders and survivors are cared for, and I am 

proud to fight alongside you. 

Beyond the immediate loss of life of 9/11, we now know with 

great documentation that thousands of first responders and survivors of the attacks are now suffering debilitating illnesses from 

its aftermath, and in fact, more than 100 firefighters and 50 law 

enforcement officers have reportedly lost their lives to WTC-related 

health conditions. Additionally, more than 1,500 active duty firefighters and EMS personnel, and over 550 law enforcement officers 

were forced to retire due to WTC-related health conditions. 

We now have a deep understanding of how the tons of dust, glass 

fragments, and other toxins released into the air affected both responders and survivors. Illnesses include respiratory diseases, 

gastroesophageal disorders, mental health conditions, and cancer. 

And that is why the James Zadroga 9/11 Health and Compensation 

Act, signed into law in 2011, is so critical. It established a program 

to monitor and screen eligible responders and survivors, and provides medical treatment to those who are suffering from World 

Trade Center-related diseases. But what is so important to note is 

that this program isn’t there to provide health insurance. These are 

complicated conditions that are chronic in nature, and require special expertise to appropriately diagnose and treat. That is why the 

program includes a network of clinics and providers specifically 

trained to treat these diseases. It also ensures that providers and 

survivors bear no out-of-pocket costs associated with these particular health conditions. 

The WTC Health Program currently provides monitoring and 

treatment services for more than 71,000 responders and survivors. 

They reside in every State, and in 429 of the 435 congressional districts. If some of you don’t know, the law is named for James 

Zadroga, a New Jersey hero who responded on 9/11 and spent hundreds of hours digging through World Trade Center debris. Mr. 

Zadroga died in 2006 from pulmonary disease and respiratory failure after his exposure to toxic dust at the World Trade Center site. 

Like him, thousands of people from all over this country came to 

the aid of our country, and helped others at Ground Zero. Those 

responders and survivors should not be abandoned, and I hope we 

can extend the health program without delay. 

[The prepared statement of Mr. Pallone follows:] 

10 

PREPARED STATEMENT OF HON. FRANK PALLONE, JR. 

Thank you Chairmen Pitts and Upton for calling today’s hearing. This is a critical 

first step in ensuring that the 9/11 Health program is extended as soon as possible. 

As you both already know, this is one of my top priorities for 2015, and I’m grateful 

for your willingness to work with me to ensure its timely passage. 

Before I get started, I have to recognize all the first responders who are here and 

to whom we owe a debt of gratitude. I also want to acknowledge Dr. Iris Udasin, 

who I’ve known for many years, who runs New Jersey’s 9/11 Health Clinic. Thank 

you for being here to share your expertise and experience with us today. 

Lastly, let me recognize Reps. Maloney, Nadler, and King from New York, who 

have joined the committee today, as well as our Members Reps. Engel and Clarke. 

Since day one you have all fought tirelessly to ensure that our Nation’s 9/11 responders and survivors are cared for. I’m proud to fight alongside you. 

Beyond the immediate loss of life of 9/11, we now know, with great documentation, that thousands of first responders and survivors of the attacks are now suffering debilitating illnesses from its aftermath. In fact, more than 100 firefighters 

and 50 law enforcement officers have reportedly lost their lives to WTC-related 

health conditions. Additionally, more than 1500 active duty firefighters and EMS 

personnel and over 550 law enforcement officers were forced to retire due to WTCrelated health conditions. 

We now have a deep understanding of how the tons of dust, glass fragments and 

other toxins released into the air affected both responders and survivors. Illnesses 

include respiratory diseases, gastro-esophageal disorders, mental health conditions, 

and cancer. 

That is why the James Zadroga 9/11 Health and Compensation Act, signed into 

law in 2011, is so critical. It established a program to monitor and screen eligible 

responders and survivors and provides medical treatment to those who are suffering 

from World Trade Center related diseases. 

But what is so important to note, is that this program isn’t there to provide health 

insurance. These are complicated conditions that are chronic in nature and require 

special expertise to appropriately diagnose and treat. That is why the program includes a network of clinics and providers specially trained to treat these diseases. 

It also ensures that providers and survivors bear no out of pocket costs associated 

with these particular health conditions. 

The WTC health program currently provides monitoring and treatment services 

for more than 71,000 responders and survivors. They reside in every State and in 

429 of the 435 Congressional Districts. 

If some of you don’t know, the law is named for James Zadroga, a New Jersey 

hero who responded on 9/11 and spent hundreds of hours digging through World 

Trade Center debris. Mr. Zadroga died in 2006 from pulmonary disease and respiratory failure after his exposure to toxic dust at the World Trade Center site. 

Like him, thousands of people, from all across this country, came to the aid of 

our country and helped others at Ground Zero. Those responders and survivors 

should not be abandoned. I hope we can extend the WTC health program without 

delay. 

I yield the remainder of my time to Representative Engel. 

Mr. PALLONE. I only have 30 seconds left for Mr. Engel, I apologize, but I yield to him. 

Mr. ENGEL. Well, thank you. I thank the gentleman for yielding. 

And let me agree with everything you said. 

In the aftermath of September 11, it is estimated that up to 

400,000 Americans were exposed to copious amounts of smoke and 

toxic substances, such as asbestos, and as a result, many of our heroes now suffer from these debilitating conditions; acute respiratory 

disorders, cancer, depression, post-traumatic stress disorder, and it 

goes on and on. And it is heartbreaking that the 9/11 survivors and 

first responders who have already given so much must now carry 

the burdens of these lung ailments, brain, very least we can do in 

thanks is to help them. 

So I was proud to be an original cosponsor of the James Zadroga 

9/11 Health and Compensation Act, and I am proud to be an original cosponsor of the reauthorization we are discussing today. A 

11 

failure on Congress’ part to pass this vital legislation would constitute an egregious affront to the Americans who gave so much on 

9/11 in service to their country. And I specifically say Americans 

because the population of those who will benefit from this reauthorization spans the entire United States. It is 429 of the 435 congressional districts that benefit from these programs. So this is an 

issue of national performance. So the first responders who rely on 

the World Trade Center Health Program did not hesitate to risk 

their lives for fellow Americans on 9/11, and we should not hesitate 

to care for them now. So it is of critical importance that we permanently reauthorize the James Zadroga 9/11 Health and Compensation Act. 

Thank you, Mr. Pallone. Thank you, Mr. Chairman. 

Mr. PITTS. The Chair thanks the gentleman. 

And as usual, all members’ written opening statements will be 

made part of the record. 

That concludes our time for opening statement. I have a unanimous consent request. I would like to submit the following documents for the record. Statements from Representative Peter King, 

New York, 2nd District, from the International Association of Firefighters, from the Sergeants Benevolent Association, from the National Association of Police Organizations, and an article from the 

New York City’s Patrolman’s Benevolent Association featuring Mr. 

David Howley. 

Without objection, so ordered. 

[The information appears at the conclusion of the hearing.] 

Mr. PITTS. We have 2 panels today. On our first panel we have 

Dr. John Howard, Director, National Institute for Occupational 

Safety and Health. Thank you very much for coming today, Dr. 

Howard. Your written statement will be made part of the record. 

You will be recognized for 5 minutes to make your opening statement. At this time, you are recognized. Welcome. 

STATEMENT OF JOHN HOWARD, M.D., DIRECTOR, NATIONAL 

INSTITUTE FOR OCCUPATIONAL SAFETY AND HEALTH 

Dr. HOWARD. Thank you, Mr. Chairman, and distinguished members of the committee. My name is John Howard, and I am the administrator of the World Trade Center Health Program. I am very 

pleased to appear before you today to discuss the program and 

those it serves, who responded to or survived the September 11, 

2001, terrorist attacks on New York City, and those who responded 

at the Pentagon and in Shanksville, Pennsylvania. 

The program’s members responded to an epic disaster, and as a 

result, suffer mental and physical injury, illness, and the risk of 

premature death. The program’s members responded to the 9/11 

disaster from all 50 States, and as has been stated, from 429 of the 

435 congressional districts. The original effort to care for those affected by 9/11 toxic exposures operated as a series of cooperative 

agreements and grants. As a discretionarily funded program, it depended on year-to-year appropriations, making it challenging to 

plan adequately to—for the members’ ongoing health needs. In 

January 2011, as has been stated, the James Zadroga 9/11 Health 

and Compensation Act became law. Stabilization of funding allows 

the program to more adequately care for 9/11 responders. In calVerDate Mar 15 2010 12:16 Mar 07, 2016 Jkt 037690 PO 00000 Frm 00015 Fmt 6633 Sfmt 6633 F:\114THCONGRESS\114X52X911HEALTHMORESCANS030416\114X52X911HEALTHPEN
12 

endar year 2014, of the 71,942 current members enrolled in the 

program, 20,883 members received treatment for health conditions 

arising from hazardous exposures from 9/11, and 28,059 members 

received health monitoring to ensure early medical intervention for 

any developing health condition that is specified for coverage by 

the program. 

Since the program’s implementation, members have been treated 

for a number of different health conditions. For example, 11,473 

members have been treated for asthma, 6,672 members have been 

treated for post-traumatic stress disorder, and 6,497 members have 

been treated for chronic respiratory disorders. The majority of our 

members suffer from multiple mental and physical health conditions, and take multiple medications for these conditions. Certain 

types of cancer were added to the list of health conditions covered 

by the program in late 2012. Since then, the program has certified 

4,265 cases of cancer. 

The World Trade Center Health Program fills a unique need in 

the lives of our members and for our society. First, members are 

evaluated and treated by medical providers who have a depth of experience dating back to September 11, 2001, and the physical and 

mental health needs of 9/11 responders and survivors they are very 

familiar with. Their extensive clinical experience with the responder and survivor populations, as well as their understanding 

of the role of exposure in causing disease, exceeds the training of 

providers unfamiliar with the types of exposures and health conditions common to the 9/11 population, and how to make the connection between exposure and illness that the Zadroga Act requires. 

Second, our members are receiving health care that cannot be 

provided, or only provided with great difficulty, by other types of 

insurance plans. For example, health insurance plans do not routinely cover work-related health conditions, leaving such coverage 

to Workers’ Compensation insurance. However, Workers’ Compensation insurance often presents coverage challenges to members 

because their 9/11 health conditions often first manifest after 9/11, 

many years later, beyond the statute of limitations found in most 

State Workers’ Compensation laws. The World Trade Center 

Health Program serves a vital role in overcoming the difficulties 

that members might otherwise experience in its absence. Without 

the program, 9/11 responders and survivors might end up in limbo 

instead of in treatment. 

Third, by providing evaluation and treatment for those most affected by 9/11 as a unified cohort, the program greatly aids not 

only the individual members, but also our national understanding 

of the long-term health effects of 9/11, including its effects on children. The program helps us better prepare for the medical needs 

arising from large-scale, long duration disasters that might not, 

hopefully, occur ever in the future. 

Thank you for the opportunity to testify, and I am happy to answer any questions you may have. 

[The prepared statement of Dr. Howard follows:] 

13 

14 

15 

16 

17 

18 

Mr. PITTS. The Chair thanks the gentleman, and I will begin the 

questioning and recognize myself 5 minutes for that purpose. 

Dr. Howard, would you continue to elaborate a little bit on the 

history of the World Trade Center Health Program, how it came to 

be, how it has changed over time? 

Dr. HOWARD. Thank you. The program started as a—an immediate response to what doctors were seeing, especially with the 

New York City Fire Department, in what was called at that time 

a World Trade Center cough, and those doctors and others that 

were recruited to the effort began to observe that individuals who 

were responding were becoming ill from inhalation of the dust and 

the toxins contained in the dust. So immediately, through FEMA 

appropriations, CDC and then the National Institute for Occupational Safety and Health, was able to offer grants and cooperative 

agreements so that those doctors could begin now many, many 

years later, their first work in trying to articulate, characterize the 

issues that responders were facing, and survivors. 

Mr. PITTS. Another question: What are the consequences of letting the World Trade Center Health Program expire in September 

of 2015? How would it affect the operation of the Centers of Excellence across the country, and the patients who use these facilities 

and services? 

Dr. HOWARD. Certainly, any of us that receive health care from 

a particular health plan, if we are notified that that plan no longer 

exists, creates great stress in our life. We have to adjust to new 

providers and other changes. Our efforts to help those who may be 

a part of our discontinued program, let’s hope that does not happen, would have to receive other providers of care, and it would be 

our responsibility to make sure they did. 

