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ASSESSING SEPTEMBER 11TH HEALTH EFFECTS:

WHAT SHOULD BE DONE?

HEARING

BEFORE THE

SUBCOMMITTEE ON NATIONAL SECURITY,

EMERGING THREATS AND INTERNATIONAL

RELATIONS

OF THE

COMMITTEE ON

GOVERNMENT REFORM

HOUSE OF REPRESENTATIVES

ONE HUNDRED EIGHTH CONGRESS

FIRST SESSION

OCTOBER 28, 2003

Serial No. 108–124

Printed for the use of the Committee on Government Reform

(

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

http://www.house.gov/reform

(II)

COMMITTEE ON GOVERNMENT REFORM

TOM DAVIS, Virginia, Chairman

DAN BURTON, Indiana

CHRISTOPHER SHAYS, Connecticut

ILEANA ROS-LEHTINEN, Florida

JOHN M. MCHUGH, New York

JOHN L. MICA, Florida

MARK E. SOUDER, Indiana

STEVEN C. LATOURETTE, Ohio

DOUG OSE, California

RON LEWIS, Kentucky

JO ANN DAVIS, Virginia

TODD RUSSELL PLATTS, Pennsylvania

CHRIS CANNON, Utah

ADAM H. PUTNAM, Florida

EDWARD L. SCHROCK, Virginia

JOHN J. DUNCAN, JR., Tennessee

JOHN SULLIVAN, Oklahoma

NATHAN DEAL, Georgia

CANDICE S. MILLER, Michigan

TIM MURPHY, Pennsylvania

MICHAEL R. TURNER, Ohio

JOHN R. CARTER, Texas

WILLIAM J. JANKLOW, South Dakota

MARSHA BLACKBURN, Tennessee

HENRY A. WAXMAN, California

TOM LANTOS, California

MAJOR R. OWENS, New York

EDOLPHUS TOWNS, New York

PAUL E. KANJORSKI, Pennsylvania

CAROLYN B. MALONEY, New York

ELIJAH E. CUMMINGS, Maryland

DENNIS J. KUCINICH, Ohio

DANNY K. DAVIS, Illinois

JOHN F. TIERNEY, Massachusetts

WM. LACY CLAY, Missouri

DIANE E. WATSON, California

STEPHEN F. LYNCH, Massachusetts

CHRIS VAN HOLLEN, Maryland

LINDA T. SANCHEZ, California

C.A. ‘‘DUTCH’’ RUPPERSBERGER, Maryland

ELEANOR HOLMES NORTON, District of

Columbia

JIM COOPER, Tennessee

CHRIS BELL, Texas

———

BERNARD SANDERS, Vermont

(Independent)

PETER SIRH, Staff Director

MELISSA WOJCIAK, Deputy Staff Director

ROB BORDEN, Parliamentarian

TERESA AUSTIN, Chief Clerk

PHILIP M. SCHILIRO, Minority Staff Director

SUBCOMMITTEE ON NATIONAL SECURITY, EMERGING THREATS AND INTERNATIONAL

RELATIONS

CHRISTOPHER SHAYS, Connecticut, Chairman

MICHAEL R. TURNER, Ohio

DAN BURTON, Indiana

STEVEN C. LATOURETTE, Ohio

RON LEWIS, Kentucky

TODD RUSSELL PLATTS, Pennsylvania

ADAM H. PUTNAM, Florida

EDWARD L. SCHROCK, Virginia

JOHN J. DUNCAN, JR., Tennessee

TIM MURPHY, Pennsylvania

WILLIAM J. JANKLOW, South Dakota

DENNIS J. KUCINICH, Ohio

TOM LANTOS, California

BERNARD SANDERS, Vermont

STEPHEN F. LYNCH, Massachusetts

CAROLYN B. MALONEY, New York

LINDA T. SANCHEZ, California

C.A. ‘‘DUTCH’’ RUPPERSBERGER, Maryland

CHRIS BELL, Texas

JOHN F. TIERNEY, Massachusetts

EX OFFICIO

TOM DAVIS, Virginia HENRY A. WAXMAN, California

LAWRENCE J. HALLORAN, Staff Director and Counsel

KRISTINE MCELROY, Professional Staff Member

ROBERT A. BRIGGS, Clerk

DAVID RAPALLO, Minority Counsel

(III)

C O N T E N T S

Page

Hearing held on October 28, 2003 .......................................................................... 1

Statement of:

Gilman, Dr. Paul, Assistant Administrator for Research and Development, Environmental Protection Agency; Diane Porter, Deputy Director, National Institute for Occupational Safety and Health [NIOSH],

accompanied by Dr. Gregory Wagner, Director of the Division of Respiratory Disease Studies, National Institute for Occupational Safety

and Health; Pat Clark, area office director for New York, New York

Occupational Safety and Health Administration, accompanied by Dr.

David Williamson, Ph.D, Agency for Toxic Substances Disease Registry 103

Herbert, Dr. Robin, co-director of the World Trade Center Worker and

Volunteer Medical Screening Program, medical co-director of Mount

Sinai; Dr. Stephen Levin, co-director of the World Trade Center Worker

and Volunteer Medical Screening Program; Commissioner Thomas

Frieden, a doctor at New York Department of Health and Mental

Hygiene; Dr. Michael Weiden, medical officer, New York Fire Department; Phil McArdle, health and safety officer, Uniformed Firefighters

Association; Jimmy Willis, vice chair for conductors, assistant to the

president, Transportation Workers Union; John Graham, health and

safety instructor, Carpenters Union; and David Rapp, former worker

at the World Trade Center site .................................................................... 22

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

Clark, Pat, area office director for New York, New York Occupational

Safety and Health Administration, prepared statement of ....................... 140

Frieden, Commissioner Thomas, a doctor at New York Department of

Health and Mental Hygiene, prepared statement of ................................. 37

Gilman, Dr. Paul, Assistant Administrator for Research and Development, Environmental Protection Agency, prepared statement of ............. 124

Graham, John, health and safety instructor, Carpenters Union, prepared

statement of ................................................................................................... 69

Herbert, Dr. Robin, co-director of the World Trade Center Worker and

Volunteer Medical Screening Program, medical co-director of Mount

Sinai, prepared statement of ........................................................................ 25

McArdle, Phil, health and safety officer, Uniformed Firefighters Association, prepared statement of .......................................................................... 57

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

of New York:

Article dated October 28, 2003 ................................................................. 7

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

Owens, Hon. Major R., a Representative in Congress from the State

of New York, prepared statement of Ms. Mount ........................................ 100

Porter, Diane, Deputy Director, National Institute for Occupational Safety and Health [NIOSH], prepared statement of ......................................... 107

Rapp, David, former worker at the World Trade Center site, prepared

statement of ................................................................................................... 74

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

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

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

of New York, article dated August 23, 2002 ............................................... 14

Weiden, Dr. Michael, medical officer, New York Fire Department, prepared statement of ........................................................................................ 46

Willis, Jimmy, vice chair for conductors, assistant to the president,

Transportation Workers Union, prepared statement of ............................ 64

(1)

ASSESSING SEPTEMBER 11TH HEALTH

EFFECTS: WHAT SHOULD BE DONE?

TUESDAY, OCTOBER 28, 2003

HOUSE OF REPRESENTATIVES, SUBCOMMITTEE ON NATIONAL SECURITY, EMERGING

THREATS AND INTERNATIONAL RELATIONS, COMMITTEE ON GOVERNMENT REFORM, New York, NY.

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

Goldwurm Auditorium of the Mount Sinai Medical Center, 1st

Floor, 1425 Madison Avenue, New York, NY, Hon. Christopher

Shays (chairman of the subcommittee) presiding.

Present: Representatives Shays, Turner, and Maloney.

Staff present: Lawrence Halloran, staff director and counsel;

Kristine McElroy, professional staff member; Robert Briggs, clerk;

and David Rapallo, minority counsel.

Mr. SHAYS. I’d like to welcome our witnesses and our guests to

this congressional hearing. And to say that this is an important

day and we are looking forward to the testimony from our witnesses.

A quorum being present, the Subcommittee on National Security,

Emerging Threats and International Relations Hearing entitled,

‘‘Assessing September 11th Health Effects: What Should be Done?’’

is called to order.

Congresswoman Carolyn Maloney invited the National Security

Subcommittee to New York City today because she understands

the threat posed to the health and welfare of all Americans by terrorism and its lingering aftermath. She has been a thoughtful,

hardworking partner in our bipartisan oversight of terrorism

issues, and we are grateful for the opportunity to be here.

In place of the fallen towers of the World Trade Center, these

two hard realities cast long shadows over our discussion today.

Many first responders are the second wave of victims in a terrorist

incident. And public health and disability compensation systems

are not fully prepared to acknowledge the unique wounds inflicted

by this all too modern war. Firefighters, police, emergency medical

personnel, transit workers, construction crews and other first responders came to Ground Zero knowing there would be risks, but

confident they’re equipment, training and community would sustain them. But, as we will hear today, better equipment and training standards are needed to match the first responder mission to

the new threats posed by catastrophic terrorism. And the dissident

patchwork of Federal, State and local health support is, in many

cases, not providing the care and comfort they rightfully expect.

2

After the 1991 war in the Persian Gulf, veterans suffered a variety of unfamiliar syndromes, faced daunting official resistance to

evidence linking multiple low level toxic exposures to subsequent

chronic ill health. In part, due to the work by this subcommittee,

long term health registries were improved, an aggressive research

agenda pursued and sick veterans now have the benefit in law of

a rebuttable presumption that wartime exposures cause certain illnesses.

When the front line is not Baghdad but Broadway, occupational

medicine and public health practitioners may have much to learn

from that distant Middle East battlefield. Proper diagnoses, effective treatment and fair compensation for the delayed causalities of

a toxic attack require vigilance, patience and a willingness to admit

what we do not know and might never know about toxic synergies

and syndromes.

Health surveillance has to be focused and sustained. New treatment approaches have to be tried now in time to restore damaged

lives. In this effort to heal the wounds of September 11, 2001 and

strengthened public health capacity against future attacks, the

Federal Government has a central role to play. The Center for Disease Control and Prevention [CDC], and its National Institute of

Occupational Health are charged to develop and implement health

protocols against new workplace dangers like Anthrax and novel

particulates from the fiery destruction of a building.

On our second panel of witnesses today we will hear about the

work and other Federal public health agencies in treating the

walking wounded of September 11th. But before we will hear from

first responders and local officials on the near and long term health

effects of the World Trade Center attack.

We appreciate our Federal witnesses foregoing the usual protocol

of going first so that they could listen and respond to all the testimony today.

All our witnesses bring impressive expertise and unquestionable

dedication to our discussion. We are grateful they could join us. We

look forward to a constructive dialog on how to mend the wounds

of this and other terrorist attacks.

At this time the Chair would recognize the very gentle, as they

say in terms, and very knowledgeable Mrs. Maloney.

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

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Mrs. MALONEY. First of all, Chairman Shays, I want to thank

you very, very much for coming to my district to hold this hearing.

But I also would like to focus and comment on your long term commitment to issues of public health, including your outstanding and

aggressive oversight of the response of the Federal Government to

the Gulf war syndrome. In fact, many people say that the September 11 health concerns are similar to the Gulf war syndrome and

that Washington is not really reacting to what is a major health

crises in an appropriate way.

The primary question before us today is everything being done

that could be done to help those workers and victims at September

11. And that is why I asked Chairman Shays to have this hearing.

And I regretfully expect that we will hear today that the answer

is no. I have read in some testimony that over 1,800 of the firefighters have had to take early retirement because of health concerns. I have read the testimony of transit workers who called the

air at Ground Zero ‘‘toxic soup’’ filled with asbestos and pulverized

glass and concrete, and that fully half of their workers are sick.

And fully one-third, I am told by Dr. Levin and others at Mt

Sinai are still experiencing long term related health problems. And,

regrettably, Dr. Levin has told me that 40 percent of the people

they have screened so far do not have health coverage.

There is substantial evidence of high levels of upper airway and

lung problems, respiratory, digestive conditions, psychological trauma problems. And there are certainly more injured that are waiting in line to be documented. But there still seems to be no coordinated response from Washington.

Anyone looking at thousands sickened by one event would think

that it would be treated as a health emergency of the highest

order. But it does not seem that there has been any sense of urgency from the Federal Government.

I hope that this hearing will help sort all of this out. And I know

that many of the panelists and my colleagues, I thank them for

being here, have a lot of questions.

First, what is being done to actually assist the injured medically?

That is what I would like to hear from the panel.

Is there a coordinated assistance for those that need help; volunteers, construction workers, residents, first responders who have

injured and have not been able to work since their time at Ground

Zero, many of whom have list their health insurance because they

are no longer able to work?

Do those who were insured know that many can apply? Many of

the injured can apply. And I want to make sure that they know

that they can apply to the Victims Fund. And do they know that

they must apply before the December 31st deadline of this year for

assistance?

What is happening with processing of worker’s compensation

claims? I hear reports that is mired in difficulty.

And most importantly, are those injured receiving the proper

care?

Why has there been such reluctance on the part of the Federal

Government to provide sufficient funds for monitoring and why

have the funds been so slow in getting dispersed?

6

It took over a year to get the leadership in Congress to support the $90 million for the medical screening of World Trade Center

workers. Federal resources for the monitoring program, even 8

months after they were appropriated, have still not been dispersed

and apparently will not be dispersed until May 2004 at the earliest. Why is this happening? This is wrong. We should figure out

to move the system forward.

And I hope that NIOSH will explain why they are proposing to

change the system, and at the very least their changes should not

in anyway disturb the monitoring the program that is already in

place and not have gaps in that monitoring programs.

And are there sufficient funds in place to properly provide the

long term monitoring that is needed? We have never had a situation in history where pulverized toxic air has been exposed to people. And we need a long term commitment to monitor these health

risks so that we can possibly plan in the future for better preventive equipment to protect people at disaster areas.

And why are the representatives of the workers so directly impacted by health concerns so unhappy with the work of the city on

the health registry?

And why are there still privacy concerns about the health registry survey?

Why did the registry not work out a protocol for providing information and referral for those injured who seek help? I had my staff

call the registry and they didn’t refer them to any other screening

or to any health treatment. And why, after 2 years of planning,

cannot the city of New York, the great city of New York do a better

job with this health registry?

In light of the revelations about the EPA’s public announcements

on the safety of the air after the disaster, the immense difficulty

the New York City House members in a bipartisan way along with

our Senators had in convincing Washington to support funding, we

have to ask why is not Washington focusing on these issues. And

I would like permission to place in the record an article that was

in the Daily News today that talks about memos from top scientists

that were released to the city about the health crises in the air and

the lack of information and support that got out to the workers.

They were not informed. I request permission to put this article in

the record.

Mr. SHAYS. Without objection, so ordered.

[The information referred to follows:]

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Mrs. MALONEY. I am in the process of developing legislation

which I hope will be a bipartisan effort which will focus on many

of the issues that we are talking about today.

First, the legislation would make sure that everyone who was injured from their time at Ground Zero, the volunteers, the bucket

brigade, the firefighters, fire officers, iron workers, construction

workers; all of those that do not have health coverage, that they

get health coverage that covers their health concerns because they

risked their lives to save other people.

And I ask a final question: How in the world are other first responders going to respond to disasters if they see that the first responders who rushed to September 11 are not, at the very minimum, given health care and health screening and health monitoring for their health concerns because of their selfless act to rush

and save the lives and work to reconstruct our city?

I would like to place in the record the draft of the legislation. It

also calls for the monitoring to continue for 20 years and for research to look into what this means, this new type of toxic air that

Americans or no one on Earth has ever experienced before on their

long term health needs. And it tries to facilitate a better coordination and oversight.

Coming here today I saw a bumper sticker that said ‘‘Remember

9/11.’’ You see them everywhere. ‘‘Remember 9/11.’’ But I hope that

today with this focus that Washington will also remember, the city

will remember and we will get the proper care to the workers. And

I hope that this is the beginning of a new and urgently needed

focus on the health impact of September 11.

And I strongly commend the work of the chairman on the Gulf

war syndrome, and for his attention and for being here today.

Thank you.

[The prepared statement of Hon. Carolyn B. Maloney follows:]

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Mr. SHAYS. I thank the gentle lady.

And at this time the Chair would recognize the vice chairman of

the subcommittee, Mr. Turner, and thank him for being here given

he has constituent issues in his home State of Ohio. And I thank

you for being here. Thank you.

Mr. TURNER. I want to thank our chairman, Chris Shays and

Mrs. Maloney, for having this hearing and for focusing on these important issues. Mrs. Maloney, thank you for having us in your district.

Our chairman, Chris Shays, has been a leader in the issues of

looking at terrorism and our preparedness both on the local and

Federal level and our responsiveness to the issue of how do we prevent terrorist attacks, how do we prepare for them and how to respond. Even prior to September 11th our chairman had made certain that this committee looked at ways that information could be

disseminated to communities and throughout the Federal Government in assisting us in our preparedness for terrorist attacks.

I am the only Representative who is here who is not from the

larger New York metropolitan area, but I can assure you that this

is a national issue. It is a national issue not only because September 11th was a national tragedy, but because the preparedness, the

information that we learn from this experience is important to all

of us in our country as we look to lessons learned and how we can

prepare in the future.

Also for my community, Dayton, OH, I served as mayor for Dayton during September 11, 2001, and even our community sent

EMS, fire and EMS responders as part of the recovery operation

in response to New York’s broader request that States throughout

the region send responders here. So I met our responders as they

were returning from New York and spoke with them about what

they saw and how their efforts here impacted their lives. And I’m

very interested then in how the overall environmental impacts

might effect the efforts of really what was the response from many

States in helping New York.

We do have a lot of real important work here to do today. One

is the evaluation of current spending. There have been millions of

dollars that have been spent and millions of dollars that have been

allocated. Have they been allocated to the appropriate things? And

what are the needs that we need to address?

In looking at the needs, we are obviously going to be looking at

the issue of the full impacts, not just those that are immediately

obviously, but as we further study this and look to the impacts in

this community.

And then also the third would be on the issue of just lessons

learned, and not only for processes but substantive, technical, scientific information that we have learned.

I am very excited about participating in this and learning from

all of the experts that you have assembled the information that we

need as we look to proceed in the future. Thank you.

Mr. SHAYS. Thank the gentleman.

At this time the Chair would recognize Mr. Townes, not a member of the subcommittee, but a member of the full committee.

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

13

Let me begin by thanking you and all my colleagues for holding

this very important hearing. I appreciate that you are holding the

hearing in the city that the most damage occurred, and that is a

fact. The tragedy of September 11 was felt more by our city than

any other place. We encountered the greatest physical destruction

and we lost the most lives. And thousands of families still mourn

the magnitude of this devastation, which was easily seen by the entire world.

I have been, and remain concerned, about the lack of attention

paid to those who live right outside of Manhattan. As someone who

represents parts of Brooklyn, I am most concerned about my Brooklyn constituents. The research shows that my concerns should not

be ignored.

According to the Environmental and Occupational Health

Sciences Institute of the University of Medicine and Dentistry in

New Jersey, the intense heat of Ground Zero blew debris, gases

and particles upwards creating a loft effect which may have caused

these pollutants to drop on people living in Brooklyn.

New York Newsday reported this finding in an article on September 11th of this year, however this evidence is not new. On August 23, 2002 Newsday reported that high resolution photographs

shot on September 11 by satellites show clear images of toxic debris getting blown in a southeasterly direction from Ground Zero

across the Brooklyn Bridge into several neighborhoods.

I would like to submit this article, Mr. Chairman, for the record,

Newsday of September 11th.

Mr. SHAYS. Without objection, so ordered.

[The information referred to follows:]

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Mr. TOWNS. This was also confirmed by an October 2002 American Prospect article that said ‘‘It is now clear, thanks to NASA

photographs, that the black toxin of World Trade Center debris

blew for more than 30 hours directly from Ground Zero to the East

River, which separates Manhattan from Brooklyn and Queens.’’

Let me point out three Brooklyn hospitals reported increases in

visits related to respiratory ailments.

While I share several concerns with my colleagues about the

health consequences stemming from the WTC disaster, I especially

look forward to hearing from the witnesses on this issue.

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

And again, I thank you for holding this hearing in the greatest

city in the world.

Thank you. I yield back.

Mr. SHAYS. I think most people agree, it is the greatest city in

the world. It is. And those of us who live near it, recognize that

what happens to New York directly impacts us, and we care deeply

about this greatest city in the world.

Mr. Nadler, we are delighted to have you join us. Mr. Nadler is

not a member of the Government Reform Committee. He is a very

active member, particularly of the Judiciary Committee. And he is,

I think, the Representative who represents the district, we are

talking about directly Ground Zero. And at this time, Mr. Nadler,

you have the floor.

Mr. NADLER. Well, thank you very much, Mr. Chairman.

Let me begin by thanking you for holding this hearing today regarding the health effects of the September 11th terrorist attack on

those who live or work near Ground Zero, and particularly for allowing me to participate in this committee, though I am not a

member of the committee.

As the Member of Congress representing Ground Zero, I have

heard from far too many constituents in the last 2 years who have

health problems because of contaminants in World Trade Center

dust that the EPA refuses to clean up or to acknowledge, despite

the fact that OSHA considers the dust to be regulated asbestos containing material and expert scientists have measured air pollution

levels worse than the Kuwaiti oil fires.

Two years ago in the days following September 11, the EPA said

the air in Manhattan was safe to breath, despite the fact that they

had no scientific evidence to make such a claim when they made

it, and they continued to make it even when they ample scientific

evidence that it was not true.

After hearing from many constituents who told me they were getting sick and that the EPA refused to help them with decontaminating their apartments, in January 2002 I asked the EPA’s

ombudsman to investigate EPA’s inaction. After the EPA’s ombudsman’s office conducted two field hearings which elicited considerable information, the EPA showed its displeasure by dismantling

the ombudsman’s office.

In April 2002, I published a white paper on EPA’s malfeasance,

and in June testified of that year before the Senate on the inadequacy of the EPA’s indoor cleanup plan, which they announced a

mere 8 months after September 11 in May 2002.

19

Two months ago the EPA’s Inspector General released the report

documenting what many thousands of New Yorkers already knew;

that the EPA had given false assurances to the people of New York

regarding the air we were breathing and that the EPA had refused,

and to this day refuses to take responsibility to decontaminate indoor spaces such as apartments, offices and schools despite the fact

that they are legally mandated to do so.

We know that several hazardous substances were present in the

World Trade Center dust and were released into the environment

when the towers collapsed. Clearly, that presented a hazard for

rescue workers on the pile, and one of the purposes of today’s hearing is to investigate the Government response to the sickness and

problems caused by those hazards, and what I would say is the

clearly inadequate Government response. But those hazardous substances were also present in World Trade Center dust that was

blasted, often with great force, into surrounding buildings and settled in homes, schools and work places. Although the EPA declared

that the outdoor air was safe, and this declaration was premature,

enough time has passed that it is probably true that the outdoor

air is no longer a problem today. On the other hand, the problem

of indoor environments and exposure to hazardous World Trade

Center dust that settled inside buildings persists to this day. And

we have every reason to believe that thousands of people are

poisoned day-by-day indoors in work spaces, schools and homes,

and will continue to be so until action is taken to thoroughly investigate and clean up these spaces.

As OSHA’s Secretary John Henshaw wrote on January 31, 2002,

and I see in the packets that were presented here a copy of his letter was placed, ‘‘In that the materials containing asbestos were

used in the construction of the Twin Towers, the settled dust from

their collapse must be presumed to contain asbestos’’ and therefore

OSHA Federal regulations apply to the removal of this material.

Nonetheless, the Government told the public is was safe and advised average citizens to clean up World Trade Center dust with

a wet mop and a wet rag, which was illegal advice if you assume

that has asbestos in it, as well as recklessly dangerous advice.

In May of last year, the EPA announced a limited indoor cleanup

plan. This plan was a complete sham designed to deflect criticism

of the agency, not to actually address the problem. And they practically admitted that by saying there is no problem, this is being

done to allay public fears; translation for PR.

