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H.R. 6594, THE JAMES ZADROGA 9/11 HEALTH 

AND COMPENSATION ACT OF 2008 

HEARING 

BEFORE THE

SUBCOMMITTEE ON HEALTH 

OF THE

COMMITTEE ON ENERGY AND 

COMMERCE 

HOUSE OF REPRESENTATIVES 

ONE HUNDRED TENTH CONGRESS 

SECOND SESSION 

JULY 31, 2008 

Serial No. 110–143 

( 

Printed for the use of the Committee on Energy and Commerce 

energycommerce.house.gov 

COMMITTEE ON ENERGY AND COMMERCE 

JOHN D. DINGELL, Michigan, Chairman 

HENRY A. WAXMAN, California 

EDWARD J. MARKEY, Massachusetts 

RICK BOUCHER, Virginia 

EDOLPHUS TOWNS, New York 

FRANK PALLONE, JR., New Jersey 

BART GORDON, Tennessee 

BOBBY L. RUSH, Illinois 

ANNA G. ESHOO, California 

BART STUPAK, Michigan 

ELIOT L. ENGEL, New York 

GENE GREEN, Texas 

DIANA DEGETTE, Colorado 

Vice Chair 

LOIS CAPPS, California 

MIKE DOYLE, Pennsylvania 

JANE HARMAN, California 

TOM ALLEN, Maine 

JAN SCHAKOWSKY, Illinois 

HILDA L. SOLIS, California 

CHARLES A. GONZALEZ, Texas 

JAY INSLEE, Washington 

TAMMY BALDWIN, Wisconsin 

MIKE ROSS, Arkansas 

DARLENE HOOLEY, Oregon 

ANTHONY D. WEINER, New York 

JIM MATHESON, Utah 

G.K. BUTTERFIELD, North Carolina 

CHARLIE MELANCON, Louisiana 

JOHN BARROW, Georgia 

DORIS O. MATSUI, California 

JOE BARTON, Texas 

Ranking Member 

RALPH M. HALL, Texas 

FRED UPTON, Michigan 

CLIFF STEARNS, Florida 

NATHAN DEAL, Georgia 

ED WHITFIELD, Kentucky 

BARBARA CUBIN, Wyoming 

JOHN SHIMKUS, Illinois 

HEATHER WILSON, New Mexico 

JOHN SHADEGG, Arizona 

CHARLES W. ‘‘CHIP’’ PICKERING, 

Mississippi 

VITO FOSSELLA, New York 

ROY BLUNT, Missouri 

STEVE BUYER, Indiana 

GEORGE RADANOVICH, California 

JOSEPH R. PITTS, Pennsylvania 

MARY BONO MACK, California 

GREG WALDEN, Oregon 

LEE TERRY, Nebraska 

MIKE FERGUSON, New Jersey 

MIKE ROGERS, Michigan 

SUE WILKINS MYRICK, North Carolina 

JOHN SULLIVAN, Oklahoma 

TIM MURPHY, Pennsylvania 

MICHAEL C. BURGESS, Texas 

MARSHA BLACKBURN, Tennessee 

PROFESSIONAL STAFF

DENNIS B. FITZGIBBONS, Chief of Staff 

GREGG A. ROTHSCHILD, Chief Counsel 

SHARON E. DAVIS, Chief Clerk 

DAVID CAVICKE, Minority Staff Director 

(II)

(III) 

SUBCOMMITTEE ON HEALTH

FRANK PALLONE, JR., New Jersey, Chairman 

HENRY A. WAXMAN, California 

EDOLPHUS TOWNS, New York 

BART GORDON, Tennessee 

ANNA G. ESHOO, California 

GENE GREEN, Texas 

DIANA DEGETTE, Colorado 

LOIS CAPPS, California 

Vice Chair 

TOM ALLEN, Maine 

TAMMY BALDWIN, Wisconsin 

ELIOT L. ENGEL, New York 

JAN SCHAKOWSKY, Illinois 

HILDA L. SOLIS, California 

MIKE ROSS, Arkansas 

DARLENE HOOLEY, Oregon 

ANTHONY D. WEINER, New York 

JIM MATHESON, Utah 

JOHN D. DINGELL, Michigan (ex officio) 

NATHAN DEAL, Georgia, 

Ranking Member 

RALPH M. HALL, Texas 

BARBARA CUBIN, Wyoming 

HEATHER WILSON, New Mexico 

JOHN B. SHADEGG, Arizona 

STEVE BUYER, Indiana 

JOSEPH R. PITTS, Pennsylvania 

MIKE FERGUSON, New Jersey 

MIKE ROGERS, Michigan 

SUE WILKINS MYRICK, North Carolina 

JOHN SULLIVAN, Oklahoma 

TIM MURPHY, Pennsylvania 

MICHAEL C. BURGESS, Texas 

MARSHA BLACKBURN, Tennessee 

JOE BARTON, Texas (ex officio) 

(V) 

C O N T E N T S 

Page 

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

New Jersey, opening statement .......................................................................... 1 

Hon. Nathan Deal, a Representative in Congress from the State of Georgia, 

opening statement ................................................................................................ 3 

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

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

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

opening statement ................................................................................................ 5 

Hon. Anthony D. Wiener, a Representative in Congress from the State of 

New York, opening statement ............................................................................. 5 

Hon. Hilda L. Solis, a Representative in Congress from the State of California, opening statement .................................................................................... 7 

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

York, opening statement ...................................................................................... 8 

Hon. Eliot L. Engel, a Representative in Congress from the State of New 

York, opening statement ...................................................................................... 8 

Hon. Vito Fossella, a Representative in Congress from the State of New 

York, opening statement ...................................................................................... 19 

Hon. Joe Barton, a Representative in Congress from the State of Texas, 

opening statement ................................................................................................ 38 

Hon. Michael C. Burgess, a Representative in Congress from the State of 

Texas, opening statement .................................................................................... 40 

WITNESSES

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

York ....................................................................................................................... 41 

Prepared statement .......................................................................................... 45 

Hon. Peter King, a Representative in Congress from the State of New York .... 49 

Prepared statement .......................................................................................... 50 

Michael Bloomberg, Mayor, City of New York ...................................................... 51 

Prepared statement .......................................................................................... 53 

Julie Gerberding, M.D., M.P.H., Director, Centers for Disease Control and 

Prevention ............................................................................................................. 56 

Prepared statement .......................................................................................... 58 

Margaret Seminario, Director, Safety and Health, AFL-CIO .............................. 78 

Prepared statement .......................................................................................... 80 

Jacqueline Moline, M.D., M.Sc., Vice Chair and Associate Professor, Department of Community and Preventive Medicine, Mount Sinai School of Medicine ........................................................................................................................ 85

Prepared statement .......................................................................................... 80 

Caswell F. Holloway, Chief of Staff to the Deputy Mayor for Operations 

Counsel, Special Advisor to Mayor Bloomberg .................................................. 97 

Prepared statement .......................................................................................... 100 

SUBMITTED MATERIAL

Prepared statement of John Reibman, M.D., Associate Professor of Medicine 

and Environmental Medicine Director NYU/Bellevue Asthma Center; Director of Health and Hospitals Corporation WTC Environmental Health Center .......................................................................................................................... 10 

Prepared statement of David Prezant, M.D., Chief Medical Officer, Office 

of Medical Affairs; Co-Director WTC Medical Monitoring & Treatment Programs, New York City Fire Department ............................................................ 21 

Page

VI 

Prepared statement of Hon. Carolyn Maloney, a Representative in Congress 

from the State of New York ................................................................................ 32 

‘‘A Pointless Departure,’’ New York Times, editorial, July 31, 2008 ................... 120 

H.R. 6594 .................................................................................................................. 121

(1) 

H.R. 6594, THE JAMES ZADROGA 9/11 HEALTH 

AND COMPENSATION ACT OF 2008 

THURSDAY, JULY 31, 2008 

HOUSE OF REPRESENTATIVES, SUBCOMMITTEE ON HEALTH, COMMITTEE ON ENERGY AND COMMERCE, Washington, DC. 

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

2322 of the Rayburn House Office Building, Hon. Frank Pallone, 

Jr. (chairman) presiding. 

Members present: Representatives Pallone, Towns, Green, 

Capps, Engel, Solis, Weiner, Deal, Burgess, Barton (ex officio), and 

Fossella. 

Staff present: Jack Maniho, Brin Frazier, Lauren Bloomberg, Melissa Sidman, Chad Grant, and Aarti Shah. 

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

Mr. PALLONE. The meeting of the subcommittee is called to 

order. And today we are having a hearing on the James Zadroga 

9/11 Health and Compensation Act of 2008. And the Chair now recognizes himself for an opening statement. 

The bill, as you know, has been introduced by Ms. Maloney, Mr. 

Nadler, Mr. King, and Mr. Fossella on a bipartisan basis and I 

want to thank all of you for your hard work on this legislation. I 

know how hard all of you have been working, not only in the last 

few weeks, in particular, but also in the last few years. 

Last year the subcommittee held a hearing to examine the ongoing medical monitoring and treatment programs related to 9/11 

health defects and I am proud to be able to hold the second hearing 

today on legislation designed to bolster current efforts and provide 

adequate monitoring and treatment services. 

I have to say, none of us will ever forget the horrible events of 

9/11, and 7 years later, we simply cannot forget about the thousands of people who helped at Ground Zero in the days and months 

afterwards. I remember, in particular, coming there a few days 

later when the President visited the Ground Zero and I also remember going with Mr. Nadler to, I guess, the Federal Court or the 

Federal building where we had a hearing—field hearing, specifically, on the health effects. I don’t remember when that was, Jerry, 

a couple weeks or a couple months later, but I remember you, in 

particular, very concerned about the health effects at a time when 

many of the—those in Washington, including then—or former GovVerDate Nov 24 2008 12:28 Oct 21, 2010 Jkt 037690 PO 00000 Frm 00007 Fmt 6633 Sfmt 6633 C:\DOCUMENTS AND SETTINGS\CWELLS1\HEARINGS\110-143 SCOM1 PsN: JIMC
2 

ernor Whitman, who were sort of downplaying the impact of it and 

saying that it really wasn’t a problem. But we have to do everything in our power to protect the responders, the clean-up crews, 

the volunteers, and the victims of the World Trade Center attacks. 

Thousands of first-responders, rescue workers, and local residents now suffer from chronic medical conditions that are directly 

related to the tons of dust, glass fragments and other toxins that 

were released into the air in lower Manhattan when the Twin Towers collapsed. Studies have shown that nearly 70 percent of the rescue workers currently suffer from complex respiratory conditions 

that were caused or worsened by the September 11 terrorist attacks. One-third have abnormal pulmonary function tests and one 

in every eight responders has experienced symptoms of post-traumatic stress disorder. 

Studies have also examined the effects on local residents, showing a three-fold increase in lower respiratory diseases, as compared 

to controlled populations, low pregnancy rates and an increase in 

the variety of mental health disorders. 

OK. Is that better? OK. I will put it back on you. All right. 

And these brave men and women who were present during one 

of our Nation’s darkest hours are in need of our help. In my district 

alone, there are 1400 known individuals who were exposed to the 

toxins released by the 9/11 attacks. It is now our turn to step up 

to the plate and help ensure that they can access the medical care 

they need and deserve. 

The James Zadroga 9/11 Health and Compensation Act is an important step in this direction. The bill is named for James Zadroga, 

who I should mention was a New Jersey hero who responded on 

9/11 and spent hundreds of hours digging through the World Trade 

Center debris. Mr. Zadroga died in 2006 from pulmonary disease 

and respiratory failure after his exposure to toxic dust at the World 

Trade Center. 

The bill would establish a permanent program to monitor and 

screen eligible residents and responders and provide medical treatment to those who are suffering from World Trade Center-related 

diseases. It would direct the Department of Health and Human 

Services to conduct and support research into new conditions that 

may be related to the attacks and to evaluate different and emerging methods of diagnosis and treatment for these conditions. And 

it would build upon the expertise of the Centers for Excellence, 

which are currently providing high quality care to thousands of responders and insuring ongoing data collections and analysis to 

evaluate health risks. 

Now, one of these centers, as Jerry knows, is located in my district and is headed by Dr. Iris Udasin. That program is a joint institute of Rutgers and the UMDNJ-Robert Wood Johnson Medical 

School, serves over one thousand rescue and recovery workers. Last 

year, I had the opportunity to visit that program, at Rutgers, to see 

how it provides the opportunity for early detection and intervention 

to lessen the severity of the illnesses that many rescue and recovery workers are experiencing. 

We are really faced with a large undertaking. But it is crucial 

that we step up and share these costs. The responders, volunteers, 

workers, and community members should not be left to bear the 

3 

burden of their health care costs after risking their lives to come 

to our Nation’s rescues. And I will also say to the Mayor, I don’t 

think that New York should have to bear as much of the costs as 

they have. The Federal Government has the overwhelming responsibility. 

Again, I want to thank all the sponsors of this bill, but I do want 

to voice my displeasure that Dr. Howard, the former Director of the 

NIOSH, is not present today to testify. While I greatly appreciate 

Dr. Gerberding being here today to testify and recognize her accomplishments as Director of the CDC, Dr. Howard has been the one 

overseeing the World Trade Center Medical Monitoring and Treatment Program since its inception. And I believe he is by far the 

most informed person in this administration to speak on these programs, and it is unfortunate that the Bush Administration refused 

to allow Dr. Howard to testify this morning. 

I am also dismayed by the Administration’s decision to not reappoint Dr. Howard for another term. Dr. Howard has done an exceptional job and has earned the respect and praise from industry 

and labor alike for his commitment to this cause. So, his expertise 

will be greatly missed. But, again, thank all of you and I now 

would recognize our ranking member, Mr. Deal. 

OPENING STATEMENT OF HON. NATHAN DEAL, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF GEORGIA 

Mr. DEAL. Thank you Mr. Chairman for holding this hearing on 

this important issue to discuss H.R. 6594 and the health concerns 

associated with the terrorist attacks of September the 11th. I want 

to thank our distinguished witnesses who have agreed to share 

their insight and perspective on this issue, which of course is of 

great importance to our entire country. 

We can certainly all agree that men and women who first responded to the call for help are true heroes. Thousands of fire fighters, police officers, emergency medical service personnel and other 

government and private sector workers heroically responded to the 

call of duty, not only on September the 11th, but for many weeks 

and months to follow as the recovery efforts and cleanup continued 

to persist. 

In the midst of a Nation rocked by the attacks, which left thousands of innocent people dead and many more seriously injured, 

these brave men and women came from across the Nation to lend 

their hands to a unified recovery effort. As we are all aware, those 

involved in these efforts and the residents of New York City were 

unavoidably exposed to toxic mixtures of dust, smoke, and various 

chemicals. Many of these individuals continue to experience persisting health issues as a result. 

This legislative hearing today, of course, is to focus on H.R. 6594, 

The James Zadroga 9/11 Health and Compensation Act and the assessment of current monitoring and treatment efforts being provided to the affected individuals. I look forward to continuing to 

work with the committee as we work on this issue and address it. 

And I, especially, appreciate the input of the panelists that we will 

hear from today. Thank you Mr. Chairman for holding the hearing 

and I would yield back my time. 

4 

Mr. PALLONE. Thank you, Mr. Deal. Next for an opening statement is Mr. Green, the gentleman from Texas. 

OPENING STATEMENT OF HON. GENE GREEN, A 

REPRESENTATIVE IN CONGRESS FROM THE STATE OF TEXAS 

Mr. GREEN. Thank you, Mr. Chairman, for calling this hearing 

on H.R. 6594, The James Zadroga 9/11 Health and Compensation 

Act. As a member of Congress from Houston and very close to my 

first responders, both firefighters and police officers, that tragic 

event on September the 11th, claiming 2,974 lives, hit everyone. In 

New York City, the attack on the World Trade Center, claiming 

nearly 2700 lives on September 11, but these individuals and their 

family were not the only people impacted by the terrorist attack. 

In the weeks and months following the attacks, 40,000 responders from Federal, State, and private organizations, other volunteers 

came to the World Trade Center site to aid with recovery and 

cleanup. We usually think of the victims of the 9/11 attacks as 

those who lost their lives on that terrible day, but in reality, many 

of these victims are still among us, suffering from the attacks. 

When the World Trade Center collapsed, asbestos, smoke, and 

other potential hazardous material was released into the air. As a 

result of the release of asbestos and smoke, the cleanup in general 

went first responders, area workers, students, residents, office 

workers have suffered physical ailments such as sinus asthma and 

The World Trade Center Cough. These individuals are also suffering from mental ailments, including post-traumatic stress disorder and increased alcohol use. 

The brave men and women who worked on the cleanup and recovery were not just from the New York area and those who were 

in New York at the time, many no longer live there. It is safe to 

say that individuals from all 50 States are suffering from adverse 

health effects related to the September 11 attacks. It is clear we 

need to establish a permanent program to provide medical monitoring for the responders and individuals in the community who 

were exposed to toxins released by the collapse of the World Trade 

Center. We also need to reopen the 9/11 Victim Compensation 

Fund and allow those who wish to seek compensation for their economic losses and harm. 

Currently, these individuals have to go to the court system for 

compensation even though they may have been eligible for the 9/ 

11 Compensation Fund or would now be considered eligible. H.R. 

6594 addresses these issues by establishing World Trade health 

center program and it provides a medical monitoring treatment 

program for responders and community members in the direct area 

of the attacks in New York and the United States. 

The bill reopens the 9/11 Victims Compensation Fund, establishes a research program, through HHS, to evaluate the World 

Trade Center conditions. The bill would help those individuals. I 

am proud to be a co-sponsor of this bill and, again, Mr. Chairman 

I am glad you called the hearing. On and on I thank our New York 

members for making sure those of us understand that we all share 

in this. And, coming from Houston, we will have a hurricane some 

time and I appreciate everyone considering our situation, just like 

we are doing this, so thank you. 

5 

Mr. PALLONE. Thank you, Mr. Green. Next for an opening statement, the gentlewoman from California, Ms. Capps. 

OPENING STATEMENT OF HON. LOIS CAPPS, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF CALIFORNIA 

Ms. CAPPS. Thank you, Chairman Pallone, for holding this hearing. I thank my colleagues for testifying and also to the Honorable 

Mayor of New York. I thank all of the witnesses who will be testifying today. Quite frankly, though, I wish the testimonies that we 

will hear today would paint a rosier picture. A picture of us having 

risen above and beyond to ensure that every individual whose 

health was adversely affected by the attacks on 9/11 and subsequent cleanup has had access to any and all necessary medical 

treatment, one where we had done a better job of assessing the environmental impact of the attacks, the rescue missions and the 

cleanup. 

Unfortunately, we find ourselves, today, 7 years later with so 

much work still to do, to ensure that victims, heroes, and neighbors 

of the World Trade Center are being properly cared for. Though I 

don’t represent New York City, I do represent many Californians 

who volunteered themselves quickly to assist and come to the site, 

and to assist in the aftermath of that horrific day, and they are 

also having a difficult time assessing the care they also, rightly, deserve. 

I am afraid this is largely due to a very weakened Environmental 

Protection Agency and OSHA under the current administration, 

but it is not too late to take the right steps now to correct what 

has gone wrong. I am proud to co-sponsor the legislation introduced 

by our colleagues Congressmen Nadler, Fossella, King, and Congresswoman Maloney that will take the positive steps to treat all 

affected individuals. 

We have a lot to learn from the experience, even including today, 

as we prepare for future scenarios that present public health emergencies. Failing to learn from past experiences and taking steps to 

prevent problems in the future is unacceptable to our way of life. 

I am confident that my colleagues and I share a commitment to 

better prepare ourselves in the future. For today, though, we must 

be strong in our resolve to care for every individual who is still suffering physically or psychologically as a result of 9/11. 

And I, particularly, welcome the opportunity to hear directly 

from the witnesses who were there that day, who have a great deal 

to tell us about how we can, in fact, help them. I yield back. 

Mr. PALLONE. Thank you Ms. Capps, and next for an opening 

statement, the gentleman from New York, Mr. Weiner. 

OPENING STATEMENT OF HON. ANTHONY D. WEINER, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF NEW 

YORK 

Mr. WEINER. Thank you Mr. Chairman and I want to thank you 

and Ranking Member Deal for taking this issue so seriously. Congressman Nadler, Congressman King, Congresswoman Maloney, 

who have, just about, in every opportunity when there was a 

chance to talk to our colleagues about this issue, have done it. I 

also want to take a moment to pay tribute to Congressman 

6 

Fossella, who championed this program for so long, almost from the 

moment it was conceived, was looking to expand it, has really 

moved this committee towards a place where we are now, hopefully, on the final steps on passing this legislation. I wanted to 

thank him for his service to this Congress and also for his sponsorship of this legislation. 

But, while we are going to have this hearing it is very important, 

to some degree, the major, the macro issues that we are going to 

discuss here have been discussed and, frankly, ruled upon by this 

Congress and by the American people. Shortly after September 11 

everyone agreed the responsibility for the heroes that walked into 

those buildings, ran into those buildings to save so many people in 

the largest civil evacuation in American history, no one disputed 

this was the responsibility of the Federal Government to pay tribute to them, to take care of them, to take care of their families. 

This Congress decided, in an overwhelming fashion, when we 

created the Victims Compensation Fund. Never once was it uttered 

here in Congress or around the country that, ‘‘ah, that is New 

York’s problem, let them worry about it.’’ Even in the context of a 

partisan country and a partisan Congress, everyone came together 

and realized this was the responsibility of the Federal Government 

to help the people of the city of New York. 

When Mayor Giuliani and Mayor Bloomberg called upon the resources of the city and contractors and volunteers and everyone to 

come down to Ground Zero and help us with the process of rebuilding and restoring and healing our city, nobody for a moment 

thought that was the responsibility of the city or those individual 

contractors. Everyone understood this was the responsibility of the 

Federal Government, as part of the obligation of the Federal Government to respond when we were attacked as a country and New 

York City just happened to be the point of that attack. 

So, to a large degree, the only question is how we decide who it 

is that we are going to be compensating and taking care of. Frankly, if we in this House knew that years and years after September 

11 there would be people dying by degrees, dying day by day because of the impact of the attack, we would have written the original laws to take into the account the idea that this might be a 

process that should go on for 10, 12 years. 