The Centers of Excellence would not operate anymore as a coordinated care operation for responders and survivors. 

Mr. PITTS. Thank you. Now, we are aware that Special Master 

Sheila Birnbaum administers the Victim Compensation Fund, 

which is housed at the Department of Justice. Is there coordination 

between the operations of the Victim Compensation Fund and the 

World Trade Center Health Program? 

Dr. HOWARD. Yes, sir, there is. We have data sharing and medical review agreements with the Victim Compensation Fund. We 

regularly meet with the staff. Our staff is embedded with their 

staff to assist in the medical review. The Victim Compensation 

Fund has adopted our program requirements for their medical review. To date, we have provided information to them on 18,262 of 

their VCF claimants. We continue to work very closely with the 

Victim Compensation Fund. 

Mr. PITTS. How much higher is the Federal Employees Compensation Act, FECA, compensation rate compared to Medicare 

Parts A and B reimbursements for hospitals? 

Dr. HOWARD. The statute—the Zadroga Act sets the reimbursement rate according to the Workers’ Compensation rates of the 

Federal Government, the FECA rates. Medicare rates are lower, 

but maybe by 10 to 20 percent lower. So they are a—the FECA 

rates are higher and our reimbursement rates for providers are 

higher than Medicare. 

19 

Mr. PITTS. Dr. Howard, I can imagine that it is a logistical challenge to provide care for the responders and survivors who are 

scattered all across the country. What can you do to ensure that 

a physician in another part of the country, seeing only a few World 

Trade Center patients, benefits from the clinical experience of the 

physicians in the New York metropolitan region who have more experience treating these WTC-related health conditions? 

Dr. HOWARD. The Nationwide Provider Network that we have, 

which is currently seeing about 8,287 individuals, we have total coordination with that provider network. On the one hand, all of 

those individuals who do monitoring for our survivors and responders that are in the nationwide program are trained—occupationally 

trained physicians so that they are equivalent to the physicians 

that we have in our Centers of Excellence in New York and New 

Jersey. We also provide them with additional training. We are 

working with Medscape right now to have online training available 

for all of our providers. We work with the—our contractor, LHI, 

which has the Nationwide Provider Network, and that physician, 

their medical director, sits in all of our groups and committees, and 

we engage actively with those physicians. So I would say that for 

our relationship with the Nationwide Provider Network, those physicians are on par with our physicians at the CCEs. 

Mr. PITTS. Good. Thank you very much. My time has expired. 

The Chair now recognizes the ranking member of the subcommittee, Mr. Green, 5 minutes for questions. 

Mr. GREEN. Dr. Howard, prior to the passage of the James 

Zadroga 9/11 Health and Compensation Act of 2010, you administered the CDC grant program that funded medical monitoring and 

treatment services for 9/11 survivors and responders. That program 

was funded through discretionary dollars, and there is always uncertainty about whether and what amount of discretionary funding 

would be appropriated for the grant program. 

Dr. Howard, can you describe how the creation of the World 

Trade Center Health Program, through the Zadroga Act, has improved your ability to ensure that responders and survivors get the 

quality medical services that they need? 

Dr. HOWARD. Thank you. I would respond in 2 ways. One, on behalf of the members, it is very stressful to constantly be told on a 

year-by-year basis that your care may go away, your doctor and the 

institution, the facility that you go to, may change. So it created 

a pervasive sense of stress. Mind you, in our population, we have 

many thousands of individuals that suffer from PTSD, and some 

highly resistant PTSD, and I am sure that if they were here with 

me, they would say how stressful year-by-year funding is to the 

program. 

From the administrative perspective, it is very difficult because 

we were always up to the last minute, thinking should we start 

preparing for the program not to be funded, and that was certainly 

something that we did not want to happen, but it requires a long 

process of preparation. So we were never sure about that. 

Mr. GREEN. So the dedicated mandatory fundings helped you not 

only plan better, but also the reaction from the patients. 

Dr. HOWARD. It is like night and day. When the Zadroga Act 

passed, I think all of us, members and us that were administrating 

20 

the program, breathed a sigh of relief that we had 5 years. We 

never had that before. 

Mr. GREEN. OK. The James Zadroga 9/11 Health and Compensation Reauthorization would permanently extend the program. 

Could you explain how a permanent extension of the program 

would ensure that responders and survivors have that peace of 

mind? You talked about that medical monitoring and treatments it 

is—they come to rely on will continue to meet their needs. 

Dr. HOWARD. Well, as I say, I think that the assurance of having 

the same provider, especially for our patients that suffer from very 

serious mental and physical conditions, is a peace of mind that can 

only be bought from mandatory funding without a—an end date. 

For us in the program, it really helps us do long-term strategic 

planning. It is very hard to do contracts when you can only provide 

a year or 2, or 5 years, but being able to look beyond that 5-year 

horizon is extremely helpful for the efficiency and the integrity of 

the program. 

Mr. GREEN. It seems the patients enjoy a great deal of understanding from the providers—the doctors and providers in the program. How do you think this affects the patient outcomes? 

Dr. HOWARD. Without doubt, the providers that I first met in August of 2002, when I became first involved in this program, are the 

very same providers that I see now in June of 2015. Their dedication to this population has been worthy of note. 

Mr. GREEN. So the doctor-patient relation is important because 

of the continuation of the program. 

Dr. HOWARD. The trust that our members have to the providers 

that we are fortunate to have cannot be duplicated anywhere else. 

Mr. GREEN. Do you think continuing the program is so important 

it—to ensuring the same level of knowledge and expertise? 

Dr. HOWARD. Very definitely. Our providers have a wealth of 

clinical information that other providers would take them years to 

develop. 

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

Mr. PITTS. The Chair thanks the gentleman. 

Now recognize the vice chairman of the subcommittee, gentleman 

from Kentucky, Mr. Guthrie, 5 minutes for questions. 

Mr. GUTHRIE. Thank you, Mr. Chairman. Thank you, Dr. Howard, for being here. 

And I spent, I guess, 6 years of my life in college and grad school 

in metro New York, and one of my favorite things to do back when 

I was an undergrad is use the USO, and spent a lot of time at the 

USO off Times Square. There was always uniformed public servants there, and it was always enjoyed getting to know and talk to 

them. I am a talker, so I engaged with them, and what a great 

service that people feel. 

You had—actually I wasn’t going to go this direction, but I think 

it is important to talk about, and it has opened my eyes a little bit 

in what you said. I will kind of emphasize or maybe go a little bit 

further. You know, I live in Bowling Green, Kentucky, so where we 

take care of our servants as well as—if a fire—if there is a fire, 

someone goes into the firehouse and they get injured or whatever, 

you know, we have assistance in place to—disability, insurance and 

so forth. And so I think a lot of us that aren’t, you know, in New 

21 

York continuously and the surrounding areas, like some of my 

friends here, is that, you know, are the programs already in place, 

and so what you have hit on today is probably the first time I have 

thought of it. I know it is unique in the massiveness of it, but why 

is it unique in terms of other injuries that people might receive in 

other—that requires its own system, other than just the volume. 

But—so could you hit the challenges, because that—because you 

have opened my eyes to some things today, and hit the challenges 

that—you have already kind of said, but emphasize why this is 

completely unique, that needs its own program, why diseases are 

different than if you were in a normal or 

a—well, I don’t know if normal is the right word, but a more 

standard, I guess, kind of situation that firefighters or other people 

would be in? 

Dr. HOWARD. I would be happy to. And I think the best way to 

answer that question is by looking at some of the findings that we 

have gotten from the investment that the Act has allowed us to 

make in research, looking at this population and the conditions. 

And I will just mention a few issues. On the mental health issue, 

we have seen a delayed onset of PTSD. Now, that is not normally 

seen in other types of situations. That is something that we are 

seeing in this population. It is—we have also seen a worsening of 

PTSD despite conventional treatments. So that is something that 

is new in this population. In terms of respiratory disease, we are 

seeing an onset of obstructive airways disease beyond 5 years after 

exposure. We are also seeing bronchial hyper-reactivity persist over 

a decade, and that is something new. In terms of asthma, we have 

seen patients in our program who have asthma, who have lost fulltime employment because of their asthma, more than we have seen 

in the general asthmatic population. 

So there are a number of findings that we are seeing from a clinical perspective in this population that we would never have 

learned had we not had the group together. 

Mr. GUTHRIE. If it was just normal Workers’ Comp or other 

things. And so I want to get to another thing. So you said there 

are 71,000 people in the program. How do you—what are the criteria—do you have—did you have to be on-site for so many days, 

or I mean—— 

Dr. HOWARD. Well—— 

Mr. GUTHRIE [continuing]. Or did you have to actually be in the 

rubble, or are you—— 

Dr. HOWARD. The simple answer—— 

Mr. GUTHRIE [continuing]. Blocks away, I mean what is the—— 

Dr. HOWARD. The simple answer is that the Zadroga Act is highly specific about the criteria for eligibility in the program. And it 

includes for—let’s say for New York City police officers—location, 

the duration of their exposure, and other factors. So eligibility criteria are pretty well spelled out in the Act. 

Mr. GUTHRIE. What about the non-public safety personnel that 

can be in the program? 

Dr. HOWARD. Right. There are criteria for eligibility for volunteers that came from all over the country to volunteer as responders. Similarly, in the section of the Act that has to do with survivors, there are eligibility—5 levels of eligibility requirements for 

22 

survivors. So if someone comes to our program, wants to be a member, the first step is filling out an application in which they—a 

lengthy application, unfortunately, I might add, in which all of that 

information is solicited so that we can establish whether or not 

their experience meets the eligibility requirements of the Act. 

Mr. GUTHRIE. And I think some concerns, as we debated before, 

I just want to emphasize this, is that anywhere in terms of health 

care and people getting the care whatever they deserve, I think— 

I know I remember asking the question, why such a separate, 

unique program, and you have given me some really good things 

to think about, so I really appreciate it very much. 

Appreciate it and I yield back. 

Dr. HOWARD. Thank you. 

Mr. PITTS. The Chair thanks the gentleman. 

And now recognize the ranking member of the full committee, 

Mr. Pallone, 5 minutes for questions. 

Mr. PALLONE. Thank you, Mr. Chairman. 

Dr. Howard, the World Trade Center Health Program relies on 

Clinical Centers of Excellence to provide most of the monitoring 

and medical care through the program, and those centers employ 

clinicians that have both the specialized knowledge base and deep 

experience in treating the unique physical and mental health needs 

of 9/11 responders. And I know you have already talked about this, 

I am kind of following up on what Mr. Guthrie said. I know that 

patients in the New York City metropolitan region continue to see 

their personal physicians for their general health care needs, but 

often obtain monitoring and treatment services for their conditions 

at these centers. And I also understand that, you know, if somebody is in another part of the country they can go to a network of 

doctors that are provided through the program. But some of them 

also come to the centers. I know that at the New Jersey centers 

we get people from all over the country that will travel just because 

of the expertise that exists. 

So if you could just comment on the treatment benefits of individuals using these centers rather than their personal physicians 

for their 9/11-related health conditions, or even, you know, traveling when they can see someone who is part of the WTC network, 

they could come to the centers. 

Dr. HOWARD. Yes, I would be happy to. And I think it boils down 

to the difference in physicians in terms of their expertise, as you 

said. Occupational and environmental physicians who are schooled 

in that particular subspecialty know how to connect an exposure 

with a health condition. When I went to medical school, I did not 

learn that. I learned how to take care of a health condition; I didn’t 

learn to go back and do an extensive history to try to figure out 

what were your exposures, and was that exposure related to this 

health condition that I see. That is a specialty of occupational and 

environmental medicine where we try to correlate the exposure and 

the health condition. 

So physicians that are—that we use both in the CCEs that are— 

have been involved since 2001, and in the Nationwide Provider 

Network, have that capability. Physicians that don’t have that capability would not be able to listen to the patient’s symptoms and 

be able to say, yes, your exposure—I am going to make a deterVerDate Mar 15 2010 12:16 Mar 07, 2016 Jkt 037690 PO 00000 Frm 00026 Fmt 6633 Sfmt 6633 F:\114THCONGRESS\114X52X911HEALTHMORESCANS030416\114X52X911HEALTHPEN
23 

mination that your exposure caused that health condition, or contributed to that health condition, or aggravated that health condition. 