As confirmed in the EPA IG report, the agency’s indoor clean up

program was wholly inadequate and did not meet even the minimum criteria for protecting human health established by law. And

the EPA refused, despite repeated requests, to require that its contractors in the clean up, require that their workers wear protective

equipment. So we can expect that many of the workers in the clean

up program a few months now will come down with respiratory ailments.

The Federal Government has never followed its legally mandated

procedures to track the release of hazardous materials, characterize the site and clean up buildings contaminated in the terrorist attack. And in this morning’s Juan Gonzalez’ article, he quoted this

20

expert at ATSDR as saying that one of the first things they must

do is characterize the site, which they have never done.

It has not done the proper comprehensive testing to determine

who has been exposed, what they are exposed to and the full extent

of why this contamination has spread. This is why Senator Clinton

placed a hold on Governor Leavitt’s nomination as EPA Administrator, and she should be applauded for getting this issue back on

the national radar screen. But until the EPA agrees to fully do its

job, the issue will not go away.

This is a very real, serious and continuing health issue that must

be addressed. I refer to many constituents who have World Trade

Center debris in their homes and their work spaces and who are

now sick.

The title of this hearing is ‘‘Assessing September 11th Health Effects: What Should Be Done?’’ It is very obvious what should be

done. All the workers on the piles should have physical examinations and their health care needs as a result of this catastrophe for

the balance of their lives should be paid for the Federal Government. The Federal Government should carry out its mandated responsibility to clean up buildings contaminated in the terrorist attack. The EPA should adopt and implement the recommendations

in the IG report, and the Federal Government should assume the

responsibility of ensuring the proper treatment for those sickened

by World Trade Center debris, particularly in cases where exposure

was the result of government negligence and malfeasance.

In conclusion, let me summarize by saying that I regard there

are being three victim populations that should be looked at separately besides the people who were killed directly by the terrorist

attack.

One is those people who were exposed, who got an acute exposure by being caught in a toxic cloud. And we should monitor and

help them with their health problems, but no one is at fault other

than the terrorist.

Second are those responders who worked on the pile for 30, 40,

50 days without proper protective equipment, have gotten sick as

a result. And after the first few days it was inexcusable that not

everyone was wearing proper protective equipment. And, again, we

have to examine all these people, we have to take care of their

problems. But somebody should be held responsible for why proper

protective measures were not taken.

Third and finally, are the thousands of people who are today living and working in contaminated work spaces, contaminated

schools which have not been inspected and have not been cleaned

up and we can predict that 15 years from now many of them will

come down with mesothelioma or asbestosis or lung cancer. We can

also predict that we can greatly minimize that problem if we do

this proper inspection and clean up now, which is why this is a current issue. It is not simply a question of dealing with past damages. We can still eliminate most of the health problems from those

people if the EPA follows the inspections, properly looks at all the

neighborhoods, not just below Canal Street but wherever that dust

cloud went, inspects and cleans up.

I thank you again, Mr. Chairman, for holding this hearing and

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

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Mr. SHAYS. Thank you. I thank the gentleman very much.

I am just going to do a little housekeeping here and ask unanimous that all members of the subcommittee be permitted to place

an opening statement in the record. And that the record remain

open for 3 days for that purpose.

Without objection, so ordered.

I ask further unanimous consent that all witnesses be permitted

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

I ask even further unanimous consent that Representative

Towns, a member of the Government Reform Committee and any

other member of the Government Reform Committee who may

show up, and Representative Jerry Nadler sit with this committee

as a full participant. And without objection, so ordered.

Before recognizing the witnesses, I want to say since this is the

first hearing, this hearing will raise many questions, a number will

not be answered today nor will we even seek to get some questions

answered. We have heard very important statements from all the

participants at this hearing. Ultimately, it would be the goal of this

committee to have every one of those questions answered and every

problem dealt with.

At this hearing, and I want to say I am going to be pretty focused on this and pretty strict in adhering to it, at this hearing we

are focused on the workers and first responders’ health conditions,

their diagnoses, their treatment, their compensation. This hearing

does not focus on residents, it does not focus on other workers who

may work there. It does not focus yet on the clean up of facilities

there. And we will. We will focus on those issues and we will make

sure that any Member who has raised his questions, gets answers

to those questions.

At this time, I would recognize our participants. We have our

first panel.

Dr. Robin Herbert, co-director of the World Trade Center Worker

and Volunteer Medical Screening Program, Medical co-director of

Mount Sinai. And she is accompanied by Dr. Stephen Levin, co-director of the World Trade Center Worker and Volunteer Medical

Screening Program.

So Dr. Herbert will be giving the statement.

We then have Commissioner Thomas Frieden, a doctor at New

York Department of Health and Mental Hygiene. Dr. Michael

Weiden, medical officer, New York Fire Department; Mr. Phil

McArdle, health and safety officer, Uniformed Firefighters Association; Mr. Jimmy Willis, vice chair for conductors, assistant to the

president, Transportation Workers Union; Mr. John Graham,

health and safety instructor, Carpenters Union, and; Mr. David

Rapp, former worker at the World Trade Center site.

We don’t usually have this many panelists. I have been liberal

when we have a smaller panel of being able to go over the 5-minutes. I would really respectfully ask that you submit your statement in 5 minutes. And if you think you need to redo it a little bit,

I can skip over you to give you a little time. But if you go 5° minutes, maybe a little longer, but we would like you stay somewhere

within that range.

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And so at that time I need to do one more. If you can all stand

up in this cozy area we have, but I do need you to stand. I do need

to swear you in.

[Witnesses sworn.]

Mr. SHAYS. Note for the record all the witnesses have responded

in the affirmative.

We are going to start with you, Dr. Herbert, and we are just

going to kind of go down the line here. And we will do a lot of good

listening, that is why we are here.

STATEMENTS OF DR. ROBIN HERBERT, CO-DIRECTOR OF THE

WORLD TRADE CENTER WORKER AND VOLUNTEER MEDICAL SCREENING PROGRAM, MEDICAL CO-DIRECTOR OF

MOUNT SINAI; DR. STEPHEN LEVIN, CO-DIRECTOR OF THE

WORLD TRADE CENTER WORKER AND VOLUNTEER MEDICAL SCREENING PROGRAM; COMMISSIONER THOMAS

FRIEDEN, A DOCTOR AT NEW YORK DEPARTMENT OF

HEALTH AND MENTAL HYGIENE; DR. MICHAEL WEIDEN,

MEDICAL OFFICER, NEW YORK FIRE DEPARTMENT; PHIL

McARDLE, HEALTH AND SAFETY OFFICER, UNIFORMED

FIREFIGHTERS ASSOCIATION; JIMMY WILLIS, VICE CHAIR

FOR CONDUCTORS, ASSISTANT TO THE PRESIDENT, TRANSPORTATION WORKERS UNION; JOHN GRAHAM, HEALTH AND

SAFETY INSTRUCTOR, CARPENTERS UNION; AND DAVID

RAPP, FORMER WORKER AT THE WORLD TRADE CENTER

SITE

Dr. HERBERT. Thank you. Thank you for asking me to testify

today.

The September 11th terrorist attacks on the World Trade Center

resulted in horrific loss of life. Amid the shock and grief we all experienced immediately after the attacks, some failed to recognize

that the terrorists had also created one of the worst acute urban

environmental disasters ever to occur in U.S. history.

Soon after the attacks, various New York area health care providers, including ourselves, began seeing workers and others with

serious health problems due to their World Trade Center exposures. Many of us participated in the working group assembled by

NIOSH to develop common approaches to the diagnoses and treatment of World Trade Center related health problems.

In June 2002, Mt Sinai received $11.8 million in Federal funding

to establish the World Trade Center Worker and Volunteer Medical

Screening Program. This funding enabled us to design and coordinate a consortium of health care centers in the New York metropolitan area, and nationally, to provide free medical screening examinations for World Trade Center responders who were involved

in various rescue and recovery efforts.

In January 2003, we released some preliminary findings from

analysis of 250 of the first 500 people who had come through the

program. We reported that 78 percent had at least one World

Trade Center related pulmonary symptom while working or volunteering at the site, and 46 percent were still experiencing at

least one pulmonary symptom in the month before the screening

exam up to 10 months after September 11th. Eighty-eight percent

had at least one World Trade Center related ear, nose or throat

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symptom while performing World Trade Center response work, and

52 percent were still experiencing at least one ear, nose and throat

symptom in the month before the screening examination.

Finally, 52 percent reported mental health symptoms requiring

further evaluation when they came for screening.

We have now seen over 8,000 men and women in our screening

program and we now know that a substantial number of World

Trade Center responders have developed upper and lower respiratory problems that are lasting as long as 2 years. However we

do not know what the long term effects of the World Trade Center

exposures will be, and in particular we are concerned about cancers.

Because of the high prevalence of persistent World Trade Center

related health problems we were seeing, as well as the worry about

what the long term consequences might be, it became clear that

there was a need for both long term medical monitoring of responders as well as a need for medical treatment for those who have developed World Trade Center illnesses. For these reasons we joined

with fellow occupational health experts, labor leaders and concerned Federal legislators in an intensive year long lobby for Federal resources for long term medical monitoring.

Last February it was announced that this money had been appropriated. Although we still await the final award of the funding,

we join with thousands of ill and injured workers and volunteers

in our appreciation of your efforts to secure those resources. Of the

$90 million allocated in the early winter of 2003, $4 million has

been provided to allow us to expand the baseline medical screening

program so that 3,000 additional workers and volunteers will receive free comprehensive medical screening examines. Another $25 million is allocated specifically for examinations of

New York City firefighters. And the remaining funding, approximately $56 million, will be used to establish, coordinate and conduct a program for long term medical monitoring of World Trade

Center responders. However, these funds are unfortunately insufficient to provide periodic medical examinations of World Trade Center responders for the 20 years that we would advocate.

We estimate that the current funding will support a program to

conduct screening examinations of 12,000 responders every year

and a half for 5 years only. However, we would recommend screening for a minimum of 20 years because the World Trade Center responders sustained exposures without precedent. These exposures

may cause new, unexpected health consequences, including possibly

cancers, which would be unlikely to show up for at least 15 years

after the time of exposure. This means that the screening program

as currently funded will not last long enough to ensure that diseases that develop only after years have passed, can be detected

when they’re still treatable.

Equally pressing at this time is the need for treatment. We’re

identifying many people who need ongoing treatment for World

Trade Center related physical and mental health problems. But,

unfortunately, there is still not an adequately funded treatment

program. At Mount Sinai we’ve sought and received funding from

private philanthropic sources to establish a treatment program for

a limited number of World Trade Center responders. But philanVerDate 11-MAY-2000 10:27 Apr 15, 2004 Jkt 000000 PO 00000 Frm 00027 Fmt 6633 Sfmt 6633 D:\DOCS\92728.TXT HGOVREF1 PsN: HGOVREF1
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thropy simply cannot provide all the sources necessary to provide

care who need it.

Among the first 350 patients we have seen in our treatment program, we have found that 75 percent have persistent World Trade

Center related upper respiratory problems; 44 percent have persistent World Trade Center related lung problems, and; 40 percent

have persistent mental health consequences related to the disaster.

But, 40 percent do not have medical insurance and about one-third

are now unemployed. It is, thus, urgent that funding be made

available to provide access to medical and mental health care for

all whose sustained health consequences from the World Trade

Center disaster; workers and volunteers involved in rescue and recovery, workers from the immediate area and area residents as

well as their children.

In conclusion, funding is vitally needed to: One, to supplement

the current appropriated dollars in order to extend the duration of

the long term medical monitoring program for a minimum of 20

years; two, to ensure access to treatment for all World Trade Center related health problems identified in screening programs; three,

to ensure that those who develop future health problems related to

World Trade Center exposures are able to receive treatment for

those conditions, and; four, to support clinical research to better

understand the human health consequences of the exposures, and

most importantly, to identify treatment modalities for those conditions.

Surely those who responded so selflessly to the disaster deserve

no less.

Thank you.

[The prepared statement of Dr. Herbert follows:]

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Mr. SHAYS. Thank you very much, Doctor.

Commissioner.

Dr. FRIEDEN. Thank you very much.

Mr. SHAYS. Is the mic on?

Dr. FRIEDEN. Good morning. Can you hear?

I am Dr. Thomas Frieden, commissioner of the New York City

Department of Health and Mental Hygiene.

I want to thank Chairman Shays of the committee and especially

Congresswoman Maloney for holding these hearings in New York

City.

The immediate effects of September 11 included the deaths from

terrorist attack of nearly 2,800 New Yorkers in addition to the passengers and crew of the two planes that crashed into the WTC. Our

efforts now are focused on the many people who may experience

long term health problems as a result of September 11.

The WTC Health Registry is a critically important effort to

evaluate the short and long term effects to both physical and mental health that may result from September 11. A comprehensive,

strictly confidential health survey of the most highly exposed people, it will identify which groups and exposures most increase the

risk of health problems and which are most in need of medical

intervention. Significant findings will be shared as soon as they become available and reports will be posted on the Web every 3

months. We intend to track the health of persons who enroll for up

to 20 years.

The registry is unique. It is the only project that will allow comparisons across groups and facilitate long term followup of a large

representative group of people with a wide range of exposures and

health histories. It is our best chance to find out both the spectrum

of health effects from September 11 and to identify and target services for the medical needs arising from September 11. Findings will

help participants, others exposed and the general public and will

provide critical information for medical professionals who evaluate

and treat exposed persons. It is a systematic evaluation that should

allow us to make conclusions about the health effects of September

11 both for those who participate and for those who do not participate in the registry.

It is not an attempt to identify and monitor every exposed person. It is also not a telephone diagnostic program intended primarily to find people with medical problems and provide care.

The registry will identify syndromes and conditions associated

with exposure and will put clinical studies into perspective. We

need both the detailed clinical evaluation that is provided by

Mount Sinai and NYU and others, and the comprehensive approach the registry provides.

The registry is a collaboration between the health department,

ATSDR, FEMA and New York City community and business organizations. The development of the scientific plan for the registry

has, from its inception, involved the collaboration of scientists from

many academic institutions both within and outside of New York

City.

ATSDR has committed funding for project years 2 through 5 for

core functions. However beginning in calendar 2005 we will need

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at last $2 million more per year for basic registry functions for the

intended 20 year life of the project.

We are very pleased with the response to the registry in the first

8 weeks of enrollment. More than 10,000 people have completed

the telephone interview. Another 5,000 have preregisted, and these

numbers continue to increase each day. We are also reaching tens

of thousands of others for whom we already have contact information.

The registry has a Federal certificate of confidentiality ensuring

protection of individual information from subpoena or Freedom of

Information Act requests.

The registry is the most recent of many activities conducted by

the health department following September 11. These include:

Syndromic surveillance to identify clusters of illness; inspection of

food distribution, mandated washing stations; emergency department monitoring for injuries; rescue worker injury and illness monitoring; community needs assessment of Lower Manhattan; indoor

air quality assessment.

And the department also implemented Project Liberty, a FEMA

funded crises counseling and public education program. Project Liberty has assisted more than 900,000 New Yorkers effected by September 11 serving a population ethnically diverse and similar to

the city as a whole.

Project Liberty is scheduled to end on December 31st of this

year. We are hopeful for an extension so that the fire and education department programs can continue.

We thank you for your interest and support. However, much

more needs to be done both to address the needs of those still suffering from the effects of the attack and to ensure that we are as

prepared as we can be. The city continues to ask the administration and Congress to provide bioterrorism and Homeland Security

funding based on risk and consequence.

We were the target of two of the four planes hijacked on September 11. We were the target of four of seven anthrax-laden envelopes

sent in the fall of 2001. And we are the target of most of the terrorist chatter that mentions a specific location. But despite having

more than half of the Nation’s recent attacks and having more

than half of the risk of future attacks, we receive less than one fortieth of the Federal dollars for bioterrorism preparedness.

In fact, per capita New York City ranks a shocking 45th out of

the 54 jurisdictions receiving bioterrorism funding.

We have asked the administration and Congress for more than

$900 million for emergency preparedness, $100 million of which is

for the health department. And as I noted before, the WTC Health

Registry, our best chance to know the health effects of September

11 and most effectively target long term interventions has a large

funding gap in the out years.

Thank you for your interest and continued support.

I will be happy to answer question.

[The prepared statement of Commissioner Frieden follows:]

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Mr. SHAYS. Dr. Weiden.

Dr. WEIDEN. Chairman and members, today I’ve been asked to

talk about the health and welfare of FDNY firefighters and the

EMS rescue workers after September 11. I will focus on what lessons we have learned and what changes should be made as we

move forward.

On September 11, two 110 story towers and several other buildings collapsed during rescue and evacuation. With these collapses,

FDNY firefighters and the EMS rescue workers went from being

first responders to victims. Although, first responders accounted for

nearly 12 percent of the dead, our surviving firefighters and EMS

and rescue workers continued to work uninterrupted both at the

WTC site and throughout NYC. We must never forget that despite

the tragedy of that day, FDNY successfully evacuated over 20,000

civilians and saved countless lives. The extraordinary heroism of

our firefighters and rescue workers will forever remain a beacon of

courage, commitment and dedication.

WTC dust is pulverized concrete, fibrous glass, silicates, carbon

particulate matter and asbestos. The upper airways were overwhelmed by this burden and the dust had an extraordinarily high

pH causing deep burns of lung, sinuses and esophagus.

Since inhaling this dust can cause considerable harm, it was important to find out if masks or respirators were available and were

actually worn by FDNY rescue workers. By week two, 70 percent

of firefighters had the proper respiratory for this exposure, but only

30 percent were able to wear it most of the time. Why? Because

these masks were uncomfortable and difficult to communicate to

through others.

To improve respiratory protection at future disasters, we need

better planning, improved respiratory design and supply. Two

years after the WTC, we still don’t have that. Improved design and

supply will naturally lead to improve compliance.

FDNY Bureau of Health Services understood the need to provide

immediate medical monitoring and treatment. From October 2001

to February 2002 we provided every FDNY firefighter and EMS

worker with the opportunity for a full medical. We also partnered

with the CDC and NOISH to provide specialized tests that were

not part of our standard medical.

Several months into the World Trade Center rescue and recovery

effort, two Port Authority Police officers were reported to have high

mercury levels. In response, authorities wanted to close down the

site. That would have created enormous emotional stress to every

family member still waiting for a loved one to be found. At that

point FDNY’s Bureau of Health Services had already done urinary

mercury levels on over 8,000 people and none were elevated. These

findings allowed the site to remain open, a major untold benefit for

families of the missing.

We have found that 25 percent of the highest exposed FDNY firefighters have airway hyper reactivity and many have asthma or reactive airways dysfunction. To date, 280 FDNY firefighters have

qualified for retirement disability pensions due to permanent lung

impairment, and we project that anywhere from 300 to 500 additional firefighters will ultimately be permanently impaired from

respiratory disease.

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Respiratory problems are not the only issues FDNY is coping

with. Since September 11 our firefighters and the EMS rescue

workers have been functioning under incredibly high stress levels.

They have lost coworkers, they have lost friends, they have lost

family. They have a different role in life now. They’ve been exposed

not just to fires, they have been exposed to a new mission.

In our FDNY WTC medical monitoring program, 48 percent of

our rescue workers reported difficulty sleeping; 36 percent reported

unusual irritability; 34 percent reported difficulty concentrating,

and; 33 percent reported anxiety. These are major problems for

people who did not have problems pre-WTC.

Eighty percent of our firefighters and EMS rescue workers, independent of their age or their extent of WTC exposure indicate that

they are concerned about their health, and 20 percent are worried

about that their future may be cut short.

Since September 11 our counseling unit has rapidly expanded to

provide educational group and individual sessions using funding

from Project Liberty, the IAFF and FDNY and local unions and private philanthropists. Project Liberty dollars supplemented by these

other sources has allowed us to provide individual counseling sessions to over 5,700 FDNY rescue workers and families. These individual counseling sessions are in addition to the many group therapy, firehouse briefings, department wide interventions that we’ve

done since that time.

To serve their needs and to allow FDNY to continue to serve the

needs of New York, it is essential that Project Liberty be continued

past its 2004 end date.

In conclusion, we cannot prevent the exposures that have already

occurred to these men, but through the long term medical monitoring and counseling programs that I’ve described today, we can all

work to restore the health of those who did survive. That is why

the Federal funding provided for long term medical monitoring of

WTC rescue workers is critically important. We are glad that the

recent agreement has been made that should help with the release

of these funds. We need to continue our commitment to each FDNY

firefighter and EMS rescue worker, a covenant that states when

you come out of the flames, we will be there for you.

[The prepared statement of Dr. Weiden follows:]

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Mr. SHAYS. Thank you, Dr. Weiden. I know that you had to skip

over parts of your testimony. The whole testimony will be a part

of the record. And I appreciate your assisting us. And I know others of you did that as well.

Mr. McArdle.

Mr. MCARDLE. Good morning, everyone.

I am Philip McArdle, health and safety officer for the Uniformed

Firefighters Association. I would like to thank this committee for

inviting me to present this information to you on behalf of the

8,500 firefighters serving the city of New York.

It has been over 2 years since the September 11 attacks and almost 1 year since the UFA lobbying before the U.S. Congress for

September 11 medical monitoring money. Many of the long term

health issues that I will discuss here today have been reported

many times to committees, in congressional hearings and to the

Department of Homeland Security. Unfortunately, even after the

countless task forces, testimonies, circumstances have not changed

for the members of the Uniformed Firefighters Associations. In

fact, in the opinion of the executive board and our membership, the

situation has gotten worse.

In the days following September 11, many firefighters were not

given the proper respiratory protection devices, even though complaints about this issue had been made for years. The department

did not have still does not have a respiratory protection program

as required by Federal regulations for air purifying respirators for

well over 10 years. This is clearly a violation of the Code of Federal

Regulations 29 CFR 1910.134, which states the standards for respiratory equipment supervision and use. The results of improper

respiratory protection are clearly stated in a study conducted by

Mount Sinai more than a year ago, with support of the National

Institute for Occupational Safety and Health that found that 78

percent participating first responders reported at least one WTC

related pulmonary symptom. The same study reported that 52 percent of the September 11 workers are suffering from some form of

post-traumatic stress syndrome. It was within 1 year that these

numbers have increased. Unfortunately, we cannot provide you

with any specific data about the amount of increase in the health

problems because the funds that were allocated for the long term

medical care of our members have yet to be distributed to the

FDNY Bureau of Health Services. We are still waiting for that

money, and it has not come.

The hold up in the distribution of funds coupled with the reality

that no money has been allocated for treatment of WTC victims’ related illnesses has resulted in the health needs of our membership

being neglected because of partisan politics and bureaucratic red

tape.

As of October 2003, the FDNY has retired approximately 1,800

firefighters due to WTC related illnesses. And I’m just going to

break from my testimony for 1 second to make another point. As

late as last night I was told by the department that there are still

some 600 members of our department who are still waiting to be

processed out of the organization.

Both the union and the fire department agree that this unprecedented retirement rate will continue as more firefighters are examVerDate 11-MAY-2000 10:27 Apr 15, 2004 Jkt 000000 PO 00000 Frm 00058 Fmt 6633 Sfmt 6633 D:\DOCS\92728.TXT HGOVREF1 PsN: HGOVREF1
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ined and diagnosed with September 11 related illnesses. All 1,800

of these firefighters were healthy before September 11, and would

have most likely worked for the fire department for an average of

20 years or longer, which had been the trend prior to September

11. Instead, we have members who in some cases are as young as

30 years old, who will be disabled for the rest of their lives.

As retirement decreases, it will cost more for long term health

care than ever before. Prescription drugs is our biggest concern.

The New York City Firefigher WTC medical monitoring treatment

that will be run by FDNY Bureau of Health Services with joint

sponsorship of the UFA, UFOA and the EMS/Paramedic Unions

has found that in the first month four firefighters required life support, mechanical ventilation, for chest surgery for severe respiratory stress following WTC exposure during the collapse. Ninety-five percent of the firefighters complained of new-onset respiratory symptoms, mostly cough, during the first week. In the first

6 months following the collapse, 343 FDNY firefighters required

more than 1 month of medical leave for new onset respiratory illnesses such as asthma. And nearly 2 years later, over 1,800 FDNY

firefighters have or in the process of receiving permanent disability

for new onset of post-WTC asthma and respiratory injuries.