So the only issue we have today, I think, is the details. How we 

make sure the city is compensated, how we make sure the contractors are compensated and how we make sure individuals are made 

whole to the greatest extent possible. And I should make it very 

clear, Mr. Chairman, New York is not being asked to be repaired. 

We can never be repaired. The attack that was suffered by so 

many—has left a scar on so many. All we are asking is for a natural continuation of the discussion that we had in a bipartisan 

fashion shortly after September 11 when we said, ‘‘you know what, 

we are all going pitch in.’’ 

The Victims Compensation Fund, only by oversight, only for lack 

of a clause that said ‘‘for those who have passed away or those who, 

as a result of this, are sick, injured or dying by degrees.’’ If it were 

not for that language, the addition of that language, we would have 

no real dispute here today. 

7 

And I want to thank you, Mr. Pallone and thank the witnesses 

and thank Mayor Bloomberg for reminding us every day of the responsibility that we have. If we get this wrong, I say to my colleagues, here is the scenario that we face. We face the possibility, 

the very real possibility, in any number of cities, in any town, or 

in any part of this country being attacked and people say, ‘‘you 

know what, I don’t want to be involved because the Federal Government, while encouraging us to do so is not taking care of us 

once we do.’’ 

This Congress is not going to let that happen and if we hearken 

back to the substance of that debate, let us hearken back to one 

other thing. This was a bipartisan agreement. We had all decided 

we were going to come together as part of a package of restoring 

our country. We were going to restore New York City. We were 

going to help to pave the way for New York City to get back on 

its feet. Today, in living rooms and dining rooms and in hospital 

rooms, frankly, all around the New York City area are people who 

are dying because of September 11. This legislation honors them, 

it does our best to make it whole and it lives up to the commitment 

we made after September 11, and I thank you Mr. Chairman for 

holding this hearing. 

Mr. PALLONE. Thank you Mr. Weiner. Next is the gentlewoman 

from California, Ms. Solis. 

OPENING STATEMENT OF HON. HILDA L. SOLIS, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF CALIFORNIA 

Ms. SOLIS. Thank you, Mr. Chairman, and I also want to welcome our witnesses, our colleagues, as well as the Mayor from New 

York, Mr. Bloomberg. It is an honor to have you here. I will be 

brief. I just want to say that I have often wondered why our government takes so long to address catastrophes like this. And we 

know that as a result of the toxins and the exposure, we see higher 

rates of asthma now in individuals that were around the World 

Trade Center and especially among our first-responders. California, 

as was noted, did send a number of our emergency responders to 

help out in that situation, and I believe that we have a responsibility to help provide the best healthcare assessments and access 

that they need in their recovery. In addition to asthma rates going 

up, care for post-traumatic stress and mental health assistance 

needs to be provided as well. So I agree, in part, with all that has 

been said by my colleagues. This is a bipartisan issue, one that all 

of us would never want to have placed upon us at any time in our 

lives. And there is an urgency for us to help people, and not just 

the first-responders, but anyone that was affected by the fallout of 

the hazardous material that spread throughout that city in that 

particular time. So, with that, I yield back the balance of my time. 

Mr. PALLONE. Thank you. The gentleman from New York, Mr. 

Towns, is recognized for an opening statement. 

8 

OPENING STATEMENT OF HON. EDOLPHUS TOWNS, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF NEW 

YORK 

Mr. TOWNS. Thank you very much Mr. Chairman, and of course 

thank you Ranking Member Deal, for convening this important 

hearing. This bill recognizes and addresses the rising health problems among the brave citizens who were exposed to unknown 

health risks as a result of the terrorist attack of 9/11. I would also 

like to thank the author of the bill, my friend and colleague from 

New York, Carolyn Maloney, in her diligence and leadership on 

this issue, and other members of our New York delegation who 

have really been very involved in pushing this bill forward: Congressmen Weiner, Engel, Fossella, Nadler, and King. And I would 

especially like to thank the Honorable Mayor of the city of New 

York for joining us this morning to offer his testimony. I would also 

like to thank the New York State Department of Labor Commissioner, Patricia Smith, for joining us. 

As we approach the seventh anniversary of the 9/11 attacks, I 

hope we can work together to bring effective medical treatment and 

financial assistance to those affected on that fateful day. I have 

held several 9/11 hearings in my Government Reform Subcommittee and this has been a long and painstaking process. But 

I look forward to a successful passing of this legislation before us 

today and moving toward a solution we can all be proud of. Now, 

we need to encourage people to be supportive of each other. We 

need to encourage people to, in times of crisis, that if you respond 

and go beyond the call of duty, we will be there for you. I think 

the Federal Government has that responsibility. So I come today 

to say that I hope that we will assume that responsibility to respond in a positive way. Again, I thank the Chairman and the 

Ranking Member for holding this hearing. I look forward to the testimony, and on that note I yield back. 

Mr. PALLONE. Thank you Mr. Towns. Next, another gentleman 

from New York, Mr. Engel recognized for an opening statement. 

OPENING STATEMENT OF HON. ELIOT L. ENGEL, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF NEW 

YORK 

Mr. ENGEL. Thank you very much Mr. Chairman. I appreciate it 

and we—those of us who are New Yorkers appreciate this hearing. 

It is one of the reasons why I am proud to serve on the Energy and 

Commerce Committee and on the Health Subcommittee. I can 

think of nothing more topical and more important to New Yorkers 

than this hearing and to try to help, based on the tragedy of 9/11. 

I would like to welcome our witnesses here today, including our 

Mayor Michael Bloomberg, my colleagues Jerry Nadler and Pete 

King and I would also like to welcome the New York State Commissioner of Labor, Patricia Smith and the New York State AFLCIO representative Suzy Ballentine, who are with us in the audience today. 

As devastating as September 11 was, there are few days I have 

been more proud to be an American than on 9/11. Within minutes 

of crashes into the Twin Towers New York’s first responders mobilized to save those trapped within the World Trade Center, putting 

9 

themselves in unspeakable danger and too many lost their life that 

day, including many of my constituents. Within days over 40,000 

responders from across the Nation descended upon Ground Zero to 

do anything possible to help with the rescue, recovery, and cleanup. 

I remember those bittersweet days. I was there in New York City 

where I was born and bred and remember seeing Americans lined 

up around blocks to donate blood. I remember the chaos as we 

didn’t know quite what to do. People knew they had to do something, anything to help our Nation rise up from the assault by the 

terrorists. 

The past 6 years have not been kind to so many of the first responders who put themselves in harm’s way. It is estimated that 

up to 400,000 people in the World Trade Center area on 9/11 were 

exposed to extremely toxic environmental hazards, including asbestos, particulate matter, and smoke. Years later this exposure has 

left a significant number of first responders with severe respiratory 

ailments, including asthma, at a rate that is 12 times the normal 

rate of adult onset asthma. 

Also common are mental health problems, including PTSD and 

depression. This has all been well documented in the scientific 

peer-reviewed published work regarding the long-term health effects of 9/11 by Mount Sinai, the Fire Department of the city of 

New York, and the World Trade Center Health Registry. 

While these illnesses should sadden all of us, what is more outrageous is that our Nation has failed to provide the first responders 

with anything more than a fragmented and unreliable health care 

monitoring and treatment program that forces those who fearlessly 

volunteered for our country to fight within a myriad of bureaucracy 

to receive care that should be given, and yet in a struggle. 

It is outrageous that officials like Christine Todd-Whitman told 

us that the air was fine and we should go about our business and 

we should just continue to do what ever is necessary when that 

was not the case. And there are many people in the area, not only 

first responders who were exposed to these deadly toxins—and I 

know my colleague, Jerry Nadler, in whose district the World 

Trade Center is, is making a very forceful case that we ought to 

not only help first responders, but we ought to help the communities around and people who were exposed to that. And I am very 

sympathetic to what Jerry Nadler has said in that regard. 

So I am proud to join with my New York colleagues, led by Representatives Maloney, Nadler, Fossella, and King and Ed Towns 

and Tony Weiner, as well, in introducing the revised 9/11 Health 

and Compensation Act. 

This comprehensive bill would ensure that first responders and 

community residents exposed to the Ground Zero toxins have a 

right to be medically monitored and all that are sick have a right 

to treatment. 

It would also rightfully provide compensation for loss by reopening the 9/11 Compensation Fund. No more fragmented healthcare. 

No more excuses. We must and shall do what is right. 

In this vein, it is troubling to me that just before the July 4 holiday CDC Director, Julie Gerberding informed Dr. John Howard, 

Director of The National Institute for Occupational Safety and 

Health, that he would not be reappointed to a second term, even 

10 

though he had asked to be reappointed. This effective termination 

came despite universal praise regarding Dr. Howard’s service of 

protecting American workers, accolades for his outstanding work 

on behalf of the heroes of 9/11 in his capacity as 9/11 Health Coordinator and strong support from Labor Employers, the public 

health community, and Congress for his reappointment. I would 

like to enter into the record an editorial from the New York Times 

criticizing the administration for this action. 

I still feel great sorrow in our remembrance of the tragedy of 9/ 

11. We will never forget what happened that day, but we must look 

forward and right the wrongs that our Nation has perpetrated 

against our own heroes and provide them with the care and compensation they so desperately deserve. 

Mr. Chairman, I urge all Americans to pause and reflect on this 

tremendous loss of life that day and how so many sacrificed so 

much for their fellow Americans and make sure that our future actions are driven by these memories and I again thank you for the 

hearing. 

Mr. PALLONE. Thank you Mr. Engel. Now, you had a unanimous 

consent request there? 

Mr. ENGEL. Yes, Mr. Chairman. 

Mr. PALLONE. All right, without objection, so ordered. 

Mr. ENGEL. Thank you. 

Mr. PALLONE. You have your hand up, Mr. Towns. 

Mr. TOWNS. Yes, I also have one. 

Mr. PALLONE. What is yours? 

Mr. TOWNS. I ask for unanimous consent to submit the testimony 

of Dr. Reibman, Associate Professor of Medicine and Environmental Medicine, Director of NYU Bellevue Asthma Center. 

Mr. PALLONE. Without objection, so ordered. 

[The prepared statement of Dr. Reibman follows:] 

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Mr. PALLONE. And next for an opening statement, the gentleman—I was going to say New York, I will say Staten Island, because we think that Staten Island is closer to New Jersey, but 

thank you for all your efforts. 

OPENING STATEMENT OF HON. VITO FOSSELLA, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF NEW 

YORK 

Mr. FOSSELLA. It is closer to New Jersey. And thank you, Chairman Pallone and Ranking Member Deal, thank you for extending 

me the courtesy of sitting on your subcommittee for today’s hearing, and at the outset I ask unanimous consent to submit, for the 

record, the testimony of Representative Carolyn Maloney, and 

without her we wouldn’t be here today. She has been the most tireless advocate, so I submit that. In addition, unanimous consent to 

submit the testimony of Dr. David Prezant, M.D., Chief Medical Officer, Office of Medical Affairs and the Co-Director of the World 

Trade Center Medical and Monitoring Treatment Programs of New 

York City Fire Department. 

Mr. PALLONE. Without objection, so ordered. 

[The prepared statement of Ms. Maloney follows:] 

STATEMENT OF HON. CAROLYN MALONEY

Chairman Pallone, Ranking Member Deal, members of the Health Subcommittee, 

I want to thank you for inviting me to testify here today on H.R. 6594, the James 

Zadroga 9/11 Health and Compensation Act, which I introduced with Representatives Nadler, Fossella, and King, with the support of the entire New York Delegation. I am pleased to be here with Mr. Nadler, Mr. King, and Mayor Bloomberg, and 

I am grateful that the Committee is taking up the important issue of health care 

for the heroes of 9/11—the World Trade Center rescue, recovery and clean up workers, residents, area workers, school children and others who have become sick because of exposures to the toxins of Ground Zero. 

On 9/11, our Nation was brutally attacked at the hands of terrorists. Nearly 3,000 

people lost their lives that day. But as we now know, many more have lost their 

health. 

The James Zadroga 9/11 Health and Compensation Act would ensure that those 

brave Americans who have lost their health have a right to medical monitoring and 

treatment for their WTC-related illnesses and the opportunity to get compensation 

for economic loss and harm. We need to pass this bill because responders came to 

the aid of our nation after 9/11 and many are sick as a result. If we don’t take care 

of them now, what will happen in the event of another disaster? 

Now, some here today might say that this is a very expensive endeavor and, truth 

be told, they would be right. Thousands of people from all 50 states were exposed 

to the toxins and many of them are sick. Monitoring, treating, and compensating 

all of them carries a hefty price tag. And it’s a price tag that the Federal Government is going to have to pay. 

Because the truth is that this is a national problem that needs a federal solution. 

We all wish the terrorist attacks had never happened, we wish all those lives 

weren’t needlessly lost, and we wish that there weren’t so many people sick because 

of the air as caustic as Drano, but that won’t change the facts. People are sick because our Nation was attacked. Not just New York City, not just New York State, 

but our Nation as a whole. In the aftermath of 9/11, Americans everywhere cried 

for our losses, prayed for our country, and found that patriotic spirit within. And 

people acted: first responders traveled from every single state in the Nation to help. 

Early on, some in Congress and in the Administration didn’t think that 9/11 

health issues were a real problem. They questioned the science. They questioned the 

need for funding. But hearing after hearing and GAO report after report made clear 

what we know today: that thousands of people are sick from 9/11 and they need 

and deserve our help. 

So we in Congress went to work to drum up the funding that was needed. Over 

6 years, we have provided $335 million for screening, monitoring, and treatment for 

20 

responders and community members. This funding allowed the Director of NIOSH, 

Dr. John Howard, to provide medical monitoring for 40,000 Responders and treatment for 16,000 sick responders. Furthermore, NIOSH made arrangements for a national program for those who live outside the New York area, and has started the 

process toward helping non-responders who are sick and need treatment. 

And what happens in this Administration to an official who does what Congress 

directs and helps the heroes of 9/11? Unfortunately, he gets fired. That’s right, although Dr. Howard asked to be reappointed as Director of NIOSH, Secretary 

Leavitt and CDC Director Gerberding refused to reappoint him to his post. There 

was absolutely no reason given for his dismissal. In fact, at a meeting just this 

morning with Secretary Leavitt and Dr. Gerberding, they refused to offer any 

grounds for terminating Dr. Howard. 

The program that Dr. Howard supervised, the WTC Medical Monitoring and 

Treatment Program, is playing a very important role in the lives of so many heroes 

of 9/11, and the facilities that are a part of this program are truly Centers of Excellence. The FDNY has a program of over 16,000 firefighters who are being monitored, and a Consortium of providers led by Mt. Sinai is monitoring about 24,000 

other responders. Combined, the responder programs are treating about 16,000 responders for WTC-related illnesses. For all the good work that the WTC Medical 

Monitoring and Treatment Program is doing, it constantly faces the challenge of uncertain funding, never knowing when they may need to close their doors or cut back 

on their medical personnel. Notably, year to year funding makes it very difficult to 

recruit and keep the high quality doctors and other care providers that make this 

Center of Excellence what it is. 

Today, residents, area workers, school children, and others are being screened and 

treated at a WTC Center of Excellence which receives no federal funding whatsoever. The City of New York is picking up the bill for the WTC Environmental 

Health Center at Bellevue Hospital, which has about 2,700 community members 

currently enrolled. 

H.R. 6594 will build on these current Centers of Excellence, expanding what’s 

working and filling in the gaps left by what’s missing. It will provide the steady 

funding that people need to know their care will continue and provide the funding 

to recruit and keep doctors who are experts in their field. It will make care for Responders and others mandatory. The care for sick heroes of 9/11 should not be left 

to the discretion of the year-to-year appropriations process. 

As I mentioned earlier, this is not an inexpensive proposition. Handling a big 

problem usually has a big cost. But, as some of you know, hand-in-hand with the 

City of New York and the AFL-CIO, we have sharpened the scope of our previous 

bill, H.R. 3543, allowing us to save billions of dollars in our newly introduced bill, 

H.R. 6594. We were able to do this because our original bill didn’t match the problem it was trying to solve on the ground. It was too broad in its scope. In drafting 

H.R. 6594, we brought the bill in line with the real problem that needed to be 

solved: monitoring only those were exposed and treating only those who are sick. 

For example, H.R. 3543 included a radius of 2 to 5 miles within which community 

members would be covered. In the new bill, we create a smaller geographic areasouth of Houston Street in Manhattan and up to a 1.5 mile radius in Brooklynwhich more closely mirrors where the dust cloud blew. Then, for anyone outside that 

smaller radius, we set up a capped contingency fund which could screen and treat 

only those community members who are determined to have WTC-related conditions. We made a number of changes like this so that the bill targeted the problem 

that needed solving and helped the people who need to be helped. 

This morning, I hope that my testimony has set the stage for you to hear more 

from the other panelists about H.R. 6594, the James Zadroga 9/11 Health and Compensation Act. 

In closing, I’m pleased to say to the Committee what I’ve told thousands of people 

before-I will not rest, we here at this table will not rest-until everyone at risk of 

illness from Ground Zero toxins is monitored and all those sick receive treatment 

for the WTC-related illnesses. This is the very least we can do, as a grateful nation. 

[The prepared statement of Dr. Prezant follows:] 

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Mr. FOSSELLA. Another gentleman who has spent the last, almost, 7 years committed to helping those in need. And I highlight 

why we are here because of the many advocates who haven’t given 

up, the Union officials, the FLC, I know has been mentioned, 

Susan and Dennis Hughes, the first responders, New York City 

Fire Department, Police Department, healthcare professionals, 

among them, Mount Sinai who just have not let us forget what 

happened, in particular, the witnesses, Congressman Nadler, Congressman King, I mentioned Congresswoman Maloney, my colleagues of the New York delegation, Mr. Towns, and one, in particular, Mr. Weiner who has been a vocal advocate to ensure that 

something get done. And above all is our Mayor from the great city 

of New York, Mike Bloomberg. He could have easily walked away 

from this issue, but there has been no one who has been more tireless and more vocal in support of those who suffered greatly on 9/ 

11 and we couldn’t have a better advocate in City Hall. So thank 

you, Mr. Mayor, for coming. 

And let me just also add something Mr. Green said earlier about 

if there is a hurricane in Houston, the Federal Government is there 

to help. Frankly, if there is a hurricane anywhere in this country 

or fire or flood, the Federal Government is there to help and that 

is what the American people do. They will respond through their 

Representatives, through their Congress to help. And, frankly, the 

people who responded in New York City and 9/11 still need help, 

and we haven’t fulfilled the obligation to all of them. So we are 

here to talk about the legislation, which is a culmination of many 

long hours of work and even longer hours of compromise from the 

offices of Ms. Maloney, Mr. Nadler, Mr. King, and the Mayor’s office. 

Their staffs have worked tirelessly to ensure that the bill we are 

set to discuss provides the best and most effective care to those still 

suffering. These individuals believe, as I do, that when we started 

working on this issue, it was for the right reasons and to help those 

still suffering. Those reasons remain the same today. We will continue pushing for the legislation till we finally see that all those 

who continue to suffer receive the treatment they deserve. 

It has been exactly 6 years, 10 months, and 20 days since the 

Nation suffered the horrible attacks. While much progress has been 

made to address the residual health effects, many of our Nation’s 

citizens are still suffering and much is left to be done. 

The bill before us is our best chance to fulfill that obligation. 

Most of all, this bill represents our joint commitment to those who 

continue to suffer and deserve the monitoring treatment that has 

been deferred to them far too long. 

We cannot continue to stress enough the national health impact 

that these attacks have had. Currently, there are individuals from 

every congressional district in our country enrolled in the World 

Trade Center Health Registry. On this subcommittee alone, Democrats and Republicans combined represent roughly 10,000 individuals affected by these attacks. 

I, sadly, represent nearly 5,000 individuals enrolled in the registry. It is hard to imagine the public outrage we would see if there 

was an attack today on our country and the Federal Government 

did not provide adequately for those injured. Yet, this is exactly 

38 

what we are experiencing today, as those who were exposed to 

these toxins from 9/11 continue to grow sick. 

The updated 9/11 Health and Compensation Act represents many 

significant changes from the original bill and much has been done 

to ensure that the best possible care is provided while minimizing 

the size of the program, specifically the geographic areas when patterned on the most likely affected population areas. Standards of 

association for those claiming health conditions related to 9/11 

have a refined and cost-share with the city of New York for medical 

monitoring and treatment has been included. Our bill has been improved in ways unrelated to health. 

As much as possible, it makes whole the companies that brought 

the equipment and know-how to the rescue and recovery operation 

at the World Trade Center site. The Good Samaritan contractors 

and subcontractors performed a federal function by dealing with 

the aftermath of the attack. The bill indemnifies those companies 

so that they and others, who wish to help our Nation in a similar 

situation in the future, will do so without fear of losing everything. 

This is a significant improvement in our bill. 

This is a national health issue that needs to be addressed as 

such. Numerous studies have documented the illnesses of those exposed to the deadly ash and smoke mixtures from these terrorist 

attacks are at risk of developing. And many who suffer from these 

sicknesses face the added financial strain of no longer being able 

to work and having to bear the brunt of their medical costs without 

a federally funded national program to incur the costs. 

The Federal Government has an obligation to come to the aid of 

both the first responders who answered the call when their Nation 

needed them most and the innocents whose health continue to suffer from these devastating attacks. Any failure on our part to address this urgent issue now can have far reaching implications on 

our future response efforts. 

To those exposed to the sickening cloud of ashes and chemicals, 

the suffering continues long after the physical remains of the taxed 

have been addressed. I applaud the work of my colleagues in coming together to help those whose health at risk due to their exposure at Ground Zero on that fateful day, and we should pledge our 

support never to forget. Thank you Mr. Chairman. 

Mr. PALLONE. Thank you. The ranking member, the gentleman 

from Texas, Mr. Barton, recognized for an opening statement. 