Mr. PALLONE. All right. I am trying to speed up here because I 

wanted to ask you—— 

Dr. HOWARD. Right. 

Mr. PALLONE [continuing]. A few more things. Have there been 

any problems with misdiagnosis or improper treatment of 9/11-related health conditions when individuals have relied on their personal physicians? 

Dr. HOWARD. Not that I am aware of. 

Mr. PALLONE. OK. 

Dr. HOWARD. Within the program, of course, we have a quality 

assurance where we look at all of the care that is—— 

Mr. PALLONE. OK. And can you just discuss briefly how the Clinical Centers of Excellence coordinate the care delivered to responders and survivors at the centers, with care delivered by their personal medical providers outside the centers, briefly? 

Dr. HOWARD. Sure. As many of you know, the World Trade Center Health Program is a hybrid program. It is not your normal 

health plan where you go in and everything that you may complain 

about relative to your body, a physician takes care of. We have a 

limited number of conditions. So many conditions we don’t cover, 

so you have to see an additional physician, your personal physician. 

So that coordination is done in the CCEs so that if those CCE physicians see a condition that we do not cover, then appropriate referral is made. 

Mr. PALLONE. OK. Now, let me just—I am going to try to summarize this last question. My concern, obviously, is that I don’t 

want this program terminated before we have an opportunity to reauthorize it, and that is why we are having this hearing and trying 

to move quickly. But in preparation, you know, if reauthorization 

legislation is not signed into law by September of next year, the 

program is terminated. And in preparation for termination, or possible termination, I understand that HHS has certain notice requirements you would have to follow. Can you just tell us, you 

know, what you would have to do? I mean, obviously, this isn’t 

what we want to happen, but I want to stress that, you know, 

there is always that danger. 

Dr. HOWARD. Well, it would be a nightmare for me personally, 

and it would be a nightmare for our members, it would be a nightmare for our CCE physicians. You cannot abandon a patient ever 

as a care provider. So we must ensure that that patient is taken 

care of somewhere, and finding a place for each of our 71,942 members would be a gargantuan task. 

Mr. PALLONE. And there are notice requirements. How— 

when—— 

Dr. HOWARD. Yes. We have to inform our patients ahead of time 

that this may happen, even though we may not be sure that it is 

happening, and certainly when it happens, and all of the efforts 

that we can make to help them support their efforts in finding additional—— 

Mr. PALLONE. But when does that process begin? Like do you 

have a term notice requirement? 

24 

Dr. HOWARD. Well, the 90-day time limit is sort of an unwritten 

notice requirement now. It can vary State by State because these 

are often State laws, but we have to go back and look—since we 

have members from every State, we would have to look at every 

State’s abandonment requirements. 

Mr. PALLONE. All right. Thank you very much. 

Thank you, Mr. Chairman. 

Mr. PITTS. The Chair thanks the gentleman. 

Now recognize the gentleman from Kentucky, Mr. Whitfield, 5 

minutes for questions. 

Mr. WHITFIELD. Well, thank you very much. And, Dr. Howard, 

thank you for being with us this morning. 

I want to just follow up briefly. When we think about health care 

systems, frequently people all work with some company that provides health care, or with Medicare, you have to be over a certain 

age, and Medicaid, income below, the trio of Tricare. So here, the 

common element is people from around the country, whether emergency responders or volunteers, came to respond to this emergency 

in New York, this disaster on 9/11. And you touched on the criteria. 

I think you have indicated there are 71,000-plus members enrolled 

in this program. And is it still eligible—if I am someone that 

worked there during that time, would I still be able to enroll today 

if I am not enrolled right now? 

Dr. HOWARD. Yes, sir, you would be. And we hope that anyone 

listening who is not enrolled in our program, who may be eligible, 

will call our eligibility line and sign up for our program. 

Mr. WHITFIELD. OK. And I won’t get into the details, but the criteria for eligibility, I am assuming you had to have been there Xdays and—is that correct? 

Dr. HOWARD. Right. They are very detailed eligibility requirements spelled out in the Act itself. 

Mr. WHITFIELD. And does your office make the decision on 

whether or not a person is eligible or not? 

Dr. HOWARD. Yes, sir. 

Mr. WHITFIELD. OK. Now, of the patients that you are caring for 

right now, what percent of them would you say—or maybe you 

don’t have this information—had an insurance program already, 

they were already covered under? 

Dr. HOWARD. Well, first of all, even if you had health insurance—— 

Mr. WHITFIELD. Right. 

Dr. HOWARD [continuing]. As a responder, you would not be able 

to use that insurance because health insurance does not cover 

work-related issues. For instance, if you have ever gone in for an 

MRI or a CT scan, at the bottom of that form it will say, ‘‘Is this 

a result of an auto accident, is this a result of a work accident?’’ 

If it is, the health insurer will not pay for it; they will refer you 

to other insurances. For survivors, then health insurance could be 

an issue, and then we recoup as much as we can—— 

Mr. WHITFIELD. Um-hum. 

Dr. HOWARD [continuing]. From the health insurer. 

Mr. WHITFIELD. Well, what percent would have been covered 

under, say, the Workers’ Compensation Program? 

25 

Dr. HOWARD. Well, theoretically, work-related injuries and illnesses would all be covered, but there are great difficulties for responders in accessing Workers’ Compensation benefits because oftentimes their condition, not the original conditions where, on the 

event, someone had an acute injury and it happened within a short 

period of time, but some of our diseases in our program, their onset 

are years later, and a lot of statutes draw a line—— 

Mr. WHITFIELD. Um-hum. 

Dr. HOWARD [continuing]. And say no—— 

Mr. WHITFIELD. Um-hum. 

Dr. HOWARD [continuing]. That is beyond our statute of limitations, we will not cover something that started—— 

Mr. WHITFIELD. Um-hum. 

Dr. HOWARD [continuing]. Five years later. So many of our members are in that situation. 

Mr. WHITFIELD. So would it be unusual that Workers’ Comp may 

pick up part of it and then this program would pick up—sort of 

playing a supplemental role, or—— 

Dr. HOWARD. It is not unusual. It is—many of our members have 

had Workers’ Compensation benefits given, and we are in the process of recouping—— 

Mr. WHITFIELD. Right. 

Dr. HOWARD [continuing]. From Workers’ Compensation. 

Mr. WHITFIELD. Um-hum. 

Dr. HOWARD. But it is not the majority, or even near the majority 

of our members. 

Mr. WHITFIELD. Um-hum. We know some people have indicated 

early on, I remember when there was first discussion about this, 

that this was sort of a unique program, but I know that there are 

health programs in effect for employees at Savannah River, Paducah, Oak Ridge, and so forth, which is kind of similar to this because those workers were exposed to certain elements many of 

them were not even aware of, and they came down with a lot of 

different cancers. And so those programs are similar to this program, would you say? 

Dr. HOWARD. Yes, sir. And, in fact, we administer the Energy 

Employees Occupational Illness Compensation Program, together 

with the Department of Labor and the Department of Energy. It 

is a program that bears a lot of similarities to our program at the 

World Trade Center. 

Mr. WHITFIELD. Yes. And so if you worked at the World Trade 

Center and you are covered, and you have 1 of, say, 12 or 14 illnesses that you all have set out, is there a presumption that, since 

you were there and exposed, that you would be covered under this 

program? 

Dr. HOWARD. Not a presumption. A physician, not in the administration of the program, but in our Centers of Excellence, would 

examine you, take your history, and make the connection between 

the exposure history that you give that physician and that health 

condition, and they and they alone say I think the 2 are connected. 

Mr. WHITFIELD. Right. Well, thank you very much for the great 

job you do at NIOSH. 

Dr. HOWARD. Thank you. 

Mr. PITTS. The Chair thanks the gentleman. 

26 

Now recognize the gentleman from Oregon, Mr. Schrader, 5 minutes for questions. 

Mr. SCHRADER. My questions have been answered, Mr. Chairman. Thank you. 

VOICE. Ms. Castor. 

Mr. PITTS. All right, then the Chair recognizes the gentlelady, 

Ms. Castor, 5 minutes for questions. 

Ms. CASTOR. I want to thank you, Mr. Chairman, for calling this 

hearing. And I would like to thank all of the first responders and 

survivors, and the medical professionals who take care of them, for 

traveling here to Capitol Hill to encourage the Congress to provide 

some continuity and certainty in the World Trade Center Health 

Program. I would like to thank my colleagues, especially from New 

Jersey and New York, Congressman Pallone and Congressman 

Lance, you all have been champions on this committee for this endeavor, along with Congresswoman Clarke and Congresswoman 

Maloney, I see Congresswoman King I think was still here, and the 

entire New York delegation, especially. 

I strongly support the James Zadroga 9/11 Health and Compensation Reauthorization Act because it will provide that important certainty and continuity of care from this point forward. And 

when you—it is interesting to see the list and understand that 

there are first responders and survivors from the World Trade Center terrorist attacks all across America now. And Florida comes in 

right behind New York and New Jersey. So it will be very important, and I think that the folks that I represent back home will be 

strongly in support of taking care of their neighbors who were 

there on September 11, and the weeks, months, and years afterwards. It is vital that we continue this specialized care for all of 

our neighbors, and all of the brave folks who were there on September 11. 

So, Dr. Howard, thank you for being here today. One of the important parts of the World Trade Center Zadroga Health Initiative 

that often gets overlooked is the funding provided for research into 

9/11-related health conditions. Between fiscal year 2011 and 2014, 

the program funded 35 projects to investigate questions about 9/11 

related to physical and mental health conditions. Could you provide 

examples of the research that has been funded by the Zadroga Act? 

Dr. HOWARD. I would be happy to. We are very grateful for the 

original drafters of the legislation to provide money for research 

into the health conditions that our members face. And as I mentioned before, we have already learned quite a bit from that research. And I would like to highlight just one aspect of it, in addition to mental health and respiratory and cardiovascular, and our 

cancer research, our research in autoimmune diseases and others, 

is the research that we have done on individuals who were children 

at the time of 2001 attacks. There were a number of elementary 

schools and Stuyvesant High School, for instance, that were immediately impacted. And we have a number of those projects that are 

going on now, about 7 that are funded, and we are learning the effect—effects on developmental issues in the children’s population. 

To date, we have funded $88.5 million worth of research, and we 

have a significant body of research that is published in peer review 

journals. The World Trade Center Registry alone has published 

27 

about 60 papers, and our various clinical researchers at our clinical 

centers have published the other papers. Our pivotal papers in cancer, autoimmune diseases, asthma, and other respiratory disorders 

have allowed us to provide better care, more focused care for our 

members. 

Ms. CASTOR. And are these—the results of the research, are they 

disseminated in an organized way to the providers and the families 

so that they have access—— 

Dr. HOWARD. Yes. 

Ms. CASTOR [continuing]. To all of that information? 

Dr. HOWARD. We have membership newsletters that highlights 

various findings that we have from research so that they know. All 

of our papers are published on our—on the World Trade Center 

Health Program’s Web site. And, of course, these are all peer reviewed publications so they appear in the science journals. And I 

am happy to say that the New York media picks up on those papers and reports them probably more effectively and more widely 

than we can on our Web site. 

Ms. CASTOR. So if the Zadroga Act is not reauthorized, will these 

research efforts come to an end, and explain to me why that would 

be harmful? 

Dr. HOWARD. They would cease altogether, and we would lose 

one of, I think, the most important advantages to the program to 

our society, is looking at the long-term health effects from 9/11. 

Ms. CASTOR. OK. And you testified earlier that health conditions 

often manifest themselves years later. The Zadroga Act provided 

funding for outreach efforts to individuals who may be eligible. We 

are now several years into the existence of the program, and you 

have successfully enrolled more than 71,000 responders and survivors. It seems to me that in addition to outreach, the continuity 

of care and retention of members will be important to protecting 

the health moving forward. That is why the Reauthorization Act 

here clarifies that funding may be used for continuity of care and 

retention. Give me your opinion on why efforts on continuity of 

care and retention of members will be important moving forward. 