Random volunteer testing of the highest exposed of FDNY firefighters present during the first day of collapse has found that 25

percent have new onset, post-WTC airway hyper reactivity/asthma

on objective medical testing—methacholinechallenge testing. This

has persisted on serial testings. Firefighters who were not present

during the collapse but were there during intense rescue and recovery efforts over the next 48 hours, nearly 7 percent have new onset

post-WTC and persistent airway hyper reactivity.

This is not a New York City issue. This is a national issue because the U.S. Government is handling the situation. It is, and will

be looked at as a template for what could happen in the future.

Long term health problems, increased disability claims and the rise

in the cost of prescription drugs needed to treat these problems will

financially impact everyone, not just the people in New York City.

We strongly believe that the $25 million that was appropriated

specifically for firefighter/EMS long term health care monitoring

needs to be distributed to the FDNY Bureau of Health Services as

soon as possible. This program is already in operation and is carefully monitored by an expert advisory panel that includes many notable experts in this and related fields. This program is in danger

of ending without funding that has already been appropriate but

not yet provided.

Furthermore, our initial findings clearly indicate that additional

services will be needed. We strongly urge that every dollar go for

its original intention: The medical care of our rescue workers. $25

million should immediately be transferred to this program.

These dedicated firefighters and the EMS workers rightfully deserve long term health care and monitoring funding immediately.

They deserve to be treated with the dignity and dedication that

they rightfully earned when they risked their lives and health

while participating in the largest rescue and recovery effort in hisVerDate 11-MAY-2000 10:27 Apr 15, 2004 Jkt 000000 PO 00000 Frm 00059 Fmt 6633 Sfmt 6633 D:\DOCS\92728.TXT HGOVREF1 PsN: HGOVREF1
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tory.

Thank you very much for your time.

It would be my pleasure to answer any questions you have regarding this issue.

[The prepared statement of Mr. McArdle follows:]

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Mr. SHAYS. Thank you very much.

Mr. Willis.

Mr. WILLIS. Good morning.

Mr. SHAYS. Good morning.

Mr. WILLIS. I would like to thank the Chair and the members of

the committee for the opportunity to speak on these vital issues.

My name is Jimmy Willis. I’m here on behalf of President Roger

Toussaint and members of the Transport Workers Union, Local

100, the subway and bus workers of the MTA New York City Transit, and most particularly on behalf of our 4,000 members who

worked ‘‘on the pile’’ at Ground Zero.

On the morning of September 11, 2001, as the Twin Towers

burned, there were two evacuations in progress. One, of course, of

the towers was due to the heroic efforts of fire, police and emergency response teams. The other evaluation took place in the subways and buses in, around and under the Trade Center and was

accomplished by Transit workers.

Due to the fact that the disaster occurred during rush hours,

there were dozens of crowded buss in the area and approximately

200,000 passengers in the subway trains in the area. All of these

passengers were safely evacuated without injury by Transit workers. Hundreds of evacuations began simultaneously in the transit

network around Ground Zero. Two of those evacuations are indicative of what transpired.

In the minutes before the first collapse, train operator Hector Ramirez had instructions to bypass the World Trade Center by subway control. As his train entered the station, Ramirez saw hundreds of panicked screaming passengers. Despite orders, he stopped

his train. Ramirez and his conductor then evaluated everyone from

the platform and took the train out of the station. That was the

last train through before the towers collapsed.

One block from the Trade Center bus operator Franklin Chandler stood by with his bus in case he was needed. After the towers

collapsed, Chandler did not leave his post. HE searched through

the debris for injured survivors, placed them on his bus until it was

full, and drove them all to area hospitals.

New York City Transit must be ready to rebuild and repair the

largest subway system in the world. Thousands of Local 100 members are hard hats: welders, track workers, payload operators, carpenters, ironworkers, etc. At approximately 11 a.m. on September

11th all of Transit’s heavy equipment was mobilized to the Brooklyn waterfront and loaded on barges. Thousands of transit workers

then sailed with the equipment to Manhattan and began the torturous process of digging through the pile.

The U.S. Department of Transportation has recently released a

report which states that: The MTA played a critical role in the rescue effort at Ground Zero and in helping restore parts of the city’s

infrastructure including communications, and; at one point MTA

employees comprised 60 percent of the rescue force at Ground Zero.

Unfortunately, this level of response has come at a terrible price.

It is well documented that rescue workers were exposed to asbestos, mercury, lead, pulverized glass and concrete, a virtual toxic

soup. Transit workers toiled for weeks at Ground Zero without respirators. Unfortunately, New York Transit, New York City DepartVerDate 11-MAY-2000 10:27 Apr 15, 2004 Jkt 000000 PO 00000 Frm 00065 Fmt 6633 Sfmt 6633 D:\DOCS\92728.TXT HGOVREF1 PsN: HGOVREF1
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ment of Health and New York State deferred site air quality and

safety to the EPA. Of the 4,000 transit workers who responded to

Ground Zero, as many as half of us are now seriously ill. Thousands of other rescue workers are also ill. Most of us should not

have been allowed to work at the site without appropriate personal

protection. The investigation into the EPA Inspector General’s report, as well as the EPA’s role with regards to Ground Zero air

quality must be thoroughly and completely investigated.

Local 100 members who were at Ground Zero are now suffering

from respiratory disease, gastrointestinal disorders and depression.

The same afflictions our brothers and sisters from the fire department, police department, emergency service and building trades

are facing. I can attest to this. I worked with our welders at the

site. As a result of my time spent at Ground Zero, I’ve been diagnosed with gastrointestinal disorders and lifelong respiratory disease. I am only one of many.

We at Transit work for a State agency that is self insured for

workers compensation and has, as a result, controverted every single case, comp case, arising out of Ground Zero. Among those cases

is bus operator, the Reverend Franklin Chandler, who I previously

mentioned, and who saved so many lives on September 11th. When

he filed for injuries arising out of his heroic work that day, he was

termed a liar, malingerer and fraud by Transit. He and his family

went 8 months without a check until a compensation judge ruled

in favor. It is outrageous that men and women who risked their

lives for their country and on behalf of others should be so callously

treated.

Local 100 President Roger Toussaint insisted the New York City

Transit partner with us in a counseling program aimed at alleviating some of the trauma associated with Ground Zero among transit

workers. I coordinated that program on the local’s behalf. After

helping only 150 of the 4,000 members at Ground Zero, New York

City Transit pulled out of the program once they became aware of

its workers comp implications.

The issue of medical treatment and compensation arising out of

work at Ground Zero and the cost associated with it, should rightfully be borne at the Federal level. Appropriations for this must

come through Congress and be signed by the President.

Many Local 100 members have been seen by the staff at Mount

Sinai World Trade Center Clinic. This program provides for initial

and followup screenings, and the programs is federally funded. The

medical and support staff at the Mount Sinai World Trade Center

Clinic have been wonderful. My members continually praise the

care they receive there. Any thought to reducing this primary

source of care to make more available to satellite clinics is ill advised. Rather, an increase in funding is called for. However, an increase in funding for screenings is not nearly enough. The members

of my local are utilizing their own medical benefits to cover the

costs of actual care. In 2 years when we begin contract negotiations

with the MTA, they will point to the burdensome charges carried

by our health plan. Costs associated with Ground Zero work. The

reality is that New York City Transit will seek to renegotiate down

our health benefits due directly to so many members utilizing care

because of Ground Zero related illness.

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Those of us who responded to Ground Zero are in crises. The response to that crises on a State and Federal level has been sorely

lacking. Federal funds need to be allocated immediately to cover

the cost of health care for those who sacrificed at Ground Zero. Additionally, the MTA, a New York State agency, needs to realize

that those of us who responded to Ground Zero must have immediate access to our workers compensation benefits without needless

controversy.

Finally, congressional leaders applauded the rescuers at Ground

Zero. On September 13, 2001, President Bush appeared at Ground

Zero and thanked us for being there when this country needed us.

We ask the same thing, Mr. President. Those of us who were there

when our country needed us are now in peril. Will you and Congress help us now that we are in need.

Thank you.

[The prepared statement of Mr. Willis follows:]

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Mr. SHAYS. Thank you, Mr. Willis.

Mr. Graham. Thank you. We’re all set.

Mr. GRAHAM. Hello. My name is John Graham. I am a health &

safety instructor and officer of the New york District Council of

Carpenters. In addition, I am an emergency medical technician. I

participated in the initial response, rescue, recovery and clean up

operation at the World Trade Center site, beginning the morning

of September 11th and ending May 30, 2002.

On the morning of September 11th, I reported to the World

Trade Center on behalf of the carpenter’s union as a safety officer

to assist and aid my fellow carpenters who were working at the

World Trade Center who might be in need of my assistance due to

the initial plane crash. Upon reaching the scene I was utilized by

emergency personnel as an EMT. Stationed at the base of the

North Tower I witnessed the more horrific events that I have ever

seen in my life, the events that continue to haunt me to this day.

I continued to perform my duties despite the appalling scene unfolding before me until I was momentarily incapacitated by the collapse of the World Trade Center.

With the collapse of the Twin Towers, I and those around me

present on that day and those who came to the scene in the days

and weeks that followed became victims of the worse chemical exposure events in the history of the United States.

On the day I was, I was engulfed in a toxic cloud composed of

but not limited to pulverized asbestos, lead, mercury, cadmium,

PCBs and benzene which are known to be highly corrosive to

human lungs. This cloud that contaminated much of lower Manhattan and Brooklyn, unbeknownst to the innocent people living and

working in the neighborhoods surrounding the World Trade Center

site. My exposure to this toxic soup of carcinogenics continued

through the 262 days I worked at the World Trade Center site.

Almost immediately I began to feel the ill effects of the exposure.

In the moments after the cloud of the collapse of the World Trade

Center began to clear, I and those around me lucky enough to be

alive, began to choke, gag and vomit from the forced inhalation of

the toxic cloud. I had to rinse my face and eyes to try to find relief

from the severe burning sensation I was feeling on my skin and my

eyes.

Within 2 weeks of my initial exposure, I began to develop severe

respiratory symptoms requiring medical attention. Knowing Dr.

Stephen Levin of Mount Sinai Occupational and Medical Center,

and his expertise in these medical chemical exposures on a job site,

I turned to him for his medical expertise.

Since October 2001 I have been receiving treatment from Dr.

Levin and his staff at Mount Sinai for my respiratory and other exposures resulting from the chemical exposure at the World Trade

Center site. I have been diagnosed with and continue to suffer from

RADS, reactive airway disease, a chronic form of asthma resulting

from the chemical exposure at the World Trade Center site. My

rescue inhaler is my constant companion, despite the staff at

Mount Sinai doing their best to help me with my medical problems

as possible at this time.

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In addition to my medical problems, I have been and continue to

suffer from chronic post-traumatic stress disorder, for which I have

been receiving treatment since October 2001.

Prior to September 11th, I was a healthy, hard working father,

son and husband. Today, I am a chronically ill man who is anxious

about my ability to support my family. I am no longer able to work

as a carpenter. My chronic asthmatic condition makes it difficult

for me to carry out my duties as a safety officer, father, son and

husband. I often have to stop my activities to use my inhaler and

catch my breath. It breaks my heart not to be able to run and play

with my two daughters, as I once was able.

I’m not alone in my ill effects that I am suffering from the chemical exposure on September 11 and the days after. I am one of thousands. Despite the best treatment available, we continue to experience severe symptoms. And more research is needed to understand

the diseases we suffer from and the treatments that will effectively

bring relief.

I am not naive enough to think that anyone can cure us from our

chemical exposure we have experienced, but some relief would be

nice.

On September 11th, 2,811 people were killed. My greatest fear

is that the number of fatalities from the World Trade Center attack

will continue to rise as time goes on and those of us exposed to this

toxic soup begin to die off from the long term effects of this deadly

chemical exposure.

It is only with the support of Martin Daly, my boss, and the National Institute of Environmental Health Sciences and the doctors

and staff at Mount Sinai that I am able to continue and function

at this time.

Thank you.

[The prepared statement of Mr. Graham follows:]

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Mr. SHAYS. Thank you, Mr. Graham.

Mr. Rapp.

Mr. RAPP. Good morning, committee, members of Mount Sinai,

ladies and gentlemen. My name is David Rapp. I’m a construction

worker with the Local 1456 Dock Builders District Council of Carpenters.

I was at Ground Zero for near 5 months including 3 days of the

first week of the terrorist attack. I hope my testimony is going to

make everyone aware of what we experienced at Ground Zero and

what I and others are going through now.

I viewed, smelled, handled things that you could not imagine. Although I worked 12 hours a day, 7 days a week, I looked forward

back for another shift. I started experiencing health problems like

dizziness, shortness of breath and skin rash while I was still working down there. Although we accomplished what we set out to do,

which was keeping the slurry wall from collapsing as the debris

was removed, our job was installing tie-backs while being exposed

to who knows what.

My job was completed in March 2002 at Ground Zero. I went to

my next job at Kennedy Airport driving piles for American Airlines

where my ability and stamina had diminished. I was laid off the

first week of April and have not worked since.

I am a 42 year dock builder that normally could do as much as

a 22 year old, and more. I could carry a 150 pound tank of oxygen

or astatine a half a block through a rough job site. But now I cannot even take out my household garbage.

I am also an auto mechanic with 5 certifications. After a long day

of dock building I could still come home and install a 200 pound

transmission on my back off my chest. Now I cannot even change

a flat tire.

There is a lot of fear in my life now. I have had several emergency visits, several short stays in the hospital. I rely on oxygen

at night to sleep and I still wake up sometimes gasping for air trying to stay calm. Sometimes I feel like I’m underwater.

I have had a sore throat for 15 months now. When I cough I can

feel the outlines of my lungs. I sleep on a recliner, straight up. I

cannot go out in the humidity or breath cold air. I need to keep

my house at a 65 degree temperature where my wife sleeps with

a quilt. I am on steroids, which have caused weight gain. I have

put on 50 pounds since I stopped working in April 2002, which

probably does not help my condition but the steroids do help.

I am on 12 other different medications, plus 3 types of inhalers.

And I carry an oxygen tank wherever I go for assistance to breath.

I cannot tell you how hard it is living like this. My fear of not being

able to get my next breath is unbearable.

I am going to two different doctors at this time. One is a Dr. Leo

Parnes and the other is Mount Sinai Health for Heros.

Mount Sinai has been great to me. They have been helping me

since November 2002. They helped me get immediate benefits from

workers compensation. Most importantly with the medications that

I rely on to breath. All of their staff have been compassionate and

express real concern for my future. They always make sure I have

enough medication.

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I would like to end this with I have a beautiful wife of 27 years

and two sons in their 20’s that fear for my future, as well.

Thank you very much.

[The prepared statement of Mr. Rapp follows:]

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Mr. SHAYS. Thank you, Mr. Rapp for your testimony. Thank you

for being here today. We really appreciate it.

I am going to call on Mr. Owens, who has joined us. He is a very

active member of the full committee. And then it’s my intention to

recognize for questions Mrs. Maloney, then Mr. Turner, then Mr.

Towns, then Mr. Owens, then Mr. Nadler and then myself.

The usual procedure in Congress is that we have 5 minutes of

questions. This subcommittee prefers 10 because you can have better followup. We are going to just set the clock at 7 minutes, Bob.

And at this time, though, Mr. Owens, this is not your question

time. But if you would like to make a statement, we welcome that.

Mr. OWENS. Thank you, Mr. Chairman.

Let me begin by thanking you as chairman and my colleague

Carolyn Maloney for putting forth the effort to make this hearing

possible.

On April 28th of this year in response to a request by the Central Labor Council under Brian McLaughlin and the New York

Committee on Occupational Safety and Health headed by Joel

Shufro, we held an unofficial hearing, Caroyln Maloney and I here

in New York on that worker Memorial Day, April 28th. And that

was several months before the EPA Inspector General issued his

report.

I see at least three of the people who testified at that hearing.

I want to thank them for their past testimony and for their testimony here today.

We are making a headway at a very slow pace, but I think that

we are bringing the attention to the fact that what happened on

September 11 highlights something unfortunate about our government. It says that certain governmental agencies have no respect

for residents and citizens and workers. They may even have contempt for them. We have a Government that proposes now to bring

justice to Iraq. After liberating them, they’re going to provide justice and just government. But here the justice does not include taking care of the workers who are suffering now, in this country, as

a result of being victimized by an act of war. It was an act of war.

And many of our colleagues in Congress seem to think that New

York is asking for something special when it asks for this kind of

help. But it was an act of war. They were not targeting the World

Trade Center because it was in New York State or New York City.

They targeted the World Trade Center because it was a target of

the United States that was the target of the terrorists.

One of the ways that we must move at the State and city level,

along with the congressional delegation and the two Senators from

New York, is to keep insisting that the World Trade Center tragedy

was a result of an act against the United States of America. The

people of New York State and New York City should not be asked

to suffer unduly or to bear the cost of righting all the things that

have gone wrong as a result of September 11th. It was an act of

war.

Homeland Security becomes a farce if we are going to treat the

people who are on the front lines of Homeland Security with contempt. And this situation shows that they are being treated with

contempt.

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We would like to see workers and all those who support workers

begin to scream louder and in a more continuous fashion to get this

injustice corrected.

In the war against terrorism, workers are going to be warriors

whether they like it or not. They are warriors. Workers must be

recognized and rewarded as heros. Certainly workers should receive the best medical care possible.

And I ask unanimous consent to enter a more expanded statement into the record with documentation.

Mr. SHAYS. Thank you.

Without objection, so ordered. It will be done.

This hearing is not, again, going to answer every question that

is raised. I am going to ask for the support of this committee to

make sure that we do not waste the opportunity with the witnesses

we have to look at the call of the hearing; and the call is what is

known about the short and long term health effects of the September 11th attack on those who worked at Ground Zero and live there

today, and how effective are the steps taken by the Federal and

local government to investigate health effects and provide treatment for those injured.

We are interested in knowing.

To start with at this hearing, next hearing we will expand it, but

we want to know what is the health condition of those who were

working on Ground Zero. What type of diagnoses, treatment, compensation, and we do not want to waste the opportunity to learn

the answers to these questions.

I realize some Members are going to ask some questions that we

may not have answers for. I felt very strongly that Members should

have an opportunity in their opening statements to address an

issue much wider than this hearing; put it on the record, challenge

the committee to deal with this issue during the course of our hearings. And I think that is the challenge that we need to accept.

At this time, Mrs. Maloney, I recognize you for 7 minutes.

Mrs. MALONEY. Thank you, Mr. Chairman.

And I thank all the panelists and I thank especially my colleagues for their ongoing support of efforts to help the victims, the

rescue workers and everyone with September 11.

And you have raised many, many issues that we need to address.

I find it startling that we did not have the proper equipment to

protect people and that we still do not have the proper equipment

to protect people in the event of a disaster.

But I have two questions that I would like to ask the entire

panel. And first of all, I would like to ask you to raise your hand

if you think the Federal Government can do more than it is doing

to help the workers, rescue workers and others because of the effects of September 11? Raise your hand if you think we should be

doing more?

Mr. SHAYS. For the transcriber, all our witnesses including Dr.

Levin has responded in the affirmative.

Mrs. MALONEY. And then I would like each of you very briefly,

because you could use up all of my 7 minutes and I do not want

it all used up, could you tell me very briefly what it is you feel the

Federal Government should be doing? And we are going to start

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with Dr. Herbert and go right down to Mr. Rapp. What more could

we be doing to be helpful? Very briefly.

Mr. SHAYS. Very briefly because I know time is short.

Dr. LEVIN. The issue has been addressed by several of the panel

members.

No. 1, there is a terrible need for treatment resources. I think

the witnesses here, the workers who are effected, made quite clear

that the resources available now really are a patchwork of a broken

workers compensation system and philanthropic funding, as well as

people’s private insurance or out-of-pocket. And this is no way,

from a public health perspective, for the Federal Government to address what is clearly a public health need.

For people to have to jump through the hoops of a workers compensation system that sets up barriers to their getting through that

system and getting actual treatment, benefits, and wage replacement is an outrage, given what these people have done.

No. 2, we need adequate funding for followup evaluations of this

population. Those who have been screened already have exhibited

high rates of respiratory problems, high rates of psychological distress. We need to follow them in the short run. Out of the $90 million, $60 million now can be used for the followup of this group of

responders. That is enough to cover, perhaps, 5 or 6 years of examinations. It will require a great deal more funding to follow them

for the minimum of 20 years they should be followed, not only because we will learn something important scientifically about what

the consequences of exposure might be, but because people who

may develop these longer range illnesses need to have these illnesses identified when they are treatable; that means the earliest

detection possible.

I do not have time to say much more. I will say only that we

need also a more comprehensive coordinated response in general,

should there be an event like this in the future, so that we are not

playing catch up and doing our first screening examinations 10

months after an event.

Dr. FRIEDEN. I’ll be brief. Three areas where we urge the Federal

Government to do more.

First, to fully fund the WTC Health Registry in the out years. There is a funding gap of $2 million each year for 20 years.

Second, as all of the panel has noted, resources for referral and

medical care for those effected by September 11 are needed. They

are not sufficient as they currently exist. This is a national tragedy

that happened, the expenses are being borne by the city, by the

workers, and by the individuals who are effected. The Federal Government should step up to the plate and provide those referral and

treatment resources.

And third, in terms of future efforts, to prioritize New York City.

Please do not play politics with preparedness. We know that most

of the risk is to New York City. We have many needs for preparedness that are not yet met. We need increased resources to meet

those needs.

Dr. WEIDEN. So I implore you to break the bureaucratic log jam

that is preventing money that has already been allocated from setting up ongoing health monitoring. I am one of the two

pulmonologists working for the fire department. I routinely say

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goodby to people after they have gotten their disability retirements.

And I say wait for a letter from us stating when and where you

should show up for your long term monitoring. There is no such letter being sent out. There is no place to bring these people back.

And the longer the gap between our ability to monitor them and

care for them, and some place that they can centrally be cared for,

the more people will fall in between that gap.

Mrs. MALONEY. Mr. McArdle.

Mr. MCARDLE. I just have four items. And basically I believe that

the Government should provide long time monitoring care for our

members. They also need to provide long term treatment for our

members, not just monitoring. But treatment. And also long term

care for our members.

Because the fourth item that I just want to mention is that the

Government has a responsibility to show the rest of the Nation

that if they follow a good template for taking care of the people in

New York, they can take care of the rest of the country the same

way. If they do not establish a good template for taking care of people here, there is going to be no confidence in Government in the

future of taking care of these catastrophic events.

Mrs. MALONEY. Mr. Willis.

Mr. WILLIS. Thank you.

Federal appropriations for long term treatment and care is a

must. And frankly, with respect to Ground Zero, the State comp

process should be taken out of it. It should really be a Federal

function.

And, Congresswoman Maloney, I could not agree with you more;

if these issues are not taken care of now, if we have another disaster, we are going to be hurting finding people to respond.

Mrs. MALONEY. Mr. Graham.

Mr. GRAHAM. My issue is I think that sooner or later I will be

disabled and the health coverage for myself is an issue, and for my

family. I am a sole provider for my family on health coverage. And

if I do go out on disability, besides for the one-third less salary I

will be bringing home, I will not have any health benefits for my

two daughters who are 9 and 5.

Mr. RAPP. I, too, like Mr. Graham am sole supporter. And I believe that we should be covered for our future. And instead of sending billions of dollars over to other countries and stuff like that, we

should be taking care of that as a priority.

Mrs. MALONEY. Thank you.

Well, would you be surprised, Mr. Rapp and Mr. Graham, who

have been working and receiving workmans comp, that the State

of New York got $175 million to help pay for workers compensation. But you seem to be having trouble getting this money, Mr.

Willis, even though the money was appropriated by the Federal

Government, the $175 million? I guess he is telling me my time is

up, but if you could——

Mr. SHAYS. No, go ahead and answer the question.

Mrs. MALONEY. If you could. In other words, we sent the $175

million and you are saying you are having trouble getting it out of

workmans compensation and we should just abolish the program

and go straight to the Feds. But if you could explain? They are

turning down people like yourselves that have risked your lives to

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save others? Could you elaborate a little bit, because this has to be

addressed. We have to get the money to the people who sacrificed

their lives.