OPENING STATEMENT OF HON. JOE BARTON, A 

REPRESENTATIVE IN CONGRESS FROM THE STATE OF TEXAS 

Mr. BARTON. Thanks, Mr. Chairman. I am conflicted by this 

hearing. We all want to take care of the first-responders at the 

World Trade Center. We want to take care of the individuals who 

were in those buildings. We want to take care of the volunteers 

who risked their lives to try to help the professionals. And we also 

want to help our congressional friends from New York. I am glad 

to have the mayor here. It is a privilege to have you here, sir. 

It is good that we are having a hearing. I mean, I have spent a 

fair amount of time complaining to Mr. Pallone and Mr. Dingell 

that things that should go through the committee are taken to the 

floor on the suspension calendar so I can’t complain that we are 

39 

having a hearing. Having said that, this is a bill that was introduced, I think, last Thursday. We have tried to get a minority witness to appear but we haven’t had time to make that happen. 

This bill is well-intended but it appears, on the surface, to be 

somewhat, to be as polite as I can about it, somewhat more comprehensive and beneficial than it really needs to be to solve the immediate problem. It is certainly something that needs to be addressed. I am told that there are several state and national initiatives trying to address it right now, Mr. Chairman, so I am a little 

bit perplexed that a bill that was introduced last Thursday, we are 

having a hearing on today. 

Again, I am glad that you have a lot of witnesses, that is a good 

thing, but if I had to vote on this legislation today, I would vote 

no. If we can narrow the legislation down, if we can target it to 

those that are most in need of help, there is certainly some gold 

in the legislation. But there are also, as it is currently drafted, 

some hidden costs that don’t necessarily need to be borne, in my 

opinion, by the federal taxpayers. So, I have another hearing, as 

you know, going on downstairs. It is good that we are having the 

hearing. It is good that we need to address the problem. 

Again, Mr. Fossella has been an absolute champion on this issue 

for a number of years, and we know that he is sincere about it, and 

I can say the same thing for Mr. Nadler and Mrs. Maloney and Mr. 

King but sometimes haste does make waste and this particular bill 

may be an example of that. So with that, Mr. Chairman, I am 

going to be happy—if we can yield during an opening statement, 

I will be happy to yield. I am willing to, sure. 

Mr. FOSSELLA. Only because you say you have to leave and 

thank you for yielding. I have the deepest respect for Mr. Barton 

and concluding with haste makes waste—almost 7 years, to me, is 

not haste. The fact is that we have tried, desperately, to have an 

adequate federal response and it has been lacking. And many people who have suffered, and their advocates, people who care deeply—I am not suggesting you don’t—could have walked away and 

left the city of New York and the city taxpayers and the State taxpayers assume that burden, which has been tremendous. And we 

have tried desperately to get the Federal Government and its appropriate agencies to do what it should have done years ago. And 

I would just, respectfully, request that if anyone has anything to 

add, expeditiously, they should do so now. 

As you know, the congressional calendar is coming to a close, 

Congress is going on recess for the month of August. We come back 

for all of, probably, several weeks. In order to get something 

achieved this year, it will have to be done sooner rather than later 

and today is perhaps the last day we will have one of these hearings. So haste does not make waste in some respects. No, I should 

say—let me be clear—yes it does, but 7 years is far from haste, so 

I say that and if anyone has something to add that makes this program better and put in place now, I think we are all ears. 

Mr. BARTON. Well, I don’t know how much time I still have, Mr. 

Chairman. I have probably consumed it. But my concern, Mr. 

Chairman, and I am not going to belabor this because I know we 

need to get forward with the hearing, is that some of the eligibility 

requirements we are giving people, that apparently—and I say apVerDate Nov 24 2008 12:28 Oct 21, 2010 Jkt 037690 PO 00000 Frm 00045 Fmt 6633 Sfmt 6633 C:\DOCUMENTS AND SETTINGS\CWELLS1\HEARINGS\110-143 SCOM1 PsN: JIMC
40 

parently—were not truly first responders. It appears to be drafted 

in such a way that somebody that just happened to be in the vicinity could be eligible and I think that we need to look at that. 

We are giving some folks that have signed waivers a second opportunity and I think that is where having a second look—I am not 

opposed to the concept. Don’t misunderstand me. I just want to try 

to narrow the scope and make sure that we target the benefits to 

those that are truly needy and truly eligible. And that is not being 

Attila the Hun, that is just trying to be responsible, but with that, 

Mr. Chairman, it is good that you are holding a hearing on the subject. 

I have a number of bills I would like hearings held on too if you 

are in the market for bills. So, with that, we appreciate your concern and we know that the New York delegation is grateful that 

you are doing this. 

Mr. PALLONE. Thank you, Mr. Barton. I see Mr. Burgess is sort 

of hesitating to sit down. Would you like to be recognized for an 

opening statement? I recognize the gentleman from Texas. 

OPENING STATEMENT OF HON. MICHAEL C. BURGESS, A 

REPRESENTATIVE IN CONGRESS FROM THE STATE OF TEXAS 

Mr. BURGESS. Thank you, Mr. Chairman, for the recognition. I 

apologize for being late. I am trying to work between two hearings. 

I do believe this country has a solemn obligation to those who selflessly responded to the World Trade Center after the attacks on 

September 11, 2001. They didn’t know the risks. These Americans 

went down to a site that, probably, more closely resembled Dante’s 

inferno than any disaster site they had ever seen before. In lower 

Manhattan the fires went on for weeks. The plume of smoke and 

ash covered downtown and surrounding boroughs. We watched on 

the news, from down in Texas, hour after hour. 

Those working on the site were exposed to numerous toxins. 

Some may result in long-term medical conditions. The psychological 

impact of the event can’t be overcalculated for those that will never 

recover the bodies of their comrades, for those that knew someone 

who may have been in the building that day or just affected by the 

sheer magnitude of this tragic act. Their mental health needs could 

persist for years to come. 

I appreciate the members of the New York delegation that are 

here today. Thanks to the Mayor for being in attendance. I hope 

as we move forward that this committee can work with you to improve H.R. 6594 and bring a bill to the floor. I think it would be 

a welcome commemoration and recognition for the sacrifice for 

those who responded to the worst terrorist attack ever to take place 

in the United States of America. 

We do need to be certain the program is a response to those who 

face an occupational illness because of their service. We need to ensure that past federal investments have been prioritized to then determine if improvements can be made and make them. This is a 

complicated issue. It is an emotional issue, but I commit to the 

Chairman that my staff and I are ready and willing to work with 

you to produce a bill, a better bill if one can be attained, but a bill 

nevertheless, one that we can all be proud of and one that will 

41 

make people in this country proud of the sacrifice exhibited by all 

of those who answered the call to service on 9/11. I will yield back. 

Mr. PALLONE. Thank you and I believe that concludes the opening statements by members of the subcommittee, so we will now 

turn to our witnesses in our first panel. 

Let me welcome all of you. Let me say to the Mayor, we are certainly honored that you are here with us today, not only because 

of what you have done on this issue, but also what you do for the 

great city of New York. I will note that Carolyn Maloney, who is 

the prime sponsor of legislation, wasn’t able to be here because she 

has a mark-up on another bill in financial services. But I do want 

to welcome all of you. 

Let me say, well—nobody here needs any introduction, but I will 

do it anyway because that is what we normally do. First, we have 

the Honorable Jerry Nadler. I have to say, Mayor, and this is not 

in any way commenting on the Republican members, but I have 

never seen anybody work harder on an issue than I see in Jerry 

and Carolyn. They have been relentless. Not only from the very beginning, when you had that hearing and called attention to this 

issue Jerry and I came to the courthouse in Manhattan, but also 

in terms of you and Carolyn constantly coming to the floor and demanding that we move this bill and have hearings and try to come 

up with something that is workable with the leadership. So, I want 

to commend you for that. And we also have with us Peter King, 

also from New York, and of course the Mayor of New York, Michael 

Bloomberg. We will start with Congressman Nadler. 

STATEMENT OF HON. JERROLD NADLER, A REPRESENTATIVE 

IN CONGRESS FROM THE STATE OF NEW YORK 

Mr. NADLER. Thank you very much. Let me begin by extending 

my thanks to Chairman Pallone, Ranking Member Deal, and the 

members of the subcommittee for convening this hearing and inviting my colleagues and me to testify here this morning. I want to 

thank Speaker Pelosi for her ongoing leadership and I also want 

to thank the chairmen of the Committees of Jurisdiction, the bipartisan members of the New York, New Jersey, and Connecticut congressional delegations, in particular Carolyn Maloney who is not 

here, about whom I will have more to say in a moment, and Vito 

Fossella and Peter King, the Mayor of the City of New York, and 

the Governor of New York, the AFL-CIO, numerous local community groups for working with us intensively over the past several 

weeks to sharpen the focus of the legislation before us today. 

As you know, Congresswoman Maloney and I, and let me say 

that, again, Carolyn has been working—we have been working together and she has been a leader on this since very early on and 

I am very sorry that she can’t be here this morning because of the 

mark-up in the Financial Services Committee, but everyone who 

knows anything about this issue knows of her leadership role. And 

along with our colleagues Congressman King and Congressman 

Fossella have introduced H.R. 6594, the James Zadroga 9/11 

Health and Compensation Act of 2008, which is not in one sense 

a brand new bill. It is a modification of a bill introduced a year ago, 

which in turn is a combination of several bills introduced over the 

years. We have bills going back 6 years on this topic and continVerDate Nov 24 2008 12:28 Oct 21, 2010 Jkt 037690 PO 00000 Frm 00047 Fmt 6633 Sfmt 6633 C:\DOCUMENTS AND SETTINGS\CWELLS1\HEARINGS\110-143 SCOM1 PsN: JIMC
42 

ually refining them on the basis of new knowledge and new experience. 

And the purpose of the bill is to ensure that the living victims 

of the September 11th terrorist attacks have a right to health care 

for their World Trade Center-related illnesses and a route to compensation for their economic losses. Although the Victims Compensation Fund part of the bill is not before this committee, today. 

We believe the current version of this bill represents our collective best efforts to provide that critical support for those affected 

by the attacks, our heroic first responders, area workers, resident, 

students or others—through a stable, long-term approach that 

builds on successful, existing programs. And it does all of this in 

a fiscally responsible manner. We are hopeful that today’s hearing 

marks the beginning of the end of our collective 7-year struggle in 

pressing this case. 

Beginning shortly after 9/11 we were warned that the air wasn’t 

safe and that our courageous first responders were not being afforded the proper protection from dangerous toxins as they worked 

on the rescue, recovery and cleanup operation. We spent years trying to convince public officials that the asbestos, fiberglass, and 

other toxins had traveled far and settled into the interiors of residences, workplaces and schools, and that a proper testing and 

cleanup program was required to eliminate the health risks to area 

residents, workers, and students. We asked that the government 

acknowledge the fact that thousands of our Nation’s citizens were 

becoming sick from 9/11 and that many more could become sick in 

the future. 

We explained to whomever would listen that our 9/11 heroes 

were struggling to pay health care costs because they could no 

longer work and no longer had health insurance, or because they 

have had their workers’ compensation claims controverted, and we 

argued vigorously that the federal response, to date, has been dangerously limited, piecemeal, and unstable. 

Thankfully, we believe that we have now finally achieved a much 

more widespread recognition of many of these problems, and nearly 

7 years after the attacks, we believe and hope that Congress will 

do what is right for our heroes and our living victims, and pass 

H.R. 6594. 

Though the devastating 9/11 attacks on the World Trade Center 

occurred within my congressional district, we know that these were 

really attacks on our Nation as a whole—figuratively and literally. 

The President has repeatedly referred to them as such. The members of the New York delegation represent thousands of people who 

were exposed to contamination in lower Manhattan and then affected parts of Brooklyn. Indeed, every member in this room represents a state that has people suffering the health effects of 9/11. 

And as this is unquestionably a national problem, it has always 

required a national response. But despite our sustained efforts to 

get the administration to develop a comprehensive plan to deal 

with this growing public health problem the New York delegation 

has instead found itself, year after year, coming to Congress with 

its hat in hand to test its luck at the annual appropriations process. 

43 

Thankfully, with growing bipartisan support for that funding, 

and with dedicated public servants like Dr. John Howard, we have 

had some key successes. But this is simply no longer a tenable 

course of action. Neither our heroes nor the excellent health care 

programs that are now in place to serve them should have to rely 

on such an unpredictable and unreliable funding source as annual 

appropriations. 

Passage of the James Zadroga 9/11 Health and Compensation 

Act would mark an end to this entire problematic approach and ensure that a consistent source of funding is available to monitor and 

treat the thousands of first-responders and community members 

who have been or will become ill because of World Trade Center 

related illnesses. And it would make sure that no matter where an 

affected individual were to live in the future, he or she could get 

care. 

The bill would also require substantial data collection regarding 

the nature and extent of World Trade Center illnesses, a critical 

step in learning more about these illnesses and then preparing for 

future natural or man-made disasters. 

And finally, as you know, this legislation would provide an opportunity for compensation for economic losses by reopening the 9/11 

Victim Compensation Fund, and would indemnify the contractors 

who dropped everything and rushed to help the rescue and recovery operations. 

The needs here are abundantly clear. We now have 16,000 firstresponders being treated for World Trade Center related illnesses 

and another 40,000 being monitored through a consortium of providers led by Mount Sinai and by the Fire Department of New 

York. And we have nearly 3,000 sick community members being 

treated in an entirely city-funded program with countless others 

being treated elsewhere. 

But unfortunately these are just today’s numbers. In a February 

2007 report to Mayor Bloomberg, the City of New York estimated 

that there were nearly 90,000 first-responders and about 318,000 

heavily exposed community members, who were living or working 

within an even more narrowly drawn radius than is used in this 

bill, an unknown number of whom may ultimately become sick as 

a result of the effects of the 9/11 attacks. 

As you may know, the preliminary cost estimates of the original 

version of this bill, last year’s version, were substantially higher 

than our expectation. Therefore, we have redesigned the bill in 

order to bring those costs down dramatically by many billions of 

dollars. We made many different cuts in the bill, and some of them 

were very difficult to swallow. With respect to the community program, a variety of cuts were required. 

First, this new bill dramatically shrinks the radius within which 

individuals who reside, go to school or work would be eligible for 

services. 

Mr. PALLONE. Jerry, I apologize, but you are 2 minutes over so 

you need to wrap up a little. 

Mr. NADLER. OK, I will try to wrap it up quickly. Second, it caps 

the number of new treatment slots for the community members to 

35,000. It places strict dollar limits on various contingency funds. 

Concerns have been raised that with these limits and caps some inVerDate Nov 24 2008 12:28 Oct 21, 2010 Jkt 037690 PO 00000 Frm 00049 Fmt 6633 Sfmt 6633 C:\DOCUMENTS AND SETTINGS\CWELLS1\HEARINGS\110-143 SCOM1 PsN: JIMC
44 

dividuals who were or are still being exposed to 9/11 toxins and 

who may become sick in the future may be excluded from help. 

These fears arise because although we do not have—because we 

have a good deal of data about toxicity there has never been a systematic testing program to determine the geographic extent of indoor contamination, as was recommended by the EPA Inspector 

General. 

And individual cap levels in the bill were determined in part by 

looking to the current number of people being treated in each of 

the existing programs. And as has been previously noted, we know 

that the population in the community program at Bellevue underrepresents the total population that is currently sick. 

Nonetheless, I am hopeful these fears are unfounded. Our goal 

has been to use the best available data and knowledge to estimate 

the number of people who could eventually get sick and craft a bill 

whose price tag allowed a real chance of passage. Our goal was not 

to deny any deserving individual care or compensation. 

Today we must decide if we are going to be a part of, in an effort 

to honor the heroes and victims of 9/11 and to provide for their 

health and for compensation for losses in a reasonable and responsible manner. I urge you to come to the aid by enacting this bill. 

You would not be alone. The broader, original, more expensive 

version of this bill had more than 100 bipartisan co-sponsors. It 

stands to reason that we will see even more support for this bill, 

which is strongly supported by the governor, the mayor, the national AFL-CIO, the contractors, numerous environmental and 

community advocacy groups and is essential if this Nation is going 

to redeem its honor and begin to behave properly toward the victims and the heroes of the 9/11 attacks on the United States. 

I urge you to give favorable consideration to this bill. I thank you 

for your attention and for your indulgence for the overtime statement. 

[The prepared statement of Mr. Nadler follows:] 

45 

46 

47 

48 

49 

Mr. PALLONE. Thank you. Congressman King. 

STATEMENT OF HON. PETER KING, A REPRESENTATIVE IN 

CONGRESS FROM THE STATE OF NEW YORK 

Mr. KING. Thank you, Mr. Chairman. Mr. Chairman, I would ask 

unanimous consent to have my prepared statement made part of 

the record. 

Mr. PALLONE. Without objection, so ordered. 

Mr. KING. Mr. Chairman, let me thank you and Ranking Member 

Deal for holding this hearing and let me commend Congresswoman 

Maloney and Congressman Nadler, who, as you rightly pointed out, 

have fought very hard on this issue very valiantly and, of course, 

Congressman Fossella who has been there from the start and that 

just works tirelessly on it. And, of course, Mayor Bloomberg 

whose—that he and his administration have dedicated themselves 

to addressing this issue. And it really is a human issue and it is 

not just a New York issue and I am glad that that has been pointed out by a number of people. 

Now Congressman Green mentioned the fact that if there is a 

hurricane in Houston, or it could also be a terrorist attack in Houston—in this year’s Homeland Security Funding additional funds 

went to Houston because of its ports, there is a prime terrorist target, so there is virtually no—whether it is Houston or Los Angeles, 

whether it is New York, whether it is Boston, Chicago, the fact is 

there are any number of terrorist targets in this country—prime 

terrorist targets—Washington, DC—and we as a Nation have an 

obligation to come together and stand together as one. 

My own district, I had over 150 people killed, over 1,200 firstresponders. Congressman Fossella, I believe, had over 400 people 

in his district killed. Congressman Nadler had, of course, thousands and thousands of residents who were affected by this, but as 

has been pointed out every—I think virtually every congressional 

district in this country sent volunteers to Ground Zero, so it truly 

is a national effort. And at the time, I believe that Congress and 

the administration, everyone did what they felt was the right thing 

to do. 

We did not anticipate that when we passed, for instance, the Victims Compensation Fund just a week after September 11, that the 

dust, debris, and the toxins would cause all of these terrible illnesses later on. And Dr. Burgess is the medical expert, but I can 

tell him there are constituents in my district, neighbors of mine, 

people in their 40s and 50s with very rare cancers, very unusually 

severe respiratory illnesses. And, again, it could be anecdotal. It 

could be coincidental, but you have such a large number of people 

who worked there coming down with these rare illnesses. 

To me, there is definitely a cause and effect. I think that that 

debate should almost be over, so we need a permanent monitoring 

system, a permanent system of treatment. We have to open up the 

Victims Compensation Fund and it has to be done for those who 

responded, those who came down, those who spent weeks and 

months, really going into the following year, working at Ground 

Zero. 

You have the contractors who showed up without signing any liability agreements, who really put their businesses on the line for 

50 

this and they could be on the hook right now for many lawsuits 

and for many actions. So it is important that they be indemnified. 

And it is really vital we just set a tone and set a program in place, 

for if, God forbid, another attack does happen anywhere else in this 

country, we wont be going through this uncertainty for 6 or 7 

years, not knowing exactly who to treat and how to treat them, 

how it is going to be paid, what the protocols are going to be. 

So, this is a bipartisan bill. It is a vital bill. It is one which we 

owe to those who responded. We owe it to those who did work 

there. I can remember Barton mentioning, he said people just happened to work there. Well, the fact is, downtown Manhattan was 

attacked because of the people that worked there. It was attacked 

because it is the financial center of the world. And so, to me those 

people just went to work, innocent people, on a Tuesday morning 

not knowing what is in store for them, but they were killed for a 

reason and those who were wounded and damaged and were suffering illnesses today, it is for a reason. They just didn’t happen to 

be there, they worked in an area which is a prime target of Islamic 

terrorism. 

So we have an obligation to defend those who were attacked, to 

work with those to provide whatever health and medical care we 

can for them. So I thank the subcommittee for having this hearing. 

I certainly hope we can get this on the floor for a vote. It should 

not be caught up in partisan politics. 

I know those of us on the Republican side will do all we can to 

work with the Administration, to work with Republican leadership 

to ensure that this is not a New York bill, it is not a Democrat bill, 

it is not a Liberal bill, this is an American bill for real Americans 

who suffered, who died and, really, in memory of those who put 

their lives on the line and we should never ever forget them. 

So with that, I thank you for holding the hearing, I certainly 

urge the adoption of H.R. 6594 and, again, thank Congressman 

Nadler, Congresswoman Maloney, Vito Fossella, of course, and 

Mayor Bloomberg for being such a champion of this issue, and I 

yield back. 

[The prepared statement of Mr. King follows:] 

STATEMENT OF HON. PETER T. KING

Chairman Pallone, Ranking Member Deal, and members of the Subcommittee on 

Health, thank you for inviting me to speak on this important issue. I would like 

to thank my colleagues, Mrs. Maloney, Mr. Nadler, and Mr. Fossella, for their hard 

work and dedication to the James Zadroga 9/11 Health and Compensation Act, H.R. 

6594, and am pleased to have the opportunity to explain why such legislation is so 

crucial. 

On September 11th, 2001, the Nation sustained the greatest attack on our homeland in history. I am sure that everyone in this room remembers the exact moment 

they found out about this tragedy and where they were as they watched the towers 

finally succumb and collapse. In New York City, as the towers burned and civilians 

were evacuating the buildings, brave men and women were rushing into the World 

Trade Center. These men and women, the members of the FDNY, NYPD, Port Authority, and other emergency services, gave their lives to save others. Moreover, in 

the weeks and months following the attack, after having already lost so many 

friends and colleagues, these same people worked diligently in the cleanup and recovery effort. Their work was an inspiration not only to me and my fellow New 

Yorkers, but to the nation as a whole. I am proud to say that over 1,200 of my constituents are among those that responded to the 9/11 attacks. 

51 

However, the devastation of 9/11 did not end once the cleanup was complete. 