Dr. HOWARD. Well, as you say, you know, our program overall, 

since its inception in July of 2011 with the Zadroga Act, has grown 

about 18 percent overall in membership, and we credit that to the 

wonderful contractors that we have who have done recruitment. 

But the other side of that is once you recruit a patient into our program, we want them to remain in our program. And every health 

plan loses members because we do not go and do outreach to retain 

them. So that is on balance now after our first 5 years. We hope 

to emphasize, in what we hope is our second phase, that retention 

of our patient population is as important as their original recruitment. 

Ms. CASTOR. And how do you propose to do that for first responders and survivors outside of the New York/New Jersey area, say, 

in the State of Florida? 

Dr. HOWARD. I think, first of all, you know, we do things as a 

team. We sit down with our representatives from survivors and responders. We have a Responder Steering Committee which is very 

active, meets every month, and we have a Survivors Steering Committee that is very active and meets every month. All of our ideas, 

28 

suggestions, we go to them and say how are we going to do this, 

and together as a group we figure out how to do it. There are many 

modalities that we could use, and oftentimes we are told by our 

members what is the most effective. 

Ms. CASTOR. Thank you very much, sir. 

I yield back. 

Mr. PITTS. The Chair thanks the gentlelady. 

Now recognizes the gentleman from Texas, Dr. Burgess, 5 minutes for questions. 

Mr. BURGESS. Thank you, Mr. Chairman. Thank you for having 

the hearing. Dr. Howard, thank you very much for being here 

today. And to all our witnesses on the second panel, thank you for 

your participation, and the people who are here in testament to the 

work that you have done. I also feel obligated to recognize the work 

of one of our colleagues, a former member, Vito Fossella, who was 

on this committee with us and, in fact, was responsible for my 

early interest in this shortly after I arrived in Congress in 2003. 

And it was because of that interest that I did become an early supporter of Representative King’s work on this. And, in fact, I was 

the one who ran the bill on the floor in the waning days of the 

111th Congress, in that late lame duck session in December when 

the bill finally did pass on the floor of the House. 

But, Dr. Howard, I am interested in—you said in your testimony 

that you provided for us today that certain types of cancer were 

added to the list of health conditions covered under this Act. Could 

you share with us what those cancers—what types of cancers those 

were—are? 

Dr. HOWARD. Yes. Currently covered in the program are every 

type of cancer, is just the short way to approach this—every type 

of cancer except uterine cancer. 

Mr. BURGESS. Are there—but are there those that are more—I 

mean what are some—what—if you were to pick the top 3 malignancies, what would those be? 

Dr. HOWARD. I think if you looked at our 4,000 or so cases right 

now, probably the top ones would be thyroid cancer. There are 5 

common cancers that Americans get, skin being the one that is our 

top cancer. There is breast cancer, that is also a top cancer for us. 

There is colon cancer, which is a top cancer for us. Thyroid cancer 

is another cancer for us. But we have seen a lot of very common 

cancers like that, and we have also seen some very rare-type cancers, and oftentimes, from an epidemiological basis, the appearance 

of rare cancers is extremely helpful in terms of doing research on 

a population to figure out what their exposures are, causing rare 

cancers. 

Mr. BURGESS. Sure. That speaks then also to the value in having 

people who have expertise in treating the types of injuries encountered because an uncommon cancer can be a difficult diagnosis to 

which to arrive. 

Dr. HOWARD. Exactly. And if they—if this cohort were distributed, we would not be able to count those. It would be very hard 

to find all those rare cancers if they were not—if the patients were 

not seen in our clinical centers, and rather, they were seeing their 

own personal physicians throughout the United States. It would be 

very difficult to do that. 

29 

Mr. BURGESS. So it provides a focus that otherwise would not be 

available. Just as far as just a brief comment, if you will, on the 

observed versus the expected cancer rates of the population that 

you are following, is this number of—I guess I calculate it to be 6 

percent based on the number of patients you are following and the 

cancers you reported, how does that stack up to the general population? 

Dr. HOWARD. Well, that comparison, I am afraid, we can’t do at 

this time. That would be something that we would have to wait 

and see what our researchers could come up with in giving us that 

kind of number. We are now looking at, and the Fire Department 

of New York City is doing some research using as a referent population to compare our World Trade Center firefighters to, another 

cohort that was assembled by the Institute of Firefighters not involved in World Trade Center—— 

Mr. BURGESS. Great. 

Dr. HOWARD [continuing]. So we hoped that line of research could 

answer your question someday. 

Mr. BURGESS. So it would give them a better control if you agematch for people who are in similar occupations. 

Dr. HOWARD. Yes, sir. 

Mr. BURGESS. Just switching gears a little bit, and you mentioned also in your testimony that, you know, you are trying to aid 

not just the individual members, but help grow the body of evidence and the body of information so that you can help in other situations. Are you going to be able to provide feedback to municipalities and boroughs as to the type of Workers’ Compensation coverage that may be provided to members of the firefighting community, or the type of health insurance that is provided? Some of the 

shortcomings you mentioned were in—within the Workers’ Compensation system. Are there lessons you have learned that can be 

extrapolated to other communities? 

Dr. HOWARD. Well, certainly, and I think New York State itself, 

its legislature and Governor have already responded to this issue 

significantly by providing a mechanism by which responders, survivors can sign up to a program. They don’t have to actually make 

a claim, but they can register, and then if they should develop a 

condition later on, that their claim would not be beyond the statute 

of limitations. So other States have also looked at that, and we 

hope that people will learn, especially from these long-duration disasters. 

Mr. BURGESS. Thanks, Mr. Chairman. I will yield back. 

Mr. PITTS. The Chair thanks the gentleman. 

Now recognize the gentlelady from Illinois, Ms. Schakowsky, 5 

minutes for questions. 

Ms. SCHAKOWSKY. Thank you, Mr. Chairman. I too would like to 

thank all of the first responders, the survivors, those who treat 

them, for coming here today. For the first responders and the survivors, I am sure in addition to some health conditions that maybe 

more visible, that the trauma of the incident and the loss of 

friends, coworkers, family, is something that lingers on forever 

really. 

In Illinois, Dr. Howard, there are 13 first responders, and between 1 and 9 survivors, the way the data is kept, it is between 

30 

1 and 9, enrolled in the World Trade Center Health Program. So 

clearly, there is no concentration of those individuals in any kind 

of program of nationwide providers. So I imagine there are physicians that have 1 or 2, et cetera, so how do you maintain that— 

the cohesiveness of that network? 

Dr. HOWARD. I think that is a very good question, and I think 

there are a couple of ways that we do that. First of all, our Nationwide Provider Network is headed by a very capable physician who 

is a part of our New York-based Centers—New York and New Jersey-based Centers of Clinical Excellence. So he participates in all 

of our meetings, and is a great educator and teacher for the cadre 

of physicians that do monitoring and evaluation of that population. 

As you point out, a physician may have only 1 or 2. Those physicians themselves are occupationally trained, so they have the same 

kind of training to be able to connect exposure and health conditions as similarly situated physicians at our clinical centers. 

As I mentioned, we are also trying to—we have been very 

pleased that Medscape is helping us put together constant training, 

so to speak, 24/7, you can go to their Web site and get information 

about the latest findings from the program that may influence your 

practice. So even though we have a distributed network, and even 

though those physicians in the Nationwide Provider Program may 

have, as you say, 1 or 2 patients, they are seeing, we want to—we 

want them to be as similarly situated knowledge-wise as the rest 

of our physicians. 

Ms. SCHAKOWSKY. Great, thank you. So my understanding of the 

data is that there are a total of 71,000 people, or approximately, 

that are in the program. And then it says, in a factsheet I have, 

that more than 30,000 responders and survivors have at least 1 

World Trade Center-related health condition. So there are some 

people in the program, I gather, that are—more than half, that are 

simply—not simply, but that are being monitored. Is that the difference in number? 

Dr. HOWARD. Yes. We offer monitoring and treatment. So if you 

are in the monitoring program and you do not have a health condition that is included for coverage in our program, then you come 

on a periodic basis for monitoring. So you are not in treatment. 

There is no condition that a World Trade Center Health Program 

physician has connected to your exposure. So they are—— 

Ms. SCHAKOWSKY. But the—— 

Dr. HOWARD [continuing]. Continuing to be monitored. 

Ms. SCHAKOWSKY. But the monitoring is done within the network, and there is not an additional cost to that individual for 

the—— 

Dr. HOWARD. Yes. 

Ms. SCHAKOWSKY [continuing]. Monitoring. 

Dr. HOWARD. No. 

Ms. SCHAKOWSKY. OK. 

Dr. HOWARD. Our members bear no costs. 

Ms. SCHAKOWSKY. So the population that you serve includes 

some number of families of—or spouses of firefighters. Some are in 

that program. Survivors that may be workers in the area, residents, students, daycare, participants, et cetera. I am wondering 

31 

what the breakdown is between first responders and then survivors. 

Dr. HOWARD. In terms of enrolled members in our program? So 

currently, total enrollment of the population, as you say, is 71,942. 

General responders, which would be police, construction workers, 

volunteers that came from all over—— 

Ms. SCHAKOWSKY. Firefighters. 

Dr. HOWARD [continuing]. The United States, is about 38,953. 

Our fire department members are 16,569, which leaves 8,133 survivors in that 71,000. 

Ms. SCHAKOWSKY. Does anybody leave the program? Aside from 

this issue of reenrollment, so do they have to reenroll every year? 

Dr. HOWARD. I am sorry? 

Ms. SCHAKOWSKY. Do they have to reenroll? 

Dr. HOWARD. No, no, no, you are enrolled once in our program. 

Ms. SCHAKOWSKY. Does anybody leave? 

Dr. HOWARD. I hope not, but I do not know that for a fact. We 

have members who have passed away—— 

Ms. SCHAKOWSKY. Well, that is certainly—— 

Dr. HOWARD [continuing]. But leaving—they may go to their—as 

has been said by Representative Pallone, they may go to their private physician to obtain health care for other nonrelated conditions. 

Ms. SCHAKOWSKY. Thank you very much. 

Mr. PITTS. The Chair thanks the gentlelady. 

Now recognize the gentleman from New Jersey, Mr. Lance, 5 

minutes for questions. 

Mr. LANCE. Thank you, Mr. Chairman. 

I don’t have any questions, but I want to thank you for what you 

are doing, Dr. Howard. I want to thank Congressman Pallone who 

has worked on this issue over the course of the last more than a 

decade, and all of the Members of the Congress who recognize the 

importance of reauthorization of this legislation. 

This is a bittersweet hearing for me. New Jersey lost more than 

700 residents. My son was playing freshman high school football, 

and he had a teammate whose father didn’t come home. I lost a 

Princeton classmate in the South Tower, and my story is similar 

to the stories of many. 

I think the best speech that the younger President Bush ever delivered was on September 14 at the National Cathedral where he 

said that this world God created is of moral design. Grief and tragedy and hatred are only for a time. Goodness, remembrance, and 

love have no end. And he concluded by paraphrasing St. Paul to 

the Romans that no evil can separate us from God’s love. What you 

have done is based on goodness, remembrance, and love, and that 

is certainly true of the first responders. And I thank all of the first 

responders, and I am sure this legislation will pass unanimously 

here, in the full committee, and on the floor of the House. 

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

Mr. PITTS. The Chair thanks the gentleman. 

Now recognize the gentleman from New York, Mr. Engel, 5 minutes for questions. 

Mr. ENGEL. Thank you very much, Mr. Chairman. And, you 

know, I too—there are none of us that represent New York or New 

32 

Jersey and the surrounding area that wasn’t deeply affected. There 

are 1,851 people in my district who are program beneficiaries of all 

you do, Dr. Howard, so we are very appreciative of it. 

You have answered some of my questions, but I want to try to 

bring out certain other things. Many of us in the aftermath—Mr. 

Lance just mentioned that the Friday after the Tuesday of the attacks, many of us in the delegation went to the site of the attacks. 

It was surreal. You just scratched your head and you couldn’t believe you were really—it was like a nightmare; you couldn’t believe 

you were really living it, and then you kind of realized every few 

seconds this is real. And so we walked around—other people 

walked around, we really weren’t wearing the masks. They did give 

us masks but didn’t really make it seem as if it was that important, so I bet a lot more people got exposure. I mean I went back 

several times. I don’t have any ill effects, thank God, but people 

who are now starting to get effects, do we have trouble tracing it 

back to—is it difficult for people to prove so many years later that 

their illnesses are a result of exposure they got at the World Trade 

Center site? 