And I have to say, Mr. Graham and Mr. Rapp, if you do go out

on disability and you lose not only your income, to lose your health

insurance is just awful. At the very least, the Federal Government

should provide the health protection for those of you who risk your

lives. I thank all of you on behalf of my constituents in my city for

your brave efforts.

But could you respond to that, in fact we sent the money, so

what is the problem? They’re not processing or——

Mr. WILLIS. OK. With regards to transit workers, we work for a

State agency. New York City Transit is self insured for workers

compensation. As such, it is a budgetary process for them. Every

dollar they spend on comp is a dollar out of their budget. They are

holding a meeting today telling the people of the city of New York

how broke they are.

It is outrageous that every comp case for a State agency has been

controverted.

We have people who were down at Ground Zero who have been

fired because they were Section 71 by the State.

Mr. NADLER. What is Section 71?

Mr. WILLIS. OK. Section 71 if you have more than 12 months off

out of work on a comp case or on an injury or an illness, the State

can seek to terminate you, and they have.

In one case I know of a welder who was at Ground Zero, is one

of our transit workers. And some of you may remember in the first

days as horns went off went they thought there would be a building collapse, this guy was knocked down. He had a knee replacement, was not able to get back to work. He has been fired. He is

not alone. OK.

This is a State agency.

Mrs. MALONEY. Well, we will followup on that.

My time is up. I thank the chairman.

Mr. SHAYS. Mr. Rapp, Mr. Graham, what about responders?

Mr. GRAHAM. I will just speak on my own behalf. My workmans

comp case has been controverted. So that is my—I know what that

means, but it means they are not paying.

Mr. SHAYS. For the record, what does it mean?

Mr. GRAHAM. It means that they are arguing my case. That they

are not actually——

Mr. SHAYS. They are protesting.

Mr. GRAHAM. They are protesting.

Mr. SHAYS. They’re protesting. OK. Fair enough.

Let us go on. How much time did we use on this question, totally

how much did we use. What does the clock say? OK.

Mr. Turner, you have the floor.

Mr. TURNER. Thank you.

I want to thank all the members of the panel for the spirit of

which they are approaching this. I appreciate Mr. Owens’ statement that this is an act of war against our country and that the

individuals who have impacted in this have been impacted by a national catastrophe and an act of war.

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And, Mrs. Maloney’s statement that this is an issue that has bipartisan support. Because certainly the Nation’s response to this

was on a nonpartisan basis. So certainly our analysis of how we go

forward is also bipartisan and nonpartisan.

When Mrs. Maloney asked the question of how many people on

the panel think that the Federal Government could do more, I wish

you had allowed us to raise our hands, too. Because I would have

joined you, Mrs. Maloney, in saying that the Federal Government

can absolutely do more.

Mrs. MALONEY. Thank you, Mr. Turner.

Mr. TURNER. The question that we have, obviously, before us is

do more of what? And so it is not a neglect of the Federal Government that there is not an action of our list of things that we could

do. This is the process that we go through, the deliberative process

of making certain that we do the things that are best and that

those get implemented.

I really appreciated the information on what are the things that

we need to do and the gap of treatment and making certain that

individuals that do not have access to treatment, receive the information of followup and the coordinating of response.

I think we all want to make certain that the heroes of September

11 get the attention and response that they need, but our concern

is that the bureaucracies of September 11 also get the oversight

that they need.

In looking at the issue of the amount of long term health monitoring and the information and the testimony that has been provided to us, some of the money has been released, some of the

money has not yet been released. But we have already on the Federal Government allocated and some spent, $122 million for assessment and for registry and for screening. That is not a small

amount. And the request that we get today is that amount be extended in 20 year programs and then looking at what that amount

will be.

My questions are twofold. One, as I acknowledged in my comments, you know mine was a community that responded to the call

from New York City to send EMS and firefighters as part of the

recovery effort that is here. So my first question is to what extent

does the fire registry program, the New York City Department of

Health and Mental Hygiene and Mount Sinai’s efforts go beyond

just the individuals that currently are in the area, but those that

were impacted that came in?

And second, I would really like some discussion specifically between Mr. Freiden and Dr. Herbert and Mr. McArdle concerning

the coordination of these programs. Because you know when you

get to $122 million and you are just beginning to scratch the surface and you are each talking about 20 year programs and the annual amounts to maintain them, to what extent are your processes

being coordinated?

Let me start with Dr. Herbert?

Dr. HERBERT. Well, actually because Dr. Levin and I are co-directors, we agreed that I would give testimony and he would respond

to questions, if that is OK.

Dr. LEVIN. She left the tough job to me.

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Well, No. 1, we have worked very well with the fire department’s

medical group and have compared notes and findings and approaches to the monitoring and evaluation of our respective groups,

really from the beginning. And what was so striking to us early on

was how similar the findings among the firefighters were to what

we were seeing among the other rescue and recovery workers.

In going forward, are very likely to be able to work out common

screening protocols so that we may even at some point be able to

share data in a common data base. And this will be important, I

think, to understand better what the clinical consequences were

and what are the best approaches to treatment.

So far as the other question, the national scope of our program,

were mandated by NIOSH, when we received a contract to establish a consortium of institutions to provide these screening examinations, to cover all of those people nationwide who had come to

New York and then returned to their home cities to do rescue and

recovery work here at Ground Zero. And we are doing this through

the coordination of the Association of Occupational and Environmental Clinics, a network of public health oriented clinics throughout the country. They are going to have provided, by the end of this

program, some 1,000 examinations at cities located geographically

pretty well-distributed across the country.

And, in fact, in Ohio I just spoke with the director of the program at University of Cincinnati who is seeing some of the people

in Ohio.

It is not enough. There are people, we are afraid, who will not

be covered. For example, the Federal employees who were paid

with Federal dollars to do their rescue and recovery work are not

covered by our program. State employees are not either. Unfortunately, unlike the State employees here in New York, there is still

no program for Federal employees who came to Ground Zero. There

is no screening program, no monitoring program going forward. I

think, again, if we’re talking about public health across the States,

this is clearly another public health mistake.

Mr. SHAYS. Let me just say, I want to give 10 minutes to each

Member. We are going to end up using it anyway. So add three.

Dr. FRIEDEN. In terms of the extent of the registry, anyone who

meets the eligibility criteria can enroll. We have already had enrollees from dozens of States, including several dozen individuals

from Ohio. And so it is available for any who were in the groups

that were most exposed to enroll.

In addition, the results of the registry will be relevant not only

for those who participated and not only for those who meet the criteria for enrollment, but also for others who had lesser levels of exposure. It will allow us to generalize. It is the only evaluation that

can put into context the clinical findings and give us the overall

picture.

In terms of coordination, I think there’s excellent coordination.

We are on the advisory committee of the Sinai group, they are on

our advisory committee. We coordinate frequently. We consult each

other when issues arise. And we are looking at different pieces of

the puzzles, which will give us the most comprehensive overview

of the impact, the groups at highest risks, the conditions that are

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most problematic, and/or what the treatments that are most effective for those who have been impacted the most.

Mr. TURNER. Mr. McArdle.

Mr. MCARDLE. I think that the points that I want to make is

that we do have some coordination, but not complete coordination.

I believe that we communicate regularly with the people at Mount

Sinai. We communication, our labor union communicates with our

medical office. And I believe that in the end what will actually happen is that the data that is collected by the New York City Fire

Department will be the very best data available on what happened.

And this is the reason why.

Our people from the day they start employment in the New York

City Fire Department get a medical annually because of hazardous

materials regulations. And because of that, we have data knowing

what everybody’s medical condition was pre-September 11. And

this is why it is so important not to hold back on the money from

the FDNY.

Our money was sole sourced. And we believe that what is happening in this battle for the rest of the money, you are neglecting

a very important portion of the information that is going to of value

to the entire Nation down the road. It is imperative that our fire

department get the $25 million right away. And there is a lot of

government haggling about the money. And we absolutely need

that to stop.

Mr. TURNER. Dr. Weiden, the issue on coordination?

Dr. WEIDEN. I think that because of the organization of our occupational health facility, we will be leading indicators. And we are

dedicated both to collecting the information, disseminating the information in an academic channel. We have now published, I think,

four articles which I think were the first. I think that we will continue to find things, publish them, get them out there and be a

light for everybody else.

So I would urge that you support us as a separate entity and

then we will then disseminate the information.

Mr. TURNER. Mr. Willis on the issue of coordination from the registries and—no answer?

Mr. GRAHAM. I think we need more research and more coordination from all departments to find out what medications might work,

what treatments might work. If someone comes up with more ideas

of treatment that might relieve some of the problems that we all

are experiencing, if that should come down and people could join

together and find out. We need research. We need somebody to find

out.

Right now my medication just keeps me at this point. I am not

tremendously getting better, I am not getting tremendously worse.

I need to find something that would cure, relief, something.

Thank you.

Mr. TURNER. Thank you, Mr. Chairman.

Mr. SHAYS. Thank you.

At this time the Chair would recognize Mr. Towns.

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

Let me begin by first commending on the outstanding work that

you are doing here at Mount Sinai. I notice that was one thing that

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everybody sort of agreed on at the table, and I would also like to

associate myself with those remarks.

Let me ask, and Dr. Herbert, you have indicated that the questions should go to Dr. Levin, right?

Dr. HERBERT. That is right.

Mr. TOWNS. OK. Dr. Levin, as the medical director of Mount

Sinai, said the earlier WTC related illnesses are detected and treated, the more likely the treatment will prevent long term illness and

disability. Given this, it makes sense to me to expand the list of

people who should be included in screenings to make sure that

every one adversely affected is checked. Maybe you pay a little

more up front to detect problems, but you save money and people’s

lives in the long run. Do you agree with the logic?

Dr. LEVIN. Yes, I certainly do. And I think that has been our approach from the very start.

We saw people being taken off that pile within the first couple

of days, gasping for breath, choking, and could predict at that time

that there would be a great deal of potential longer-term effects

with respiratory problems—upper respiratory problems and lower

respiratory problems.

But in our clinical center, our Center for Occupational and Environmental Medicine, before our screening program began we were

seeing community residents. We were seeing people who had returned to office space down in lower Manhattan for whom this

screening program is not intended. Those people suffered respiratory illnesses as well. Do I think the Federal Government

should have developed a program to evaluate those people who

came back to work in the area, who came back to occupy residential space, the school children who came to school so early? Yes, I

do. I think from a public health perspective that would have been

the correct thing to do. I still think it is worth doing.

Mr. TOWNS. Right.

Dr. Freiden, how do you feel about that?

Dr. FRIEDEN. Certainly early detection and effective treatment of

conditions related to WTC is something that can minimize future

impact.

Mr. TOWNS. Right. Well, let me say this: On August 26, 2002 following the Newsday article ‘‘Winds of 9/11: No Scrutiny For Brooklyn For Attacks, Toxic Smoke Drifted.’’ I wrote to you expressing

my concerns about leaving Brooklyn residents who may have been

exposed to WTC toxins out of the World Trade registry. Given the

additional research performed which shows that the intense heat

of Ground Zero blew the pollutants upwards creating a loft effect

causing these pollutants to blow toward Brooklyn and dropped on

my constituents, do you think that it might be worth reconsidering

now whether Brooklyn residents should be eligible for the registry?

Dr. FRIEDEN. Let me clarify several things.

First, the services available for evaluation, medical evaluation

and treatment are not related to participation or to eligibility for

participation in the registry.

So whether or not someone is eligible to participate in the registry and whether or not they do actually participate in the registry

has no bearing on the services available to them. The same services

will be or will not be available to them in either case.

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As it is, there are in our estimate close to 400,000 people who

would be eligible for participation in the registry. Given that, our

focus is on those most heavily exposed so that we have the best

possible chance of documenting what the health impacts were and

the extent of those impacts.

There is no harm to opening the registry up for more people who

would want to participate, however it is not currently funded for

a broader group of individuals who are not among those who are

among the most intensely exposed. If resources were available, we

would not in any way be opposed to allowing people from Brooklyn

or, for example, from between Canal and Chambers which is also

not in the eligibility now of the registry to participate. They’re undoubtedly exposed. We are not saying that they are not exposed.

What we are saying is that given the extent of the exposure, the

heaviest exposed groups are those that are currently eligible for enrollment. If resources were to allow, we would have no objection to

having additional people eligible enroll.

Mr. TOWNS. And when you say additional resources, what are

you really talking about?

Dr. FRIEDEN. It costs, to be frank about it, about $100 per person

who enrolls in the registry. We are currently funded to allow the

enrollment of as many as people as are eligible from within that

most heavily exposed group. This, from a scientific perspective, we

do feel will allow us to make conclusions about all of the groups,

not just those who are most heavily exposed, not just people who

are participating, but also others including those from Brooklyn.

And I would also comment that many people from Brooklyn do

fall within an exposure category and are eligible for participation.

We already have thousands, I think more than 1,000 of Brooklyn

residents who are part of the registry, as we also have thousands

of people who are from the unions who are part of the registry. We

have had a very good response, and we continue to encourage people to participate so that we have the best possible chance of documenting and evaluating the population-based long term health impacts.

Mr. TOWNS. I think the reason I’m raising this question, as you

know, the Newsday article indicated that from the photo you actually could see this cloud up in the sky and it was dropping over

Brooklyn.

So it seems to me we should have a great interest in trying to

find out more about that, being we are trying to get as much

knowledge as we possibly can. And it has been indicated by Mount

Sinai that early detection makes a lot of sense. So it seem to me

that we would want to devote some of our resources and energy

into trying to make certain that we find out this information as

soon as we possibly can in order to prevent long term disability and

all kinds of other things that might occur if we do not do this.

Dr. FRIEDEN. Based on the best data available, atmospheric data,

analyses of the plume, analyses of exposure, we feel that the current exposure groups for the registry do represent those individuals

most heavily exposed to and most at risk for potential health effects of September 11.

Mr. TOWNS. Right. Well, you know I just want to make certain

that we do not leave Brooklyn out.

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Let me just sort of move on to coordination point.

Running down the table, can you think of anything that needs

to be done that might assist in the coordination? Because I think

that coordination is very, very important because we are not talking unlimited resources.

Yes?

Dr. LEVIN. Well, I will comment on that. Yes, I think the coordination should have been in place from the very start of this terrible

event, and going forward, should there be another disaster, whether it is a terrorist attack or some other natural disaster, we need

certain things in place. And that includes, for example, an independent, already identified panel of experts, environmental health

experts, who could be convened rapidly to assess the hazards and

the likely health consequences and clinical effects of these exposures.

When I say ‘‘independent,’’ I mean independent of political and

economic considerations. Not that they will not come into play at

some point, but in the deliberations of that expert panel, they

should not be influenced by politics and by money considerations

as they consider the issues of health consequences and the decisions made to protect people’s health.

In such an event you need a rapid comprehensive registration of

everybody who is down there. And as much as it was the wild west,

surely we could have done better in trying to capture who was

down at that site. And that may occur in the future, the necessity

to try to register people quickly.

You need the rapid distribution of respirators. You need the

rapid training of people to wear respirators. A number of people

here have talked about that issue; how late it was in getting adequate respiratory protection to people who really needed it.

You need the rapid establishment of health evaluation and treatment capability, including a fast-track mechanism of funding from

the Federal Government to institutions that can provide this kind

of an evaluation, so that we will not be in the position again of

waiting 8, 10 months, a year before people get their first evaluation

after they have been ill now for at least that period time.

Yes, we need coordination. The coordination has to be immediately in response to the event, and then all those institutions and

agencies that are involved in trying to provide a public health response have to be working together under some coordinating unit.

Mr. TOWNS. Right.

Any other comments on coordination? Because I think that is

very, very important.

Yes, Mr. Willis.

Mr. WILLIS. Actually, Congressman Towns, at that time at that

day I lived in Brooklyn. On the morning of September 12th my wife

and daughter woke up to think that there was a fire in the house.

What they were smelling was a cloud coming down from Ground

Zero. At that time we lived by the foot of the Verrazano Bridge,

which is down in Bay Ridge—10 miles away. And they thought

there was a fire in our house.

And in terms of coordination, I think that Federal agencies simply need to recognize that there is an issue here and they have to

wake up and give help now.

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Mr. TOWNS. Thank you.

Doctor.

Dr. WEIDEN. So, I am an academic. And on the academic model

one of the ways of assuring coordination and transparency is a series of annual meetings with all of the stakeholders participating

where the current results are presented in public. And I think that

would go very far to ensuring the various constituencies here that

everything that can be done is being done; that the money is well

spent and disseminate the information beyond the specialized centers to the board constituencies with regard to care.

Mr. TOWNS. Right. And, Mr. Chairman, I have enough for Mr.

McArdle’s answer?

Mr. SHAYS. Yes.

Mr. TOWNS. Yes, sir?

Mr. MCARDLE. Just a few issues. As far as coordination goes, I

think that one of the important things is to make sure that when

we have these types of events, that there is compliance with Federal safety regulations. Clearly, they were not followed on September 11. I know a lot of the rules went out the window. But labor

organizations, who are a good part of the early operations, were basically ignored. And some of their concerns about their members’

health was ignored. And now we are paying the consequences for

that right now.

And I think the strict safety discipline at these events in the future is also very important and going to prevent long term exposure issues and long term medical problems.

Dr. FRIEDEN. I would just like to say very briefly that at the city

health department, we have a total commitment to openness and

transparency. We are clear about what we know, what we do not

know, what studies we have done, what they have found.

I think at the general level, Federal, State, local there are many

very controversial issues, particularly environmental issues are

controversial.

In regard to environmental issues, there is a great deal of suspicion, there is a great lack of knowledge. And it would serve the

public best if there were a combination of complete openness and,

as was called for before, a kind of independent, impeccable respected, scientifically-valid group to look at what we know already,

what we do not know already and determine what more we might

need to know. Because there have actually been an enormous number of studies done, some of them done superbly by groups here at

this panel, some of them by others. There is, in fact, an enormous

amount of environmental data available.

And so I think it is important that we have the mechanism to

look at that openly, transparently, hearing from everyone and

being clear about what we know, what we do not, and what more

we need to know.

Mr. TOWNS. All right. Thank you, Mr. Chairman.

Mr. SHAYS. Thank you.

Mr. Owens, Major Owens, you have the floor.

Mr. OWENS. Let me begin with one narrow question to followup

on my colleague Mr. Towns’ question. We are both concerned about

the fact that residents of Cobble Hill, Brooklyn Heights and Park

Slope who, incidentally, lost a number of lives in the World Trade

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Center think they have been abandoned, deserted in terms of concerns about the pollution impact there.

In your determination of the areas that you would focus on, were

there any criteria other than budgetary ones that determined how

broad, how wide your scope would be, how big your area would be?

Dr. FRIEDEN. Let me reiterate that there is no less attention to

those who were exposed in any area. The World Trade Center

Health Registry does not enable people to get more health services,

nor does it restrict health services from any other groups. It is an

attempt to systematically document health impacts, so that we can

generalize about the people who were exposed and identify what

syndromes are associated with exposure to WTC.

Many residents from Brooklyn have already enrolled. We hope

that many more enroll.

In determining which were the most heavily exposed groups, we

did not look at budgetary issues at all. We looked at what the exposures were, and the exposures related to residents, they related to

presence, they related obviously to rescue and recovery operations

both in WTC and at the Fresh Kills landfill where there was exposure directly to the potentially toxic materials that were involved

in the WTC. Residents in lower Manhattan are all included.

Mr. OWENS. What’s the geographical, you know, if they are in

proximity to the site? Nobody went out and took any measurements

in Brooklyn——

Dr. FRIEDEN. No. Actually extensive—right.

Mr. OWENS [continuing]. To find out much debris had dropped

there.

Dr. FRIEDEN. Extensive analysis of the plume was done. And in

no way are we saying there was not exposure in Brooklyn. However, all of the evidence that we have reviewed does indicate that

the exposure, that the plume, fell most heavily in lower Manhattan.

Mr. OWENS. Thank you.

I see that a representative of the National Institute for Occupational Safety and Health was scheduled at one point to testify here.

Mr. SHAYS. Panel two.

Mr. OWENS. Panel two. Well, I will save this for panel two then.

Well, I will ask you. Anyone of you, what kind of role have you

seen OSHA play in this drama from beginning to end? Would you

like to make any significant comments as to the role of OSHA?

Yes?

Mr. GRAHAM. OSHA was there very early on. They were there to

help myself and many other workers there. It was a touch job they

were put into. There is no real regulations that state what do you

do when a 110-story building collapses, how do you handle it.

Extremely enforceful. They mandated that anyone on the job site

not complying was removed. My administration complied to that.

A lot of due diligence on OSHA’s part. They were there 24 hours

a day, 7 days a week to do the best job they could.

Mr. OWENS. What has been your experience at Mount Sinai with

OSHA? Any significant?

Dr. LEVIN. Well, we have many colleagues and friends who were

on the ground, so to speak, working with OSHA trying to determine levels of exposure, trying to ensure respiratory protection.

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There was clear arena of debate, and that is that OSHA was not

in enforcement mode. They were in a consultative mode. There was

a partnership between the contractors and the unions to enforce

safety regulations on the job. And if you look at the actual accident

rates and the fact that not one fatality occurred on that site, clearly

the accident rates were half of what would have been expected on

a comparable demolition or constructionsite with that many person

hours worked.

Nevertheless, the fact that OSHA was not in enforcement mode

did mean that some of those workers out there on the pile were not

wearing adequate respiratory protection and there was not full enforcement requiring that they do so. And there was a price that

was paid in the health consequences for people who were there.

I do not fault those hard-working OSHA people that we have

worked with for so long for their efforts, because they tried very

hard to do the right thing. The policy question of whether that was

the right way to go, I think is a remaining subject for debate and

discussion.

Mr. OWENS. Are you getting cooperation from them now that is

compensatory to what they had to do then?

Dr. LEVIN. In our screening program we have worked most closely with NIOSH, the National Institute for Occupational Safety and

Health, which is sort of the research arm under the CDC. And we

have worked very well with our colleagues at NIOSH. Our only

complaint is we would like to see this funding coming through for

long term medical monitoring fast enough so that we will not be

stuck in a situation where there is a gap between the current

screening program and the future longer term monitoring. But in

the development of the medical protocol, in how to think about

these issues, we have worked very well with NIOSH and found the

experience with them to be very helpful.

Mr. OWENS. My final question is a little broader. The Federal

Government is to be congratulated, the administration and both

parties, for the steps it took to deal with the casualties, the victims

at the World Trade Center, the way the insurance and the compensation has been handled I think is outstanding. You know, I

voted for it so I take some credit. But it was unprecedented.

Is it not possible to deal with workers on the site and their problems in the same kind of way? Under one umbrella make some decisions about who is to be compensated for what and what kind of

care, who it is entitled to and for how long, and what kind of damages people are due compensation for? Is that undoable?

We are dealing with a finite number of people. I am not talking

about residents. I am talking about workers who were there on the

site, most of them who can prove they were onsite. Is it not possible to look at some kind of bigger more comprehensive program

which would deal with all these problems and not have to nickel

and dime it and then beg your way through philanthropy and agency generosity here and there?

Dr. LEVIN. Well, if you are asking us at Mount Sinai that question?

Mr. OWENS. I am asking everybody who might want to comment,

yes.

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Dr. LEVIN. Well, we certainly feel it ought to be possible. Because

the actual experience of people who responded down there, whether

they were workers or volunteers, has been absolutely awful.

I mean, you heard from people today what it is like trying to get

through this broken workers compensation system. The system was

broken not just after September 11. It was broken before. It is

quite stark now that you have people who did so much down there

to help others who——

Mr. OWENS. Yes. But there was no system for the insurance, the

payment of people who lost their relatives there. We created a system afterwards.

Dr. LEVIN. Yes, you are right.

Mr. OWENS. And that is what I am talking about. Can we not

create a system which then would become a model for the future

in terms of situations like this instead of trying to put together

with rubber bands and gum?