Those that responded are now becoming ill due to the dust, debris, and toxins they 

were exposed to on 9/11 and during the recovery effort. These individuals sustained 

not only serious physical harm, but also extreme emotional and mental trauma as 

a result of their work. 

As you heard from my colleagues, Congress has appropriated some funds for an 

ongoing medical monitoring and treatment program for 9/11 first responders. This 

program has resulted in a number of medical studies showing the detrimental effects that exposure to toxins at Ground Zero have had on first responders, volunteers, and area residents and workers. It is a scientific fact that those who worked 

in the recovery efforts have decreased pulmonary function, have developed adult 

onset of lower and upper respiratory conditions, and have experienced worsened 

symptoms of asthma and other conditions. 

With limited resources, the WTC Centers of Excellence in the New York metropolitan area have done an outstanding job of monitoring and caring for responders, 

but funding for this program should not be an annual battle. These men and women 

are very sick and they are so because they rose to the occasion and did the hard 

work that the Federal Government asked them to do. While I have been supportive 

of all current efforts, more must be done for the heroes of 9/11. We must come to 

the aid of those who selflessly responded to the 9/11 attacks by creating a permanent program of treatment and monitoring. The list of ailments currently being endured by those who had 9/11 exposures may only grow longer as the years since 

the attacks pass. We must ensure that these individuals receive adequate preventive care in the present, but we must also create an infrastructure and be prepared 

to care for these individuals in the future. 

The program that would be established by H.R. 6594 would put in place a structure under which all those affected by 9/11, both responders and residents, can receive that healthcare. The cost of this program is a small price to pay given the sacrifice these courageous individuals have made. 

Furthermore, it was not only New Yorkers that responded to the attacks. Every 

district in this country has at least one responder that answered the call of duty 

on 9/11. H.R 6594 would establish a national treatment and monitoring program so 

that those responders who either came from out-of-state to help New York in our 

time of need or who have since moved can receive quality medical treatment for 

their 9/11-related illnesses even if they do not live in the New York metropolitan 

area. I am extremely grateful to those that traveled from Texas, Florida, California, 

Pennsylvania, North Carolina, and across the country to help their fellow citizens 

in need. The national program established by H.R. 6594 would show that the Federal Government is also grateful for what these compassionate and patriotic individuals did. 

The reality is that the FDNY, NYPD, and others who responded to the attack on 

New York were on the front lines of the first battle in the War on Terror. Just as 

they were there for us when our country was challenged, these heroes now need our 

help. The Federal Government has the responsibility to care for all those who responded to the attack on the World Trade Center, just as those who responded at 

the Pentagon have been protected by the Federal Government. The men and women 

in New York—without question, without protest—worked tirelessly for months on 

the burning pile; the least we can do is to ensure they are receiving medical treatment for the ailments they have as a result of this work. This is truly a national 

problem and Congress must act now to help the heroes of 9/11. 

Mr. PALLONE. Thank you. Mayor Bloomberg. 

STATEMENT OF MICHAEL BLOOMBERG, MAYOR, CITY OF NEW 

YORK 

Mr. BLOOMBERG. Chairman Pallone, Ranking Member Deal, Congresswoman Solis and Congressmen Towns, Weiner, Burgess, I 

wanted to thank all of you and particularly the New York delegation, Vito Fossella, Carolyn Maloney, who couldn’t be here, Congressman Nadler and King who have worked so hard on this. I understand that my presence on this panel, along with members of 

the Congress defies the normal procedures and I would like to 

thank Speaker Pelosi for her strong commitment to moving this bill 

52 

forward. And I think it underscores the historic importance of this 

measure. 

Passing this bill would, at long last, fully engage the Federal 

Government in resolving the health challenges created by the attack on our entire Nation that took place on September 11. The destruction of the World Trade Center was an act of war against the 

United States. Now people from every part of the country perished 

in the attack and people from 50 States took part in the subsequent relief and recovery efforts and I might point out that planes 

went into a field in Pennsylvania and into the Pentagon, right here 

in Washington. 

And that makes addressing the resulting and ongoing health effects of 9/11, I think, a national duty by any standard. Members 

of the committee, nearly 2 years ago on the fifth anniversary of 9/ 

11, I directed New York City Deputy Mayors Ed Skyler and Linda 

Gibbs to work with the city health experts and agencies to make 

a thorough investigation of the health problems created by the terrorist attack. And their report, published 6 months later, established beyond question that many people suffered physical and 

mental health effects as a result of the World Trade Center attacks 

and its aftermath and they included fire fighters and police officers, 

community residents, school children, and owners and employees of 

neighborhood businesses. And also, and most importantly, construction workers and volunteers from across America that took 

part in the historic task of clearing the debris from the World 

Trade Center site. 

The report made clear that the ultimate scope of these health effects is still unknown. It also identified the two most important 

challenges presented by these health problems. And the great 

strength of this bill is that it addresses both of them. First, it 

would establish consistent federal support for monitoring, screening and treatment of health related problems among eligible 9/11 

responders and community residents. It would also fund essential 

ongoing medical research so that we can better understand what 

the health impacts of 9/11 are and what the resources we need in 

order to address them. The Federal Government has provided ad 

hoc appropriations for monitoring treatment for first-responders 

and workers who answered the call on 9/11. As you know, Congress 

has also, in the past, appropriated funds for residents, area workers and other community members whose health was affected by 

the attack, but until last week the Federal Department of Health 

and Human Services had not released those funds and only now 

has issued a request for proposals. 

And now you should know that New York City has not waited 

for federal funds to address this unmet need. In fact the city has 

budgeted nearly $100 million for 9/11 health initiatives. About half 

of that will be used to treat residents, workers, and others at the 

World Trade Center and Environmental Health Centers in our 

Health and Hospitals Corporation. 

But providing long-term treatment to those who are sick or who 

could become sick because of 9/11, really, is a national responsibility. And to date, uncertain and insufficient federal support of 

treatment efforts has jeopardized the future of these programs and 

53 

the passage of this bill would make those funds—that future secure. 

Similarly, the World Trade Center Health Registry that we created and that we maintain, in partnership with the Federal Government, is the most comprehensive nationwide database on 9/11 

health related issues and consistent federal support for the registry, made possible by this bill, will guide essential research and 

treatment for Americans whose health was effected by 9/11. 

The bill also incorporates strict cost containment standards for 

spending on treatment. For example, it requires that New York 

City, itself, and its city taxpayers to pay five percent of the cost of 

treatment provided at our public hospitals and clinics. And we accept this obligation. It gives us a powerful incentive to work with 

federal health officials, to ensure that expensive and finite medical 

resources only go to those who truly need them. 

The second key element of this bill, and I will close in a minute, 

is that it would reopen the Victims Compensation Fund. This is an 

essential act of fairness for those whose 9/11 related injuries or illnesses had not emerged before the fund was closed in December of 

’03, or who couldn’t be compensated because of the overly narrow 

eligibility requirements in place at that time. 

It would also heal rifts that have needlessly emerged since 9/11. 

Today, the Victims of 9/11, the city of New York and the construction companies that carried out the cleanup at the World Trade 

Center site are being forced into expensive legal procedures. This 

bill would stop those needless and costly court cases. It would allow 

the city to help, rather than litigate against those who are ill. It 

would end misplaced efforts to assign blame to the city and the 

companies who worked to bring New York back from 9/11 instead 

of to the terrorists who attacked our Nation. It would create a 

mechanism for converting $1 billion now available to the Captive 

Insurance Company for this purpose. It would indemnify the city 

and its contractors from future liabilities in such cases and it 

would send the clear message that if, God forbid, terrorists strike 

us again contractors and responders can meet the challenge urgently and unselfishly, knowing their government stands behind 

them. 

In summary, this bill directly addresses the current and the future health problems created by 9/11 and also provides important 

relief for past injuries and illnesses. Members of the committee, we 

will observe the anniversary of 9/11 just 6 weeks from today, and 

let us work together to pass this bill and ensure that the brave 

men and women, who bravely answered the call of duty, when our 

Nation was attacked, receive the health care that they deserve. 

Thank you very much for having me. 

[The prepared statement of Mr. Bloomberg follows:] 

STATEMENT OF MICHAEL R. BLOOMBERG

Chairman Pallone; Ranking Member Deal; Congressmen Towns, Engel, and Weiner; members of the subcommittee. I want to thank you for this extraordinary invitation to testify on this panel along with the bipartisan sponsors of the ‘‘9/11 Health 

and Compensation Act.’’ 

I understand that my presence on this panel along with Members of Congress 

breaks with the normal procedures of Congress. And like Speaker Pelosi’s strong 

commitment to moving forward on this bill, that strongly underscores the historic 

54 

importance of this measure. Passing this bill would, at long last, fully engage the 

Federal Government in resolving the health challenges created by the attack on our 

entire nation that occurred on 9/11. 

The destruction of the World Trade Center was an act of war against the United 

States. People from every part of the country perished in the attack, and people 

from all 50 states took part in the subsequent relief and recovery efforts. And that 

makes addressing the resulting and ongoing health effects of 9/11 a national duty. 

Members of the Committee: Nearly 2 years ago, as the fifth anniversary of 9/11 

approached, I directed Deputy Mayors Edward Skyler and Linda Gibbs to work with 

City health experts and agencies to make a thorough investigation of the health 

problems created by that terrorist attack. Their report, published 6 months later, 

established beyond question that many people suffered physical and mental health 

effects as a result of the World Trade Center attack and its aftermath. They include 

firefighters and police officers, community residents, schoolchildren, and owners and 

employees of neighborhood businesses, and also construction workers and volunteers 

from across America who took part in the heroic task of clearing the debris from 

the World Trade Center site. 

The report made clear that the ultimate scope of these health effects is still unknown. It also identified the two most important challenges presented by these 

health problems. The great strength of this bill is that it addresses them both. 

First, it would establish much-needed year-in, year-out Federal support for monitoring, screening, and treatment of health-related problems among eligible 9/11 responders and community residents. It would also fund essential ongoing medical research so that we can better understand what the health impacts of 9/11 are, and 

what resources we need in order to address them. 

To date, the Federal Government has provided ad hoc appropriations for monitoring and treatment for first responders and workers who answered the call on 9/ 

11. Congress also appropriated funds for residents, area workers, and other community members whose health was affected by the attack. But until last week, the Federal Department of Health and Human Services had not released those funds, and 

only now has issued a request for proposals. 

New York City has long recognized this unmet need; we have not waited for Fed- eral funds to address it. In fact, the City has budgeted nearly $100 million for 9/ 

11 health initiatives. About half that will be used to treat residents, workers, and 

others at the WTC Environmental Health Center in our Health and Hospitals Corporation. But providing long-term treatment to those who are sick, or who could become sick, because of 9/11 is rightly a national responsibility. 

And while Federal funds have supported important research and treatment efforts, the uncertain and insufficient nature of that support has needlessly jeopardized the future of these programs. Passage of this bill would make that future secure. 

Similarly, the World Trade Center Health Registry that we created and that we 

maintain in partnership with the Federal Government is the most comprehensive 

nationwide database on 9/11 health-related issues. Consistent Federal support for 

the Registry will guide essential research and treatment for Americans affected by 

9/11-related health problems—who live in all but four of the nation’s 435 congressional districts—for years to come. 

The bill also incorporates strict cost-containment standards for spending on treatment. For example, it requires the City of New York to pay 5% of the cost of treatment provided at our public hospitals and clinics. We accept this obligation. It will 

give us a powerful incentive to work with Federal health officials to ensure that expensive and finite medical resources only go to those who truly need them. 

The second key element of this bill is that it would re-open the Victim Compensation Fund. This is an essential act of fairness for those whose 9/11-related injuries 

or illnesses had not emerged before the fund was closed in December 2003, or who 

couldn’t be compensated because of the overly narrow eligibility requirements in 

place at that time. It also would heal rifts that have needlessly emerged since 9/ 

11. 

Today, the victims of 9/11, the City of New York and the construction companies 

that carried out the clean-up at the World Trade Center are being forced into expensive legal proceedings. This bill would stop these needless and costly court cases. 

It would allow the City to help, rather than litigate against, those who are ill. It 

would end misplaced efforts to assign blame to the City and the companies who 

worked to bring New York back from 9/11, instead of to the terrorists who attacked 

our Nation. 

It would also create a mechanism for converting $1 billion now available to the 

Captive Insurance Company for this purpose. And it would indemnify the City and 

its contractors from future liability in such cases. 

55 

And it would send the clear message that if—God forbid—terrorists strike us 

again, contractors and responders can meet the challenge urgently and unselfishly, 

knowing that their government stands behind them. 

In summary: This bill directly addresses the current and future health problems 

created by 9/11, and also provides important relief for past injuries and illnesses. 

Members of the committee: We will observe the anniversary of 9/11 just 6 weeks 

from today. 

Let’s work together to pass this bill and ensure that men and women who bravely 

answered the call of duty when our nation was attacked receive the health care that 

they deserve. 

Mr. PALLONE. Thank you, Mayor. It is the tradition not to ask 

questions of the members panel and unless someone has a problem 

with that, I am going to release you and thank you very much for 

being here, and have you know that, as I have mentioned to Jerry 

and Carolyn, that it is not our intention to just have a hearing. We 

do want to move a bill and we are very much cognitive of the fact 

that—— 

Mr. BLOOMBERG. Mr. Chairman, can I say one more thing? I am 

sorry Congressmen Green and Barton aren’t here, but Congressman Burgess from Texas is. Texas, in particular, of all the States 

in this country, is a state that should know just how much of a burden it is to come to the relief of other parts of our country. I have 

always had great admiration for the city of Houston and its people 

and its Mayor, Bill White, who had came to the aid of the terrible—the people who were involved in the terrible tragedy of 

Katrina. I was in New Orleans last week. Their population has 

gone from 500,000 to 250,000; 150,000 of those went to the city of 

Houston, that continues to try to provide jobs and education and 

healthcare and housing to them. So it is a State that really does 

understand that we all have an obligation to help each other. It is 

a State that also could use some help from other States who— 

which should be a part of that, and if you would express my views 

to your associates in Texas and particularly the Mayor of Houston, 

who I have great admiration for. 

Mr. BURGESS. Thank you. We will have that hearing when—— 

Mr. PALLONE. I didn’t commit anything. 

Mr. BLOOMBERG. What is fair is fair. 

Mr. PALLONE. I am not committing anything, but we do want to 

move the bill that is before us. Let me tell you that, and again 

thank you very much. Thank you all. I would ask the second 

panel—I guess it is just one person, the panelist to come forward. 

OK, on our second panel, we have but one witness, and I want 

to welcome Dr. Gerberding. Is that the correct spelling, what we 

have there on your—G-e-r-e-b-e-r—no. OK, it is G-e-r-b-e-r-d-i-n-g. 

All right, thank you. Well, welcome. Thank you for being with us 

today. Dr. Julie L. Gerberding is Director of the Centers for Disease Control in Atlanta. You know we have 5-minute opening statements that become part of the record, and each witness, in the discretion of the committee, may submit additional brief and pertinent 

statements in writing. So we may, depending on the questions, ask 

you to submit additional material. I thank you for being here and 

I now recognize you. 

56 

STATEMENT OF JULIE GERBERDING, M.D., M.P.H., DIRECTOR, 

CENTERS FOR DISEASE CONTROL AND PREVENTION 

Dr. GERBERDING. Thank you. I appreciate the opportunity to provide information for the committee, relevant to CDC and NIOSH’s 

activities related to the World Trade Center catastrophe. I was 

thinking this morning, probably every American knows exactly 

where they were the morning of 9/11, and I know when I saw the 

plane hit the tower, my first thought wasn’t ‘‘oh, we are under a 

terrorism attack.’’ It was basically ‘‘where is my daughter?’’ because 

our stepdaughter was working in Manhattan at that time, and as 

the events unfolded many CDC workers were there, in the pit at 

Ground Zero, helping with a variety of different issues and the 

safety for those people that I care for and those people that I am 

responsible for at CDC was something that has been on my mind 

ever since the attacks occurred. So, what I thought I would try to 

do in my remarks this morning was to just give you, kind of, an 

umbrella picture of what we see the health concerns are and what 

we see the likelihood of ongoing need for monitoring and treatment 

of these individuals, maybe both the responder community as well 

as those in the community that were adjacent to the Trade Centers 

when they collapsed. 

The first thing is to recognize that there is a lot of uncertainty 

about this. We have never experienced any kind of an event of this 

nature or this scale. But when we think about what was the nature 

of the work that people were doing with such passion and such 

dedication, what was the nature of the exposure that they may 

have received in this environment and what are the long-term 

health effects. There is no precedent. We know something about 

the dust. We know something about the combustibles. We can predict what kinds of toxins and chemicals were inhaled. We know 

that there is likely to be variability in the dose that people receive, 

both because of the time that they were first exposed and the duration of their exposure, and perhaps the respiratory protection that 

they used. But nevertheless, there is a great deal of uncertainty. 

What we can say, right now, thanks to the New York Fire Department and their annual screening effort where about 14,500 fire 

workers are undergoing monitoring and evaluation, is that a significant proportion of those responders did experience respiratory 

symptoms following the collapse of the Towers and a significant 

proportion of them are continuing to experience respiratory symptoms and signs out of proportion with what we would expect for a 

comparable cohort of people of the same age or the same smoking 

history or their overall similar health histories. 

Of the people who have conditions, the majority of them are experiencing what we would call aerodigestive disorders or respiratory problems. Another significant proportion are reporting 

chronic mental health related issues along the lines of post-traumatic stress disorder. The people who have respiratory complications have been assessed and have had data published in several 

publications, which I can submit for the record, but which are also 

available on the CDC Web site. 

About one-third of people get better over time. About one-third 

of people are staying the same, and about one-third of people are 

getting worse. So when we have the challenge of assuring that peoVerDate Nov 24 2008 12:28 Oct 21, 2010 Jkt 037690 PO 00000 Frm 00062 Fmt 6633 Sfmt 6633 C:\DOCUMENTS AND SETTINGS\CWELLS1\HEARINGS\110-143 SCOM1 PsN: JIMC
57 

ple receive the appropriate monitoring care and treatment that 

they deserve and need we have very little background data to go 

on, in terms of assessing costs or requirements. 

We have to admit that we are learning as we go here. We have 

made good faith estimates. Health and Human Services has allocated about $925 million so far for the support of responders, and 

more recently non-responders, in the community. We think we 

have done a pretty good job of accurately assessing what the projections are, but we could be wrong and if we need more than what 

we are prepared to invest right now, we will tell you because we 

all want the same thing. We want the best possible treatment, a 

fair deal for the people who gave so much to really help America 

during that very challenging time. 

I think we also need to know more about these health effects. 

One of the things we have been very careful about is to not use the 

appropriation that Congress has provided us for research of activities that weren’t directly linked to the support and treatment of the 

people who were affected. But now that we have some information, 

we are now raising questions and there is a need to know more to 

do some science work in the laboratory, to do some work in cohorts 

of people and to really get as much information as we can. Not just 

for the sake of the people who were affected in the New York environment, but for people who, sometime in the future, may find 

themselves in a similar situation. 

We have learned a lot of lessons about worker protection. I think 

we have learned a lot of lessons about what communities are going 

to need and we need to make sure that we have the science and 

the evidence to apply those lessons to protect people in a more 

proactive manner in the future than we have been able to do this 

time out. 

So we are committed. We want to do the very best we can and 

we will continue to try to do our job in supporting the responders 

and the non-responders who were affected. Thank you. 

[The prepared statement of Dr. Gerberding follows:] 

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Mr. PALLONE. Thank you Doctor, and we will have some questions now, and I will begin by recognizing myself for some questions. Mr. Barton, of course, mentioned that this bill was just introduced, I guess, about a week ago. But we have had other legislation that this was based on around for some time. I know that you 

state in your written statement that you are not ready to comment 

on the bill before us, but my problem, of course, is the session is 

running out. We have a month between now and when we come 

back, I guess, on September 8 and then 3 weeks. And we would 

like to move to mark-up the legislation, so I am hoping that we can 

get your feedback within the next few weeks or so, so that we could 

have it to look at over the August recess. What is your time table 

for giving us feedback on the bill? One week, 2 weeks, hopefully not 

much longer. 

Dr. GERBERDING. I don’t know how big the bill is or everything 

that is in it, but obviously we want to be able to express our perspectives and our voice and we will do everything we can to respect 

your timetable, so we will make it a priority. 

Mr. PALLONE. Let me just say that we do intend, over the August 

recess, to look this over, to talk, both Democrats and Republicans, 

and see if we can come up with a consensus so we really would like 

to have input from you within the next couple weeks if possible. We 

are not going to wait until we come back. 

Dr. GERBERDING. I understand. 

Mr. PALLONE. Thank you. At the last hearing that we had on the 

larger issue, including some of the precursor legislation to this, 

there was a lot of criticism of the administration, either because 

not enough money had been expended for these centers, or because 

the administration, frankly, hadn’t come up with its own legislative 

initiative or long-term solution, if you will, regardless of whether 

it was legislative or not, to deal with the problem. In other words, 

the sense was that we are operating on an ad hoc basis, we are operating on contingency funding and that we need to do something 

permanent, which is why this bill is before us. So what is the reason why the Administration hasn’t submitted its own long-term 

proposal, if you will? 

Dr. GERBERDING. I can’t really comment on the broader administrative perspective, but what I can say is that, as a doctor, what 

I am seeing—and I have read the literature in detail. I am seeing 

what is going to be an ongoing need. How long, how bad, I don’t 

think we know, but we need to prepare for a sustainable—— 

Mr. PALLONE. But what I am saying, and you understand I am 

not trying to be difficult, is that what this bill tries to do is to not 

just look at this ad hoc, the way we have, but say OK this—we are 

going to set up a federal program that is long-term and that deals 

with this problem. Is there any talk with the administration of 

doing that, or even at least supporting such a long-term solution 

whether or not it is this bill? 

Dr. GERBERDING. I am hesitant to speak for the broader administration, but from the standpoint of NIOSH and CDC we know that 

a long-term broad program is needed and I think we would welcome authorization that moves us out of the appropriations process 

and into something that creates some consistency. I am, as an 

agency head, very well aware of the congressional intent around 

68 

making sure that there was a care and treatment program for 

these individuals. That has not been part of CDC, NIOSH’s traditional mission, so part of the reason this has been difficult for us 

is because we don’t really provide insurance or provide care and 

treatment. We are a research agency, in this sense, and so this has 

been something that, again, we would look forward, during the authorization process, to really look at who should be doing what and 

how can we assure that the research needs are met as well as the 

care and treatment needs. 