Dr. HOWARD. It is difficult. It is difficult for any of us to recall 

exact details of what we did a month ago, a year ago, let alone this 

many years ago. So for new members coming in our program, a lot 

of the questions that we ask about their exposure is—they are very 

difficult to answer. Recall is imperfect in all of us, but we take that 

into consideration in terms of the questions we ask and the answers they give us. 

Mr. ENGEL. First of all, Doctor, thank you for the great work you 

do. Really great work. It makes me proud to have been an original 

cosponsor of this legislation, and I think in all the years I have 

been in Congress, I have never seen our delegations more united 

on 1 thing, particularly the New York delegation. Since the program has been continuing, and obviously when things continue, 

you see what works, what doesn’t work, you make adjustments, 

what would you change in the program? What have been some of 

the things that you have found difficulty with that perhaps we 

should consider modifying or changing to make it more efficient? 

Dr. HOWARD. Well, I don’t think that we have found anything in 

the Act that has been a showstopper for us in administering the 

program. We look at all of the items in the Act as helping us, and 

we consider the Act to be a well-written document that has given 

us a roadmap and, as for so many years, for over a decade, we had 

no authorizing language, so we made it up as we went along, together with our Clinical Centers of Excellence. So we are extremely 

happy to have this authorizing outline for us. 

Mr. ENGEL. How much flexibility exists with regard to the World 

Trade Center Health Program’s eligibility requirements? For example, if someone meets 9 out of 10 benchmarks but is desperately 

in need of care, can exceptions be made to ensure that care gets 

to those who need it? How does that work? 

Dr. HOWARD. We look at every case on a case-by-case basis. As 

I said, you know, recall is not perfect this many years later, and 

we take that into consideration. We only decide that somebody is 

not eligible when we are absolutely certain that they do not fit any 

33 

of the stated criteria in the Act. If we err at all, it is on the side 

of including someone in the program. 

Mr. ENGEL. In your written testimony, you noted the work that 

has been done through the World Trade Center Health Program 

to—work has been done to understand the impact that 9/11 had on 

children, and I understand that the program has funded research 

projects to specifically examine the effects of 9/11 on the physical 

and mental health of children and adolescents. Can you talk a little 

bit about that? 

Dr. HOWARD. Well, first of all, we are very privileged to have a 

number of researchers in New York who are interested in this area 

of pediatric research for 9/11. And as I say, we have 7 projects that 

are funded in this area. They have not been completed as yet, so 

we are looking forward to those findings, so I can’t report today 

about what those studies are showing, but it is important that 

the—that we have them and they continue, and we are very privileged to have a very—a couple of very good researchers working on 

that. 

Mr. ENGEL. Thank you, Doctor. And again, thank you for all you 

do and we are really very, very grateful to you. It affects those of 

us in the New York area every single day and our constituents are 

grateful. Thank you. 

Mr. PITTS. The Chair thanks the gentleman. 

I understand Dr. Bucshon doesn’t have any questions. The Chair 

recognizes Mrs. Brooks from Indiana 5 minutes for questions. 

Mrs. BROOKS. Thank you, Mr. Chairman. 

Dr. Howard, I am a former deputy mayor of Indianapolis in the 

late ’90s, and we hosted the World Police and Fire Games in the 

summer of 2001, before the 9/11 attack, and there were many New 

York, New Jersey firefighters and police officers who perished in 

the attack—New York firefighters and—who perished that had participated in those games. But we also had a group called Taskforce 

1 that traveled from Indiana to the World Trade Center, and we 

have—I have since learned, because of this hearing, that we have 

53 people in the State who responded. I have 12 in my particular 

district, and I want to pay particular tribute, as other colleagues 

have done, not only to all of those from New York and New Jersey 

but people like individuals from Taskforce 1, engineers and technical experts and their search dogs traveled immediately that day, 

and continued to operate around the clock with all of their brothers 

and sisters in New York. 

There was a story several years ago about an Indianapolis fireman and a member of Taskforce 1, Charlie Gleason, who was deployed, and he said in that TV story, he said, and I quote, ‘‘He got 

a little bit of that World Trade Center cough’’ from that mix of the 

fumes, and—but he said that he would gladly answer the call 

again. And I understand the risk, but we have to take care of the 

men and women that are going, and that continue day in and day 

out to risk their lives for fellow citizens. And I want to thank you 

and all of the men and women who are here today for their service, 

and all the men and women around the country who did answer 

that call. 

I would like to ask you what you lose sleep about with respect 

to this program, what are your greatest challenges, you have anVerDate Mar 15 2010 12:16 Mar 07, 2016 Jkt 037690 PO 00000 Frm 00037 Fmt 6633 Sfmt 6633 F:\114THCONGRESS\114X52X911HEALTHMORESCANS030416\114X52X911HEALTHPEN
34 

swered incredibly well so many questions posed to you, but what 

would you say are the greatest challenges facing this program that 

we must reauthorize, and how do you plan to respond to those programs—— 

Dr. HOWARD. Well, the—— 

Mrs. BROOKS [continuing]. Or to those challenges? 

Dr. HOWARD. The biggest thing that worries me is that I would 

have to spend any amount of time, waste my time closing the program as opposed to growing the program. 

Mrs. BROOKS. And the manner in which you plan to grow the 

program, how do you plan to do that? 

Dr. HOWARD. I think, you know, one of the issues that we have 

faced in the program, and I think I can speak for all of our Clinical 

Centers of Excellence, directors, and our Nationwide Provider Network, is when the bill passed, the President signed it on January 

3, 2011, we had to be up and running July 2011. It was a very 

short implementation time. By a lot of work, by a lot of people, we 

were able to open our doors on July 1, 2011. But I think what we 

have done over the last 5 years, and we hope to continue to do, is 

quality improvement of the services we offer. Our pharmacy benefit 

plan, for instance, and other support for our members. We want to 

receive their input so that we can continue to improve the program. 

Mrs. BROOKS. Thank you. Thank you for your service. 

I yield back. 

Mr. PITTS. The Chair thanks the gentlelady. 

Now recognize the gentleman from New York, Mr. Collins, 5 minutes for questions. 

Mr. COLLINS. Thank you, Mr. Chairman. And I too want to recognize all our first responders here. I think any time you come, as 

you have, it just helps Members of Congress in what we know is 

going to be a bipartisan support, as previously stated, to unanimously pass this reauthorization. 

But first of all, Mr. Chairman, I would like unanimous consent 

to enter into the record a statement from Representative Dan 

Donovan who represents Staten Island and a portion of Brooklyn. 

Mr. PITTS. Without objection, so ordered. 

[The information appears at the conclusion of the hearing.] 

Mr. COLLINS. And I would also like to recognize Representative 

Peter King that is with me today, and thank Dr. Howard for all 

you have done. You have pretty much answered, I think, most of 

our questions. I represent 105 towns of western New York in the 

Buffalo, into the Finger Lakes area, and I believe probably most, 

if not all, of our volunteer fire departments—and we are mostly 

volunteer; we have 1 paid fire department in my district—sent individuals down to Ground Zero. That is what firefighters do and 

first responders. It is the community of brotherhood, and I am just 

happy to have learned more today about how those individuals are 

more than likely in your program being monitored, and I think, 

again, in a bipartisan way we are with you, and you are doing 

great work. And I don’t believe you are going to have to lose any 

sleep about shutting this program down. 

With that, Mr. Chairman, I would like to yield the remainder of 

my time to Representative King if he would have any comments 

that he would like to add. 

35 

Mr. KING. If that is appropriate? 

Mr. PITTS. The Chair recognizes the gentleman. 

Mr. KING. Thank you, Mr. Chairman. And I do appreciate the opportunity of you allowing me to sit in and take part in the hearing. 

And I thank the gentleman from Upstate New York, Mr. Collins, 

for yielding time. 

I would just like to say that there is probably no more important 

bill that we have passed during the time, you know, that I have 

been in Congress than this 9/11 Zadroga Act. I had about 150 fatalities from my district, but more than that, I see every day to this 

day people still have rare lung diseases, respiratory illnesses, blood 

cancers, so this is something that is absolutely necessary to continue. And I know that people may find this might be wrong or 

that might be wrong, the fact is this is as effective as any program 

I have seen since all the time I have been in Congress, and it provides a need which is a lasting need. It is absolutely essential to 

go forward, and I want to thank all these men and women who are 

here today, the first responders, FDNY, NYPD, construction contractors, I saw—before certainly, you know, people who are residents of the area, and really everyone who answered the call that 

day, everyone did what they had to do, and those who are suffering 

these illnesses, people in the prime of life who have, again, lost 

their jobs, have these debilitating illnesses which have changed 

their lives so radically, all because they did what had to be done. 

So again, I thank the chairman for holding this hearing. I thank 

the committee for taking this issue up. I thank all of you for being 

here today. And I certainly thank Mr. Collins for yielding me the 

time. And I yield back to him. Thank you, Mr. Collins. 

Mr. PITTS. The Chair thanks the gentleman. 

And now recognize the gentlelady from North Carolina, Mrs. 

Ellmers, 5 minutes for questions. 

Mrs. ELLMERS. Thank you, Mr. Chairman. And thank you, Dr. 

Howard, for being with us. And I too want to thank all of the first 

responders who are here today. 

You know, a very emotional subcommittee hearing, and so I am 

going to try hard to stick to the information and get into some of 

these questions. Along the lines of where we are today, and I know 

that you have already stated, Dr. Howard, that as the number of 

affected first responders have come forward, those who have been 

determined to have cancer, how many are in existence right now? 

How many are with us? What number do you have of potentially 

affected patients who have a diagnosis of cancer? 

Dr. HOWARD. Well, right now, we have about 3,400 cases of cancer—individual cases of cancer. Some of those cases may represent 

an individual that may have more than 1 cancer—— 

Mrs. ELLMERS. Um-hum. 

Dr. HOWARD [continuing]. But generally speaking, that is the 

number of members that we have who we are—we have certified 

with cancer. 

Mrs. ELLMERS. Now, as far as the certification process, I am just 

curious as to how you determine approval or denial and, you know, 

do you have numbers that play out as far as the possibility of being 

approved or denied? 

36 

Dr. HOWARD. Sure, and let me just briefly explain the process. 

The physician who is seeing the patient makes the connection between their exposure and the health condition, in this case, cancer. 

Mrs. ELLMERS. Um-hum. 

Dr. HOWARD. So they can say that it is caused by, contributed 

to, or aggravated by their exposure. That is the determination that 

is made by the physician. 

Mrs. ELLMERS. I see. 

Dr. HOWARD. We don’t make it in the program. That is an independent view that the physician has. Then they submit it to us—— 

Mrs. ELLMERS. Um-hum. 

Dr. HOWARD [continuing]. And we make sure that all of the supporting information is there, and then we certify it. If the supporting information isn’t there, we have a question, we go back and 

forth—— 

Mrs. ELLMERS. Um-hum. 

Dr. HOWARD [continuing]. Until we are all absolutely sure, including the determining physician and us that this is a case to be 

certified. Certification then means that you get your cancer covered 

for health care. 

Ms. ELLMERS. Um-hum. And having the concentration on cancer 

leads me to the next question, which is, Do you anticipate adding 

other possible diseases outside of the cancer realm? 

Dr. HOWARD. Well, we have received to date 7 petitions—— 

Mrs. ELLMERS. Um-hum. 

Dr. HOWARD [continuing]. For requests adding conditions. Two of 

those were cancer. The original cancer petition that Chairman Pitts 

referred to—— 

Mrs. ELLMERS. Um-hum. 

Dr. HOWARD [continuing]. 001, and then soon after that we had 

a petition with regard to prostate cancer, and then 5 others. With 

the 5 others, we did not find sufficient scientific evidence—— 

Mrs. ELLMERS. Um-hum. 

Dr. HOWARD [continuing]. To support their addition. We get quite 

a few requests for adding conditions. It is hard to estimate—— 

Mrs. ELLMERS. Um-hum. 

Dr. HOWARD [continuing]. What conditions we would add in the 

future, but we evaluate each of those requests on their scientific 

basis. 

Mrs. ELLMERS. And then in regard to autoimmune diseases, I understand that you have made a determination that those would not 

be identified or added. 