Dr. LEVIN. I certainly think that such a system could be developed. I think the experience that we at Mount Sinai, and others,

who have provided care to such workers and volunteers could help

develop such a system. And it would be rational and it would put

in place a mechanism for getting people treatment, for their studies

that they absolutely need, without their having to go through the

nightmare of trying to get some workers comp insurance company

to say yes to this after a year and a half has passed and still nothing has been done. Yes, we could develop a system.

Mr. OWENS. Thank you for putting that on the record.

Thank you, Mr. Chairman.

Mr. SHAYS. Thank you, Mr. Owens.

Mr. Nadler.

Mr. NADLER. Thank you, Mr. Chairman.

First, just to followup on the workers comp for a moment. Commissioner Freiden, you have heard here that the MTA, which is a

State agency, has controverted and disputed every workers comp

case arising out of the World Trade Center catastrophe. Has the

city administration done anything to speak to the Governor the

State or the MTA about this disgraceful practice?

Dr. FRIEDEN. I am not familiar with that, but we could certainly

find out about it and get information back.

Mr. NADLER. I mean, in other words all these employees of government agencies, every single case the MTA says, the government

says you may be a hero in September 11 but you are a malingerer,

you are a liar, you are a phony false claimer. Every single case. I

find that disgraceful. I find it disgraceful for the State government.

I find it, frankly, disgraceful that the city government has not done

anything about it. No. 1.

No. 2, Mr. McArdle, Mr. Willis, Mr. Graham, Mr. Rapp, when

you were working on the pile were you wearing respirators?

Mr. MCARDLE. I was, yes.

Mr. NADLER. The entire time?

Mr. MCARDLE. Yes.

Mr. NADLER. And you still have all these health effects?

Mr. MCARDLE. I am not one of the people who is impacted by it.

Mr. NADLER. OK. Mr. Willis?

Mr. WILLIS. No, I had a paper mask.

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Mr. NADLER. I’m sorry?

Mr. WILLIS. I had a paper mask.

Mr. NADLER. Not a respirator?

Mr. WILLIS. No.

Mr. NADLER. Were you offered a respirator?

Mr. WILLIS. I’m sorry?

Mr. NADLER. Were you offered a respirator?

Mr. WILLIS. No. None were available.

Mr. NADLER. None were available? Did you ask for one?

Mr. WILLIS. No.

Mr. NADLER. But you were made aware that none was available?

Mr. WILLIS. Yes. There was no one around me at that time in

the first, you know, in the first few days that I saw where we were

working who had them.

Mr. NADLER. And then was just the first few days.

Mr. WILLIS. Right.

Mr. NADLER. What about after the first few days?

Mr. WILLIS. After that, you know, some of our people in transit

who were respirator qualified——

Mr. NADLER. Were respirator qualified?

Mr. WILLIS. Right. You have to be qualified for a fit?

Mr. NADLER. You mean physically qualified?

Mr. WILLIS. Right. Yes. Yes. For instance, with a beard, you are

not.

Mr. NADLER. And if you were not qualified, they did not tell you

to shave off your beard, they said go work there without the respirator?

Mr. WILLIS. That question did not even come up. We were ordered there, and a lot of us actually volunteered. I, for instance,

volunteered.

Mr. NADLER. But respirators were or were not available after the

first few days?

Mr. WILLIS. No. No, no, no, no. They were not—first of all transit

does not even have that quantity of respirators to cover the thousands of hard hats that they had there.

Mr. NADLER. So people in transit worked for weeks on the pile

without respirators and no one made any attempts to get them respirators.

Mr. WILLIS. I mean, we had bus operators. For instance, the firemen for the most part were brought down to the site from Canal

Street by our bus operators back and forth. I am aware of bus operators who will never work again because they had no respirators.

Mr. NADLER. OK.

Mr. Graham.

Mr. GRAHAM. During the initial collapse I did not have a respirator. Following that my trips down there were, I did have a respirator and I did do—personally give my membership a tremendous

amount of—we spent a tremendous amount of money, my membership, on respirators and fit testing.

Mr. NADLER. The union bought the respirators?

Mr. GRAHAM. Yes, they did.

Mr. NADLER. Not the State or city government, or the Federal

Government?

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Mr. GRAHAM. I am trying to give you the exact date. The 12th

or 13th, those days are a little blurry to me, sir, but that week my

particular union bought thousands of dollars in respirators.

Mr. NADLER. In respirators.

Mr. GRAHAM. And we bought fit testing and we brought it to the

site. And we got our membership and we started fit testing our

membership.

Mr. NADLER. And you saw the necessity of doing that right

away?

Mr. GRAHAM. Yes. I felt it.

Mr. NADLER. OK.

Mr. GRAHAM. In my chest.

Mr. NADLER. Mr. Rapp.

Mr. RAPP. Yes. Me also. I had a respirator from November to

March when I was working.

Mr. NADLER. From November? What about September to November?

Mr. RAPP. No. I wasn’t there. I volunteered. I did not have the

respirator.

Mr. NADLER. So you used the respirator the entire time?

Mr. RAPP. Well, it was hard to communicate with your other

workers——

Mr. NADLER. So you used it part of the time?

Mr. RAPP. Yes.

Mr. NADLER. Part of the time?

Mr. GRAHAM. Mr. Nadler.

Mr. NADLER. Yes.

Mr. GRAHAM. Just one other thing. I would love for the congressional hearing to try to work, even sitting at a desk, for a 12 hour

day with this respirator on.

Mr. NADLER. With a respirator on? I understand.

Mr. GRAHAM. Not walking up and down and not digging in a pit,

but just sitting for 12 hours, even 2 hours. Just try it and see what

it is like.

Mr. NADLER. Yes.

Now, Mr. McArdle, in your testimony you say that many firefighters were not given the proper respiratory protection devices

even though complaints about this issue have been made for years,

the department did not and still does not have a respiratory protection program as required by Federal regulations for air purifying

respirators for well over 10 years. This is in violation of CFR

1910.134. To your knowledge they still do not have those respirators?

Mr. MCARDLE. Yes. And I would just like to make a clarification

also, Mr. Nadler. When you asked the question about respiratory

protection, I had respiratory protection when I initially got down

there, which was self contained breathing apparatus, not a full

faced APR. Once the air supply ran out, that was it.

When I say that the department did not have respiratory protection, they did not have full faced air purifying respirators——

Mr. NADLER. They did not have the adequate proper protection?

Mr. MCARDLE. Right.

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Mr. NADLER. Mr. Weiden, does the department not have the

proper protection that is required by law or does it? And if it does

not, what are you doing to change that?

Dr. WEIDEN. I do not know what the law is. I am a clinic physical

taking care——

Mr. NADLER. OK. I’m sorry, do no answer that. I thought you

were more higher up in the department or differently, laterally in

the department.

Dr. FRIEDEN. He is higher up.

Mr. NADLER. That is why I said laterally. That is why I said laterally in the department.

Dr. WEIDEN. But let me answer it to the extent that I can.

Mr. NADLER. Yes.

Dr. WEIDEN. The police department has issued terrorism bags,

which include a respirator to all of its membership. There is no

such equivalent, currently sanctioned equipment that either goes

with the member or on any of the apparatus——

Mr. NADLER. For the fire department.

Dr. WEIDEN. For the fire department. The only respirator that is

currently being used is the full face self contained breathing apparatus.

Mr. NADLER. So in other words, it is fair to say that it differs by

department and for volunteers and people from other departments,

a lot of people did not have respirators and some did.

Let me ask the following question: Dr. Freiden, you state in your

testimony and you spoke about it in response to earlier questions,

that you concentrate in the registry and where people were most

heavily exposed, that is to say below Canal Street. What scientific

data do you have that Canal Street is the boundary for heavy exposure; that there is any difference between one block south of Canal

Street or one block north of Canal Street, or for that matter in

Brooklyn or on the other side of the Hudson River, New Jersey? Is

there any scientific basis for the boundary for—well, in fact what

you did was simply copy the boundary that the EPA made for their

so called clean up program. Is there any scientific basis for this

boundary?

Dr. FRIEDEN. Well, first of all, I would like to clarify that it is

not solely geographic. There are different groups that are

eligible——

Mr. NADLER. No, no. But residents——

Dr. FRIEDEN. Individuals who are eligible to participate include

those who worked in rescue or recovery, those who went to school

or taught in schools—in lower Manhattan. Those who lived or

worked there.

Mr. NADLER. All right. People who lived or worked there. Just

please answer the question, I have more questions.

Part of this is geographically limited. What is the scientific basis

for the geographic limit?

Dr. FRIEDEN. There is a question if a decreasing level of exposure. At——

Mr. NADLER. Well, my question is how do you know given the

fact that you haven’t done—nobody has done what the IG recommended, namely concentric circle testing going out in concentric

circles from the World Trade Center, how do you know that in fact

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there is a decreasing exposure as you get further away and how do

you know where it is appropriate to place a boundary? What is the

scientific basis for that?

Dr. FRIEDEN. We are making the best judgments, given the available data, of what the highest level of exposure is. We are not saying that those who are a block away from that are not exposed. We

are saying that there is a gradient of exposure based on the best

available data.

Mr. NADLER. Could you furnish us that data? Because everything

that I know says that there is wholly inadequate data. Every testimony that we have had at other hearings says that there’s wholly

inadequate.

Well, let me ask Dr. Levin. Do you believe there is adequate data

to sustain what the Commissioner just said?

Dr. LEVIN. Well now, we have been advocating all along, really

since early city council hearings, that this approach of going from

Ground Zero in radians in all directions, assessing levels of surface

contamination in interior surfaces, ought to have been done. It is

a straight-forward approach, and still could be done. Because not

all clean up has occurred.

Mr. NADLER. And that is the IG’s recommendation?

Dr. LEVIN. That would be the way to characterize the extent and

perimeter of the contamination that occurred.

Mr. NADLER. But do you believe that the Commissioner is accurate in effect saying that a boundary line at Canal Street, or any

particular street over there, is scientifically based on where the

most heavy exposure is?

Dr. LEVIN. I do not think——

Mr. NADLER. And not just Canal Street, but——

Dr. LEVIN. I do not think he said that. I think he said ‘‘on the

basis of the best available data.’’ He, I think, did not speak to the

question of whether the available data are truly adequate. I do not

think they are adequate to make that determination. I think the

characterization by this sort of approach we just were talking about

really ought to be done, and then he can answer the question.

Mr. NADLER. So it is not scientifically valid to do that unless we

have data that we do not yet have.

Dr. LEVIN. Generally we like to proceed from data.

Mr. NADLER. OK. Thank you.

Mr. SHAYS. Thank you. I am going to take the questions now and

just read a part of the briefing paper that we had, and this was

replete with this kind of information.

Various sizes of particular matter floated in the air and

blanketed New York City streets. Fires burned under the debris

until the middle of December 2001. A mixture of plastic, metals

and other chemicals and products burned or decomposed into very

fine particles. The content of the plume varied centimeter by centimeter. Some researchers found one molecule that had never been

there before. According to Paul Lioy of the Environmental Occupational Health Science Institute of the University of Medicine in

New Jersey ‘‘Initial exposures were basically a blackout, people

will, cumulatively, never see in a lifetime. The problem we have

now is we do not know the long term lifetime health consequences.

We just do not know.’’

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Do any of you disagree with that basic description?

Let me say to both you. Commissioner, thank you for staying. I

know you feel a little anxiety because the Council has asked you

to be there, too. We got you first. And thank you for staying.

And Dr. Levin, I think your health registry is hugely important.

And your screening is hugely important. I just want to go on the

record. I am troubled, however, that of the 200,000 potential people, that only approximately 12,900 have been enrolled and only

6,000 have completed the 30 minute telephone survey. And I am

puzzled by this.

We have allocated $10 to $20 million for that. I cannot in a lifetime think of how we would spend so much money for that. And

I need you to explain it, and that is why I am happy you stayed.

Dr. FRIEDEN. Thank you very much. And thank you for your support of the registry. The registry began enrollment only 8 weeks

ago. And so the money was allocated. It was up to the ATSDR, the

Agency for Toxic Substance and Disease Registry, to select a contractor. They went through the contracting process. That took a relatively long time.

Mr. SHAYS. So you have not spent $10 million yet?

Dr. FRIEDEN. Oh, no. No, no.

Mr. SHAYS. OK. It is allocated for it?

Dr. FRIEDEN. That is correct. That is correct.

Mr. SHAYS. OK.

Dr. FRIEDEN. And as of today, we have more than 10,000 people

who have already completed. And so it is really rapidly expanding.

It is not that the money is already spent. The registry just began

enrollment 8 weeks ago.

Mr. SHAYS. If we care about the people who are impacted, the

200,000 who may be, one of the most important things that could

come from this hearing is having people be aware of it. We need

people to register, we need these interviews to take place, we need

this data.

Tell us, Dr. Herbert, your screening is basically the workers who

are working in this facility primarily, correct?

Dr. LEVIN. It includes—the people who are eligible—include

those rescue and recovery workers and volunteers other than New

York City firefighters, State employees and Federal employees. It

also includes people who restored essential services: the telephone

services, the electrical services, water services, etc. It also includes

those people involved in cleaning up the buildings immediately adjacent to Ground Zero. And it includes those workers out at the

Staten Island landfill who did what they did in the effort.

So they are the groups that were included.

Mr. SHAYS. And it is screening, it is diagnoses, it is you are providing medical assistance as well?

Dr. LEVIN. No. No funds are available for medical treatment.

What we do is identify people who, on the basis of their history,

their physical examination findings, their laboratory findings, have

illness which we feel are related to World Trade Center exposures,

and we have a case management function built into this to make

sure that they get plugged into care. That is the role of the screening program.

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Identify those who are ill and make sure, whether it is on physical grounds or psychological grounds, and make sure that they get

put into care. We do not have the resources to provide the care,

other than some moneys from philanthropic sources that enable us

to see a small number for a relatively short period of time. And

that program, which we are grateful is funded, now has a 3 month

waiting list to get in.

Mr. SHAYS. During our Gulf war hearings, of which we had more

than I can even remember the number, we had a pilot who had

ALS. He could hardly move any part of his body. He could only

whisper. His wife and sometimes his father had to tell us what he

said.

The last question we asked him was knowing what you know,

would you still have done what you did. And I think you know the

answer; he said he would do it again. He would do it again.

I suspect that all four of you were less concerned about your

health and more concerned about meeting a very drastic human

need.

Mr. McArdle, you wisely used a respirator. If you had not, do you

think you would be feeling some of the health effects of our other

three witnesses?

Mr. MCARDLE. Yes, absolutely I would be feeling some of the

same effects. I was fortunate enough to have one with me when the

event occurred.

Mr. SHAYS. Thank you.

How many days did you work in Ground Zero?

Mr. MCARDLE. Approximately 10. I got there right after the—I

pulled up on the scene right as the first building collapsed.

Mr. SHAYS. Mr. Willis.

Mr. WILLIS. Would I go back? I had—like I said, I volunteered

to be there, but I had a special reason. I lost two family members

under there. So, yes, of course I would.

Mr. SHAYS. You lost two family members?

Mr. WILLIS. Yes, I did.

Mr. SHAYS. Let me ask you this, how many days were you at the

site?

Mr. WILLIS. Weeks.

Mr. SHAYS. Weeks.

Mr. Graham.

Mr. GRAHAM. Would I go back?

Mr. SHAYS. I do not need to ask you that question.

Mr. GRAHAM. OK.

Mr. SHAYS. I am really asking you how many days in the site?

Mr. GRAHAM. I was there at least 3 days a week throughout the

whole project.

Mr. SHAYS. Right.

Mr. Rapp.

Mr. RAPP. I was there through—for 5 months.

Mr. SHAYS. Five months.

Mr. RAPP. Five whole months.

Mr. SHAYS. Well, thank you for what you gentlemen have done.

Now, there is no question on the part of any panelists that people need to be properly diagnosed, they need to be properly treated

and they need to be properly cared for. Some of that may be a FedVerDate 11-MAY-2000 10:27 Apr 15, 2004 Jkt 000000 PO 00000 Frm 00099 Fmt 6633 Sfmt 6633 D:\DOCS\92728.TXT HGOVREF1 PsN: HGOVREF1
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eral responsibility, some of it may be a State responsibility, some

of it may be a local responsibility. In any instance, however, it

needs to be a process that is seamless and does not make you sick

just going through the process. And nothing should delay that process from happening.

I would like to know as it relates to the long term health effects

exposures, what is the best treatment for those suffering from respiratory problems? What is the best treatment? What do we know?

Dr. LEVIN. Well, there is a standard of care for irritant-induced

asthma and sinusitis. It usually involves inhaled steroids, either

nasal steroids or the kind of steroids that asthmatics use. And, of

course, Mr. Graham here talked about his rescue pump. These are

broncho-dilators, things that open the airways when they are shutdown. And there are a number of other anti-inflammatory medications that are taken either by inhalation or by mouth that can be

effective.

When sinuses become acutely infected, one is on antibiotics; even

a person who has asthma who develops a bronchitis, winds up on

antibiotics. But the basic standard of care for these conditions is

well established.

Mr. SHAYS. Dr. Freiden, if you need to go, why do you not leave.

Thank you.

I’m sorry.

Dr. LEVIN. There is a well established standard of care which involves the use of these anti-inflammatory medications.

Mr. SHAYS. Is it expensive?

Dr. LEVIN. Is it expensive? Yes.

Mr. SHAYS. Yes.

Dr. LEVIN. Unfortunately, these inhalers are quite expensive.

Mr. SHAYS. No, but the whole process of dealing with someone

with this type of ailment?

Dr. LEVIN. The evaluation expenses?

Mr. SHAYS. The evaluations, the treatment?

Dr. LEVIN. And the treatment is expensive.

Mr. SHAYS. Describe to me what expensive means?

Dr. LEVIN. Well, each one of these inhalers runs between $60 to

$80 for a single unit. A person who has active asthma, you know,

will go through several of these in the course of a month.

Mr. SHAYS. Dr. Herbert, you can answer the questions, too.

Dr. HERBERT. Actually, some of the inhalers are even more. I

mean——

Mr. SHAYS. But I am asking about the whole treatment. Forget

just this little element of it. I want to know are we talking thousands of dollars a month, are we talking thousands of dollars a

year? The total treatment, the total care. I want to grasp something about the magnitude of the cost.

Yes, Dr. Weiden.

Dr. WEIDEN. So they are involved in screening, I am involvement

in treatment.

Mr. SHAYS. OK.

Dr. HERBERT. We also do treatment——

Dr. WEIDEN. So that their agenda is not treatment of all people

who come to them.

Mr. SHAYS. Yes, sir.

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Dr. WEIDEN. My agenda is treatment of all people who come to

them. And I can just tell you that on average I will treat these patients for well over a year. I will see them at least once a month

frequently, two or three times a month. I will order testing that

will come up to maybe $2,000 to $5,000 for any individual case.

And I would guess that the respiratory component will cost between $200 and $400 a month. And in addition with regard to prevention, one of the surprising things that we found is that these

patients also have severe heartburn. And that treating the heartburn, which is also quite expensive, then markedly improves the

respiratory symptoms that respiratory patients have. So I think

there is an advantage to having all of this done in one place with

physicians who see a high volume of these patients, and it allows

us to be more efficient.

Mr. SHAYS. Let me ask you, is there anything that any of you

want to want to record?

First, may I just ask, is there any Member that just has a question that needs to be put on the record, any Member here? If not,

anything that any of you would like to put on the record before we

go to panel two?

Yes, sir?

Dr. WEIDEN. One of the things that has been obliquely mentioned

but is not really been the focus of the testimony is post-traumatic

stress disorder. I am not an expert in this, but it is my assessment

that a large proportion of the patients who I treat for respiratory

illness have post-traumatic stress disorder. And I believe that as

many permanent disabilities will occur on this basis as on a respiratory basis, and it has already occurred within the fire department that the number of suicides related to the World Trade Center has far exceeded any other cause of mortality after the initial

collapse.

Mr. SHAYS. Anyone else like to put anything on the record?

Yes?

Dr. HERBERT. We, in fact, have treated hundreds of responders.

And one of the concerns I have is that in addition to treating the

respiratory conditions and the mental health conditions, our patients are a group who have tremendous psycho-social needs because many of them are disabled. They need social services as well

as physician care. And I would hope that would be thought about

in any plans for treatment.

Mr. SHAYS. Yes?

Mr. NADLER. Dr. Levin, one question. On a long term basis based

on what you have seen of respiratory ailments and all the other

things that you’ve seen, would you expect to see a high incident in

all these people of long latency diseases that come out 15 years

from now, cancers and so forth?

Dr. LEVIN. We do not know, but there are certain groups among

the people that we have screened that we worry about a great deal.

That includes the people who were cleaning those buildings day in

and day out, disturbing settled dust without respiratory protection,

without training. And there were some people who were on that

pile, right where the plumes of smoke were coming out containing

high concentrations of carcinogenic agents, without respiratory proVerDate 11-MAY-2000 10:27 Apr 15, 2004 Jkt 000000 PO 00000 Frm 00101 Fmt 6633 Sfmt 6633 D:\DOCS\92728.TXT HGOVREF1 PsN: HGOVREF1
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tection who may, in fact, may be at significantly increased risk for

cancer.

Mr. NADLER. You are talking about the people who were cleaning

buildings afterwards?

Dr. LEVIN. Cleaning buildings after the collapse of those towers,

who were provided with no respiratory protection, no training, who

did this disturbance of settled dust day in and day out and in enclosed spaces and really may have sustained enough exposure——

Mr. NADLER. Are you talking about the people who were cleaning

in the EPA clean up, or you are not referring to that?

Dr. LEVIN. Not necessarily that specific group. I do not know

their levels of protection.

Mr. NADLER. OK.

Dr. LEVIN. I know that building after building, office buildings

and residential buildings, were cleaned by largely immigrant workers who were provided——

Mr. NADLER. Through private contractors.

Dr. LEVIN. Through private contractors.

Mr. NADLER. That is inside and out?

Dr. LEVIN. Inside and out, and the issue for them may in fact be

one of concern about cancer down the road.

Mr. NADLER. And OSHA, nobody enforced standards or protection on these workers?

Dr. LEVIN. Not to my knowledge.

Mr. NADLER. Thank you.

Mr. SHAYS. Thank you.

Any other closing comments from anybody? Yes, Mr. Graham?

Mr. GRAHAM. With your statement before about OSHA, OSHA

did lose their office and they did mobilize quite quickly with no office, no communications and no equipment. So, I just wanted to put

that in.

Mr. SHAYS. Thank you.

I think, Mrs. Maloney has a comment.

Mrs. MALONEY. A brief question to Mr. Rapp, Mr. Graham and

Mr. Willis, all of whom are suffering from health problems related

to September 11. I would like to know possibly in writing, since our

time may be running out, who is paying your medical bills? How

are you managing financially? Did you apply to the Victims Fund,

the special fund that is managed by Mr. Feinberg? Did they respond to your concerns? And what is the current status of your

workmans compensation plan? Are you having trouble or has that

been resolved?

Mr. SHAYS. Let us do this; we will supply you a letter with those

questions. You will make sure our committee has that. And if you

could respond to it, it would be very helpful.

Do you have a general response in terms of that question that

you would like to respond to before we go?

Mr. GRAHAM. Well, generally my union’s paying. Thank God I am

still working.

Mr. SHAYS. You say your union is paying?

Mr. GRAHAM. My union benefits, my coverage through the union

is paying for that. And——

Mrs. MALONEY. But if you terminate because of health reasons,

there will be no health coverage?

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Mr. GRAHAM. Right. I have to work so many hours to earn my

benefit hours. So if I do not work, there is no benefit. And I have

applied for victim’s compensation. And my workmans comp has

been denied, whatever.

Mr. SHAYS. OK. Denied.

Mrs. MALONEY. Denied? Unbelievable.

Mr. SHAYS. Contested?

Mr. GRAHAM. Contested at least.

Mr. SHAYS. OK. Well, we got our work cut out for us, do we not?

Thank you all very much. You have been a wonderful panel. I

appreciate your patience.

Mr. OWENS. One of the members of the audience, you know her

written testimony, she could not testify.

Mr. SHAYS. Yes. If we could have the name of the individual and

their address and we will submit it into the record. And we will

note for the record who that is.