Mr. PALLONE. OK. Now, the other aspect, of course, is that the 

criticism which again we had at the previous hearing about the 

funding not being forthcoming, not that Congress wasn’t appropriating it, but that it wasn’t forthcoming, even though it had been 

appropriated. And my understanding is that the money that was 

appropriated for this fiscal year, which I guess began last October, 

but I don’t know exactly when it was finalized, probably a few 

months after that, was just released last week. I mean, can you explain why the CDC would delay taking action until this past week 

and what are the administrations plans to make sure that this 

$108 million appropriated for the fiscal year is utilized? 

Dr. GERBERDING. If you ask me how would we go about spending 

x amount of money to build the gulf standard surveillance system—— 

Mr. PALLONE. No. I am just trying to find out why it took so long. 

I mean, it is July, and this money was available as early as January, February, as far as I remember. 

Dr. GERBERDING. The challenge that we were facing is how do we 

provide a program for non-responders. Is that everyone who lives 

in Manhattan? Is that a few thousand people who are right next 

to the pit. I mean, with tremendous variability in who should be 

included and how we would go about planning for a medical program for an—— 

Mr. PALLONE. Do you know, Doctor, and I know I am interrupting you. My time has run out, but when I go to the center at 

Rutgers, which is the one that I am familiar with in my district, 

and—she is not here today, Dr. Udasin, because she wasn’t able to 

be here, who is in charge or it. All they did was tell me how they 

needed more money for this, they needed more money for that, they 

have all these people that they want to do things for and they can’t 

because of limited resources, so there doesn’t seem to be any reason 

to wait 6 months to release funding that we have already appropriated. That is all I am asking. Why 6 months and how do we 

make sure this money gets out there? I mean, we appropriate it, 

but it doesn’t seem to get out there. 

Dr. GERBERDING. I think we have mechanisms to cover all the 

groups that were included in the congressional intent, right now. 

But I got to tell you, it is hard and that is why I brought up the 

issue that this is not something we do at CDC, we are starting 

from scratch here, to try to figure out how do we build a care and 

treatment program for non-responders when we have never done 

anything even close to this before, so it took us longer than you 

would have liked. And believe me, I wish we had done it faster because it would have satisfied your constituents, but also because 

we would have less question about what our intent really was. We 

69 

are committed. I think the mechanisms are there. These are long 

standing opportunities, now, to renew and continue funding. And 

I think you will see a better time line in the future. 

Mr. PALLONE. All right, thank you. Mr. Deal. 

Mr. DEAL. Before I ask Dr. Gerberding the questions, Mr. Chairman, I would like to ask you in response to your statement that 

you have intentions of moving a bill on this. Could you give us 

some idea of the timeline that you have in mind? 

Mr. PALLONE. Mr. Deal, I don’t have a timeline. I am hoping that 

you and I and Mr. Barton and Mr. Dingell and our staff can spend 

some time over the August recess so that when we come back we 

have a consensus. Obviously, since we are going to only be here, 

probably a short time in September—I don’t even know if we go 

into October. We would have to do something in September, but I 

think what I would ask is that we spend the time during the August recess, get the Administration’s input, meet on a bipartisan 

basis with the staff and try to see if we can come to a consensus 

by the time we come back. 

Mr. DEAL. Welcome to the committee. I think I understand the 

concern that you have about being asked to do something that is 

not traditionally within the role of CDC, and I can understand that 

haste, in that regard, would probably result in a lot of criticism for 

money that might be misspent, and so I appreciate the complexity 

that you have outlined that you are facing. And that is one of the 

concerns that all of us, I think, should share. We know that there 

have been fraudulent claims submitted under the Victims Compensation Fund and so there are those who wish to take advantage 

of this catastrophe for purposes that are not intended by either 

Congress or anyone else, to be reimbursed for those kinds of things. 

So I commend caution and I think that is what you have done. 

As I understand your written testimony, there is about $138 million that still is appropriated that is available for healthcare monitoring, et cetera. Is that about correct? 

Dr. GERBERDING. This is a moving target so my testimony was 

reflecting on what we understood in April when we submitted a report to Congress, but obviously people have been treated and seen 

and costs are accumulating and money has been spent since that 

time so I would have to give you a refreshed understanding of 

where we actually are with the spending right now. 

Mr. DEAL. OK. Obviously, you have learned a lot in terms of trying to administer the funds that have, currently, been appropriated. Will you, as an agency, be in a better position now to administer any future appropriations for programs such as the one 

outlined in this bill than you were initially? 

Dr. GERBERDING. Yes, I am not sure what is outlined in the bill, 

but if it is expectation of continuing what we are doing right now, 

I mean, I think we are on a good track. We are still challenged and 

that is one of the areas, I think, we would like to consult and confer both within the department, but also with the committee because we might not be the best place to do all of the things that 

the bill is asking us to do. And we feel strongly that there are some 

things that only we should be doing and we would like to make 

sure that we are playing to everybody’s strengths. But the really 

important thing is, we want to make sure that there is a care and 

70 

treatment program for both the responders and the affected nonresponders. 

Mr. DEAL. Because traditionally, CDC has not been the agency 

that supervises what is really a large entitlement program for 

healthcare. 

Dr. GERBERDING. Exactly. 

Mr. DEAL. That is not your traditional role. 

Dr. GERBERDING. That is our challenge. 

Mr. DEAL. And I think that is a legitimate concern as to where, 

if we are going to do this, where is the appropriate place for that 

kind of oversight and administration to take place. Would you give 

us a brief idea, though—I know you summarized rather quickly, 

but could you give us a brief idea how the CDC and NIOSH have 

been working with the city of New York to deal with this issue? 

Dr. GERBERDING. There have been several activities within the 

department and specifically within CDC and NIOSH. One is the 

registry program where people who believe that they were exposed 

or affected are welcome to register so that we can monitor and 

track them over time. Right now, there are about 75,000 people, 

mainly from the metropolitan New York area, who are included in 

that registry. 

We have also funded quite a few of the hospital—well, we funded 

all the hospital facilities that are seeing patients through these 

Centers of Excellence concept, and the Mount Sinai consortium. 

About 24,000 visits have occurred for the first visit and about 

13,000 follow-up visits have occurred. In the national program, 

there are about 4,000 people who are being followed that are not 

in New York. They are—this is happening around the country. And 

the fire department is following about 14,800 people and has done 

more than 20,000 follow-up visits. So there have been a lot of base 

line and follow-up visits and that is where we are beginning to get 

the accumulated knowledge that this problem is not going to go 

away, that people have been affected and there will be ongoing 

health issues for those, particularly, who were exposed early or exposed for a long period of time, at Ground Zero. 

We also believe there are going to be some health effects in the 

people who surrounded that area, but we know a little bit less 

about the long-term durability of those. And when you look at this 

dust, this material and you think about how deep it was and how 

dark it was when it was contaminating the air, you just have to 

appreciate that peoples lungs have been affected by their exposure 

to these materials that may include chemical and metal toxins, but 

also just particulates including asbestos. 

So there is a legitimate concern here and I am emphasizing that 

because sometimes I have—not here, but in other environments, I 

have seen a tendency for some people to be dismissive about the 

long-term seriousness of these effects and I wanted to be very clear 

and on the record as a physician and as a CDC Director that this 

is very credible evidence to me that this requires a long-term 

health monitoring program. 

Mr. DEAL. Thank you Dr. Gerberding. 

Mr. PALLONE. Thank you, Mr. Deal. Ms. Capps. 

Ms. CAPPS. Thank you, Mr. Chairman, and thank you Dr. 

Gerberding for your testimony today and for taking questions. One 

71 

issue of worker safety that has come up is that workers at Ground 

Zero were not required to wear fit-tested respirators during cleanup. As a public health nurse, I know it is well documented that the 

tested respirators are an effective tool to reduce inhalation of asbestos and hazardous materials, as well as to prevent the transmission of disease. 

I find it no surprise that workers at the Pentagon site, who were 

required to wear them, have experienced fewer negative health effects. In fact, I understand that even some of the workers at 

Ground Zero itself, who wore respirators, have not suffered as 

much as those who did not. I don’t know if this is scientifically 

demonstrated, but there has been some documentation. So without 

going back to revisit what happened that day, what steps are the 

CDC and other federal agencies that you are associated with, taking to ensure greater usage or mandatory usage of fit-tested respirators and any other protective equipment for future emergencies. In other words, as you prepare pre-mitigation planning, including the possibility of Avian Flu or other pandemic? 

Dr. GERBERDING. I wanted to address two points very quickly. 

One is there is a big difference between what happened in New 

York and what happened at the Pentagon in terms of the kinds of 

exposures and so forth, so it is not just a matter of respiratory protection, but that is likely. I mean, it is common sense that it would 

make a difference, so I agree with your overall principle. 

NIOSH has published, now, four volumes of guidance based on 

the lessons that we have learned from these experiences for protecting responders in situations of various kinds of emergencies, including an emergency such as an implosion or an explosion of a 

building, and it certainly does emphasize the importance of respiratory fitting and required use. 

We are also initiating a process of going State by State and examining the statutes and regulations on a State basis to assure 

that it isn’t just a matter of guidance that we are supporting that 

with effective regulatory and statutory language where that is required at a state level because not all states function the same 

way. So we think this is very important and we are doing everything that we can, as a government agency, to support that. 

Ms. CAPPS. So if there was an emergency, God forbid, in the next 

few days, would there be more of these fit-tested respirators—— 

Dr. GERBERDING. Absolutely. 

Ms. CAPPS [continuing]. Available and would they be deployed? 

I mean, nothing can happen 100 percent overnight, but—— 

Dr. GERBERDING. There are several issues here. One is availability, absolutely availability and access to testing. Those things 

can and will be done effectively. But there is a practical aspect of 

wearing one of these masks. I mean, what I remember in those 

early days is the fire personnel were there searching for their colleagues that were missing. And they were not thinking about themselves. They were thinking about rescuing people that they cared 

about. In that environment it is hard to breathe in a mask when 

you are working that hard and exerting that much, these masks 

get very—the work of breathing goes up. You get exhausted and 

they take the mask off, so there is a practical issue as well as a 

kind of infrastructure issue. 

72 

Ms. CAPPS. And as we all do here, there is drilling and preparation so that instinctively you know, just like on a plane, you put 

your own oxygen mask on before you assist—— 

Dr. GERBERDING. And the supervisors in the field have to plan 

on the fact that people will get tired of breathing with these masks 

on and work out schedules and rests and other administrative procedures to assure that workers can continue to work and wear 

their masks. I have many poignant photographs of masks hanging 

on pieces of concrete or beams, not because they weren’t there, but 

because people, just simply, couldn’t tolerate using them for as long 

as they were working. 

Ms. CAPPS. Thank you. If I have time, I want to address another 

issue. I am a member of Congress from California and I am disturbed to learn that there are only a small number of clinics in a 

very few States nationwide that are equipped to respond—provide 

screening and monitoring services for World Trade Center responders. Can you tell me where some of these are located? I represent 

the Central Coast of California and know personally and was so 

proud to say that a group of very brave talented, specially trained, 

first-responders responded very quickly to the call for help and now 

they are not sure where they can go for assessment and so forth. 

And shortly after we had Katrina, and so we know now that an 

event of that magnitude that happened on 9/11 is going to bring 

people from all over the country. 

Dr. GERBERDING. Some weeks ago we announced an award to an 

organization that operates national occupational health clinics, and 

they will assume the responsibility for providing care to the people 

who are outside the areas of New York and New Jersey where the 

Centers of Excellence are currently operational. So this award has 

been made. These clinics are scaling up. They want to be able to 

create a continuity of care so that there isn’t, ‘‘you had everything 

here and now you got to start all over.’’ So there is a transition period. 

Ms. CAPPS. Right. 

Dr. GERBERDING. But I think you are going to see, over the next 

year, a significant improvement in access. 

Ms. CAPPS. And this is now just beginning? 

Dr. GERBERDING. Several weeks ago the award was—— 

Ms. CAPPS. But all these years have gone by. 

Dr. GERBERDING. But we awarded the money the year we got it, 

so it is—we could have—— 

Ms. CAPPS. Used it earlier. 

Dr. GERBERDING. I have heard we should have been faster based 

on people’s need, but we did make that award available, and I 

think it is an expansion of what we were doing before and a broadening of the scale and scope of the reach. I hope it will be successful. We will have to monitor carefully to make sure that we are not 

missing people that need to be treated in that program. 

Ms. CAPPS. Thank you. 

Mr. PALLONE. Thank you. Mr. Weiner. 

Mr. WEINER. Thank you, Doctor, appreciate your testimony. Can 

you help us clear up a couple of concerns that some of our colleagues have had about the bill. You have spent some time in your 

testimony and response to questions to Mr. Pallone talking about 

73 

why it has taken so long to, kind of, come up with a foundational 

system to, kind of, deal with this problem. That is in stark contrast 

to what the ranking member, Mr. Barton, said earlier about us 

being hasty. In your view, have we been hasty in providing services 

to those in need? 

Dr. GERBERDING. I don’t think anyone would characterize our response as hasty. 

Mr. WEINER. Can I ask? You have been very frank about the 

long-term need for monitoring and the complexities of what is in 

peoples bodies at this point. Is there any question, in your mind, 

that the affliction that these people have is a direct result of 9/11? 

Dr. GERBERDING. On any given individual basis, I think that is 

always going to be impossible to say for sure, if a person has a 

problem was it attributed to the exposure or not attributed to the 

exposure, but the scientific information, looking at the population 

of exposed people, suggests that there is a significant attributable 

impact from the exposures at Ground Zero. 

And two lines of evidence support that. One is the proportion of 

people with respiratory and mental health issues is much greater 

than it was before 9/11, especially among the people who were enrolled in annual screening. But, in addition, compared to controls 

in the community who weren’t exposed that have higher rates and 

then finally, to the best of peoples ability to estimate dose of exposure. There is a dose response, so the earlier you were in, the 

longer you were there, the more likely you are to have significant 

symptoms and that has been documented with pulmonary function 

tests, independent of whether people also use tobacco products or 

not. 

Mr. WEINER. Right, but if—I mean, not expecting you to drill 

down to metaphysical certitude. As a medical professional, is there 

any doubt in your mind that the attack of September 11 and exposure to the after effects of that attack has led to the debilitating 

illness, in many cases, of thousands of people? 

Dr. GERBERDING. That is what the scientist says is the truth. 

Mr. WEINER. Well, I appreciate that. Can I also ask you this 

question, there is this question about how it is you define the universe of who we are going to cover, and you have touched on, in 

your testimony—I mean, I am concerned we must not let the perfect be the enemy of the necessary. We might never know with absolute precision every single human being and be able to issue 

them a card, you are affected, and then they come in and flash it. 

But, all that being said, there are some indicators that physicians can see and say, ‘‘you know what, this isn’t someone who just 

got off the bus from Kansas City trying to fill the gaps in their 

health insurance plan, and are trying to get into this.’’ This notion 

that we are creating, that there is a danger of creating this wide 

open system—there are markers that doctors can see. There is a 

way to separate, at least in the broadest sense, the wheat from the 

chaff. 

I think that what is truly mysterious is there is some opposition 

to saying, ‘‘Oh, you don’t want to create this open-ended health 

care plan.’’ 

By the way, that should be the worst thing we ever do, Mr. 

Chairman, is create an open-ended health care plan where people 

74 

can get healthcare. That should be—like people say that what a 

crime that would be to create healthcare for Americans. 

But there is this idea that, oh, we are going to create this process 

that the port authority and JFK and La Guardia are going to be 

filled up with people, I want to get a piece of this program. There 

are ways that physicians would some—we can acknowledge whether someone is showing the signs of the elements of asbestos, the 

elements of the dust, the elements of precedent that has been set 

from people who have been monitored. I can’t imagine that this is 

a process that needs to go on another 2, 3, 4, 7 years. I mean, there 

has got to be some, not universal consensus, but some sense of physicians who have been down there, have been taking a look at the 

files of people affected to be able to say, ‘‘you know what? This is 

clearly a case. Let us get on with providing the care.’’ Isn’t that the 

case? 

Dr. GERBERDING. Well, I have not personally been involved in the 

care of any of these people, so I can’t answer you from my own personal perspective, but obviously for some people it is easy. It is a 

no-brainer. They were there. They have the classic presentation 

that we were describing in this literature and it is very clear, but 

I think what we are trying to do here is balance the importance 

of being inclusive and acknowledging our uncertainty that we have 

got a lot to learn. 

There may be other things that emerge that we haven’t predicted 

or haven’t thought of yet, so you can’t exclude something because 

you haven’t seen it yet. At the same time we have to be accountable for the investment that we are making and that is an important part of this too. 

Mr. WEINER. Well, I think that is right, and my time is up, but 

I think that the most important part of your testimony is the notion that we need to be inclusive. We need to make sure that if we 

are going to create a program, it includes people in the community, 

it includes, I mean—the much more desirable mistake to make is 

to include two larger universes of people than it is to draw a line 

that includes too few people. And I think that that needs to be the 

defining ethos of people who take a look at this bill. We can always 

take an imaginary line and constrict it and make it smaller if it 

turns out OK. 

But I have to tell you something, I was standing on the deck of 

my office on Emmons Avenue in Sheepshead Bay, not exactly in 

the neighborhood. And we literally had dust and ember falling 

there—pieces of paper falling there. I can imagine how much fine 

and particulate matter that wasn’t written on a piece of paper I 

couldn’t see, how far that was going. I would encourage your office—we will try to deal with the fiscal constraints that we are 

handed, but your job as a medical professional is to think of the 

most expansive universe that we can and then, as we get through 

time, as you learn a little bit more, maybe you do draw the lines 

in. 

But that last thing we should do is draw such a tiny bubble then 

say, well, this is the only absolute certitude that we know and we 

wind up excluding thousands or tens of thousands of people who 

really do need this care simply because of our desire to find the 

perfect line. We are not going to find that. I acknowledge that, but 

75 

right now, inertia is the enemy because there are people, right 

now, that need care and people, right now, tragically, as you know, 

are dying because of the effects of 9/11 air. 

Dr. GERBERDING. And I think that the—at least our understanding of the congressional intent and the appropriation that was 

made was to be inclusive of the various groups. And we, as I admit, 

we were not as fast as you would like us to have been, but we have 

made a good faith effort to be inclusive of both the responders and 

now the community. And yes, there is uncertainty over what we 

will ultimately need to be doing, but we intend to reflect your intent. 

Mr. WEINER. Well, I thank you. You are the living, breathing 

speaking rebuttal to Mr. Barton’s notion that we are being hasty. 

And I have to tell you, if there is any benefit from your not being 

so quick, it is clear that Mr. Barton’s—— 

Mr. PALLONE. We have to move on, but thank you, Mr. Weiner. 

And, oh, Mr. Engel is here, so we have Mr.—the gentleman from 

New York is recognized. 

Mr. ENGEL. Thank you, Mr. Chairman. Doctor, I said in my 

opening statement that I was disappointed with your not reappointing Dr. Howard, and I would like to ask you if you could 

tell us why not, why you did not choose to reappoint him. I don’t 

agree that 12 years is too long. I don’t think that is an acceptable 

answer. There were others, Donald Miller, who served for 12 years, 

from ’81 to ’93. Linda Rosenstock was reappointed and served eight 

years. I know you have said it is a personal issue and you don’t 

want to discuss it. That is not acceptable. 

CRS tells us that there is no legal reason for you not to answer 

to Congress about a secretary level appointment. You have said you 

have given him a job in Atlanta to finish out his time before retirement. I don’t find that acceptable. It is not about finishing his tenure, it is about the great work he has done that you are putting 

an end to and you have said he had a problem with horizontal 

management. I don’t find that acceptable. I don’t know what it 

means. And does it mean that he was doing what Congress told 

him to do and not allowing things to be dissolved into CDC. 

And let me just say, if you won’t reappoint Dr. Howard to another 6-year term, I believe that you should keep him on as acting 

director through the end of the year or extend his term for a period 

of 1 year to provide continuity and give the new administration 

time to determine the appropriate leadership, as Chairman Obey, 

Chairman Harkin and ranking member Specter have called on you 

to do. And at a minimum, I think Dr. Howard should be retained 

as an advisor to Secretary Leavitt and the Office of the Secretary 

to oversee, and be a liaison on the World Trade Center Health Program. So I would like to ask you those things. 

I have put the New York Times editorial ‘‘A Pointless Departure’’ 

into the record. There are quotes praising Dr. Howard’s work from 

so many different organizations, including the Chamber of Commerce, the AFL, CIO and the American Industrial Hygiene Association, so obviously I am quite worked up about this and I would like 

to ask you to comment. 

Dr. GERBERDING. Thank you. It has been heartening, I think, to 

understand and respect how much Dr. Howard’s work on the World 

76 

Trade Center has been to the New York delegation and to those 

who are concerned about the overall situation with care and treatment for the responders and the non-responders who were affected. 

And I also think I need to be very clear that we appreciate Dr. 

Howard’s service. Dr. Howard has accepted a new position at CDC 

where he is actually going to be involved in working on issues related to worker protection around emergency response in our public 

health law program where his law degree will be serving him well, 

I think. As I mentioned to the Congresswoman, we are interested 

in making sure that we have statutes and regulations that protect 

workers generically on these kinds of disasters and that is going 

to be the focus of his ongoing work. And he has committed to making himself available to me and to his successor, Dr. Christine 

Branch, who is here in the room today. The deputy that he selected 

a year, or so, ago who has been also working on these issues and 

is a credible and credential scientist in her own right. 

We are taking away from this an acknowledgement of your expectation that you want a comparable level of support and service 

from CDC and NIOSH that you have come to enjoy with Dr. Howard. And so, I take it as a personal challenge to assure that we continue to focus on the World Trade Center efforts, that we make 

ourselves available, that we are responsive. 