Dr. HOWARD. Right. 

Mrs. ELLMERS. And can you just expand on that? 

Dr. HOWARD. Right. We received a petition, our last petition, to 

add a large number of autoimmune diseases to our statutory list. 

We reviewed all of the information, including the very excellent 

study that had recently stimulated that petition by FDNY—— 

Mrs. ELLMERS. Um-hum. 

Dr. HOWARD [continuing]. And we found that it was insufficient 

at this time. 

Mrs. ELLMERS. Um-hum. Um-hum. 

Dr. HOWARD. It doesn’t mean that—and this is why we are—I 

emphasize so much the importance of research—— 

37 

Mrs. ELLMERS. Um-hum. 

Dr. HOWARD [continuing]. Funding in this program, is the additional work that is going on by other CCEs and our World Trade 

Center Health Registry to look into that—— 

Mrs. ELLMERS. Um-hum. 

Dr. HOWARD [continuing]. Issue. So it doesn’t mean that forever 

and ever—— 

Mrs. ELLMERS. Right. 

Dr. HOWARD [continuing]. It will not be added, but at this 

time—— 

Mrs. ELLMERS. Um-hum. 

Dr. HOWARD [continuing]. We are not adding it. 

Mrs. ELLMERS. Well, thank you, Dr. Howard. I do appreciate all 

of the information that you have helped us with, and I am glad to 

know that this is considered to be an ongoing process into the future, because we don’t know what the future holds for this. And 

again, God bless all of the first responders who are here, and your 

families. Thank you so much. 

I yield back. 

Mr. PITTS. The Chair thanks the gentlelady. 

Now that all the members of the subcommittee have had an opportunity to ask questions, with unanimous consent I ask that the 

member of the full committee, Ms. Clarke, be given 5 minutes for 

questioning. 

The Chair recognizes Ms. Clarke. 

Ms. CLARKE. Thank you very much, Mr. Chairman. We have 

been joined here by Congressman Gerald Nadler of New York, 

original sponsor of the Zadroga Act, and I wanted to yield some 

time to him if it is—— 

Mr. NADLER. I thank you for yielding, and let me thank the 

chairman for holding the hearing, and the members. 

I simply want to say that as someone who is one of—along with 

Mr. King and Ms. Maloney, was one of the 3 original sponsors of 

this bill, we struggled for years and years to pass it, I am glad to— 

and the history has proven the necessity of this bill, and I want 

to thank Dr. Howard for his wonderful service. I am glad that the 

chairman has called this hearing, and that, judging from the comments at the hearing, there seems to be a lot of bipartisan support 

for extending this bill. We know the necessity of that so I just want 

to urge that that be done, and that—and I thank the chairman and 

the committee again. Extension of this bill is essential because the 

diseases won’t go away, and this is for both the first responders 

and the survivors in the community. And so I urge the extension 

of the bill. 

I thank Ms. Clarke for yielding, and I yield back to her. 

Ms. CLARKE. Thank you. 

Dr. Howard, just following up on a couple of the questions that 

Mrs. Ellmers asked about the conditions. For the record, what is 

the process by which you can add new conditions to the program? 

Dr. HOWARD. Well, first of all, the administrator has the ability 

to add a condition on his or her own motion. The other very common route that we have seen so far is the public can petition the 

administrator to add a condition. As I said, we have received 7 petitions so far; 2 of those we have added the condition, the first one 

38 

being cancer, the second one being a particular type of cancer; prostate cancer. The other 5 we have found insufficient evidence for. 

Ms. CLARKE. I understand that the statute outlines specific timing requirements for you to respond to those petitions. Could you 

describe that for us? 

Dr. HOWARD. Right. The administrator has 60 days to respond to 

a petition, unless the administrator refers the petition to our Scientific and Technical Advisory Committee, and then the time frame 

is 180 days. So for the—for instance, in terms of the first petition 

on cancer, we referred that to our Science and Technical Advisory 

Committee. They had 180 days to make their decision. 

Ms. CLARKE. Do you have any concerns with the statutory time 

frames under which you would have to respond to such petitions? 

Dr. HOWARD. Well, one of the things that the GAO report pointed 

out in their review of our cancer petition and—or addition of cancer 

was that there was no external peer review of our science that we 

used to justify the addition of cancer. We believe in peer review 

very, very much, and we want to do external peer review, but the 

time frame of 60 days was just—given the enormity of the task of 

adding all those numbers of cancers, that was a very short period 

of time, so we were unable to engage in external peer review. 

Ms. CLARKE. Very well. Can you briefly tell us about the registry? It is our understanding it was created to follow individuals 

who were exposed to environmental toxins related to the World 

Trade Center terrorist attack. Tell us a bit more about the registry 

and why it is important—an important tool for studying the WTCrelated health effects. 

Dr. HOWARD. The World Trade Center Health Registry, which is 

operated by the New York City Department of Public Health and 

Mental Hygiene is a vital participant in the research aspects of the 

program. They started very soon after 9/11. They have, interestingly enough, about 71,000 members also, and I might add, I was 

told by the director last week that they have registrants in the registry from every congressional district, all 435. And they have produced almost 60 papers in this area. They followed the same people 

over periods of time, so they—every so many years, they study 

them to figure out what their experience is. So their research is 

vital to this program. 

Ms. CLARKE. Do we have a sense of any of their findings so far? 

Dr. HOWARD. All of their findings are not only on their Web site, 

but also on ours. And I think some of the things that we have 

learned already, the issues about asthma, mental health, persistent 

PTSD, et cetera, have come largely from the World Trade Center 

Health Registry studies. 

Ms. CLARKE. So you think it is important that we continue our 

work? 

Dr. HOWARD. It is absolutely vital. 

Ms. CLARKE. I thank you very much, Dr. Howard. 

And I yield back. Thank you, Mr. Chairman. And I thank the 

ranking member. 

Mr. PITTS. The Chair thanks the gentlelady. 

That concludes the questions of members who are present. 

39 

I am sure, Doctor, we will have follow-up questions from members. We will send those to you in writing. We ask that you please 

respond promptly. 

Dr. HOWARD. Thank you, Mr. Chairman. 

Mr. PITTS. Thank you. 

That concludes our first panel. We will take a 3-minute recess as 

the staff sets up the witness table for the next panel. 

Committee stands in recess. 

[Recess.] 

Mr. PITTS. All right, the time of recess having expired, we will 

reconvene. I will ask the guests to please take their seats. 

Ladies and gentlemen. Ladies and gentlemen, please take your 

seats. The committee will reconvene. I would ask the guests to 

please take their seats, and I will introduce the second panel. 

We have 3 witnesses on the second panel, and I will introduce 

them in the order in which they will present testimony. 

First, we have Dr. Iris Udasin, Medical Director, Environmental 

and Occupational Health Sciences Institute, Robert Wood Johnson 

Medical School. Welcome, Dr. Udasin. Secondly, we have Mr. David 

Howley, retired police officer, New York City Police Department. 

And finally, we have Ms. Barbara Burnette, a former detective, 

New York City Police Department. Thank you very much for your 

patience, for coming, for your testimony. Your written testimony 

will be made a part of the record. You will each be given 5 minutes 

to summarize. There are a series of lights on the table, so you will 

see green fist, then yellow. When red appears, we ask that you 

please conclude your testimony. 

So at this time, Dr. Udasin, you are recognized for 5 minutes to 

summarize your testimony. 

STATEMENTS OF IRIS G. UDASIN, M.D., DIRECTOR, ENVIRONMENTAL AND OCCUPATIONAL HEALTH SCIENCES INSTITUTE, ROBERT WOOD JOHNSON MEDICAL SCHOOL; DAVID G. 

HOWLEY, RETIRED POLICE OFFICER, NEW YORK CITY POLICE DEPARTMENT; AND BARBARA BURNETTE, FORMER DETECTIVE, NEW YORK CITY POLICE DEPARTMENT 

STATEMENT OF IRIS G. UDASIN 

Dr. UDASIN. My name is Iris Udasin, and I serve as Director of 

Rutgers Clinical Center of Excellence in New Jersey. We are 1 of 

6 clinics in the New York/New Jersey area that provide medical 

monitoring and treatment for World Trade Center first responders. 

I am a physician who is board certified in internal and occupational 

medicine, and am a professor at Rutgers, and a member of the National Toxicology Panel, an expert panel that advises the National 

Institute of Environmental Health Sciences concerning the relationship between exposure to toxic chemicals and health. 

I want to thank the committee for giving me the opportunity 

today to testify concerning the importance of our Clinical Centers 

of Excellence, and for the opportunity to provide the best quality 

medical care through the Zadroga Act to those brave responders 

who have suffered from multiple, chronic and often disabling medical illnesses, including pulmonary fibrosis, sarcoidosis, asthma, 

gastric reflux, sinusitis, and sleep apnea. 

40 

We have been monitoring World Trade Center patients in New 

Jersey since January 2003, and began treating patients with Federal funding starting in 2007. In addition to the treatment of the 

aforementioned conditions, over the past 3 years we have been able 

to use our funding under the Zadroga Act to optimize cancer care. 

This is critical, since as early as 2008, our responders were already 

showing a cancer rate that was 15 percent higher than people their 

age, who were not at the disaster site. This rate is only increasing, 

and our patients are much younger than usual cancer patients and 

are nonsmokers. They were highly exposed to environmental toxins 

as well as severe mental health trauma from what they witnessed 

at Ground Zero. From seeing people jumping off tall buildings to 

their death, or finding charred remains. 

Our designation as a Clinical Center of Excellence has allowed 

us to provide quality of care for these responders by centering all 

their care in a convenience location with staff members sensitive 

to their needs, coordinating treatment from start to finish. The 

combination of program-wide knowledge gained over 12 years of 

care delivery, in addition to my personal knowledge in New Jersey, 

has allowed us to understand this cohort of patients using medical 

and pharmaceutical resources wisely to accomplish the following 

objectives, which I will illustrate with specific patient examples. 

Coordination of care for complex cases. Diagnosis and treatment of 

patients considering both physical and mental health aspects of 

disease. Use of state-of-the-art diagnostic techniques for early diagnosis and treatment. Use of knowledge gained in our treatment of 

patients to allow for early intervention, enabling our skilled patients to stay at work. 

I am proud to share this panel with David Howley, a retired police officer, who performed many months of search and rescue work 

at the site. David presented with swelling in his neck in 2006, 

which was eventually diagnosed as an aggressive metastatic cancer 

of the throat. This is an unusual and rare cancer in healthy, nonsmoking Americans. However, in my center, we have seen 8 other 

patients with this cancer in New Jersey alone. David’s treatment 

has required a team of doctors, including myself as primary care, 

the general oncologist, the radiation oncologist, the general surgeons, the ear, nose, and throat surgeons. Because of the complicated nature and location of his cancer, it has been extremely 

difficult to treat, but at the present time, he is tumor-free since 

April of 2014. 

The second patient I want to tell you about is a retired detective, 

with severe shortness of breath, chest discomfort, fatigue, and inability to perform his duties as a police officer, who was present at 

the 9/11 site on the date of disaster, reported being engulfed in the 

dust cloud, and witnessing people jumping out of buildings. He was 

treated by his personal physician, with 5 medications for his respiratory issues, but no other conditions. His evaluation at our center confirmed the presence of asthma, but we were also able to diagnose rhinitis, gastric reflux, sleep apnea, post-traumatic stress 

disorder, and panic attacks. This patient was given treatment for 

those conditions, and received therapy for PTSD and panic disorder. The patient was able to recognize that his panic attacks 

were causing him to use increased amounts of his asthma medicaVerDate Mar 15 2010 12:16 Mar 07, 2016 Jkt 037690 PO 00000 Frm 00044 Fmt 6633 Sfmt 6633 F:\114THCONGRESS\114X52X911HEALTHMORESCANS030416\114X52X911HEALTHPEN
41 

tion, and he learned to control his attacks. At his most recent examination, he no longer needs mental health medications, and is 

enjoying his retirement. 