Mr. OWENS. Ms. Heidi Mount.

Mr. SHAYS. Without objection, that will be submitted into the

record.

[The prepared statment of Ms. Mount follows:]

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Mr. SHAYS. We are going to call our next panel. Our next and

our final panel, we appreciate their cooperation.

Our next panel is: Mr. Paul Gilman, Assistant Administrator for

Research and Development, Environmental Protection Agency; Ms.

Diane Porter, Deputy Director, National Institute for Occupational

Safety and Health [NIOSH] accompanied by Dr. Gregory Wagner,

Director of the Division of Respiratory Disease Studies, National

Institute for Occupational Safety and Health. And our third witness is Ms. Pat Clark, area office director for New York, New York

Occupational Safety and Health Administration also accompanied

by David Williamson with Ms. Porter is Dr. David Williamson,

Ph.D, Agency for Toxic Substances Disease Registry.

If our witnesses will stand up, please, and we will swear you in.

[Witnesses sworn.]

Mr. SHAYS. And I thank others for standing in case we needed

to go on your expertise. That is very thoughtful.

I am going to say again thank you for being the second panel.

Thank you for listening to the first panel.

We know what our task is, and we are going to get to it. We are

going to start first with Ms. Porter. We will go to Dr. Gilman and

then we will go to Ms. Clark. And that will be the order of it.

Ms. Porter, thank you.

STATEMENTS OF DR. PAUL GILMAN, ASSISTANT ADMINISTRATOR FOR RESEARCH AND DEVELOPMENT, ENVIRONMENTAL PROTECTION AGENCY; DIANE PORTER, DEPUTY DIRECTOR, NATIONAL INSTITUTE FOR OCCUPATIONAL SAFETY AND HEALTH [NIOSH], ACCOMPANIED BY DR. GREGORY

WAGNER, DIRECTOR OF THE DIVISION OF RESPIRATORY

DISEASE STUDIES, NATIONAL INSTITUTE FOR OCCUPATIONAL SAFETY AND HEALTH; PAT CLARK, AREA OFFICE DIRECTOR FOR NEW YORK, NEW YORK OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION, ACCOMPANIED BY DR.

DAVID WILLIAMSON, PH.D, AGENCY FOR TOXIC SUBSTANCES

DISEASE REGISTRY

Ms. PORTER. Good afternoon, Mr. Chairman, Representative

Maloney and members of the committee. My name is Diane Porter

and I am the Deputy Director for National Institute for Occupational Safety and Health, a part of the Centers for Disease Control

within the Department of Health and Human Services.

Accompanying me here today are Dr. Gregory Wagner, a physician and the Director of the NIOSH’s Division of Respiratory Disease Studies and Dr. David Williamson, the Director of the Division of Health Studies with CDC’s agency for Toxic Substances and

Disease Registry.

Thank you for this opportunity to appear today to provide testimony on behalf of CDC and ATSDR regarding our ongoing efforts

to address the health impacts of the World Trade Center disaster

on the rescue, recovery and response workers and on the nearby

community members who were so directly effected by the events

that day.

As you know, CDC provided extensive emergency assistance to

workers and residents near Ground Zero in the immediate aftermath of the September 11th attacks. My testimony here today will

104

focus on our subsequent activities to address the health effects of

that disaster on the emergency and front line workers who came

to help, and to evaluate the physical and mental health impacts on

the wider community of people living, working and going to school

in the vicinity of the World Trade Center site.

In the interest of time, I will summarize these activities today,

but a more detailed description of our efforts is in the written

statement submitted to the subcommittee.

In the weeks following September 11th, NIOSH was in close contact with the medical staff of the fire department of New York and

with other community based occupational health providers who

began reporting health problems they were finding in workers and

volunteers who had been at the site. An informal network of occupational medicine specialists was established with NIOSH’s assistance.

Mr. SHAYS. Let me just interrupt you a second and say if this

panel, given it’s three, goes over its 5 minutes, you know that is

acceptable. We want you to put on the record what you need to put

on. So do not feel you have to rush.

Ms. PORTER. Thanks.

This informal group, lead by Mount Sinai’s School of Medicine

Center for Occupational and Environmental Medicine discussed

their findings and began to better define the type and severity of

health problems they had seen. And this activity laid the ground

work for the creation of a comprehensive medical screening program for these workers.

In November and December 2001, NIOSH was contacted by several labor unions and employers representing workers employed in

buildings near the World Trade Center site asking us to look into

their health. In response, NIOSH performed a series of health hazard evaluations that showed elevated rates of upper and lower respiratory and gastrointestinal system symptoms as well as symptoms of depression and post-traumatic stress disorder in the World

Trade Center area workers compared to similar workers elsewhere.

These symptoms were still present 2 to 6 months after September

11th.

In January 2002, with funds from FEMA, CDC provided $4.8

million to the New York City Fire Department and $2.4 million go

the New York State Department of Health to conduct baseline

medical evaluations for New York City firefighters and State employees who responded at the World Trade Center site. Shortly

thereafter, also in 2002, Congress gave $12 million to CDC for

baseline medical screening of the other emergency service and

recuse and recovery personnel who responded to the events of September 11th.

CDC awarded the contract to Mount Sinai Center for Occupational Environmental Medicine to establish this program within

weeks of receiving the funds. Mount Sinai, in consultation with

CDC and other occupational health experts, developed a comprehensive screening program which beginning in July 2002 provided response workers with a baseline medical assessment and assistance with referrals for followup care. A consortium of occupational health clinics was created to provide these services to reVerDate 11-MAY-2000 10:27 Apr 15, 2004 Jkt 000000 PO 00000 Frm 00108 Fmt 6633 Sfmt 6633 D:\DOCS\92728.TXT HGOVREF1 PsN: HGOVREF1
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sponse workers and volunteers throughout the New York City area

and in the rest of the country.

As of October 2003, the consortium has screened over 7,000

workers.

In 2003 also, Congress directed that FEMA provide $90 to CDC

for long term medical monitoring of the World Trade Center rescue

and recovery workers and volunteers including $25 million that

was designated to the use for current and retired New York City

firefighters.

In anticipation of receiving these funds, CDC held a public meeting in New York City in May 2003 to gather input regarding the

content and structure of a long term screening program. There was

broad consensus among leading participants that the program

should include: Multiple clinical sites; that the existing short term

screening program was very satisfactory and therefore current providers should continue to provide services; that quality control

across the centers is important, and; that the content of the program should remain flexibility to accommodate evolving needs and

treatment.

There was also agreement that the baseline screening program

should be extended beyond the 9,000 workers who were currently

funded.

Based on this input, CDC supplemented the existing contract

with Mount Sinai within 6 working days of receiving the funds

with $4 million to cover baseline screening examines to approximately 3,000 additional workers. These examinations will be conducted through March 2004.

The $25 million designated for long term followup for the New

York City Fire Department will be provided to FDNY to conduct

a program in coordination with CDC.

Just as the baseline screening program is completed in March

2004, the remaining dollars will be provided to clinical centers to

implement the long term medical screening program that will provide workers with a choice of providers. The program will also include a centralized coordination center to assure quality control

and allow for periodic review of screening.

In addition to our activities to address the health needs of rescue

response and recovery workers, HHS agencies in collaboration with

others are working to identify the health effects of the World Trade

Center disaster on the people who were living, working or going to

school in the vicinity of Ground Zero. Details on these studies are

outlined in my written testimony.

Finally, the subcommittee has expressed specific interest in the

World Trade Center Health Registry which was launched on September 5, 2003 with an extensive outreach campaign. In collaboration with the New York City Department of Health and Mental Hygiene and with startup funds provided by FEMA, ATSDR has established a registry to identify and track over the long term the

health of tens of thousands of workers and community members

who were mostly directly exposed to smoke, dust and debris from

the World Trade Center site. To date, more than 10,000 people

have been interviewed. It is estimated that the registry will included 100,000 to 200,000 individuals including rescue and recovVerDate 11-MAY-2000 10:27 Apr 15, 2004 Jkt 000000 PO 00000 Frm 00109 Fmt 6633 Sfmt 6633 D:\DOCS\92728.TXT HGOVREF1 PsN: HGOVREF1
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ery workers, office workers, residents and school children making

it the largest registry of its kind.

The registry will provide a complete picture of the health effects

resulting from the events of September 11th. It also will serve as

a resource for future research studies into the health consequences

of September 11th and a tool for disseminating important health

information to the public and to health care providers so that people can make informed decisions about their health care.

In addition, people interviewed also will be provided with referrals to health care providers for health problems they may be currently experiencing.

The registry will be maintained over time by the city Department

of Health and Mental Hygiene.

In summary, CDC and ATSDR are committed to assessing the

health effects resulting from the September 11, 2001 attacks on the

World Trade Center and identifying the physical and mental health

needs of effected workers, residents and community members.

Thank you for your attention.

I’m please to answer any questions.

[The prepared statement of Ms. Porter follows:]

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Mr. SHAYS. Thank you, Ms. Porter.

Dr. Gilman.

Dr. GILMAN. Can I show my slides from the podium?

Mr. SHAYS. Yes, fine. And as we pick you up in the mic, that is

fine.

Dr. GILMAN. OK.

Mr. SHAYS. And we will see it on this TV screen here, I guess.

Dr. GILMAN. Mr. Chairman, first, if I could just go over the elements of EPA’s response to the events of September 11th.

EPA in its emergency response capability activated its emergency response team within minutes of the attack and sent on senior coordinators to begin collecting bulk dust and air samples, both

at the site of the World Trade Center and subsequently on the 11th

to areas of New Jersey and Brooklyn as well.

In the days following September 11th we began to establish a

fixed air monitoring system which ultimately consisted of 20 different monitoring stations in addition to the network of monitoring

stations that are in place for activity such as monitoring for particulate matter under the Clean Air Act.

EPA’s principle mission immediately following the collapse was

to address the safe collection and disposal of large amounts and

quantities of dust and debris. And along with other Federal agencies, my colleagues here today, supplying respirators and protective

gear to workers and truck operators for Ground Zero.

EPA had subsequently been asked by the city to initiate its residential clean up program, which began in May of last year. And we

continue to perform laboratory health effects research on dust and

other contaminates from the World Trade Center in our effort to

try and better understand the health consequences of that day.

In that regard, let me speak to you about our draft exposure and

human health evaluation which was released in December of last

year. It is currently undergoing peer review and response to that

peer review. And let me start by saying a few things that—I will

start by saying what the report does address and then what it does

not address.

The draft report does focus on outside air. It focuses on the general public.

It highlights six particular contaminates that we believe were

most important to assess. It also tries to look at what the human

exposures to the contaminates were. As you know, a contaminate

may have a health effect, but just what kind of health effect it has

depends on how much an individual is exposed to of that. So we

are trying to assess how much individuals were actually exposed to

these contaminates.

We discussed the potential health impact of those contaminates

and utilized the data that was available at that time.

The draft report does not address indoor air except incidentally.

It doesn’t address first responders at Ground Zero. It doesn’t assess

residential or occupational exposures. And it doesn’t predict human

health effects, nor does it purport to examine all the different contaminates that were found at the site at the time.

Now, let me generally give you the findings of the report, then

we can talk a little bit of the specifics of the contaminates in question.

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First of all, people exposed to extremely high levels of outdoor

pollutants on September 11th at the time of the collapse in the vicinity of the World Trade Center are at risk for both acute and potentially long term or chronic respiratory and other types of health

impacts.

We found that the information available on September 11th and

in the days following did not really allow us to well characterize

this particular period of exposure and the potential health effects.

Except for exposures on September 11th and possibly during the

next few days, we did find that the people in the surrounding community were unlikely to have been exposed to contaminates in a

way that would result in either short term or long term adverse

health effects.

Now, the status of the report is, that is currently draft. It is

going through revisions and we hope to have it finalized in the

spring of 2004.

The contaminates we looked at included particulate matter, asbestos, dioxins and PCBs, metals and volatile organic compounds.

For the particulate matter, in the several days after the attack

monitors were showing high levels of particulate matter that did

exceed the EPA’s 24 hour air quality index, but by mid-October

those levels had receded to ones historically seen in the city.

For asbestos, there were reactively few outside air measurements

of asbestos that exceeded EPS or OSHA standards.

And I should comment that for all of these substances we are

hampered to some degree by the fact that we had not in the past

expected to have to look at short term exposures. So the benchmarks we are utilizing in doing this analysis are borrowed from the

occupational agencies and other circumstances. EPA has traditionally focused on longer term chronic exposures.

So for asbestos, the air measurements taken. There were a few

exceedences of EPA and OSHA standards. High levels of asbestos

were found in dust in two apartments sampled on the 18th and in

the grab samples that were done in the area of the World Trade

Center.

The report also does discuss the ATSDR study that was done on

apartments beginning in the November timeframe.

Dioxins and PCBs, there were high measurements in the first

month after September 11th, in particular in and around the World

Trade Center Ground Zero site. Exposures by inhalation of dioxins

in particular were not at a level that should cause either acute concerns or long term concerns. The major path for dioxins of concern

is really through ingestion, through food exposures.

For metals, there were some exceedences of EPA benchmarks for

lead in the first month, but the way the lead standard is set is it

is for exceedences that extend over a 90 day period, and we did not

see anything like that for the lead at the site or in the areas surrounding the site.

And last, for volatile organic compounds, we did see elevations

principally of benzene over the month following the Trade Center,

but none of those exceeding benchmark standards.

Now let me speak for a moment to our efforts at trying to reconstruct the exposures that people have seen. What I have here on

this screen is actually a graphic of reconstruction of the plume for

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the first days following the collapse of the World Trade Center. It

is animated, and as you can see through time the wind direction

did shift.

This is the standard sort of a tool we have available to us today.

It is based on meteorological information that comes to us from

sites like LaGuardia Airport or Kennedy Airport. And currently the

Department of Energy and NOAA are engaged in putting place systems in a number of cities around the country that are much fine

scaled, if you will. Where the meteorological information that is collected is much better represented for the areas in question.

EPA is currently engaged in collaborating with them, and what

we are actually trying to do is apply some tools we had begun to

develop in midtown New York. We are trying to better understand

how people living in a urban setting are exposed to normal pollutants.

What we have done with what is a computer model, a numerical

model, is now transfer that work to the lower end of Manhattan

and try and computationally understand how the particles and

emissions flowed in the area in and around the World Trade Center. And so this is a visualization now of that kind of modeling.

The field that is moving through shows you the different directions and volicities of the wind, the different points along the

southward movement at the World Trade Center.

And we are using this model along with an actual physical scale

model that was done for lower Manhattan at our research facility

in Research Triangle Park to work back and forth between the

physical model, a wind tunnel model of lower Manhattan, and that

computational model that I described. And this is a scene of gases,

simulated gases being released at the World Trade Center site.

The result of moving back and forth between this kind of physical model and computational model is that we can begin to recreate exposures at the time of the collapse and in the few days following that we cannot do from actual measurements. So what you

see here is a recreation of concentrations of no particular pollutant.

We have yet to go back and plug in to these models actual omissions data. But what this represents is, and let me explain the different so called ‘‘isolines,’’ lines of common concentration.

The yellow circle in and around the World Trade Center site represents the highest concentration. The green line with the No. 10

on it would represent a 10-fold reduction in the concentration of a

contaminate. And the blue line, a 100-fold in the contaminate. Also

marked on this map is the area that represented the exclusion zone

in the initial phases of the disaster. We have also done this now

for one other wind direction, and we are continuing to expand that.

Our hope is using a model like that and also, again, a computational approach to understanding what happened immediately as

the World Trade Center collapsed, we will be able to recreate the

exposure levels that people were exposed to.

What I have here is a computer generated model. This is not an

animation. This is actually a calculation done of the collapse of one

of the buildings at the World Trade Center. And it is through this

type of modeling that we hope to be able to combine the physical

model that I showed you, the numerical model and begin to better

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estimate the exposures that people present at the time of the collapse and first responders were subjected to.

Let me now summarize for you some of the things that the EPA

has done since the World Trade Center in an effort to improve our

response capability. We have updated and revised our national approach to response. We have expanded our training and incident

response. We have built a more sophisticated and larger emergency

operation center. We have established both at headquarters and in

the regions a support corps. Actually back up folks for our trained

professional in emergency response.

We have also purchased special communications and monitoring

equipment that would overcome some of the difficulties we had in

establishing a monitoring network in the case of the World Trade

Center. We have established another emergency response team, national emergency response team in the west. And we have created

a Homeland Security Research Center to develop the kinds of technologies and first responder computer tools that I have been trying

to show you here today.

Those rapid risk assessment tools, we believe, can help with

preplanning for first responders.

We have also developed a scientific response team that will be

available to both first responders and EPA decisionmakers for future events.

We have also been trying to improve those models, as I showed

you, on air transport.

And also, we have upgraded our laboratory capacity to serve as

a backup to the Department of Defense when it comes to biologicals

and other agents.

And I will stop there, Mr. Chairman.

[The prepared statement of Dr. Gilman follows:]

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Mr. SHAYS. Well, Dr. Gilman, you have given us a lot to think

about and you will generate a number of questions by your presentation. Thank you.

Ms. Clark.

Ms. CLARK. Mr. Chairman, members of the panel. Thank you for

this opportunity to discuss OSHA’s role in protecting workers after

the tragic events of the World Trade Center on September 11th.

I am the Regional Administrator for Region 2, OSHA, which covers New York, New Jersey, Puerto Rico and the Virgin Islands.

OSHA’s mission is to ensure safe and healthful working conditions for employees in this Nation. Within hours of the attack,

OSHA joined with other Federal, State and local agencies, as well

as safety and health professionals from contractors and trade

unions onsite, to help protect workers involved in recovery, demolition and clean up operations. Working under perilous conditions,

OSHA began coordinated efforts to protect the health and safety of

workers.

In line with the Federal Response and National Contingency

Plans, OSHA determined it could be most effective by providing assistance and consultation. It was apparent the site was not a typical construction or demolition project. Workers needed immediate

protection from hazards, the scope and severity of which were unpredictable.

OSHA’s primary responsibilities were to conduct personal air

monitoring to characterize exposure, distribute and fit respirators

along with other personal protective equipment, and conduct safety

monitoring. OSHA committed nearly 1100 staff, sometimes as

many as 75 a day. Our employees remained on the site for 10

months providing a 24-hour presence, 7 days a week. Our staff

spent more than 120,000 hours onsite. We conducted over 24,000

analyses of individual samples to quantify worker exposure. We

collected more than 6,500 air and bulk samples for asbestos, lead,

other heavy metals, silica, other inorganic and organic compounds

totaling 81 different analytes.

Personal sampling was conducted around the clock each day and

coordinated with safety and health professionals onsite. OSHA’s

sampling efforts included breathing zone samples of workers on

and near the pile. The tasks included search and recovery, heavy

equipment operation, steel cutting and burning, manual debris removal and concrete drilling and cutting.

OSHA’s breathing zone samples showed exposures that were well

below the agency’s permissible exposure levels for the majority of

chemicals and substances analyzed.

To ensure that workers were fully informed about the potential

risks, we employed several means to disseminate the information.

We distributed sampling summaries to trade unions, site contractors and agencies during daily safety and health meetings. Personal sampling results, including an OSHA contact number were

mailed directly to worker. Those whose sample results exceeded the

PEL were encouraged to seek medical consultation. We also posted

these results on our Web site within 8 hours.

OSHA consistently recommended workers on the site wear appropriate respirators. The respirators were selected jointly with all

the site safety and health professionals. We agreed on a high level

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of protection. A half mask, negative pressure respirator with high

efficiency particulate/organic/vapor/and acid gas cartridges. This

was communicated through orders and notices posted throughout

the sites. And you will see a number of exhibits labeled No. 1

through No. 8, as well as the poster in the front showing this.

OSHA continued to conduct extensive risk assessment to verify

the selected respirators remained appropriate. When sample results for jack hammering and concrete drilling operations indicated

a higher level of protection was needed, a full face piece respirator

was required for those operations.

Shortly after the attack, OSHA became the lead agency for respirator distribution, fitting and training. At the peel of the operation, basically the first 3 weeks, we gave out 4,000 respirators a

day. We distributed more than 131,000 during the 10 month recovery period.

Mr. SHAYS. Could you repeat that number again? How many?

Ms. CLARK. 131,000 in the 10 months.

Distribution to workers did pose challenges. OSHA initially deployed staff by foot with bags of respirators. We followed this up

by mobile teams on all terrain vehicles, as you will see in exhibit

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We also established a distribution point at the Queens Marina,

which was the fire department of New York’s staging point. We

opened multiple equipment distribution locations throughout the

16 acres site. You will see two of those in exhibits 10 and 11.

OSHA conducted over 7,500 quantitative fit-tests for negative

pressure respirators, including nearly 3,000 for FDNY personnel

specifically. You can refer to exhibit 12 for that. Fit-testing included instruction on storage, maintenance, the proper use and the

limitations of respirators. 45,000 pieces of other protective equipment were given out as well, such as hard hats, glasses and gloves.

We are also proud that despite this highly dangerous rescue and

recovery mission there was not one fatality. More than 3.7 million

work hours were expended during the clean up operations with

only 57 non-life threatening injuries. This is really remarkable

given the nature and the complexity of the site.

The key to success was working in partnership. A joint labor

management safety and health committee was established to identify hazards and recommend corrective actions. And unusually high

level of safety and health oversight, training and direct involvement of workers resulted.

Union stewards met weekly with us and with the other agencies

and their employees. They distributed safety bulletins directly to

their workers and they held tool box talks. OSHA and the Center

to Protect Workers Rights of the AFL–CIO collaborated to provide

mandatory safety and health training for all the workers on the

project.

We learned a great deal at the WTC site, lessons that can help

the agency and the Nation improve emergency preparedness. Employers must regularly review and practice evaluations. Also essential to establish channels of communication prior to an emergency.

Nationwide, OSHA’s reaching out to the entire emergency response community and coordinating this with the Department of

Homeland Security. One of the goals in this is to ensure that first

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responders wear properly fitted and maintained respirators at work

sites that may have toxic releases.

The agency is also working in partnership with the CPWR to

provide skilled support personnel with the training to ensure that

America has a work force that is prepared to safely respond to national emergencies.

Mr. Chairman, in addition to my concern for workers at the WTC

site, I have personal interest in the short and long term effects of

exposures because my staff and I spent so much time there, 10

months. Our Manhattan area office was destroyed when the North

Tower of the WTC collapsed on our building. During evaluation our

employees were exposed to all of the same potential contaminates

in the atmosphere as others who were in lower Manhattan that

day. I can say with confidence and pride that OSHA’s staff did everything humanly possible to protect the workers during their recovery efforts.

Thank you.

[The prepared statement of Ms. Clark follows:]

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Mr. SHAYS. Thank you.

Before recognizing Mrs. Maloney, I want to say that this has

been very important testimony, and there will be some tough questions to follow, but I wish some of this information had come out

sooner. And I will say to you, Ms. Clark, I think our previous

panel, some of the witnesses to make sure that your work of your

agency was recognized. Because you were in the thick of it.

And I am also going to say that in the first day or two we probably needed the respirators more than later. But I know the mentality of everyone there; they just wanted to do whatever was necessary to get the job done. And I hope we do not forget what motivated people in those first few days. It was not about their own

safety, it was just see if we can find anyone who is still alive. And

we know that.

And I am also going to say that we are all Americans here. We

love our country and we love the people who serve it, and we love

the people who were involved in this effort. And we are just going

to look backward and go forward.

And so, with that, I am going to first recognize Mrs. Maloney. I

am going to then go to Mr. Turner, then to Mr. Owens and then

to Mr. Nadler. We might have a second round if it is deemed necessary or partly that.

And so, Mrs. Maloney, you have the floor for 10 minutes. I am

not going to let you ask a question and in the 10th minute that

takes them 5 minutes to then respond to. I am going to keep you

to the 10.

Mrs. MALONEY. OK. Thank you, Mr. Chairman. And I thank all

of the panelists for your testimony and your hard work.

If you were here earlier, I asked a question of the first panel. I

asked them if they thought the Federal Government was doing all

that they should or could do to respond to September 11. And everyone raised their hand saying that they did not believe that

enough had been done, and then they said what they thought

should be done.