I, this morning, had a chance to meet with some members of the 

delegation and gave them my personal cell number and my card 

and if there is ever an issue that you feel that CDC, NIOSH, HHS, 

or the administration are not responsive, I want you to please contact me directly because that is not my intent. I hope you would 

support us meeting in New York, having stakeholder conversations 

and really building on Dr. Howard’s successful engagement on the 

World Trade Center as we go forward. 

Mr. ENGEL. Well, let me just say, and this is nothing against the 

current deputy who I am sure is doing a fine job and will do a fine 

job, but it is very aggravating that you have been adamant in, just, 

not listening to all of us who feel so strongly in the New York region about what has happened. There is no reason whatsoever for 

Dr. Howard not to be reappointed, and this is not just my opinion. 

It is my strong opinion, but it is the opinion of the vast overwhelming majority of those of us and I—it is very disheartening 

that our wishes were not respected. It is just very, very disheartening. Let me ask you one other question. 

Mr. PALLONE. Time is expired. I will allow one more because I 

have let other people go over, but let us have the one and that is 

it. 

Mr. ENGEL. OK, thank you, Mr. Chairman. I am forever in—— 

Mr. PALLONE. You don’t have to be. Go ahead. 

Mr. ENGEL. Thank you. Why was Mount Sinai Hospital, the largest clinical center of the New York/New Jersey consortium, not allocated the original budget request and will additional funds be 

available to provide necessary services to this population of heroes? 

Why was it allocated $1 million dollars less than what they actually spent last year when they had expected growth in treatment 

from 5,000 to 6,000 patients? They were awarded $24 million and can’t under the grant update that they got last night, can submit a supplement for up to $6.4 

77 

million, which is still considerably less than they feel they will 

spend based on cohort size and continued growth and treatment 

and monitoring, plus inflation. So I wonder if you could explain 

this because even if awarded the supplemental later in the year, 

it still wont get them to what they expect will be the cost of $32 

million plus. 

Dr. GERBERDING. My understanding from the NIOSH team and 

conversations that I had, both with Dr. Howard as well as his deputy for management, is that the Mr. Sinai request, as it originally 

came in, was for $32 million and the senior grant managers in both 

sides of that equation looked at some of the projections and the estimates and said, ‘‘no, 30 was the more appropriate request 

amount.’’ So there was already a negotiation that $30 million dollars was what they were projecting they would need. 

We have looked at last year’s resource utilization. We have 

looked at money that has not been obligated and that is carried 

over as of April. Significant dollars had not yet been spent. It is 

impossible to say exactly what they are going to need. And I acknowledge a great deal of uncertainty, so we made sure that—we 

knew they would need at least $24 million, let us get that out. If 

there is evidence through our better monitoring programs, now, 

that the spend rate is going to continue to go up, as I wont be surprised if it does, we will need to make sure that they have the additional resources and if that doesn’t cover it or we don’t have what 

we need, we are going to have to come back and tell you we need 

more. 

So I am prepared to update these investments if the information 

and the experience suggests that there is a greater requirement 

than we are projecting today. But I am also clear that there is a 

lot of uncertainty here and we have never done this before and we 

don’t really know what people are going to need and we just have 

to make sure that you know that we will come back and ask if we 

need it and that our goal here is not to attenuate needed services, 

it is to try to support them, but also in an accountable and cost effective way that—we don’t want to end up in a situation where we 

have not been fiscally accountable and then we would have to come 

back to this committee and explain why we hadn’t been managing 

the money effectively. So we want them to get what they need. 

Mr. PALLONE. All right. Thank you very much, and thank you 

Eliot. And we appreciate your testimony. It has been very helpful. 

Thanks again, and I will ask the third panel to come forward. 

OK, welcome to the third panel, today. Let me introduce you. 

Starting on my left is Ms. Margaret Seminario, who is Director of 

Safety and Health for the AFL-CIO. Then we have Dr. Jacqueline 

Moline, who is Vice Chair and Associate Professor of the Department of Community and Preventive Medicine at Mount Sinai 

School of Medicine, in New York City. And, finally, Mr. Cas Holloway, who is Chief of Staff to the Deputy Mayor for Operations 

Counsel and Special Advisor to Mayor Bloomberg. 

And I will just say, I think you know the drill. We have 5-minute 

opening statements that become part of the record, and each witness may, in the discretion of the committee, submit additional 

brief and pertinent statements in writing. We may ask you addiVerDate Nov 24 2008 12:28 Oct 21, 2010 Jkt 037690 PO 00000 Frm 00083 Fmt 6633 Sfmt 6633 C:\DOCUMENTS AND SETTINGS\CWELLS1\HEARINGS\110-143 SCOM1 PsN: JIMC
78 

tional questions in writing, and we will start with—from my left, 

with Ms. Seminario. 

STATEMENT OF MARGARET SEMINARIO, DIRECTOR, SAFETY 

AND HEALTH, AFL-CIO 

Ms. SEMINARIO. Thank you very much, Chairman Pallone and 

ranking member Deal and members of the committee. I appreciate 

the opportunity to testify today to express the AFL-CIO’s strong 

support for the 9/11 Health and Compensation Act of 2008. This 

legislation will provide much needed and long overdue help to thousands of brave responders, recovery and clean-up workers and residents who are now sick as a result of exposures to toxins and other 

hazards that resulted from the attacks on the World Trade Center 

in 2001. 

We have already had a lot of testimony this morning reviewing 

what has happened and what we know. we know, with respect to 

the 9/11 attacks and the resulting collapse of the Trade Center, 

that we had, really, a level of unprecedented exposures to very 

large numbers of individuals, both on the day of the attack with 

the collapse of the towers and in the days and months that followed 

with the fires that burned and the dust exposures that continued. 

We also know that these exposures were made much worse by 

the fact that EPA pronounced that the air was safe and that for 

10 months on the clean-up of that site that the Occupational Safety 

and Health Administration did not enforce the law. As the committee has heard, last September and today, there is wide spread 

disease that has occurred as a result of these exposures and that 

we have thousands of workers who are now sick. Many of these 

people are disabled and they can no longer work, and a number of 

individuals have died. 

We have also heard that these problems, indeed, are serious and 

they are persistent. They are long term. And we have also heard 

that despite the fact that we have known about these serious 

health problems for some time, that still we have no action by the 

Bush Administration to put in place a comprehensive plan or a 

comprehensive response to what is a very, very large public health 

catastrophe. 

So today we are here to talk about H.R. 6594, a legislation that 

has been introduced that would establish such a comprehensive 

program and plan. This legislation has been under development for 

some time. A bill was introduced last September that actually 

formed the basis for this legislation. The new bill is a refinement 

on that piece of legislation. So we have not moved hastily on this 

at all. In fact, we in the labor movement, and others with the involvement, obviously, in leadership of Congresswoman Maloney, 

Congressman Nadler, Congressman Fossella, and the city of New 

York, we have been working on this for a very, very long time. 

First, with respect to putting in place the programs that are in 

place, as a result of funding that has been appropriated, but also 

tried to come up with a long-term legislative solution. And we 

think that H.R. 6594 is a very responsible measure, a much needed 

measure to address the problems that have been identified. 

Let me just briefly review what the bill would do and what has 

been done to try and address some of the concerns about the cost 

79 

of this program. The legislation attempts to build on the successful 

existing programs, so it builds on the Centers of Excellence at the 

Fire Department of New York and at the Mount Sinai Medical 

Consortium, because those programs have been successful and 

have been working. So that is the basis for this legislation. It also 

would establish a community program to finally provide, in an ongoing basis, the services, the medical treatment to those in the 

community who have been affected. It would provide monitoring to 

those who are eligible and it would provide medical care and medical treatment to those who have been determined to have a World 

Trade Center related condition. 

We have now refined the bill to include provisions to address the 

concerns that many have expressed about cost. But let me just 

state, because the problems are extensive, we have 18,000 responders who we know are sick, who have been in medical treatment. 

Because the problems are extensive and serious, the cost will be 

large. There is no getting around that. What has been done to try 

to address these costs in the bill are a number of things. 

First of all, the program is based at these Centers of Excellence 

and designated providers by including and limiting the care to 

these particular centers, it will both provide the high quality care, 

but it will also constrain cost by having people seen by individuals 

who know these conditions and can diagnose them and treat them 

effectively. 

The legislation also now includes particular provisions that raise 

the standard of proof and causality that is required for these to be 

considered World Trade Center related diseases. There are offsets 

included in the bill where workers compensation payments are 

made and those claims are accepted, the workers’ comp reimbursement cost will be reimbursed and offset to the program. 

For individuals who don’t have a work related problem, health 

care will be the primary payer with the federal program being the 

secondary payer. And New York City has also, in the bill, been designated to be responsible for a five percent cost share on the community program. 

And to deal with the questions of uncertainty, the bill now includes a cap on the number of participants in the program, that 

being set at 35 additional responders and 35 additional individuals 

in the community program. And so we think these measures are 

sound, they are responsible and that they have addressed the concerns that have been raised by individuals and Members of Congress about the potential large cost of this program. 

In conclusion, let me just say that on September 11, 2001 and 

the days that followed, tens of thousands of brave firefighters, police, emergency workers, and construction workers answered the 

call when the Nation was attacked. They toiled for days, weeks, 

and months trying to save lives, recover victims and repair a broken city, and now thousands of these workers and others are now 

sick. Some are disabled and many have died. These brave responders have received the Nation’s gratitude, but now they need the 

Nation’s help. The September 11 attacks were an attack on the Nation and the Federal Government has a moral obligation to assist 

those who responded just as it would assist others who have defended our country. 

80 

And now 7 years after the September 11 attacks, it is time for 

the Congress to make a commitment and establish a long-term permanent program to provide these responders and all who are sick 

the ongoing medical care and compensation they need and deserve. 

The AFL-CIO urges the Committee to move with all speed to support and favorably report the 9/11 Health and Compensation Act 

of 2008 so that this long overdue measure can be enacted into law. 

Thank you. 

[The prepared statement of Ms. Seminario follows:] 

STATEMENT OF MARGARET SEMINARIO

Chairman Pallone, Ranking Member Deal and Members of the Committee, I appreciate the opportunity to testify today to express the AFL-CIO’s strong support 

for the James Zadroga 9/11 Health and Compensation Act of 2008 (H.R. 6594). This 

legislation will provide much needed and long overdue help to the thousands of 

brave responders, recovery and clean-up workers and residents who are now sick 

as a result of exposures to toxins and other hazards that resulted from the attacks 

on the World Trade Center in 2001. 

Nearly 7 years ago, the September 11, 2001, terrorist attacks claimed the lives 

of 3,000 individuals, injured thousands more and brought unparalleled grief and anguish to the nation. But soon after the 9/11 attacks it became clear that those who 

died and were injured on that day were not the only victims. Tens of thousands rescue and recovery workers—including firefighters, police, emergency medical technicians, workers in the building and construction trades, transit workers and others— 

and hundreds of thousands of other workers and residents near Ground Zero were 

exposed to a toxic mix of dust and fumes from the collapse of the World Trade Center. The scale and scope of these exposures was massive and extraordinary, with 

tons of glass, pulverized concrete, asbestos, lead, and burning jet fuel forming a dust 

and smoke cloud that engulfed the WTC site and lower Manhattan and spread 

throughout the area. The exposures continued for months as the fires at the WTC 

burned, rescue, recovery, and clean-up operations ensued, and toxic dust contaminated the area. The exposures were made much worse by EPA’s pronouncements 

that the environment was safe and OSHA’s failure to enforce workplace safety and 

health requirements during the entire 10-month period of rescue, recovery, and 

clean-up operations at the WTC site. 

As this committee heard at a hearing last September, the exposures resulting 

from the attacks on the World Trade Center and its aftermath have caused significant and widespread health problems among rescue, recovery, and clean-up workers, 

residents, and others who were exposed. Peer reviewed studies by the New York 

City Fire Department (FDNY) show that 90 percent of FDNY rescue workers suffered new respiratory problems, experiencing an average loss of 12 years of lung capacity. A study of Ground Zero responders, recovery and clean-up workers conducted 

by the Mount Sinai Medical Center found that 69 percent had new or worsened 

upper or lower respiratory symptoms and one-third had abnormal pulmonary function tests. Similar findings have been reported by researchers from the Penn State 

University College of Medicine and Johns Hopkins in studies of police and other recovery and clean-up workers. These and other studies have also documented a high 

incidence of gastrointenstinal and mental health problems. 

While those who responded on September 11 and the days that followed had the 

highest exposures, other groups of workers and residents were exposed to the toxic 

dusts and also suffer similar health problems. A study of clean-up workers conducted by researchers from the Johns Hopkins University found that workers who 

started working at the WTC site after January 2002 also experienced significant 

respiratory health problems. And studies and surveys of residents and area workers 

conducted by the New York City Department of Health World Trade Center Registry have found similar patterns of reported respiratory and mental health problems in these populations. 

Despite the fact that serious health problems among World Trade Center responders have been documented and recognized for several years, it has been a struggle 

to get these brave workers and others affected the help and the care they need Since 

September 11, 2001, the Bush Administration has failed to provide leadership or 

take action. The administration has opposed reprogramming already appropriated 

funds for medical treatment, and dragged its feet on funding and establishing monitoring and treatment programs for responders outside the NY area, for federal 

81 

workers, and for residents and area workers. Repeatedly, the administration has 

failed to request the level of funding needed to support these programs. And most 

recently, the administration failed to reappoint Dr. John Howard as Director of 

NIOSH, also terminating his appointment as Director of the World Trade Center 

Health Program, despite widespread universal support from labor, industry, and the 

occupational health community and bipartisan support from Members of Congress. 

Largely at the initiative of Congress, in 2002, a federally funded screening program for firefighters, police, rescue and clean-up workers was established which 

identified serious health problems among these workers. This screening program 

was conducted by the FDNY and a consortium of medical centers with expertise in 

occupational health coordinated by the Mt. Sinai Medical Center. In 2004 this program was expanded to provide more comprehensive medical monitoring, which confirmed significant respiratory and gastrointestinal problems as a result of exposure 

to the toxic dust and fumes. But the workers’ compensation claims of many workers 

who were sick and disabled were contested by the city of New York and private contractors, leaving them nowhere to turn for medical treatment. Due to their health 

conditions, many of these sick responders are unable to work and have lost their 

health insurance. And even for those who have insurance, health insurance policies 

generally do not cover work-related conditions since they are supposed to be covered 

by workers’ compensation. None of these insurance policies provide coverage for ongoing medical monitoring for individuals who have been exposed and are at risk of 

developing disease. 

In FY 2006, through the efforts of the New York delegation and the unions, the Congress appropriated $75 million to further support these programs and to provide 

medical treatment to workers sick as a result from their exposures from the World 

Trade Center attacks and its aftermath. This medical treatment was provided 

through the same medical centers that had conducted the earlier screening and 

monitoring and had first identified and documented the health problems in responders, recovery and clean-up workers. In FY 2007, $50 million for medical treatment 

was included in a supplemental spending measure, and in FY 2008 a total of $158 

million was appropriated. The National Institute for Occupational Safety and 

Health (NIOSH) has coordinated and overseen these monitoring and treatment initiatives through the WTC Medical Monitoring and Treatment Program, which until 

recently was headed by NIOSH Director Dr. John Howard. 

In 2006, the city of New York announced and established the WTC Environmental 

Health Center at Bellevue Hospital to provide medical treatment to residents, cleanup workers and area workers who were not covered by the federally funded treatment programs. In the FY 2008 Consolidated Appropriations Act, Congress designated that some of the appropriated funds should be used to fund medical treatment for residents, students and area workers with World Trade Center Health 

problems. But HHS has yet to distribute these funds for this purpose. 

As of December 2007, 39,368 responders had received at least one examination 

in the FDNY or Mt. Sinai Consortium programs, according to the April 2008 Department of Human Services ‘‘Report to Congress: Providing Monitoring and Treatment Services for those Experiencing Injuries or Illnesses as a Result of the World 

Trade Center Exposures.’’ The FDNY conducted 14,620 of these initial exams and 

the Mt. Sinai consortium conducted 22,748 initial exams. HHS reports that of 

among the responders and recovery workers examined, 9,744 received medical treatment for a combination of respiratory and gastrointestinal conditions such as asthma, interstitial lung disease, chronic cough, and gastroesophageal reflux disease 

(GERD), and 5,674 received treatment for mental health conditions such as posttraumatic stress disorder (PTSD). According to FDNY and Mt. Sinai between 40 to 

45 percent of the responders in the monitoring program have been treated for WTCrelated health conditions, with some individuals being treated for both physical and 

mental health problems. 

The number of individuals in monitoring and treatment continues to grow as more 

responders have enrolled in the program, many of whom are sick as a result of their 

WTC exposures. It should be noted that these numbers do not include approximately 4,000 responders who live outside of the NY-NJ area who have also received 

screening or monitoring or the approximately 2,700 residents, area and clean-up 

workers who have received medical treatment for WTC-related health conditions 

through the WTC Environmental Health Center at the Bellevue Hospital. Nor do 

they include individuals who are not enrolled in existing programs or receiving 

treatment from other health care providers. 

In November 2007, in a Congressional briefing on the WTC responder monitoring 

and treatment program, NIOSH estimated the cost of the responder medical monitoring and treatment program at approximately $218 million for FY 2008. Of this 

amount, the estimated cost of treatment is $149 million, the cost of monitoring is 

82 

$37.5 million, and the cost of program coordination, data collection and other support is $32 million. 

As more responders become sick, as is still the case, these costs will likely increase. Since many of the WTC-related health problems are chronic conditions, 

these individuals will need medical treatment for years to come. Moreover, due to 

the massive and complex exposures that occurred, there is concern that new conditions with longer latencies, including cancer, fibrosis, and auto-immune diseases will 

also emerge. 

The medical monitoring and treatment programs that have been established at 

the FDNY, Mt. Sinai Consortium, and Bellevue Hospital have been vital for the 

thousands of workers and others who are now sick as a result of their exposures. 

But nearly seven years after the collapse of the World Trade Center towers, these 

efforts are still temporary and piecemeal; and there is no comprehensive permanent 

program to provide ongoing guaranteed medical monitoring to those who were exposed and medical treatment to responders, recovery and clean-up workers and 

members of the community who are suffering from WTC-related health problems. 

THE JAMES ZADROGA 9/11 HEALTH AND COMPENSATION ACT OF 2008 (H.R. 6594) 

The 9/11 Health and Compensation Act of 2008 (H.R. 6594) would establish a 

comprehensive program to provide medical monitoring to those who have been exposed to WTC toxins and medical treatment and compensation to those who are 

sick. It would also fund ongoing research on WTC-related health conditions and reopen the Victim Compensation Fund (VCF) to provide compensation to those who 

have been harmed or suffered economic loss. 

Specifically H.R. 6594 would amend the Public Health Service Act to establish the 

World Trade Center Health Program within the National Institute for Occupational 

Safety and Health, to be administered by the NIOSH director or his or her designee. 

The legislation would establish a monitoring and treatment program for responders, a program for the community and a national program for those eligible individuals who reside outside the NY Metropolitan area. 

The legislation builds on the successful monitoring and treatment programs that 

have been providing services to these populations. The responder program would be 

delivered through Clinical Centers of Excellence at the FDNY and the Mt. Sinai coordinated consortium, in which five medical institutions currently participate. The 

community program would be delivered through Clinical Centers of Excellence at 

the Bellevue Hospital. This delivery system will ensure that workers and community members are evaluated and treated by physicians who have expertise in diagnosing and treating World Trade Center related conditions, and will receive high 

quality care. Additional clinical centers and providers may be designated by the program administrator, providing they have the necessary expertise and meet other 

program requirements. 

Steering committees of providers and representatives of the affected populations 

would be established to help guide and coordinate the responder and community 

programs. 

Coordination of these clinical center programs is to be overseen by Coordinating 

Centers of Excellence at the FDNY, Mt. Sinai and Bellevue Hospital which will collect and analyze uniform data, develop medical monitoring and treatment protocols, 

coordinate outreach and oversee the steering committees for the responder and community health programs. 

The bill sets forth eligibility criteria for inclusion in the program, which are based 

upon exposure to World Trade Center toxins and hazards, and are defined in geographic and temporal terms. For the responder program, the eligibility criteria are 

based upon work at the World Trade Center site and related disposal and support 

facilities. These criteria are based on those that have been utilized in the existing 

WTC Medical Monitoring and Treatment Program for responders and have been approved by NIOSH. Responders who meet the eligibility criteria qualify for the medical monitoring program. As stated earlier, approximately 40,000 responders have 

received monitoring exams in the current program. Estimates of the total population 

of responders who may qualify range from 50,000 to 100,000 individuals. 

Responders who are in the monitoring program are eligible for medical treatment, 

if an examining physician at a clinical center of excellence diagnoses a condition 

that is on the list of identified WTC-related health conditions included in the bill, 

and the physician determines that exposure to WTC toxins or hazards is substantially likely to be a significant factor in causing the condition. The list of conditions 

included in the bill is the same list utilized in the current responder monitoring and 

treatment program that has been approved by NIOSH. 

83 

Under the bill, the NIOSH Administrator is responsible for making final eligibility determinations and certifying individuals for participation in the monitoring 

program and their eligibility for medical treatment. 

Recognizing that the scientific and medical evidence on WTC-related health problems continues to evolve, the bill provides for the addition of conditions to the list 

of identified WTC-related conditions, with the review and input of a Scientific and 

Technical Advisory Committee. It also provides for special independent expert medical review procedures for the consideration of medical treatment claims of individuals diagnosed with WTC-related conditions that are not yet on the list. 

While we do not know the full extent of WTC-related disease among responders, 

we do know that in the current program approximately 40 0945 % of those in the 

monitoring program have been treated for a WTC-related health condition, and the 

number of sick responders continues to increase. 

For the community program, the bill also sets forth geographic and exposure criteria for defining the potential population that may be eligible for the program. The 

bill designates the geographic area covered by the bill as lower Manhattan South 

of Houston Street and the area in Brooklyn within a 1.5 mile radius of the World 

Trade Center site, and sets various time limits for residing, working, or being 

present in the designated area. In addition the bill requires the WTC Program Administrator to develop and adopt more refined eligibility criteria within 90 days taking into account the period and intensity of exposures, based upon the best available 

evidence, in consultation with the Bellevue Hospital, the Community Steering Committee and affected populations. 