The third patient I want to speak about works as a consultant 

to prevent tax fraud. An abnormality was noted on his chest x ray, 

and he was referred for a CT scan. A small nodule was noted in 

November of 2014, which grew larger in January. This was evaluated by a radiologist who is an expert in interpreting lung CT 

scans. She was concerned about the suspicious nature of this nodule and its growth since the original CT scan. This patient was referred to our university surgeon who removed a stage 1 lung cancer, which does not need chemotherapy or radiation. And I want to 

say this patient is back at work. He is overseas looking for people 

who have cheated the Government paying taxes. 

And finally, Rutgers University and NYU have combined to do 

research, finding markers for sleep apnea associated with environmental exposure. This expertise has allowed for early diagnosis and 

treatment of obstructive sleep apnea, enabling us to get people to 

work safely. 

My fourth patient is a pilot for a law enforcement agency, with 

a history of GERD and sinusitis, which are risk factors for sleep 

apnea. Thanks to early diagnosis, this patient has been successfully treated for his conditions, and he is fully qualified under Federal standards to skillfully operate his aircraft. He asked how he 

could thank me for his treatment, and I said that he should continue catching terrorists. 

In summary, all of our patients are honored and treated by 

skilled clinicians. We believe we are continuing to acquire the 

knowledge to provide early diagnosis and treatment of emergency 

responders who were exposed to toxic agents and psychosocial 

stressors. We are striving to continue to achieve excellence and 

cost-effectiveness in treating our patients, as well as preparation 

for providing the best possible medical care for any emergency responders who were exposed to a multitude of unpredictable exposures. 

[The prepared statement of Dr. Udasin follows:] 

42 

43 

44 

45 

46 

47 

48 

Mr. PITTS. The Chair thanks—— 

Dr. UDASIN. Thanks for the extra time. 

Mr. PITTS [continuing]. The gentlelady. 

And now recognizes Mr. Howley, 5 minutes for your summary. 

STATEMENT OF DAVID G. HOWLEY 

Mr. HOWLEY. Thank you, sir. First thing I would like to do is 

thank you for having this hearing. It is obviously very important 

by the amount of people that are here today, and it is both an 

honor and a privilege to be here and address you. 

There are a lot of things I would like to say about this, but I 

think the most important is to answer a question that you all basically posed to Dr. Howard, and that is what happens if. And Dr. 

Howard was wonderful in his answers, but I think I am going to 

be a little more blunt about it. People are going to die. The men 

and women that are sick, that are being taken care of now. I have 

only been cancer-free a little over a year. I could easily—and if it 

wasn’t for this lady right here, I wouldn’t be here at all. So to end 

this program, people are going to die. It is just—it is a fact. It is 

unquestionable, and that is what is going to happen. 

I was born and raised in Mr. Pallone’s district, and I lived in his 

district once I retired, and then I moved a few years ago, and I live 

in Congressman Lance’s district. So I have both sides of the aisle 

covered here. This is not something that should have any political 

fighting. This should be an absolute bipartisan, 435-to-0-type bill. 

This is a ground ball and no-brainer, as far as I am concerned. 

And as—the other—and the last point I would like to make, because I am going to try to keep this brief, is, I wouldn’t be here, 

sitting here, if it wasn’t for the doctors and Dr. Udasin’s and her 

other colleagues’ knowledge, skills, abilities, research. They have 

become the absolute experts in what is ailing us, and not just me 

but all the other people that are part of this program. You can’t 

go to your regular doctor. They don’t have the knowledge. They just 

don’t. They are not bad doctors, there is nothing wrong with it, but 

what has happened to us because of the conditions that we were 

in is—has become very specific. And I didn’t have a normal cancer, 

and there are a lot of other people who don’t have normal or normal blood diseases, and because of their absolute dedication, they 

have come up with plans and outlines and—that they can treat and 

get us through these difficult diseases. And that is the most important thing is that we can have a quality of life to go forward. 

And I am going to leave it at that. I will be happy to answer any 

of your questions. 

[The prepared statement of Mr. Howley follows:] 

49 

50 

51 

52 

53 

54 

Mr. PITTS. The Chair thanks the gentleman. And now recognizes 

Ms. Burnette 5 minutes for your opening statement. 

STATEMENT OF BARBARA BURNETTE 

Ms. BURNETTE. Thank you subcommittee—Ranking Member 

Green, and members of the subcommittee on Health for inviting me 

to appear before you today. 

My name is Barbara Burnette, and I live in Bayside, New York. 

I am 52 years old, a wife, a mother, and a grandmother. With me 

here today are my husband, Lebral, Sr., and my son, Lebral, Jr. I 

am a proud former New York City police detective. I retired from 

the department after 18 1⁄2 years of service. My career came to an 

end because of an illness I developed from the time I served at the 

World Trade Center site. I served there for more than 3 weeks; 

about 23 days in total. The morning of September 11, 2001, I was 

working in Brooklyn, New York, in the Gang Intelligence Division. 

When my fellow officers and I learned that the morning—the terrorist attacks in New York City, we rushed to lower Manhattan the 

fastest way possible, which was by boat. When we arrived, the towers had collapsed. The air was thick with dust and smoke. I put 

my hands over my mouth and noise just to breathe. My fellow officers and I worked all day and well into the night. We evacuated 

people from around the World Trade Center site. We directed them 

away from the disaster. There was so much dust, but I was not 

given any respirator or any kind of protection for my eyes, throat, 

or lungs. I had to wash out the debris of my eyes and throat, picking up a hose. My fellow officers and I, along with all the rescue 

workers and first responders, could not stop doing what we had to 

do. The first night I finally left the World Trade Center around 

10:00 p.m., after 12 hours. Five hours later, I reported back to the 

World Trade Center site at 4:00 a.m. in the morning on September 

12. I removed debris by using buckets and shovels, and at no time 

was I provided with respiratory protection. If I was not crying over 

what I was seeing in the room, tears streamed down my face from 

burning, irritating dust. 

I spent weeks at the World Trade Center site, shoveling, clearing 

away debris, searching for survivors, and later sifting for body 

parts of the dead. We worked side-by-side and hand-in-hand with 

ironworkers, construction workers, firefighters, police officers, all of 

us searched in the dust and removed debris together. We were 

searching and removing wreckage of the World Trade Center. We 

were working right on top of the burning, smoky, hot rubble. The 

fires never stopped burning. Air quality, we were told, was not a 

concern. All of us working 24/7. 

The work was tough and dirty, we were choking, and it was dangerous, but there was never a time when I even thought about 

quitting or leaving. I thought of thousands of poor victims. If our 

work brought the removal and recovery efforts closer to the end, we 

were glad to contribute. 

I live with the consequences of 9/11 every day. I have been diagnosed with interstitial lung disease; more specifically, hypersensitivity pneumonitis with fibrosis in my lungs. The inflammation in my lungs interferes with my breathing, and destroys the tissues that get oxygen to my blood. My lungs are permanently 

55 

scarred. I cannot move around my home or take the stairs without 

wheezing or gasping for breath. I start each morning connecting to 

a nebulizer and inhaling multiple doses of medications. I am told 

I will eventually need a double lung transplant. Long steroid use 

has caused weight gain and other—and has—and other prescription medications have caused many additional illnesses. I have 

been diagnosed with diabetes, high blood pressure, osteoarthritis, 

and rheumatoid arthritis. I have suffered partially detached retinas 

in both eyes, each requiring surgery. Prior to my World Trade Center service, I was in top shape. I had no history of lung disease, 

I never smoked, I always had a physically demanding lifestyle and 

career. During my time with NYPD, I worked for 5 years in the 

Plainclothes Narcotics Unit. These assignments required me to 

walk 4 miles per day, making arrests in buy-and-bust operations, 

and executing search warrants. I have made over 200 arrests in my 

career, and have assisted in hundreds more. I have been recognized 

by the NYPD numerous times for excellent police duty. I have also 

received several medals for meritorious police duty. 

I was born and raised in Brooklyn, New York. I played high 

school and college basketball. I played on the police league women’s 

team which competed across the United States internationally. Life 

has become very different since I became sick. Every month, I see 

the doctors at Mount Sinai to receive care and renew my prescriptions. This program saves lives. It is saving my life today. It provides medical structure in my life by coordinating doctors and 

medications. My family does not have to suffer the financial burden 

of doctors’ visits, copayments, deductibles, and the terrible cost of 

prescription medication, which I—would not be available to me 

without the program. 

I would also note that the health conditions are worsening. Many 

of the first responders’ colleagues have been diagnosed with cancer. 

Many colleagues have died of cancer. The amount of dust to which 

we were exposed was unprecedented. Many of us fear cancer and 

other injuries that arise late after toxic exposure. 

Recently, more than 60 types of cancers have been identified by 

medical researchers as being directly related to the toxins found at 

Ground Zero. Cancer arises years and years later. For these reasons, I would urge the committee to approve the bipartisan legislation before it. 

Thank you. 

[The prepared statement of Ms. Burnette follows:] 

56 

57 

58 

59 

60 

61 

62 

Mr. PITTS. The Chair thanks the gentlelady. And thanks to all 

the witnesses for their testimony. 

I will begin the questioning by members and recognize myself 5 

minutes for that purpose. 

Dr. Udasin, we will begin with you. In your testimony you talk 

about the coordination of care that your client provides, and that 

you can spend time with your patients. Can you elaborate in more 

detail about that? 

Dr. UDASIN. Since David is sitting next to me, it is a really good 

example. David’s condition was in such a peculiar location that we 

had to find different surgeons that were able to get to where his 

cancer were—was. So this required speaking to people individually 

to determine who had the right expertise to actually take care of 

his cancer. Where he could get the right radiation, that was a big 

issue in David’s case also because there were certain issues with 

how he was receiving radiation, and he could better go to one place 

and not go to another place. And the good news for David was that 

he had a supportive family to take care of his other needs, but we 

have had other patients not as fortunate as David where, unfortunately, we have had to coordinate getting them into things like hospice care. So my staff—and I would like to acknowledge Tracey 

Berspese, my administrator, who is sitting there, who helps us arrange a lot of the important things that we do with our patients. 

Getting them from place to place, making sure they get a good appointment and a prompt appointment. 

So, you know, you go into a doctor’s office, and you have an abnormal test, and then you have to go and see a specialist. If you 

go in just by yourself, they say, oh, you can have an appointment 

next November. That is their next available appoint. But I can assure you, when I call up, you will be in by Tuesday. So if that answers your question. 

Mr. PITTS. Yes. Well, just to follow up with the coordination and 

having time, very important for the level of care that you give. Was 

it possible to provide this level of care before Congress established 

the World Trade Center Health Program? 

Dr. UDASIN. It was not possible to obtain this degree of care. Initially we had, in—the end of 2002, 2003, we just had the monitoring program, and it was very frustrating because you could find 

something wrong with a person and we really didn’t have the resources to make sure they got to see the correct person. And I am 

grateful for the Zadroga funding that we have now so that we can 

do that. 

Mr. PITTS. Thank you. For Mr. Howley and Ms. Burnette, can 

you talk about your care before and after the creation of the Centers of Excellence in the Zadroga 9/11 Health and—— 

Mr. HOWLEY. I—— 

Mr. PITTS [continuing]. Compensation Act, and in your view is it 

better coordinated? 

Mr. HOWLEY. I was thinking of a story when you just asked the 

doc a question. I am probably one of her original patients going 

back to the monitoring program back in 2003. The first time I went 

there, my blood pressure was basically somewhere off her chart. 

My sinuses were completely blown out. I had constant infections, 

I had GERD, which is acid reflux, and she basically refused to let 

63 

me leave her office unless I went straight to my doctor to get treated for the blood pressure. And I am 6’3’’ and she is about 5’1’’, and 

I believed here that she wasn’t going to let me out of the office. 

So yes, there is a big difference. As far as—and she is just wonderful, and I am sure—and I haven’t really dealt—I have only dealt 

with one other of the doctors at her office, and I have never been 

to any other offices, so I can’t speak about any of them. But the 

doctors at—you know, are just tremendous, and they—as she was 

saying, when the cancer has kept coming back for me, and it has 

reoccurred 4 times for me. You can now—she can make those 

phone calls now, where—and get me to the right—and when she 

says Tuesday, she is not kidding you. 

Mr. PITTS. Thank you. Ms. Burnette, would you respond to that, 

you know, as a patient in the World Trade Center Health Program, 

are you satisfied with your access and the care you have received, 

and compare before and after. 