I would like to ask you the same question and to respond with

what you think Congress should be doing or the Government

should be doing to respond to the disaster of September 11. And

be very short and go right down the line, starting with Ms. Porter

and going straight down, or Dr. Williamson.

Ms. PORTER. I think related to the health issues of workers that

it is critically important that the screening program, which is underway, be continued and be funded for the long term.

I think that in addition funds for treatment would be appropriate, as would funds for research studies that could be done.

Last, I think that having listened to the first panel, it is really

important that we sort out the workers compensation issue.

Mrs. MALONEY. Yes.

Dr. Wagner.

Dr. WAGNER. In our particular arena, I think the efforts at getting our emergency response teams prepositioned, trained and

properly equipped are underway. We need to complete that.

We continue to support research both in the short run for better

understanding of what took place in terms of human health at the

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World Trade Center, and more broadly for other potential terrorist

attacks for the future.

Mrs. MALONEY. OK. Ms. Clark.

Ms. CLARK. I think it’s essential that we not lose focus about

what happened here and that we not forget and do not plan. Planning is absolutely essential. Emergency preparedness is all about

using the things that we learned here; what went right, what went

wrong and try to work on these.

I think working with the respirator community on having respirators that are more likely going to be worn by workers is very

important.

Working with the responders to make sure that they are comfortable with respiratory protection. Prior to September 11 they

really were only accustomed to the self-contained breathing apparatus, the scuba-like tanks. They did not know what negative pressure respirators were, and that was a problem.

And we are working very hard with those groups.

Coordination, collaboration and let us not forget that we have to

keep working on this issue. I think that is absolutely essential. We

can all do more in that regard.

Mrs. MALONEY. Ms. Porter, if you heard the first panel, I would

like to place into the record a series of questions really on the funding. The funding for the monitoring was a bipartisan effort, along

with Senator Clinton and Senator Schumer and others. And Mr.

Shays and Mr. Turner all supported it. Yet what we heard from the

first panel is they are not getting the money. The fire department

says they’re not getting the $25 million to continue their monitoring and treatment, and Mount Sinai does not know if there will be

a disruption in their screening program. They have people on the

waiting list trying to get in to be screened.

And I am sure you heard the comments that they felt the central

registry, both in Mount Sinai and the city, was more effective in

compiling the data for future research. I understand you have

plans to market it out to different areas around the city, or whatever. And this might be problematic.

And my overall question is why can’t they get the funding? We

voted on this months ago. This was a bipartisan effort. It was

signed into law. And they are still telling us they do not have the

money.

Ms. PORTER. Right. The funds were transferred to us from FEMA

on June 17th. And 6 days subsequent to that, we provided funding

to the Mount Sinai Clinic to extend the baseline screening work,

which was what was deemed appropriate after the May 2nd meeting that we had, which we had, by the way——

Mrs. MALONEY. But the continued funding, the $25 million and

the continued $90 million.

Ms. PORTER. Right. And then on 10 days, subsequent to receiving

the funds, we provided—we signed a contract with the New York

City Fire Department. And, unfortunately, we have in working together with the fire department, learned that we want to encourage firefighters to participate in the program, ensure the quality of

the data as well as the consistency of the data with the other

screening programs so that it’s utility over time is there. And, unfortunately, we determined that the contract mechanism was not

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the appropriate mechanism to use, even though it got the money

out there quickly, it meant that the Government had to have the

data. In other words, the data was transferred to us. The fire department was concerned about that issue related to confidentiality.

Mrs. MALONEY. Well, I would like to work with you in a future

meeting on how we can get these funds released and out of Washington.

Ms. PORTER. Right. Right.

Mrs. MALONEY. And into where they were designated.

Dr. Gilman, as I mentioned, that there was an article today in

the Daily News where they talk about a memo that came out directly after September 11 saying that it was a health crises, it was

detrimental to the health of people, that they should not return to

the area, should not be in the area. And I do not know if you have

read the article, but it is a scientific——

Dr. GILMAN. Juan Gonzalez’ column.

Mrs. MALONEY. Juan Gonzalez’ column, but a scientific expose,

basically saying that there was not a response.

Just in walking outside for a moment, several people came up to

me, including one reporter, who said they were at Ground Zero.

The catastrophe happened on Tuesday, but it was not until Saturday before any monitoring notice was put up saying that the air

could be problematic. That there was no monitoring notices put up

until Saturday.

You said in your testimony that you responded immediately, yet

they are telling me nothing was put out publicly to them until Saturday. And according to Juan Gonzalez’ article, the scientific analysis that was done was not responded to.

Because he is going to cut me off I know, I just want to say that

at this map that you showed of the plume going out and where it

was the most problematic, I quite frankly was surprised to see that

the area that we the most infected really was in Brooklyn in the

plume that went out from the study.

So I would like to know if you have any data, Ms. Porter or others, on the emergency rooms that responded on September 11, particularly from Brooklyn hospitals after September 11? According to

that plume, there should have been more medical problems in

Brooklyn, and I have been told through hearsay from medical doctors that there were huge increases in admission for adult asthma

and general respiratory problems after September 11. In Brooklyn,

as much as 23 percent. I do not know if there is any historical data

on that. But if you could get back in writing to me on it, if we do

not have the time.

But, Dr. Gilman, what they are telling me out there including reporters, they are saying I was down at Ground Zero. There was

nothing put up telling us that there was a health problem from

EPA until Saturday, clearly many days after the disaster?

Dr. GILMAN. Well, let me start by saying your interpretation of

the graphics is incorrect. The first two photos appended to the testimony actually show the greatest concentration in the immediate

vicinity of the World Trade Center, not Brooklyn in fact.

Mrs. MALONEY. But this one, the impact after days. Is that not

Brooklyn. This graph, this plume study.

Dr. GILMAN. The plume study, yes.

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Mrs. MALONEY. That is Brooklyn.

Dr. GILMAN. And that is not the dust plume, but that would be

the plume from fires and the different concentrations are color

coded there with the greatest concentration being in close in the

red area. And there is no question that in the first hours and probably all the way through to the second day, there were debris from

the World Trade Center found in Brooklyn, as the representative

from the New York Department of Health was saying. The question

was where were the concentrations the greatest, where was the

greatest concern for exposures to people.

As far as information available to the folks at Ground Zero, the

EPA and other Federal agencies were getting together within 24

hours of the event and trying to sort out——

Mrs. MALONEY. But they are saying no notices were put up. We

have an example of a notice here for safety.

Dr. GILMAN. Well, I do know——

Mrs. MALONEY. But nothing was put from EPA saying that this

is a dangerous zone, watch out for your health. That there was no

air monitoring reports to the public until Saturday. That is what

they are telling me.

Dr. GILMAN. Well, two different things.

Mrs. MALONEY. OK.

Dr. GILMAN. The public at large and the people located at

Ground Zero and at the site of the collapse, the World Trade Center, EPA professionals as well as other agencies were telling people

at the site that it was a dangerous place in terms of what was

being breathed. And so the advice throughout was, as offered by

OSHA and others, was to use respirators.

The question of what was being said to the public, you know, I

cannot speak to the availability of flyers or not. But I can speak

to the fact that there were oral communications with the city, with

the workers on the part of, I think, all of our agencies about the

danger at Ground Zero.

Mrs. MALONEY. My time is up. Thank you.

Mr. SHAYS. And we will be able to ask a few more questions here,

so it is not your last chance here.

We are going to go to Mr. Turner.

Mr. TURNER. As the Nation watched the tragedy of the World

Trade Center collapsing, I do not think that there is an individual

who witnessed that, either on television or here in this community,

who did not intuitively understand that there were health impacts

and that there were health concerns as a result of those towers collapsing. It does not take an EPA report or an OSHA report for all

of us around the country immediately to have understood the

health struggles of those who were both responding and who were

fleeing the tragedy. We saw them all on television, we read them

in our newspapers. And scientific analysis was not really needed

for us to initially understand that the people who were responding

were doing so as true heros and in peril of their own safety.

Dr. Gilman, I have some questions concerning the EPA’s jurisdiction. There have been some questions concerning the EPA’s actions

during this time period. And I am assuming that there is a regional air pollution control agency in this area other than just the

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Federal EPA or other air control agencies or monitoring agencies

present in the New York area, are there not?

Dr. GILMAN. The way the Clean Air Act is it really is a partnership.

Mr. SHAYS. I am going to ask you use one mic and we will just

have one mic directly in front of you.

Dr. GILMAN. It really is a partnership under the Clean Air Act

with State government and the Federal Government. And so, for

example, some of the monitors I mentioned that were used that

were already in place for purposes of the Clean Air Act are ones

that are not operated by the Federal Government.

Mr. TURNER. So this information was readily available to the

State agencies and perhaps even the local agencies, not just merely

handled or controlled under EPA?

Dr. GILMAN. Yes. And we did create a Web site quickly. It was

actually up and functioning by about, I believe it was September

26th to provide general access to the public for the information as

well.

Mr. TURNER. In your testimony and the slides you gave us, you

mentioned the nationwide air monitors that were already were in

place that were staked, that you were coordinating with the EPA.

Then you go on to say that the EPA established 20 World Trade

Center air sampling stations. Now, I am assuming that information

was not solely in the control of the EPA when these stations would

report. Who else would have had the information that was coming

from these stations?

Dr. GILMAN. Well, there was a task force put together of State,

city and Federal agencies that were all trying to share that information. A data base was created. I do not know the exact date at

which it was up and running for sharing among the different agencies. But, as I say, the publicly available site was up by September

26th. Maybe Kat Callahan of Region 2’s office can——

Mr. TURNER. My basic point, though, in asking about who had

access to this information is that there has been some perception

that somehow the EPA or others might have controlled the spin of

the dissemination of this information. And it is my belief that this

information would have been much more widely available to State,

local agencies so that it would not have been able to be controlled

by the EPA or others in its dissemination or spin, if you will.

Dr. GILMAN. Why do we not have Kathy Callahan, who was in

charge of this effort for our Region 2 office——

Mr. SHAYS. You got your own mic.

Mr. TURNER. And I hope my time will be extended while we do

all this.

Mr. SHAYS. No, we do not need mics. We are all set. Everybody

has a mic. I am losing control.

I would like you to tell me your name, your title and then answer

the question.

Ms. CALLAHAN. I am Kathleen Callahan. I am from EPA’s Region

2 office. And I am the Assistant Administrator for Response and

Recovery in New York City operations.

Mr. TURNER. Yes.

Ms. CALLAHAN.

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And to answer the question of who had access to what information. On September 12th we established, and it began the afternoon of the 11th, but we began our first of many, many conference

calls with agency representatives from the Federal Government,

from State government, from city government. Initially, actually,

from the private sector as well because they were taking samples.

And we exchanged sample results among that group and consulted

on what to do next and what the implications of those samples

were.

In addition to that, everyday the emergency operations committee that was established uptown, which had representatives from

a broad base of Federal agencies, State agencies, city agencies had

morning meetings at which, you know, data results were provided.

Evening meetings to see if there was anything new to add. And

downtown there was a daily meeting at which sample response results were provided and health and safety issues were also—everyday.

Mr. TURNER. So the analysis of this information, the dissemination of it, the reporting of it to the community was not solely controlled by one point or one agency?

Ms. CALLAHAN. Absolutely not.

Mr. TURNER. Mr. Gilman, in looking at the information that you

had—Dr. Gilman, excuse me. If you look at the information that

you have concerning EPA’s indoor air monitoring and cleaning program, one of the misconceptions that I heard during panel one was

that the EPA had a mandated responsibility to clean up all of the

buildings and the apartments that were around the World Trade

Center. And when I read your testimony it talks about a request

that you received from New York City and your response, and a

voluntary program where you went to individuals that were in the

area and provided some services. And there may be some criticism

or question as to the effectiveness of your program. But I just want

to touch on the point of whether or not you were legally mandated

to clean up the results of the World Trade Center collapse?

Dr. GILMAN. I will defer to Kathy in a moment, but I will say

that under an emergency response and under the emergency response plan, different responsibilities get divided up among the different agencies. In the case of the indoor air, the initial responsibility went to the city of New York. Subsequently, the city asked the

EPA to become more involved and ultimately to take over the testing and clean up program that was begun in May 2002.

Kathy, do you want to add?

Ms. CALLAHAN. That is absolutely accurate. And I think that in

addition to that, the underpinning of our sort of statutorial authorizations is important. The Stafford Act is what defines sort of the

agency’s funding and statutory opportunities to respond to a federally declared disaster. And so EPA was operating under the Stafford Act.

In addition, EPA operates under the SuperFund law and the national contingency plan regulations that support that law in supporting its role within the Federal Response Plan and in support

of the Stafford Act.

Mr. TURNER. Could you expand your answer related to testing,

but specifically with the area of clean up. I mean, it is the same.

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Your testimony was that both testing and clean up concerning the

program was not something that EPA was mandated to do internally in individual dwelling spaces. Is that correct?

Ms. CALLAHAN. The National Contingency Plan and the SuperFund law, which is part of what we are responding under, authorizes EPA to undertake certain actions. But there are a lot of criteria that are applied in exercising the judgment so that we determine when we proceed on that authorization. And in a federally declared disaster, we do that in the context of a Federal Response

Plan and the Stafford Act as well. And so it is not, per se, a directive to conduct certain activities. It is an authorization to conduct

them given the agency’s evaluation of the appropriateness in the

response.

Mr. TURNER. Ms. Porter, when you talked about the different

baseline medical screening and the data bases that were being created, we have a split that is happening between the New York Fire

Department’s baseline screening, what Mount Sinai is doing for

those individuals who responded to the site, worked on the site but

were not necessarily members of the fire department, and then we

also have what the health department is doing with individuals

that live in the area.

What is your assessment of the coordination of those programs

and what advice might you have in that area?

Ms. PORTER. I think currently there is a steering group where,

as you heard them testify, all Mount Sinai sits on the fire department’s steering council as does the fire department sit on Mount

Sinai’s group. And so there is coordination.

Could there be better coordination? Always. And I think that as

we construct the longer term program, we will actually mandate in

the announcement a steering group that will be constituted and

funded through that mechanism.

Mr. TURNER. Thank you.

Thank you, Mr. Chairman.

Mr. SHAYS. I thank the gentleman.

At this time the Chair would recognize Major Owens.

Mr. OWENS. Thank you, Mr. Chairman.

I would like to begin by getting some clarification from Mr.

Clark, since they distributed the largest number of respirators. Can

you clarify the terminology? There were some workers who said

they never had anything for the first few weeks but paper masks.

Is that a respirator, a kind of respirator? You mentioned half mask,

full mask; there are two categories. Are there other categories? Do

people mistakenly call it something else, the respirator?

Ms. CLARK. I can talk about what we provided. And we did this

under the auspices of the New York City Department of Health.

We offered that we would take over the respirator distribution

and fit checking and fit-testing eventually process for them. And

we did so. Prior to that the New York State Department of Labor,

Public Employee Safety and Health Program as early as the 12th

were involved with handing out respirators.

I mentioned that as a group all the safety and health professionals on the site got together very early on, after the first couple

of days, and determined that because the site was so unpredictable

and we were not able to determine exactly what the exposures to

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the workers might be, we would go to a high level of protection.

And that was the half faced piece negative pressure respirator with

the three types of cartridges. The high level particulate filter that

would be appropriate for things like asbestos or silica or other particulates. An organic vapor that would be for things that might be

coming out of the fires, the plumes and acid gases that also might

be in that context.

Those are the three major categories of——

Mr. OWENS. So this is one mask you are talking about with three

different internal components that can be adjusted?

Ms. CLARK. Three large—it has a very large canister. In fact, in

your exhibits, and I think it is exhibit 7 or 8, you will see two of

my compliance officers who were onsite wearing the respirator with

that cartridge on with the triple cartridges.

That is what we felt was appropriate, and we continued to do so

until we found some of the higher levels in particular operations.

And then we said not just a half faced respirator, but one that is

full faced for people who were doing jack hammering or some of the

core drilling operations you need a higher level of protection that

is afforded by that kind of respirator.

Those were the kinds of respirators that were provided us

through the city of New York. They got contributions from all over

the country, our Assistant Secretary called equipment manufacturers of respirators early that first week asking for donations. Those

were all provided. The city bought a lot of respirators.

In addition, contractors and unions also brought respirators to

the site. Very early on, though, the site safety and health mandated, as you can see by the signs and in some of the exhibit, that

type of respiratory protection, that high level. And that is what we

were involved with using.

Mr. OWENS. Are you familiar with the mask that Members of

Congress have been given. All our offices have a certain supply of

masks. I think they are called gas masks. Maybe that is a popular

term. Are they same as respirators? Are you familiar with the

model that are distributed to Members of Congress.

Ms. CLARK. A mask, some people do use the term gas mask to

refer to a type of respirator. I am not familiar specifically with the

ones that you may have in your offices. No, I am not. I am happy

to work with you if you would like to have a separate consultation

on that.

Mr. OWENS. Before I go any further, I just want to congratulate

OSHA for the magnificent job they did. You were as much a victim

in many cases. Your whole agency wiped out, as other people were.

Your heroism is to be—certainly you are to be congratulated for

that. But I hope your experience can be used for the future.

And one of the items that you anticipated where I was going, is

there a problem with a supply of respirators in the country, manufacturers? Is there a problem the technology of respirators when

they are so clumsy that people do not want to wear them? They

do not feel that they can work in them and wear them. Are we on

top of a respirator crises or was there a respirator crises?

The city certainly did not have enough. You said they had to get

them from various sources. The Federal Government did not have

any, otherwise you would not have to turn to the city. I mean, you

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had no procedure for a large number of masks that you could reach

and pull into the situation right away.

Ms. CLARK. There actually was a large number, a cache of respiratory protection in the city itself. We did lose our own office, our

Manhattan area office. So all of our people were without. I am very

fortunate that my regional office is a mile and a half north of the

city. We did have some respirators there. We also have——

Mr. OWENS. You have respirators stored in your office?

Ms. CLARK. Yes. Yes. And we had enough for the Federal community. We also certainly consider your concern about lessons

learned issues on respirators. This is clearly one of the major

issues that has come up. And we’re working on that in a number

of ways.

Under the Department of Homeland Security we are working

with them to establish caches of equipment around the country including respiratory and protective equipment.

Goggles, the dust on the site was also very intense. And that was

appropriate to have eye protection as well.

And so these caches will have that kind of equipment and they

will be located throughout the country.

We are also working with the equipment manufacturers, the respirators especially, to determine what their turnaround time is to

put more respirators out if we need them and where can we get

them, and how can we get them to the site. If the issue is in lower

Manhattan, how can we get them there very quickly?

The National Guard and all of the other groups that were very

helpful in our supply route was very essential of that. But that is

part of our preparedness that I talked about before this. So essential.

Mr. OWENS. It is recognized that we need a system for dealing

with supplies of respirators.

Ms. CLARK. Absolutely.

Mr. OWENS. And that system is in process at this point?

Ms. CLARK. Yes.

Mr. OWENS. Being developed?

Ms. CLARK. Yes.

Mr. OWENS. One other question. At least one person mentioned,

they used the phrase ‘‘that OSHA was not in enforcement mode.’’

What is the significance of that? You have mentioned partnership

model and my committee, which is responsible for work force protection, I am constantly being assailed by the majority party about

the need for partnership models. I generally agree that it is a good

approach. But did that have anything to do with limiting the liability of anybody in terms of the city or the State, and does that have

any impact on the callous way in which people who did get ill and

have been effected are being treated? Did that remove any obligations?

Ms. CLARK. Absolutely not. As I did try to explain before, we

were working within the guidelines of the Federal Response Plan

and the National Contingency Plan, which provide for us to do consultation and assistance in some kind of catastrophic event such as

this.

We quickly determined that this was not a typical

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forcement would work. The enforcement process is a very legal

process that can take months to years to occur. That was not what

was needed.

What was needed was to have safety and health professionals,

OSHA onsite, the eyes and on that site finding hazards, getting

them corrected immediately. That is why I had so many people

there for 24 hours a day, 7 days a week for 10 months working

with all of these other safety and health professionals.

And as someone has already mentioned, it did work. We did not

lose another life on that site during that time. And I think that certainly the issue of having people there, their presence. We had

workers tell us, ‘‘You know, these respirators are tough but when

I see one of your people, I remember to put it back on. I might take

it off to talk to someone or I might not put it on after the break,

but your guy reminded me.’’ I mean had people there telling me

that.

Mr. OWENS. Yes, it is miraculous that no lives were really lost

there. And the whole atmosphere, obviously, was conducive to getting the job done with minimum risk.

Just the last question is can anybody whose brought into court

by some of the sick workers who are looking for relief use your

whole harmless approach as an argument, find that your whole

harmless approach is being used as an argument against their

being able to get compensation for their disability?

Ms. CLARK. By not using our enforcement tool, that only meant

that we did not issue citations to the contractors. Those were the

people who would have received any kind of citation. That is the

only issue. And there would have been——

Mr. OWENS. The contractor cannot say in court that you gave

them carte blanche to operate a certain way, therefore they cannot

be liable?

Ms. CLARK. No. They certainly cannot. Because under the partnership agreement that you mentioned earlier, we had a very

strong commitment that this type of respirator protection was part

of that partnership agreement. Every contractor on the site, the

four major contractors on the site signed it. The union signed it.

The city agencies that were directing it. The FDNY and the Department of Design and Construction. We all signed that. We were

all committed to this very comprehensive safety and health program that went far beyond what our regulations would require as

far as the respiratory protection, the safety measures, the training.

No, I think they actually were under a higher level of requirement,

actually.

Mr. OWENS. And you do not cover the Transit Authority and the

city and State?

Ms. CLARK. That is correct. We hold that the private sector and

Federal employees, we—in New York State the New York State

Department of Labor Public Safety Employee and Health Program

covers the State and municipal workers.

Mr. OWENS. Thank you.

Mr. SHAYS. We will be able to come back.

Mr. OWENS. Thank you, Mr. Chairman. I am sorry I went over.

Mr. SHAYS. No, these are excellent questions. I am learning a lot

from both the questions and from, obviously, our witnesses.

169

In the 9 years I have chaired this committee, the only person I

never swore in was Senator Byrd, because I chickened out. I do

want to make sure, I think Ms. Callahan, you were sworn and you

stood up behind. Yes, so we will just note for the record you are

sworn in as well. I did not want to add you to my list. You would

have been in high company there.

At this time the Chair recognizes the gentleman whose district

is, obviously, directly impacted though so many were.

Mr. NADLER. Thank you, Mr. Chairman.

Mr. Turner asked a number of questions or made some statements a few minutes ago which I think go to the heart of some of

the questions here. And he said that the EPA does not have a mandate to clean up these buildings. Dr. Gilman, Ms. Callahan said the

same, or answered the questions to that extent. And Ms. Callahan

referred to the Stafford Act.

Now, my impression, and let me very careful on this. It is not

my impression. My knowledge. Is that under Presidential Decision

Directive No. 62 signed by President Clinton in 1998, the EPA is

mandated to clean up any building contaminated in a terrorist attack. Administrator Whitman testified to this effect before the Senate in November 2001. Acting Administrator Herinko testified in a

recent deposition under oath that PDD 62 applies to the World

Trade Center case and to the clean up of building interiors. Under

President Bush’s National Strategy for Homeland Security issued

in July 2002, after the World Trade Center, admittedly, the EPA

is ‘‘responsible for decontamination of buildings and effected neighborhoods’’ following a major incident.

Would you like to withdraw what you said a few minutes ago

and reconfirm it under oath?

Ms. CALLAHAN. What I said was the exercise of our authority

under the Stafford Act and under the National Contingency Plan,

and I believe it is consistent with the Presidential Decision Directives, was a decision process. And we made those decisions as to

what was appropriate and we feel we made them reasonably.

Mr. NADLER. Well, let me ask you this question then. Is it or is

it not the duty of EPA under Presidential Decision Directive 62,

and I would say also under the CIRCLA law, but more importantly

under PDD 62, to see to it perhaps by delegating to the city or to

somebody else, but making sure it gets done one way or the other,

it is your responsibility to see it that indoors as well as outdoors

is cleaned up from hazardous waste discharges as a result of a terrorist attack? Yes or no?