For the community program, the bill includes provisions for making determinations of eligibility for medical treatment similar to those as for the responder program. The major difference in the programs is the expectation that the community 

program will not provide a comprehensive monitoring program but rather will focus 

on more limited screening and treatment of individuals with World Trade Centerrelated health conditions. 

For those eligible responders, residents or non-responders who reside outside the 

NY metropolitan area, the bill directs the WTC Program Administrator to establish 

a national program with services to be provided by health care providers designated 

and approved by the administrator. These providers must have expertise and experience in treating the type of medical conditions included on the list of identified 

WTC-related conditions and agree to follow the established medical treatment and 

data collection protocols set forth in the bill. 

PROVISIONS TO ADDRESS PROGRAM COSTS

The AFL-CIO recognizes that many in Congress are concerned about the costs associated with this legislation, particularly since the bill is structured as an entitlement to ensure ongoing funding for medical treatment for those who are sick as a 

result of World Trade Center exposures. Unfortunately, due to the massive exposures that occurred and the failure to protect workers and residents, the health 

problems that have resulted are serious, persistent and extensive. 

While we do not know the full extent of the health problems that have resulted 

or will result from WTC exposures, nearly seven years after the September 11 attacks, we do have substantial knowledge and experience, particularly concerning responder health problems and related treatment costs. As stated earlier, there are 

approximately 40,000 responders who have received monitoring and 18,000 individuals who have received medical treatment for WTC-related physical and/or mental 

health conditions. According to NIOSH, the current cost of WTC Responder Monitoring and Treatment Program is approximately $218 million a year. 

For the community program, there is less experience and less information since 

the WTC Environmental Health Program at the Bellevue Hospital was just initiated 

in 2006. To date, approximately 2,700 individuals have received medical treatment 

for World Trade Center-related health problems similar to those seen in the responder population. While the exposures of most residents and area and clean-up 

workers were not as great as responders who worked at the WTC site, many of 

these individuals had significant exposures and are suffering from serious health 

problems. Moreover, the number of individuals seen in the Bellevue program does 

not represent the full populations of those who are eligible or sick with WTC-related 

health conditions. In a September 2007 report, ‘‘Addressing the Health Impacts of 

9-11: Report and Recommendations to Mayor R. Bloomberg,’’ an expert panel of New 

York City officials estimated the potential costs of treatment for residents and area 

workers for 9/11 conditions at approximately $200 million a year. 

While the costs of WTC-related health problems will be large, the legislation includes a number of provisions to constrain these costs. First the program is limited 

84 

to the Centers of Excellence or providers designated by the administrator who have 

experience with WTC-related health conditions. Eligible individuals must receive 

monitoring or treatment through these designated providers. 

Evaluations of exposures and health conditions are to be made utilizing standardized questionnaires approved by NIOSH, and treatment provided according to medical protocols established by the program. 

For conditions that are work-related, the medical treatment costs are offset by 

any workers’ compensation payments and the Centers of Excellence are required to 

assist eligible individuals to file for these and other available benefits. Unfortunately, since the city of New York and other employers continue to contest these 

claims, to date the workers’ compensation benefits for these conditions have been 

limited and delayed. 

For those conditions that are not work-related and are covered by existing health 

insurance, the legislation designates the WTC treatment program as the secondary 

payor, with private or public insurance having the primary obligation to pay for 

treatment. 

In addition, for individuals receiving treatment in the community program at 

Bellevue Hospital or other facilities of the Health and Hospitals Corporation, the 

city of New York is responsible for a 5 percent cost share of treatment costs. 

But because the numbers of individuals who may be affected is indeed uncertain, 

the legislation imposes a mandatory cap on participation. For the responder program this cap is set at 35,000 additional responders to the number currently enrolled in the monitoring program, bringing the total program participation to approximately 75,000 responders. For responders this cap applies to the number of responders in monitoring, of which, based on current experience, approximately 40 

0945% or 30,000 to 34,000 individuals can be expected to require some type and 

level of medical treatment. 

For the community program, the cap is also set at 35,000 participants in addition 

to the approximately 2,700 individuals who are currently enrolled in the Bellevue 

program. Because of the design of the Bellevue program, which only enrolls those 

with diagnosed WTC-related conditions, all of those certified as eligible for the community program are expected to receive medical treatment. 

Because the geographic area for the community program has been limited and due 

to the uncertainty about the extent of exposures and disease, the bill provides for 

a contingent fund of $20 million a year to provide medical treatment to residents 

and non-responders who are diagnosed with WTC-related conditions, but fall outside 

the scope of the bill’s exposure and geographic eligibility criteria. For example, this 

contingent fund would be available to pay the cost of medical treatment for individuals diagnosed with WTC related conditions in New Jersey, Staten Island and other 

locations in the NY metropolitan area who were exposed outside the geographical 

boundries set in the bill. 

In order to track the program’s progress and experience, the legislation requires 

the WTC Program Administrator to provide an annual report to Congress setting 

forth the experience with claims, the nature of the diseases treated, the results of 

new research, program costs and other information. In addition, if and when 80 percent of the cap in either the responder or community program is reached, the administrator is required to notify Congress, so a determination can be made if further 

congressional action should be taken. 

THE CONGRESS SHOULD ACT NOW TO PROVIDE ONGOING MEDICAL TREATMENT TO

RESPONDERS, RESIDENTS AND OTHERS WHO ARE SICK FROM WORLD TRADE CENTER

EXPOSURES AND ENACT THE 9/11 HEALTH AND COMPENSATION ACT OF 2008 (H.R. 

6594) 

On September 11, 2001 and the days that followed tens of thousands of brave firefighters, police, emergency workers, and construction workers answered the call 

when the nation was attacked. They toiled for days, weeks and months trying to 

save lives, recover victims and repair a broken city. 

Now thousands of these workers and others are sick as a result of World Trade 

Center exposures, many are disabled and some have died. For the past several 

years, the Federal Government has provided monitoring and medical treatment for 

responders who are ill through a series of temporary short term funding measures. 

But many more who are ill have yet to receive the care they need, and there is no 

long term plan or funding to ensure that medical treatment will continue. 

These brave responders have received the nation’s gratitude but now they need 

the nation’s help. The September 11 attacks were an attack on the nation and the 

Federal Government has a moral obligation to assist those who responded just as 

it would assist others who have defended our country. 

85 

Seven years after the September 11 attacks it is time for the Congress to provide 

these responders and all who are sick as a result of the World Trade Center attacks 

the ongoing medical care and compensation they need and deserve. The AFL-CIO 

urges the Committee to move will all speed to support and favorably report the 

James Zadroga 9/11 Health and Compensation Act of 2008 (H.R. 6594) so that this 

long overdue measure can be enacted into law. 

Thank you. 

Mr. PALLONE. Thank you. Dr. Moline. 

STATEMENT OF JACQUELINE MOLINE, M.D., M.SC., VICE CHAIR 

AND ASSOCIATE PROFESSOR, DEPARTMENT OF COMMUNITY 

AND PREVENTIVE MEDICINE, MOUNT SINAI SCHOOL OF 

MEDICINE 

Dr. MOLINE. Good afternoon. I am a board certified specialist in 

Occupational Medicine and in Internal Medicine and I am the Director of the Mount Sinai Clinical Center for the World Trade Center Medical Monitoring and Treatment Program. Our center is the 

flagship of a regional and national consortium that has been supported by NIOSH, and since July 2002 has seen over 25,000 responders in the New York metropolitan area and across the United 

States. 

In the days, weeks, and months that followed September 11, an 

estimated 50,000 to 100,000 people from across the country responded selflessly without concern for their own lives or well-being 

when our Nation needed them. Workers and volunteers, traditional 

first-responders, firefighters, police officers, paramedics, the National Guard, and the not so traditional—a diverse force of operating engineers, laborers, iron workers, telecommunication workers, transit workers, sanitation workers, building cleaners and 

many more. They came from across America, tens of thousands 

from the metropolitan New York area, but from every state in the 

Nation. They toiled for days, weeks, and months in and around 

Ground Zero, at the Staten Island landfill, engaged in rescue and 

recovery work, the restoration of critical services, debris removal, 

and clean-up. Their hard work and bravery got New York back on 

its feet and we owe them tremendous gratitude. 

While they were there, they were exposed to a complex and unprecedented mix of toxic chemicals. Ninety thousand liters of jet 

fuel created a dense plume of black smoke with volatile compounds 

in it, such as benzene, metals, and polycyclic aromatic hydrocarbons. The collapse of the Twin Towers, and later that day a 

third tower, World Trade Center seven, produced an enormous dust 

cloud filled with pulverized cement that was 60 to 65 percent of 

that dust mass. Trillions of microscopic glass particles and fibers, 

asbestos, lead, hydrochloric acid, PCBs, pesticides, furans, and 

dioxins were in the air. Levels of airborne dust, estimated by the 

U.S. Environmental Protection Agency, range from—up to 100,000 

micrograms per cubic meter creating a thick airborne soup that 

turned a bright sunny day into night. The high content of pulverized cement made the dust extremely caustic with a pH similar to 

lye. Fires burned both above and below ground until December. 

Rubble removal operations continued until May, continuously reexposing individuals to this dust. 

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In addition to the physical exposures there were extreme psychological stressors. Responders lost friends and family and during the 

desperate search and rescue operations; thousands of them came 

upon human remains. Stress was compounded by fatigue as these 

dedicated workers remained at the site working for hour on hour. 

Among those most affected are the non-traditional responders, 

those not trained for any emergency, but who responded when our 

Nation needed them. 

Mount Sinai, through its Center for Occupational and Environmental Medicine has taken a leading role in treating these workers. This work began days after the attack, many months before 

any Federal program was in place. We designed and developed 

what stands as the Federal Government’s health response to 9/11, 

a model based on experience and expertise of academic physicians 

who are trained in Occupational Medicine, surrounded by specialists in Pulmonary Medicine, Psychiatry, Rehab Medicine, and other 

healthcare workers. 

We have been proud to work as a partner with all of you, legislators, agencies, and the stakeholders, to represent them to provide 

a program that brings experience and excellence. We have a regional consortium that you have heard of earlier today: Mount 

Sinai, SUNY Stony Brook, University of Medicine and Dentistry of 

New Jersey, in your region Chairman, the Queens College Center 

for Biology of Natural Systems and Bellevue. Together with the national program that we, until recently, coordinated has provided, as 

of the end of May, nearly 40,000 examinations to over 25,000 responders from all 50 states. 

In that time, we have also provided 70,000 treatment services in 

our consortium. At Mount Sinai alone we have provided over 

53,000 treatment services and over 24,000 of those services have 

been since federal funding was in place. Earlier we had philanthropy that covered many of the costs. 

Much of what we know about the health effects has been learned 

through our program and our sister program at the Fire Department of New York. Our physicians have diagnosed and carefully 

documented diseases and responders and linked these conditions to 

the exposures at the World Trade Center. We have provided expert 

medical, mental health and social work treatment, as is needed, to 

all who come in our doors. We remain constantly vigilant for newly 

emerging diseases and trends in the 9/11 population. People are 

still coming in. In the past year, almost seven years after September 11, an average of over 160 new, eligible responders come 

in every month. 

Adverse health effects are suffered by a large percentage of our 

responders. There have been social and financial impacts which 

have added to the problems they face. Respiratory conditions have 

been well documented in peer reviewed literature. In 2006 we published a paper that showed that among monitoring responders new 

or worsened respiratory symptoms were experienced by 63 percent; 

lower respiratory symptoms, such as asthma, COPD in 47 percent. 

One quarter had objective measures of decreased pulmonary function and rates were higher, five times higher, in some tests than 

in comparably non-smoking, non-exposed Americans. 

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Mental health consequences also afflict a large percentage of 9/ 

11 responders. We recently published a paper that shows that 

PTSD, or post-traumatic stress disorder, rates are at rates similar 

to returning veterans from Afghanistan, with 11 percent. 

Mr. PALLONE. I am sorry, but I just wanted you to know you are 

a minute-and-a-half over, so you have to wrap up. 

Dr. MOLINE. Oh my goodness, I will talk faster. 

Mr. PALLONE. Right, or summarize. 

Dr. MOLINE. I will summarize. We continue to see health effects, 

gastrointestinal problems in the folks we treat. Four thousand people in the past 6 months have been treated. Mental health problems in one-third, lower respiratory conditions in nearly half, 25 

percent of our folks are on disability and out of work as a result 

of their health problems, and over 60 percent have multiple World 

Trade Center conditions. 

The medical literature from all the programs, whether it is the 

Mount Sinai consortium, the Fire Department, Bellevue’s Environmental Health Clinic, we have all published. We have all found the 

same percentages of illnesses. These illnesses are real. They are 

persistent and we need a long-term stream of funding in order to 

ensure that people can get adequate healthcare going forward, 

without concerns about interruption in the care so that we can 

learn and be prepared for diseases that may come in the future. We 

know there are carcinogens and other health hazards that will 

manifest in the future and we need to be prepared through our 

Centers of Excellence to be able to cover these. 

[The prepared statement of Dr. Moline follows:] 

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Mr. PALLONE. Thank you, and your full statement will be put in 

the record too. Thank you, Doctor. Mr. Holloway. 

STATEMENT OF CASWELL HOLLOWAY, CHIEF OF STAFF TO 

THE DEPUTY MAYOR FOR OPERATIONS COUNSEL, SPECIAL 

ADVISOR TO MAYOR BLOOMBERG 

Mr. HOLLOWAY. Thank you very much, Mr. Chairman. Can you 

hear me? Thank you very much. 

Mr. PALLONE. Maybe bring it closer. 

Mr. HOLLOWAY. There we go. Sorry about that. 

Mr. PALLONE. That is good. 

Mr. HOLLOWAY. Thank you, Chairman Pallone and the members 

of the committee who were here. I want to reiterate Mayor 

Bloomberg’s thanks to Speaker Nancy Pelosi, to the New York delegation, particularly Representatives Nadler, King, and Fossella for 

making this legislation a priority. My name is Cas Holloway and 

I am Chief of Staff to New York City’s Deputy Mayor for Operations, Edward Skyler and a Special Advisor to Mayor Bloomberg. 

Along with my colleague, Rima Cohen, who is also here behind me 

today, I served as Executive Director of the Panel convened by 

Mayor Bloomberg at the fifth anniversary of the attacks to assess 

the health impacts of 9/11 and what needed to be done to ensure 

that those who are sick or could become sick get the treatment that 

they need. 

I also want to acknowledge Dr. Joan Reibman and Dr. David 

Prezant, who are also sitting behind me as back-up. Dr. Reibman 

runs the Bellevue Center, which is the only center open to residents and community members and is currently treating 2,700 patients. And, of course, Dr. Prezant, who I think is known to everybody involved with this issue, who runs the Fire Department’s program. Both of these doctors have submitted testimony to the committee, which details the same effects and treatment information. 

For example, in the community program they are fielding 100 calls 

a week and admitting as many as 25 patients a week over the last 

6 months, so the need is clearly there. 

And as the Mayor said when he testified, just a short while ago, 

this bill establishes two critical things. It provides the long-term 

funding that we need to meet the health needs. It also reopens the 

Victim Compensation Fund. 

I don’t want to go back over all of that. What I would like to do 

though is focus on some of the controls that are in the bill, some 

of the changes that have been made over time, that working with 

the people sitting with me here, we think, will do a lot to control 

the costs and make sure everybody who needs care gets care, because we recognize that these are public dollars and Mayor 

Bloomberg is as committed to fiscal responsibility as anybody on 

the committee. 

First, the bill defines specific groups, for example, firefighters 

and recovery workers and specific geographic areas the people 

must have been in or on or within a defined period after 9/11 to 

be eligible for treatment. Now, there is a defined specific contingency fund for people who would be outside that area because, the 

fact is, we don’t know the full extent of the problem and the goal 

of this bill is to cover anybody who could be sick. 

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Second, although people who meet these criteria are eligible for 

treatment under the bill, to actually get treatment a doctor with 

experience treating WTC related conditions must determine, based 

on medical examination, that the exposure was caused or exacerbated by 9/11. That assessment has to be based, in part, on standardized questionnaires. And even after a condition is deemed to be 

WTC-related, it is subject to review and certification by the World 

Trade Center administrator under the bill. 

Now, these are tough standards, and they are based to a large 

extent on protocols already in place at the Environmental Health 

Center at Bellevue at HHC, and I know that there are lengthy 

questionnaires that are used for the responder programs. 

The bill also caps the number of responders and community 

members who can get monitoring and treatment. These limitations 

are based on the best available information. And to make sure that 

we don’t get it wrong, there is a provision in the bill to notify Congress if those caps are reached, which is critical to making sure, 

again, that anybody who is ill gets covered. 

In addition to these controls, which apply to every potential patient, the bill mandates the establishment of quality assurance and 

fraud prevention programs that act as further safeguards against 

the misuse of these funds for any purpose other than to monitor 

and treat those who were affected by the 9/11 terrorist attacks. 

The bill also ensures important provisions to contain costs and 

make sure that federal dollars are used wisely. As Peg Seminario 

mentioned, there is an offset for workers’ compensation if it has 

been paid. The program acts as the last payer if there is health insurance that covers the conditions that people present for. 

And finally, as Mayor Bloomberg pointed out, under the bill, the 

City is responsible for paying 5 percent of treating anyone treated 

at a Center of Excellence that is within the Health and Hospitals 

Corporation. Currently, by the way, that is everybody in the community program because it is only an HHC program that is open 

to community members. We accept this responsibility because 

Mayor Bloomberg thinks that it is critical for the city to have an 

investment in making sure that these dollars are spent wisely and 

that that is fully consistent with this being a national obligation. 

I do want to mention one issue that we would like addressed as 

the bill moves forward. The bill establishes steering committees for 

both the responder and the community programs and we would 

like to make sure that there are representatives from the Police 

Department and another responder agency on the responder committee and that the Department of Health is represented on both 

of the committees because we think that is important institutionally, as we move forward. We are actually working together to resolve those issues, but I wanted to just mention it. 

The bill also ensures that critical 9/11 related research is expanded and existing efforts like the World Trade Center Health 

Registry are continued because long-term research is the only way 

that we are going to be able to develop a full understanding of the 

health impacts of 9/11. 

And finally, this bill fulfills another core recommendation of 

Mayor Bloomberg’s World Trade Center Health Panel, the urgent 

need for Congress to reopen the VCF. The VCF was fair and effiVerDate Nov 24 2008 12:28 Oct 21, 2010 Jkt 037690 PO 00000 Frm 00104 Fmt 6633 Sfmt 6633 C:\DOCUMENTS AND SETTINGS\CWELLS1\HEARINGS\110-143 SCOM1 PsN: JIMC
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cient and it provided a means of relief for the victims of the attacks 

and their families. It is imperative that the fund be reauthorized 

to take care of those who were not eligible to benefit before it 

closed in December of 2003. The fact that their injuries were slower 

to emerge or that the initial criteria were too narrow should not 

disqualify them from getting the help they need. 

The reason we need this is that the city and the contractors need 

the indemnity that the bill also provides, is to ensure that, God forbid another attack like this is to happen again, the private sector 

and the public sector would respond knowing that they had the full 

backing of the Federal Government. And, in addition, the way the 

bill is structured once these things are in place, the one billion dollars that is currently available in the Captive Insurance Company 

would be made available to pay out claims under the VCF. 

So, in sum, this bill achieves two critically important things to 

help complete the recovery from 9/11, the health funding and reopening the VCF. That is why it has gained such strong support 

in the New York delegation and that is why Mayor Bloomberg has 

come down here many times and was down here today, in support 

of the bill. We are pledged to working with you to do everything 

in our power to make sure that it moves forward and is ultimately 

enacted. Thank you. 

[The prepared statement of Mr. Holloway follows:] 

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Mr. PALLONE. Thank you and thank you to all of you. I am going 

to recognize myself for questions. Initially, I am trying to get one 

in for each of you in my time, so let me start with Ms. Seminario, 

and I understand you were actively involved in the drafting of this 

new version of the bill and I am going to be very parochial on this 

one. 

I am curious about how the changes from the first bill to this one 

might affect my constituents and the citizens of New Jersey. I 

mean, I am sure you are aware that many New Jerseyans were affected by the attacks. Most of the people who live in the—and who 

worked on one of the top floors from—what was it Cantor, they 

mostly were—most of those people that died were in my district, 

actually. 

So, specifically, the way that you did this with the radius so that 

it is south of Houston and within one-and-a-half miles of Brooklyn, 

would the previous bill, in terms of—not first-responders, but the 

people that actually lived or worked there—would the previous bill 

have included parts of New Jersey that would not be included the 

way it has been struck now. I mean, I know now it wouldn’t include Staten Island or New Jersey because you have to be Manhattan or Brooklyn. I mean, is there a reason for that and is it because 

the cloud didn’t go over New Jersey or Staten Island? That would 

be my first question. 

And then, with regard to the Centers for Excellence, obviously 

the site in New Jersey has been very important for the State. Is 

there any way that the legislation guarantees that we continue to 

have the site in New Jersey? I am being very parochial here, as 

you can see. And I also assume that Staten Island is part of New 

Jersey too, but go ahead. 

Ms. SEMINARIO. That is fine. Let me address the first question 

with respect to the coverage under the bill. From the initial bill, 

3543 to this bill, the criteria, essentially for the responders, remained the same, so that didn’t change at all, but what did change 

were some of the criteria with respect to the residents and area 

workers, those who would be affected by the community program. 

The original bill, essentially, set a 2-mile radius from the World 

Trade Center site as the area in which those who were residents, 

working and meeting certain criteria would be potentially eligible. 

It, then, left it to the World Trade Center administrator, working 

with Bellevue and others in the community to tighten up those criteria to try to determine who, exactly—— 

Mr. PALLONE. Well, was the 2 miles—would that have included, 

say, New Jersey and Staten Island? 