Ms. BURNETTE. Yes, I am very satisfied with my care because in 

2004, I started blacking-out at work and nobody knew why, and 

with the regular doctors I was just being sent out for different kind 

of tests. In the program, they send me to 1 doctor, who sends me 

to another doctor to make sure everything is covered. They schedule everything for you. And I think it is very important that they 

follow up in what is going on, and how they treat us is very well. 

Mr. PITTS. thank you. My time has expired. 

The Chair recognizes the ranking member, Mr. Green, 5 minutes 

for questions. 

Mr. GREEN. Thank you, Mr. Chairman. 

Mr. Howley, from your testimony I understand you have been 

seeing Dr. Udasin since the permanent World Trade Center Health 

Program was established under Zadroga. Would you explain what 

being able to see Dr. Udasin at the Rutgers Center of Excellence 

has meant to you? And I know it sounded like a little bit from the 

earlier question. 

Mr. HOWLEY. That is fine. How do I phrase this in—their knowledge that they have acquired, because they have seen so many of 

us, when I present the next set of conditions or a former set of conditions that I had, she can tell me, Dave, go see Dr. X, Y, and Z, 

and not Dr. A, B, and C, because of her knowledge and skill and 

what she has been able to put together by seeing so many of us, 

she has that template, those tools in her belt—— 

Mr. GREEN. Yes. 

Mr. HOWLEY [continuing]. That will send me to the right person. 

Mr. GREEN. Do you think you would have been in worse condition without being in the center? 

Mr. HOWLEY. I wouldn’t be here. This chair would be filled with 

somebody else. I would not be here. There were only 3—the last 

surgery I had last year, there were only I believe it was 4 surgeons 

that were qualified to do what I needed to get done. 

Mr. GREEN. OK. Ms. Burnette, from your testimony I understand 

you receive medical monitoring treatment services at the Mount 

Sinai Clinical Center of Excellence. Could you explain what care 

you have received at Mount Sinai, and what it has meant to you? 

Ms. BURNETTE. The care I received has been excellent. They did 

an open lung biopsy which determined that I—which lung disease 

64 

I had and how they were able to treat it, and what doctors I needed 

to see. 

Mr. GREEN. OK. And could you explain what the care you received at Mount Sinai—I assume it is similar to what Dr. Udasin, 

you know, your—they are treating the whole person. 

Ms. BURNETTE. Yes. I have a primary doctor. They send me to 

individual doctors for the different diseases I have, like GERD, 

asthma, sinusitis, and one primary doctor coordinates all of that. 

Mr. GREEN. OK. Do you think your condition would be worse if 

you hadn’t had—didn’t have access to the 9/11 Health Program? 

Ms. BURNETTE. I believe it would be terribly worse because I 

was—I had that World Trade Center cough. I was not able to hold 

a conversation without the program providing me with the medications that I needed. 

Mr. GREEN. Dr. Udasin, why does this cohort of patients need the 

types of specialized care that is provided at the Clinical Centers of 

Excellence? 

Dr. UDASIN. We have people with rare conditions like David that 

need specialists’ help. We have been able to use our best university 

resources to get people that have seen many abnormalities on 

things like CT scans to get patients, like the gentleman I mentioned, to have the cancer removed. But I think really, the total— 

the number of conditions that we see and the complicated cases 

that we see, so you might have one condition and that influences 

another condition, and makes the third condition worse. So if you 

have mental health issues and you have reflux, and then you get 

chest pain, and you have asthma, you end up taking too many 

medications, and then you get a side-effect from medications. Many 

of the asthma medications, if you take too many of them, can precipitate heart disease. So I feel like early recognition and treatment 

of all the conditions correctly allows for much better outcomes for 

people. 

Mr. GREEN. It sounds like, with so many possible illnesses, misdiagnosis would be—would not be uncommon. 

Dr. UDASIN. Well, that is correct. And Ms. Burnette described 

her shear number of conditions. And, yes, that is the issue because 

you don’t want to—so you treat one condition really effectively, but 

you kill the patient while you are doing it because she had some 

other condition that you ignored. And so that is what I believe we 

are able to do. As the primary care gatekeeper-type person, I can 

make sure that all the specialists are talking to each other, and 

making sure that the total patient is treated correctly. 

Mr. GREEN. Thank you, Mr. Chairman. And I think because of 

the complications and the exposure to no telling what, that you 

need to have someone who looks at the whole person and actually 

treats all of the illnesses that you are subject to. 

Thank you, Mr. Chairman. 

Mr. PITTS. The Chair thanks the gentleman. 

Now recognize the gentleman from New Jersey, Mr. Lance, 5 

minutes for questions. 

Mr. LANCE. Thank you, Mr. Chairman. 

Dr. Udasin, can you explain in a little more detail your Center 

of Excellence and what that means, and how many there are in the 

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metropolitan region, and what qualifies your organization as being 

a Center of Excellence? 

Dr. UDASIN. Well, thank you. We are part of the Non-FDNY Responder Program, and so FDNY has a separate center. We are one 

of the New York/New Jersey consortium, which includes centers at 

Mount Sinai, NYU, Stony Brook, Queens College, and Rutgers. 

Mr. LANCE. Mount Sinai and NYU would be in Manhattan, 

and—— 

Dr. UDASIN. Yes. 

Mr. LANCE [continuing]. Stony Brook is on Long Island, and—— 

Dr. UDASIN. And—— 

Mr. LANCE [continuing]. Queens is obviously in Queens, and Rutgers—— 

Dr. UDASIN. Queens is sort of in Nassau also. It is kind of on the 

border over there. And we serve as a Center of Excellence in New 

Jersey. What makes us different, our physicians are board certified 

in primary care specialties, internal medicine, and occupational 

medicine. It is double board certified. Almost all of our physicians 

have at least 2 board certifications. As I said, Rutgers has an Environmental Center of Excellence in our same building, and we do extensive work on exposure and health effects, and that happens beside—that is the rest of the faculty that I work with in Rutgers. 

So we have a lot of experience with exposure and illness. 

We have a pulmonary doctor that actually comes into our practice and sees patients with us. We have mental health people that 

come into our practice and see patients. And then across the street 

from us we have our surgeons, our gastroenterologists and a number of other specialties—specialists that we need in the Rutgers 

Center. 

By the way, we changed our name to Rutgers. We need to get 

that on the record that we changed from UMDNJ to Rutgers. In 

any event—— 

Mr. LANCE. That is because our State legislature has permitted 

the combination of the University of Medicine and Dentistry and 

Rutgers. 

Dr. UDASIN. Right. So in any event, then I have my registered 

nurses who are there helping us take care of patients, making sure 

that histories are obtained correctly, making sure that people actually know how to use their medications. This is really very important that we have people making sure that not only medications 

are used, but they are used correctly. Then I have, as mentioned, 

my mental health corps, then I have my administrative corps 

which Tracey Berspese heads, and that group of people is performing audits to make sure that everybody else is doing everything correctly. We are using our pharmacy correctly. We are doing 

the best that we can to keep costs down, using generic drugs, and 

that all of our providers and people that are writing prescriptions, 

that everybody is certified appropriate to do this, and that our patients actually get their medications when they get to the pharmacy. So that is part of coordination of care. And I can assure you 

we are performing these audits because I want to make sure that 

we have funding to treat our patients. Presumably you guys are 

going to unanimously confirm this bill, and I want the money to 

be there to treat our patients. 

66 

Mr. LANCE. Thank you very much, Doctor. 

And to Mr. Howley and Ms. Burnette, thank you for your superb 

public service, and certainly, we honor that public service. 

Ms. Burnette, what position did you play in basketball when you 

played basketball? 

Ms. BURNETTE. Point guard. 

Mr. LANCE. Point guard. I was 5’8’’ so I never played basketball. 

Mr. Chairman, I have a letter from, I think, 38 members of the 

New York and New Jersey Delegation to Speaker Boehner and 

Leader Pelosi requesting early passage of this bill. I would request 

that it be submitted for the record. 

Mr. PITTS. The gentleman seeks unanimous consent—— 

Mr. LANCE. I seek—— 

Mr. PITTS [continuing]. To put in the record. 

Without objection, so ordered. 

[The information appears at the conclusion of the hearing.] 

Mr. LANCE. Thank you, and I yield back 7 seconds. 

Mr. PITTS. The Chair thanks the gentleman. 

Now recognizes the ranking member of the full committee, Mr. 

Pallone, 5 minutes for questions. 

Mr. PALLONE. Thank you, Mr. Chairman. 

Dr. Udasin, I wanted to get into the—try to have you explain, if 

you will, the importance of not only the Rutgers Center but all of 

the centers that are part of this World Trade Program in terms of 

research, because there is an extensive research component, and I 

want you to kind of emphasize if you can how you are developing 

diagnosis and treatment of disorders that, you know, people might 

not even be aware of, and how that research and, you know, the 

uniqueness of the center makes that possible. Could—so could you 

just kind of describe how the Rutgers Center is involved in research into World Trade Center-related conditions, and how that 

research is improving our ability to diagnose and treat WTC-related health conditions, and the benefits of that research? 

Dr. UDASIN. So answering the Rutgers only—— 

Mr. PALLONE. That is fine, sure. 

Dr. UDASIN [continuing]. Rutgers and NYU research is, we have 

a lot of sleep apnea experts in those 2 centers, and what I am really proud to say is that between our laboratory toxicologists and our 

sleep experts, we have developed certain markers that we are seeing in certain of our patients. Dr. Sundaram, one of our sleep experts, presented this at the recent American Thoracic Society meetings, that certain markers were developed that certain people can 

be predicted possibly to have sleep apnea. And this is really important because these are inflammatory markers, and these people at 

9/11 site were exposed to all kinds of toxins that can cause inflammation. And so because of that association between environmental 

exposures and inflammation, we have been able to find people a lot 

sooner, get them treated. And for people to think about sleep apnea 

and the environment, because traditionally sleep apnea was 

thought of something that you had to be enormously obese to get, 

and we have patients that are not quite playing point guard, but 

are in awfully good shape that have sleep apnea. And we are able 

to—as I said, we—because of our occupational expertise, sleep 

apnea is a very serious condition. There was somebody who died 

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recently, a celebrity, on the New Jersey Turnpike because a bus 

driver fell asleep. And we have a lot of our patients who have to 

drive commercial vehicles, operate planes, operate the subway, operate all kinds of heavy equipment, and it is really good that we 

are able to treat them and keep them safe and awake. And I feel 

like that is one thing our research has accomplished, which is not 

only applicable to our patients, but it is applicable to other people 

with environmental exposures. 

Mr. PALLONE. I appreciate that. The other thing I wanted to— 

if you could get across is how we can expect an increase among the 

population that—of these 9/11-related conditions. In other words, 

my understanding is as time goes on, we find more cancers, more 

disorders, you know, as people get older, that maybe didn’t exist 

before and that have to be—and that now we are finding through 

your research or others in these centers that are related to 9/11 

that we didn’t know about before. 

Dr. UDASIN. So I want to say that certain kinds of malignancies—poietic malignancies, have very short latency periods, and 

you would expect to see something like that within just a couple 

of years after exposure to toxins, but other toxins like asbestos 

have much longer latency periods, and they might be seen later on 

and at a different time. 

And if I could use just a few minutes to also answer a question 

that you asked Dr. Howard earlier about mistakes made by providers outside of the program. If I could just add that we have 

found in the program that people have been undertreated by local 

providers for various cancers, for various severe lung conditions 

like pulmonary fibrosis, and I do want to say, even though that 

wasn’t exactly the question you asked, I do want to say that we 

have been able to improve the health care by tuning up, by getting 

better diagnostic services to our patients than they were able to get 

from some of the local people. 

Mr. PALLONE. Thank you very much. 

Thank you, Mr. Chairman. 

Mr. PITTS. The Chair thanks the gentleman. 

That concludes the questions of the members. They will have follow-up questions in writing. We will submit those to you, ask that 

you please respond promptly. 

I would remind members they have 10 business days to submit 

questions for the record. And they should submit their questions by 

the close of business on Thursday, June 25. 

Thank you very much for sharing your personal experience, for 

your excellent testimony. The committee will take up this legislation, I assure you, and act on it. And you have performed a public 

service by being here today. Thank you very much. 

And without objection, the subcommittee is adjourned. 

[Whereupon, at 12:41 p.m., the subcommittee was adjourned.] 

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