Dr. GILMAN. Kathy is not the attorney for the agency.

Mr. NADLER. So you are the attorney?

Dr. GILMAN. And I am not an attorney, either.

Mr. NADLER. We have been pursuing this question for almost 2

years now.

Dr. GILMAN. Yes. And I am not an attorney for the agency, either. And you may be a trained attorney. And I am happy to try

and get some response to your question. I am not qualified to answer it. I am not sure that Kathy is either.

Mr. NADLER. Well, let me say, both of you sat here and said essentially it was the city’s job, they did it—or they did not do it, but

it was the city’s responsibility and they asked you for help. At

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other times people from EPA have testified that the city asked you

not to help. And we have been maintaining for 2 years that it is

EPA’s responsibility to do it or to delegate it to someone, but make

sure it gets done under their supervision. And essentially you have

been saying that is not your responsibility.

We have been saying, and again Acting Administrator Herinko

testified in his deposition a few months ago that it was. The agency

should be able to say it is or it is not your responsibility.

Dr. GILMAN. But, Congressman, at the time I did say, we have

taken on that responsibility.

Mr. NADLER. No, you have not. Well, I want to know is or is it

not your responsibility to do it? And whether you have taken it or

not is a separate question. I would say you have not, and I will not

get into that now.

If you do not want to answer under oath, etc., without getting

a lawyer, fine. But I would ask that you supply an answer to that

question afterwards.

Dr. GILMAN. Sure. Be happy to.

Mr. NADLER. Thank you.

Mr. SHAYS. I would like to say, that these are very fair questions,

but under no circumstance do I think that our witnesses are doing

anything but just trying to provide very honest and very candid responses. But I also want to say to the gentleman that I know this

has been a gigantic and legitimate concern and answers have not

been forthcoming. And it is important those answers happen.

We did not ask the legal side of EPA to be here to even deal with

that issue, frankly.

Mr. NADLER. I raised it because Mr. Turner did.

Mr. SHAYS. Right.

Mr. NADLER. Let him supply the authority.

Mr. SHAYS. Right. And then there will be, and also I just assure

the gentleman, he will be given more time. I did interrupt.

Mr. NADLER. Thank you.

Let me also just make one comment and then go into some questions.

Mr. Turner said that, and quite logically, that it was common

sense if you smelled the thing and went there that people knew

that there was something wrong with the air. The problem is that

starting 2 days after the disaster in the person of Ms. Whitman

and others, the EPA started assuring everybody do not worry, the

air is safe to breath. There have been reasons for that those assurances were done. I will not get into the IG report, but there were

a lot of assurances and at the very least mixed messages.

Now, let me ask you, Dr. Gilman, in the clean up that the EPA

began in May 2002, despite demands from my office, the workers

who were cleaning up asbestos laden material when the testing revealed asbestos, did not wear any protective equipment. Why?

Dr. GILMAN. I am not personally familiar with that clean up program.

Mr. NADLER. Ms. Callahan.

Ms. CALLAHAN. Based upon the data that was collected in the

clean up of the immediate surroundings of the World Trade Center,

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mitted workers not to wear personal protective equipment in the

clean ups that were being conducted under——

Mr. NADLER. But you did testing. And if you had—go ahead.

Ms. CALLAHAN. Under Scope A, which was where there was very

minimal dust in the apartment.

In the Scope B clean ups that we characterized where there

might be substantial dust still there, they would indeed comply

with wearing personal protective equipment.

So we worked in conjunction with OSHA on that issue.

Mr. NADLER. Well, let me say first that Secretary Henshaw’s letter says that wherever there is any dust you must wear—where

there is any asbestos you must wear protective equipment, No. 1.

No. 2, I would hope that OSHA can supply us with a copy of that

letter saying they do not have to wear protective in Scope A clean

ups. And then I would like to square it with Secretary Henshaw’s

prior letter of January 2002.

And third, it is my information from talking to dozens of people,

constituents, we never observed a worker ever wearing protective

equipment in a Scope A or a Scope B clean up. So I do not know

what evidence you can produce at this point that they did.

Also, would you define ‘‘minimal dust’’ for this purpose?

Ms. CALLAHAN. A light coating of dust, minimal dust.

Mr. NADLER. A light coating. With a 1-percent asbestos in it, perhaps?

Ms. CALLAHAN. We did not test for asbestos content.

Mr. NADLER. So was it one——

Ms. CALLAHAN. We made an—excuse me, if I could finish, Congressman, I think it is important to your point.

Mr. NADLER. OK.

Ms. CALLAHAN. We made an assumption that all the dust had

the potential for asbestos from early on. And so, you know, we felt

we were being consistent. And the negative exposure assessment

was based on the personal monitoring of workers that worked in

heavily, heavily contaminated areas. And I think that is why

OSHA felt that they could give that assurance and permit us to

proceed.

Mr. NADLER. So a light coating of dust which might have 2 or

4 or 5 percent, for all you know, asbestos in it, it is safe to have

people remove it with no asbestos, and legal for that matter, with

no protective equipment?

Ms. CLARK. Congressman, if I might join the discussion?

Mr. NADLER. Yes, please.

Mr. SHAYS. Hold it a second. These mics do not turn on until a

person starts to speak, and then they pick up.

I want no comments from the audience, please.

Ms. CLARK. As part of the EPA clean up of the residences, we

were involved in doing 156 safety and health inspections of those

clean up operations to look at what was happening with the workers that were involved. Some of those involved Scope A, as I understood it, no visible dust or Scope B where there was some visible

dust as well as any cleaning of the heating and air conditioning

systems.

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And as Ms. Callahan indicated, during Scope A they were not

wearing the protective equipment, the respirators, but they were

during Scope B and with the HVAC.

All of our sample results for those 156 clean ups did not show

any over exposures for asbestos.

Mr. NADLER. OK.

Ms. CLARK. In fact, as far as air, the majority of them were nondetected.

Mr. NADLER. I have another question. And the yellow light is on.

Thank you.

I have two more questions. One should be very quick. It is Ms.

Porter. You said that we should do a lot more screening. What

about medical care for people who the screening tells us need medical care, do you think the Federal Government should get into this

in a big way on this?

Ms. PORTER. I think that as you heard, Mount Sinai testified 40

percent of the workers are uninsured that have gone through their

screening program. And in those instances there is a need for some

bridge funding to enable people——

Mr. NADLER. Bridge funding?

Ms. PORTER. Some funding to enable people——

Mr. NADLER. Some sort of funding? Thank you.

Ms. Clark, if I read your testimony, in fact your testimony was

that there was low levels of contaminates or safe levels. You read

that testimony here. ‘‘OSHA’s breathing zone examples of exposure

is well below the agency’s permissible exposure levels for the majority of chemicals and substances analyzed.’’ By the way, that is

interesting. Does that mean that there were dangerous levels of a

minority of substances tested?

Ms. CLARK. There were 3 percent of all of the samples that we

analyzed for all of those substances that I mentioned were found

to be at or above the permissible exposure level.

Mr. NADLER. OK. Thank you. Thank you.

Ms. CLARK. Those were, however, within the protection factor of

the respirator we recommended.

Mr. NADLER. For any substance? For any substance?

Ms. CLARK. Yes.

Mr. NADLER. OK.

Ms. CLARK. I can——

Mr. NADLER. I do not want more details now. Please. Because I

do have to finish the real point of the question.

You go on about you tested a lot of things and 95 percent were

below detection limits for asbestos, etc. And you have out all these

respirators. And you also said that the ‘‘key to success at the World

Trade Center site was working in partnership.’’

Given this, it was a success; yes, in the fact that no one was

killed. But how do you regard it as a success, and more to the

point, given all these low levels of contamination why are the majority of workers who worked at the site have lung impairments of

one sort or another at this point? Why do we have what I regard

as a catastrophe of hundreds, maybe thousands of people who

have—not just people caught in the cloud but of workers, of people

who came and worked on the pile, the majority of workers tested

I’ve seen estimates of some departments up to 78 percent have long

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lasting lung incapacity problems of one or sort of other? And we

have no idea, obviously, yet how many are going to come down with

cancer 20 years from now.

Given the fact that there were these low levels of contaminates

and a wonderful job was done giving out respirators, why do the

majority of workers have very severe health problems at this point?

Ms. CLARK. Mr. Nadler, I am a physician so I cannot speak to

the health outcomes. I can tell you what we did, what we found.

I can talk about the fact that I had people there everyday looking

for safety and health issues. I had people there around the clock

asking employees, begging them, sometimes almost coming to

blows with them to wear respiratory protection. We did hear from

the employees that they were uncomfortable, that they sometimes

interfered with communication. Clearly, they did not wear them all

the time. And that’s very unfortunate, and I regret that very much.

I really feel, though, that on our part we and the other safety

health professionals did everything we could to get the proper respiratory protection on the site and to have it available in such a

way that the employees understood why they should wear it. We

provided the risk communication. Unfortunately, the risk communication sometimes suggested to some of them that because we

weren’t finding high levels in certain areas, that perhaps they did

not wear it. I think that if you look at, however, certain groups.

The ones that were doing more of the drilling operations, the ones

that were doing the welding and cutting where we did have some

higher levels, up to 5 percent of the samples sometimes over the

permissible exposure levels, you did find better compliance.

You also found better compliance from the trained construction

workers who were more accustomed to wearing respiratory protection.

It was a very, very horrendous situation. Working 12 hours a

day, fires. It was not a situation where it was very easy.

Mr. NADLER. Let me just—let me——

Ms. CLARK. I cannot answer, though, why the health problems.

Mr. NADLER. Of course not.

Let me make a comment, if I may, Mr. Chairman.

Mr. SHAYS. Yes.

Mr. NADLER. I have looked at this for 2 years now. We have been

doing a lot of work with a lot of people. It is clear to me that I fault

nobody for lack of wearing respirators or getting the respirators,

etc., for the first few days, maybe a week. Because you had to get

in. There might be people alive. You got to get in, you do the job

and, you know, maybe precautions take second place. But after the

few days, or the week or the first 2 weeks there were people working on that pile for months and you have heard in our previous

panel, whole departments apparently—and it may not be your department’s, maybe some other departments or the city of New

York, or somebody—were not getting the proper protection.

And the second thing I want to say, and I am not going to go

into detail now. This has been at other hearings. But these statistics on this testing of pollutants, they do not jive with a lot of the

other testing.

For example, the testing that the University of California, Davis

under contract with, I think, it was Department of Energy when

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they put the instruments on the roof of 201 Varick Street where

my office happens to be located, Federal office building, a mile

north of Ground Zero. They were placed there on October 2nd and

they stayed, I think, until mid-January. They found levels of volatile organic compounds, dioxins, mercury; everything known to

man. They said the worst chemical factory they had ever seen,

worse than the Kuwaiti oil fires for several months afterward. So

this was a very, very bad pollution. It should not be minimized.

And the people who were there were subjected to very bad conditions and we’re seeing the results now from the first panel. And,

unfortunately, I don’t want to characterize a particular department

because I do not know, but the efforts that were made obviously

were not satisfactory. And I say that now not because I want to

condemn anybody, but we have to learn for, God forbid, the next

time.

Thank you, Mr. Chairman.

Mr. SHAYS. I thank the gentleman.

And let me just say, I thank the questions from all our panelist.

I know how heartfelt this is, and I know how important this.

And I also want to say to our three primary witnesses and also

to Ms. Callahan who also responded, that I have been very impressed with your testimony. I have been very impressed with your

sincerity.

And I said to both my colleagues on both sides, Ms. Clark, you

did a terrific job. You did. And you were under lots of pressure, you

have been, but you have done a terrific job.

We do know that we have our challenges. I am concerned that

the administration seems so reluctant to release some data from

EPA and to answer questions, which it makes me feel that they

have a story that they do not want to tell. And yet when I hear

the story, I think it is a fairly good story, if not a great story.

I thought, Dr. Gilman, your presentation was very helpful. I

would have liked to have seen it sooner, and I know it is a work

in process.

I totally agree with Mr. Turner. There is not a person who did

not know that whoever went to Ground Zero was dealing with a

building in absolute flames, with gases, with every conceivable

thing burning; plastics, to asbestos to whatever. I even know that

there was talk about whether people should go down, like Members

of Congress, to visit. But, you know, we wanted to at least thank

people for what they were doing.

And it is probably likely the first week was the most horrific and

everything else went down in terms of its ultimate impact. It is

surprising to me there were so many respirators. Not surprising to

me that people did not use them. Having built part of my own

home and knowing I should use and knowing I did not want to,

and forcing myself to. And they are not easy to work with, especially when you want to get a lot accomplished.

But we need questions answered. And I think, Dr. Gilman, you

know that.

Ms. Porter, I have a particular concern with how money has been

allocated. I mean, the first panel described one or two instances

where they are not feeling they are getting the money in due time.

175

And if anything could happen from this hearing, I would like to

think that we could see some quicker response there.

I would like Mrs. Maloney just outline some issues, and maybe

you could respond to them.

Mrs. MALONEY. In December 2001, $12 million was released for

the monitoring and FEMA released another $20 million for the registry. And $4 million out of the $90 that we appropriate quite a

while ago, practically a year ago, was released for emergency continuation. But my question, as we heard from the fire department

earlier and as we heard from Mount Sinai, the $25 million that the

fire department was allocated and earmarked for them has not

been released. And the $65 million for the monitoring has not been

released.

Now we are told that you are reviewing how you are going to release the money. But it seems like we have a system in place that

seems to be working and it seems that we should make sure that

it continues. We have people on waiting lists trying to get in for

monitoring. And there is some concern that there will be a gap in

the services. And basically since the money has been sitting there

for well over 6 months, why has it not gotten out of Washington

and into the hands of the people that are providing the services for

the sick first responders?

Ms. PORTER. We have been working very aggressively with

Mount Sinai and the other clinics in New York that are providing

services to these workers as well as with the fire department. And

as you’ve all mentioned, this is a new and unique experience that

we are going through. There has not been a long term medical

monitoring program set up like this in the country ever before. And

we are wanting to ensure that it is as comprehensive, that it

reaches as many workers as possible, and with our partners have

been working aggressively to put it forward.

I can guarantee you that there will be no lapse in funding between the baseline screening and the long term medical monitoring. The funding will be out no later than March 2004.

Mrs. MALONEY. Well, that is good.

Ms. PORTER. And the solicitation for that funding will come out

on November 10th giving people enough time to write their application and put forward their proposal.

Mrs. MALONEY. Also, they testified on the first panel that the

money is not there for long term screening. They testified that

medical experts are saying that this should be tracked at a minimum for 20 years.

Ms. PORTER. Right.

Mrs. MALONEY. Because many of the health problems may not

emerge. We are hearing they are merging a year after, 2 years

after, 5 years. One doctor testified he anticipated cancer 15 years

out.

And I am told from the first panel that the funding that is in

place is not enough for the 20 year monitoring. And have you

looked at how much it will cost for the 20 year monitoring? How

far does the $90 million go?

Also, it seems that you want to branch it out to other places,

which seems to counteract the whole idea of coordination and having it one place.

176

Ms. PORTER. Right. What we want to do is through this committee that we will establish is to have clinics working from the same

protocol, working together so that the data is comparable. But we

want to make sure that workers have access and that workers have

choice as to where they want their medical care—excuse me. Medical screening program delivered.

So, that is why we are——

Mrs. MALONEY. But have you done any studies as to how far the

funding will go for the—for the expected 20 year review period?

Ms. PORTER. Yes, ma’am. We believe that in fact the money that

has been appropriated this far will serve us for the next 5 to 6

years. And beyond that we will be working in concert with our

partners to define what needs are subsequent to that.

We agree that the 20 year followup program is what is necessary.

Mrs. MALONEY. Get back to us with how much more you think

is needed.

Ms. PORTER. Right.

Mrs. MALONEY. Also, you testified that there were environmental

health studies being done. And what are these projects that were

listed in your testimony and what are the status of them. And, as

I said, some of the victims are saying they were treated in Brooklyn. That the plume effected health in Brooklyn. That the number

of people that went to the hospitals were up as much as 23 percent.

Have you done any studies on what happened in the intake in

other hospitals as a reaction to September 11?

Ms. PORTER. Yes. There have been some studies that have been

funded with the NIH, and we will be happy to provide you the data

on when those studies are expected to be completed and the results

of them.

Mrs. MALONEY. Thank you.

Mr. SHAYS. Ms. Porter, I am going to suggest that maybe we

could get the Members here to meet with you and to just go over

some of those dollars. Just so we are clear about that as well.

Ms. PORTER. Great.

Mr. SHAYS. I think Major Owens had a few more questions, and

then we are going to kind of close this panel up in a second.

Mr. OWENS. Just one or two questions related to the workers who

were involved in the clean up of the apartment houses and the offices adjacent to the World Trade Center.

You said you made 156 inspections, did I hear correctly, of those

particular sites?

Ms. CLARK. That was the clean up that EPA did of the residential facilities in lower Manhattan from May on.

We also conducted evaluations of prior. And these were enforcement inspections. For areas outside of the 16 acre project. That was

during the time from, basically October on. We started an emphasis program, especially to look at the buildings that were most

heavily effected around the site where there was the greatest level

of clean up. So we did——

Mr. OWENS. It was documented that contractors had brought in

a large number of immigrant workers, undocumented workers.

There was even a mobile unit set up to encourage those workers

to be tested. Are you familiar with that? And what was OSHA’s

role in protecting those workers?

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Ms. CLARK. I am familiar with the mobile testing van. And, actually, we provided some information. At the van we took over our

poster in both English and Spanish, realizing that there were some

immigrant, possibly non-English speaking people coming through

there. And we also provided the sampling result summaries that I

had talked about that we provided to workers onsite. We also provided those to that mobile van as well.

And we were, again as I indicated, doing inspections outside of

the project. It took us a little while to come back, because as I indicated, we lost our whole office and we were having so many involved at the site. But we did start—we resumed enforcement inspections overall.

Mr. OWENS. Do you know who those contractors were? You have

listings of them?

Ms. CLARK. We never received any—do you mean the ones that

we inspected? Yes.

Mr. OWENS. The ones who were employing the immigrant workers?

Ms. CLARK. I do not have any specific names. None were ever

provided to us in that regard, no.

Mr. SHAYS. Is there a way we could find out these names, and

so on? How would we track that down?

Ms. CLARK. I suppose we could ask the group that had the mobile van if they had any names of contractors. We did not receive

any complaints out of our posting of our information there. And we

did attempt to try to determine if we could get any referrals for inspections. But we did not receive any. But we could certainly ask

that of the individuals who ran that van.

Mr. SHAYS. Just to continue. We are interrupting you. If the gentleman would yield, Mrs. Maloney has some point.

Mrs. MALONEY. We know that there were five general contractors

who were assigned to the site, so we could merely ask those contractors whether or not they were involved in this.

Ms. CLARK. Those five contractors, I am quite familiar with.

They were the partners in the project.

Mrs. MALONEY. Yes.

Ms. CLARK. I think what Congressman Owens was talking about

would have been actually was occurring outside of the project.

Mrs. MALONEY. Outside of the project?

Ms. CLARK. That were not contractors working for those general

contractors.

Mrs. MALONEY. Then the city of New York would have a listing

of the organization that oversaw that.

Mr. SHAYS. But we’ll track it down, though. It needs to be

tracked down. I think that is a good point.

Mr. OWENS. I can assume that there were no—OSHA did not go

into a nonenforcement mode for those mode and agree that there

was no enforcement?

Ms. CLARK. That is correct. The only area that was a consultative

mode was within the 16 acre World Trade Center site itself. The

recovery project specifically. And it was only because that site was

still controlled by the FDNY as the site commander and eventually

the city Department of Design and Construction. They were the inVerDate 11-MAY-2000 10:27 Apr 15, 2004 Jkt 000000 PO 00000 Frm 00181 Fmt 6633 Sfmt 6633 D:\DOCS\92728.TXT HGOVREF1 PsN: HGOVREF1
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cident commanders. And so within that area we did consultation.

Outside we resumed enforcement.

Mr. OWENS. Thank you.

Mr. SHAYS. Thank the gentleman.

Is there anything that any of our witnesses and Dr. Wagner and

Dr. Williamson. Sometimes I notice that people who say nothing ultimately in the end have the most important things to say. Not to

put pressure on you. But if any of you would like to say anything,

please feel free.

So, is there any comment that you would like to make?

Dr. GILMAN. Yes, if I may.

Mr. SHAYS. Yes, Dr. Gilman.

Dr. GILMAN. During your remarks you suggested that there was

data available or data that EPA had that they had not made available. I am not aware of anybody asserting that we withheld data

associated with these monitoring activities.

Mr. SHAYS. Yes. I would not want the data, but information

about specifics. There are questions asked and there do not seem

to be some answers to them. And we would love those answers.

Dr. GILMAN. OK. And I know we are processing some information

requests for the Congressmen. And I know they are working on

that right now.

Mr. SHAYS. Yes, sir.

And let me just say, Members of Congress feel very protective of

a Member who, in his own district or her district, needs information. So you would find both Republicans and Democrats alike

wanting Mr. Nadler to get this information and it is information,

obviously, that we are all interested in.

I guess my only point was the more I hear the story, the more

I feel that it is a story that has some answers to. I am struck also

by the fact that data was available to a lot of different agencies and

no government agency said to another do not share this information.

I do know this, though. I do know the administration shortly

after September 11th in general about a lot of things was trying

to calm people down. And I got in a little bit of a dispute with some

of them about how I thought they were understating the risk of

terrorism, overstating the safety of flying airplanes and so on, you

know, to try to calm people down.

I think you tell the American people the truth, whatever it is,

and they then want you to do the right thing, whatever that may

be. And so your point is well taken about the data.

Dr. Wagner, did you want to say anything?

Dr. WAGNER. Well, only I think a number of the questions that

were unanswerable today point out the need for high quality continuous collection of the best information that we can on the effected workers and others as well as the importance of the continuing analysis and research so that we can understand the nature of

the health effects, the best treatments and the ways to minimize

the adverse outcomes.

Mr. SHAYS. Ms. Porter is nodding her head, so you spoke for her

in that instance.

Dr. Williamson, any comment?

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Dr. WILLIAMSON. Yes. I would like to thank you, Congressman

Shays, for acknowledging the importance of the registry. I would

also like to reenforce the fact that we do think that this is a unique

opportunity for folks to participate in a data base that will allow

us to track and determine what the health impacts have been of

the World Trade Center, both long and short term.

I would also like to respond to one question about the lessons

learned. And one of the things that I would like to reenforce is, obviously, the collaborations are critical. But I think another thing

that we are doing at CDC and ATSDR is putting together a mechanism which will help us, God forbid, we are ever in a situation as

we have been in September to have a rapid response registry so

that with perhaps a quick funding mechanism, along with a rapid

response registry we can gather some of the important scientific

data that Dr. Wagner mentioned and yet at the same time get it

out in a timely fashion so that the funding and the infrastructure

is there.

Mr. SHAYS. Thank you. Let me thank, obviously, my colleagues

for their participation in this hearing. And I want to also thank

both panel one and panel two. You have been an excellent panel.

I want to thank our audience for its cooperation.

And also to say that it is clear to me that there is more to the

story that we have to deal with, more issues. It is clear that there

are residents in the area who have concerns. There are workers in

the area who have concerns, that these concerns need to be addressed.

We have learned a lot of lessons on September 11th. We know

we have a lot more lessons to learn.

I want to also thank the staff of Mount Sinai Medical Center for

the use of this facility and all their help preparing for the hearing.

I want to thank Congresswoman Maloney and her staff. They

have been terrific.

I would also like to thank David Rapallo of the minority staff for

the full committee. And Larry Halloran, my chief of staff for my

subcommittee. And let me also recognize the work of Kristine

McElroy and Bob Briggs of the subcommittee staff. Kristine did a

tremendous job preparing us for this hearing.

And finally, thanks to the official reporter, Jennifer Rosario.

Thank you very much.

And to all that made this a very important hearing. Thank you.

With that, this hearing is adjourned.

[Whereupon, at 2:29 p.m., the subcommittee was adjourned.]

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