Ms. SEMINARIO. It would have included Staten Island, definitely, 

and I believe from my recollection looking at the map, it would 

have included parts of New Jersey. As far as the present bill, the 

geographic criteria were changed to make is south of Houston, 

within lower Manhattan, and a radius of 1-and-a-half miles into 

Manhattan. That population—— 

Mr. PALLONE. No, from Brooklyn, I thought. 

Ms. SEMINARIO. I am sorry, Brooklyn, correct. 

Mr. PALLONE. So what is the justification for that other than the 

money? 

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Ms. SEMINARIO. The money was the driver on this because in 

looking at the bill, it starts with a pool of potentially eligible people 

from where they live or where they work and with that number 

being pretty large—Manhattan and the New York area is a very 

densely populated area. There were a very, very large number of 

people who it potentially affected. In structuring the bill as an entitlement, that meant that anybody who was in that area, that presented with possibly a World Trade Center related—— 

Mr. PALLONE. But what I am asking you is, was there some reason to believe that the people in Brooklyn, for example, were affected greatly and those in Staten Island, New Jersey were not? 

Ms. SEMINARIO. Yes, in terms of where the cloud went. 

Mr. PALLONE. Yes, I mean, that is what I want to know. 

Ms. SEMINARIO. We really tried to look at where the greatest exposure was and put those individuals in the area that were in the 

potentially eligible pool. But we also did—recognizing that there 

may be other individuals because we don’t know who were exposed 

but aren’t in that defined area. We created a contingent fund, and 

essentially what the bill does is it allows those people to come forward just like anybody else. Come forward and to be evaluated and 

for a determination made that they have a World Trade Center related condition. The only difference is, essentially, which pocket it 

gets paid out of. One would be an entitlement. The other is, essentially, a contingent fund that would provide payment for those individuals. 

Mr. PALLONE. What I would ask you to do, if you could get back 

to us and explain this phenomenon of the cloud and how—— 

Ms. SEMINARIO. Sure. 

Mr. PALLONE. It is true that if you are in Brooklyn or Manhattan, you are much more likely to be exposed than somebody that 

might have been to the west or to the—I don’t know, sand house 

to the south and west, I guess. New Jersey’s to the west. 

Ms. SEMINARIO. Right, but let me just make—— 

Mr. PALLONE. If you could get back to us with that. 

Ms. SEMINARIO. Be happy. One point, though, as far as the individuals. If they worked in Manhattan, if they worked in that area, 

they are covered. 

Mr. PALLONE. Right, no I—— 

Ms. SEMINARIO. The only people who aren’t are the people who, 

essentially, were residing outside of that area. 

Mr. PALLONE. Right. 

Ms. SEMINARIO. They would not—— 

Mr. PALLONE. Well, you have to give us some information on 

that. 

Ms. SEMINARIO. We would be happy to, and then the next question you asked, just very quickly. 

Mr. PALLONE. The center. 

Ms. SEMINARIO. The center, yes. The center is specifically covered 

in the bill as one of the Centers of Excellence. It is established, as 

a matter of statute, as one of the ongoing Centers of Excellence to 

provide treatment and care for these individuals. 

Mr. PALLONE. The one in New Jersey? 

Ms. SEMINARIO. That is correct. 

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Mr. PALLONE. OK. We will come back. Let me yield to the gentleman from New York. Well, I have more, but we can go back and 

forth— 

Mr. HOLLOWAY. Chairman, do you mind if I just add one or two 

points on the—— 

Mr. PALLONE. On that? Sure. 

Mr. HOLLOWAY. The radius, as Peg first pointed out, there are 

categories of people in the bill, including for responders and nonresponders, where if you were downtown working in Manhattan, if 

you worked on the pile. If you are in those groups, you are covered. 

Mr. PALLONE. Right. 

Mr. HOLLOWAY. The radius really covers—we were looking at 

this more from the community perspective and working with Dr. 

Reibman and HHC we said, OK we have 2,700 people in our program now. Based on who we have seen, where are they falling, 

what is the scatter plot? What is the reasonable line drawing we 

can do based on what we know now, recognizing that it is so difficult to draw lines in this context, period. But it is important to 

note, I think, that those—so that was part of the calculus here. In 

terms of the cloud, we also, if you look there has been some research done on this. 

Mr. PALLONE. Well, I will ask any of you to get back to me in 

writing on—to respond to that. It may very well be that the literature out there shows that it is primarily people or even exclusively people who were in Manhattan south of Houston and in that 

radius around Brooklyn, but I just would like to have whatever you 

have on that to get back to us, and I will yield to the gentleman 

from New York. 

Mr. FOSSELLA. Well, thank you, and I am sorry I missed your 

testimony, but thank you again for appearing, in particular Mr. 

Holloway for representing the Mayor’s office. Obviously, you heard 

today, still some skepticism and perhaps some education that still 

needs to take place regarding what happened on that day and what 

we need to do to respond. 

Evidently, at the core, I think we can easily talk away the 

money, but clearly, impediment, to getting this legislation passed 

to date has been the cost. So, to follow up on the Chairman’s point, 

if I am not mistaken it is the research and the science and other, 

sort of critical, elements that have minimized the scope of this initial area as opposed to, if you will, the broad brush of the first go 

around—the first iteration of this legislation, is that correct? 

And in part, while you still may become eligible, in part it was 

to move this process forward, given the potential cost, which was 

clearly an obstacle to getting it beyond where we currently are. Is 

that a fair point? We have had to strike a compromise, if you will. 

Mr. HOLLOWAY. Yes. 

Ms. SEMINARIO. Yes. That is absolutely correct and we tried to 

do that based upon the evidence, based upon the information, 

based upon what we know. 

Mr. FOSSELLA. Right. 

Ms. SEMINARIO. We don’t know everything, but based upon what 

we do know, that is how we have tried to structure this bill and 

come up with something that we think is—it will cover people, but 

also is reasonable and responsible. 

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Mr. FOSSELLA. And Dr. Moline, there are people out there who 

question whether people are really sick because of the Ground Zero 

toxins. In short and in plain English, what do you say to those who 

are skeptical? 

Dr. MOLINE. I say, come to our clinical center or any of our clinical Centers of Excellence. Come talk to an iron worker who used 

to climb up 20, 30 flights of stairs, who can barely climb up one. 

Come meet someone who used to run marathons that can’t walk a 

mile. Come look at someone who used to work two jobs and now 

has to rely on others. Come see the people that are sick. We have 

people that have upper and lower respiratory problems, they have 

gastro esophageal reflux disease. Those are the three main physical 

categories of diseases, and we have people who have post-traumatic 

stress disorder and depression. 

We have people at Mount Sinai and the Mount Sinai consortium, 

the Fire Department at Bellevue’s program. We have all published 

and we all have the same numbers, the same diseases, independently arrived at it, everyone has the same types of disorders, and 

remarkably consistent numbers. The police department did a study. 

They found 28 percent have abnormal pulmonary function tests. 

We did a study, exact same number in a much larger group of individuals. The numbers are out there. The diseases are consistent. It 

is in the medical literature, but they should look at the human 

faces. They should come meet these responders. 

These are people—the average age of our population is about 42, 

people in the prime of their earning lives. These are people who are 

in physically demanding jobs who were well on September 10. 

From September 11 on, they were no longer able to do what they 

used to do. They were in physically demanding jobs. They were the 

healthy workers, and now they are ill. They have respiratory problems. They have gastrointestinal problems and they have mental 

health conditions, and they are suffering, and they continue to suffer. 

We have moved into a chronic phase, now. We see people—some 

have gotten better, some were able to maintain on a variety of 

medications, the cost of which can be astronomical for many of 

these folks. Some have not gotten better and some are getting 

worse and we are also concerned that others will continue to get 

worse in the future or new diseases. 

Mr. FOSSELLA. Let me just thank you for that, and Mr. Holloway, 

you get the sense of the opposition to this and some of it is, I think, 

maybe you still need to educate more. For example, the questions 

come, well, of first-responders—responded, aren’t they taken care 

of? Well, we know by now that it wasn’t just—there weren’t just 

first-responders who responded and suffered. The whole group of 

people, construction workers, iron workers, carpenters, residents, 

who don’t fit the technical definition of a first-responder, who 

should be treated equally. So you sort of get that issue of, evidently, we still need to educate those who don’t seem up to speed 

on what happened. 

But having said that, there is another—the tact is well, why 

should we do it, I mean the Federal Government? Why should the 

Federal Government assume this? Aren’t there existing programs 

in place? Aren’t there existing compensation programs in place? 

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Isn’t there the family doctor that one can see? Why is it our responsibility, meaning the Federal Government? Mr. Holloway, how 

would you best address that? 

Mr. HOLLOWAY. Well, first I think—and as Mayor Bloomberg testified earlier we think it is beyond doubt and I think Congress’ reaction immediately after the attacks, reinforces this in the strongest way possible that 9/11 was an attack on the Nation, that people 

came from all 50 states. If you look at the registry, which only has 

71,000 of the estimated more than 400,000 people who were the 

most heavily affected by the attacks, but that is still a huge number. They come from every congressional district in the country but 

four. 

The response was immediate and the response was national. The 

attack was against the Nation and to say that one particular locality should bear the cost, happening to have been the unlucky target 

of that attack simply is just not—it doesn’t make sense. 

And so, in terms of conceptualizing it as being a national issue, 

this includes responders and non-responders, then that means the 

community, the residents, the schoolchildren, the office workers, 

the people who were doing what they do in lower Manhattan on 9/ 

11 and after. And those are also the people who, whether they were 

volunteers or doing other things, who helped to bring the city back 

and finish the work on the recovery which was historically quick 

and unprecedented in its nature that way. 

And what you see when we have looked at the data is that for 

those most heavily exposed, that includes about, up to 100,000 or 

some say even more responders, people who were there doing the 

work. That includes contractors. But then about 320,000 residents, 

office workers, community members, that is just within the narrow 

area of the most heavily exposed in the registry. If you look at the 

area under the bill, you are talking about approximately 630,000 

people and, you know, for the city, and I think really based on the 

fact that the bill is out and how Congress has acted in the past, 

there is just no question that this is a national problem. 

And the city, though, recognizing that these are—dollars are 

scarce today in the current economic environment, but this is really 

a program for over the long run, so it is not a short-term question, 

but the city is putting in 5 percent of the cost to cover for those 

treated at HHC. That will cover responders and non-responders because the city recognizes we needed incentives to make sure that 

these dollars are spent wisely. 

Let us just talk about the third thing that you mentioned. What 

are the other mechanisms? Well, I guess you could describe those 

as, kind of—you could have health insurance. You could have workers compensation, and the first thing to recognize, and this was not 

in the earlier version of the bill, is that for workers compensation 

that has been paid, that is an offset of what would be paid under 

the bill. 

For health insurance, the program acts as the payer of last resort, if a person has health insurance for an injury that is not work 

related, and so that coverage would cover first. So those mechanisms, to the extent that they will cover, are actually being brought 

to bear under the bill. 

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I should note, though, that a lot of people don’t have health insurance. The community members at Bellevue—50 percent and up 

to 60—50 percent or more of people don’t have health insurance or 

they are under insured. Their co-pays and deductibles and what we 

are trying to do here is make sure that where those gaps exist, we 

fill them so that people who are injured, because of these attacks 

on the country, that those gaps are filled. And I think that this bill 

does that in a responsible way, plus the city has skin in the game, 

so to speak. The city is on the hook. 

Ms. SEMINARIO. Could I—— 

Mr. PALLONE. Thank you. Sure, go ahead. 

Ms. SEMINARIO. I wanted to add to that. I think it is important. 

We have tried with this revised version, to call upon the other resources that might be available to bear some of the cost. 

But that being said, we also think it is really important to structure this program so that first and foremost it is designed in a way 

that people get the quality care they need, and that is why we developed it and delivered these services through the Centers of Excellence. So there will be an attempt to recoup money. We think 

it is really important that Dr. Moline and Dr. Reibman and Dr. 

Prezant have the ability and the program is structured in a way 

that first and foremost they are able to develop and deliver the 

services for these people in a timely way and not have to wait for 

the comp claim to be resolved three years later for that individual 

or to fight it out with the insurance companies necessarily. 

And I just wanted to make that very, very clear and that is why 

we think it doesn’t make sense just to turn this into a health insurance program that people go off to their own doctor who don’t have 

the qualifications and have to fight with them about getting coverage. So it is a hybrid but it is put together that way for a very 

important reason and that is to take care of those who are sick. 

Mr. PALLONE. Dr. Moline. 

Dr. MOLINE. And just why shouldn’t someone go to their family 

doctor rather than a center of excellence? I can’t tell you how many 

patients I saw who were treated with antibiotics in the fall of 2001 

for a cough, who didn’t have a cough that was related to an infection. They had the World Trade Center cough. That was due to inflammation, and if they had gotten appropriate treatment earlier, 

perhaps they wouldn’t have long-term health consequences. 

If people are—if their care is fractionated and they are not going 

to centers, one other critical element will be lost, which is we will 

never know what exactly has happened to the group of responders 

who worked at the World Trade Center site because we will never 

know who got sick where. We won’t have a systematic way of collecting it and reporting after our colleagues to better prepare us in 

the future. 

We also are the ones—the centers have seen collectively, literally, 50,000 individuals with World Trade Center exposures. We 

can treat them. We do a good job. We talk to each other. If someone 

has seen an unusual condition, we say ‘‘hey, have you seen any of 

these?’’ Just last month on a conference call that we have we were 

talking about a potential new condition. That is going to be lost 

and people won’t recognize and know to look for new diseases unless there are centers where this care can be delivered. 

111 

Mr. PALLONE. Thank you. Mr. Engel. 

Mr. ENGEL. Thank you, Mr. Chairman. Let me start with Dr. 

Moline. Since you are at Mount Sinai, and I am sure you were here 

before when I questioned Dr. Gerberding on the fact that Mount 

Sinai is the largest clinical center in the New York/New Jersey consortium and it was not allocated the original budget request. I am 

wondering if you would care to comment on that. 

Dr. MOLINE. Well, every year we have put in budget requests 

and we have been able to refine our requests as we have had more 

experience and we know what our expenses have been for the past 

time intervals and our budget request that we put in for the fifth 

year, which we got notice of just yesterday, for a budget year that 

started July 15, was for about $81⁄2 million less than we asked with 

the ability to supplement it up by about 25 percent. It wont make 

us up to the exact amount we asked, but the—we have spent all 

the money we have been provided and then some. We have to ask 

for supplemental funds. We have to ask for them every year to 

cover the costs as the treatment expenses come in. 

I would like to be spending a lot more time dealing with the 

medical aspects rather than the budgetary aspects. We do have an 

absolute fiduciary responsibility to make sure that we are spending 

this money wisely, we are spending it on the responders, but it is 

frustrating to be asked to put in a budget that is based on real 

numbers and your best estimates and then be given a number that 

is significantly less with the expectation, come back and ask us if 

you need more. Well, our track record is such that we know we are 

going to need more. So it is just a matter of coming in with a budget now that is for one third less than we asked and then having 

to supplement it when we will need it and it is a matter of, just, 

which month we will need it in. 

Mr. ENGEL. I couldn’t agree with you more, and I think we need 

to keep pushing that point. Let me ask you a question—your take 

on why it is necessary to make the World Trade Center Medical 

Monitoring and Treatment Program into a long-term entitlement 

program rather than just funding it year to year as Congress has 

done over the past few years. Give us your take on that. 

Dr. MOLINE. There are a variety of reasons why long-term funding would be beneficial. Some of the toxins that I was mentioning 

earlier in my testimony—many of the diseases that may occur are 

going to take years to manifest so we need a long-term program to 

ensure monitoring to look for the health effects that may develop 

so that we can diagnose diseases early and treat them. That is the 

ultimate goal. 

Year to year funding—we never know if we are going to have to 

send that letter out saying, ‘‘I don’t have any more money, I am 

going to have to try to provide you with another physician or another critical center or if I am going to have enough money to treat 

you.’’ The year to year funding, while we have been absolutely appreciative of all that we have been given, it makes it difficult to 

run a stable program. People don’t necessarily want to come to a 

place where they might only have a job for a year. Getting a physician credentialed takes a minimum of 3 months. The turn over, the 

expertise that we have amassed, you don’t want to lose that by 

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having people worried are they going to have a job in 9 months, 

do I have to start looking for a new position? 

But we want to make sure the resources are available, going forward, to take care of all who need the help. We know that these 

conditions are going to last. People are going to continue to need 

that medication for asthma or for reflux or their PTSD meds and 

we don’t want to have to worry about, is there going to be enough 

to cover this med this year and that med that year. 

Long-term funding, as an entitlement, would allow people to get 

the care they need without concern about interruptions and allow 

the centers to be able to provide that care without worries that we 

are not going to be able to deliver it in a manner in which the responders deserve. 

Mr. ENGEL. Let me ask Ms. Seminario, why does—any relation 

to Tony Seminario, by the way? 

Ms. SEMINARIO. I have been told that he is a distant cousin. 

Mr. ENGEL. OK. I served with him in the New York State Assembly many years ago. Why does this bill task NIOSH with the administration of a WTC health program? Isn’t that outside the scope 

of what NIOSH usually does? And let me also ask you if you could 

explain why there are so many different committees created in this 

bill. 

Ms. SEMINARIO. NIOSH is tasked because they are the agency 

that stepped up to the plate and actually has the experience in 

dealing with these problems and so they have been the lead agency. This program started, initially, as a screening program and a 

monitoring program. And that is exactly what is NIOSH’s responsibility under the OSHA law and what they have done under the 

Mine Safety Law, so they have a long experience in conducting and 

overseeing monitoring and screening programs. 

Those screening programs and monitoring programs found that 

people were sick, and so they needed to be treated. So now we are 

in a position where we need programs to provide medical treatment, so NIOSH is tasked with this because they have the expertise in dealing with occupational health problems and that they 

have been overseeing it, but I think it is important to understand 

that there is the expectation and it is in the bill itself that NIOSH 

will work with other agencies and other entities to provide and administer this program. It is provided for in the bill that NIOSH can 

enter into contracts and arrangements with other agencies, for example, to provide reimbursement for the health costs. And so they 

could look to a private insurer. They could look to CMS. They could 

look to the Department of Labor, FICA, workers’ comp program 

that routinely process claims and provide reimbursement for these 

kind of services. 

So that is actually envisioned in the bill, but we want a lead 

agency that has expertise in the issue and not just an administrative agency that, essentially, is cutting checks for medical care. 

With respect to the committees in the bill, there are three committees that are set up under the bill. One is a scientific technical 

advisory committee to the program administrator that is tasked at 

looking at the scientific data to make determinations, first of all, 

if there should be additional diseases added to the list of what are 

identified World Trade Center related conditions, and also tasked 

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with looking at the scientific data to see if the eligibility criteria 

in populations that are covered under the bill should be modified 

or changed. And so that is a technical committee. 

Then there are two committees set up, one for the responder program and one for the community program that, essentially, are advisory committees comprised of providers and the affected communities to help coordinate and oversee the program. The program delivered through the Mount Sinai consortium and the FDNY, the responder program and similar for the community program. There is 

already an existing committee and the bill builds upon it. 

We think it is really, really important that there be mechanisms 

for those who are affected to have a role and participate in input 

into the programs that are affecting them, and so these are committees built on, again, the existing model, which are comprised of 

the providers and those who are affected to look at what is happening, try to coordinate the care and improve it so that those who 

are affected can get better services. 

Mr. PALLONE. Mr. Engel, I am going to—I hesitate to say this 

but I am actually going to have a second round because I—so, if 

you want to wait, we will just do a second round. All right. And 

I don’t want to keep people too long, but I have to ask these two 

additional questions so I am going to recognize myself and then we 

will go back to the other two members. I will try to put them together, although not related. What I wanted to ask Dr. Moline is 

if you just tell us a little more about why these Centers of Excellence are so important as opposed—I know you got into it a little, 

in responding to Congressman Fossella’s question about why not 

just go to your family practitioner—why the expertise and the 

knowledge is so important. 

And then, I wanted to ask Mr. Holloway, after that, I still don’t 

understand how people are treated if they are first-responders 

versus if they are people that happen to be working there or living 

in the area. Is there a difference in treatment? Is there a difference 

in where they go? Because, again, in terms of this being more narrowly focused in the new bill, there may be some—there obviously 

are going to be more limitations on the people who are not firstresponders. 

So let me start with you, and you don’t have to go on too long, 

but I just think that we need to have a little more on the record 

about why these centers are crucial. 

Dr. MOLINE. The centers have been in existence since 2002 monitoring the healthcare. We have seen between the Fire Department 

Center and Mount Sinai Center, and I am speaking for the responder consortium, we have seen 40,000 individuals and monitored their health. About 40 percent of those are in treatment at 

our centers. 

Individuals have complex medical conditions. They have a constellation of findings that we are seeing and also are beginning— 

we are concerned that there may be new conditions emerging. We 

have developed the expertise in dealing with the complex physical 

and mental health conditions that the responders have. They have 

them together, often. Sixty percent of our folks have more than one 

World Trade Center related condition and they are getting comprehensive care for all of these conditions at one center that has 

114 

seen thousands of other cases similar to this and knows how to develop best practices, find the most cost effective delivery of care 

and provide the best care possible. 

Another critical reason for these Centers of Excellence is the 

data coordination. We are able to collect the data through these 

Centers of Excellence using standardized instruments so that we 

can report out to the public, the medical community and the public 

at large what we have been able to find. We also can put into place 

quality assurance programs to make sure that the care is most effective and is most appropriate and also is elastic enough to move 

to meet the needs as they change over time. And also, through 

these centers, this is the way we are going to find out what new 

diseases might be emerging. Without those centers, you are going 

to lose that ability. You are going to lose the ability to tell whether 

rates of diseases are increased over the general population. 

Mr. PALLONE. All right, that is fine. Thank you, and either Mr. 

Holloway or Ms. Seminario, you know you have these two defined 

universes, I guess. One is the first-responders that can be anybody 

who came there and then the second is, this now more narrowly 

defined radius or whatever of people who work there, lived in the 

area, whatever. Is there a difference in terms of where they go or 

how they are treated now and under the bill? Or they are all treated the same, to where they can go to the same places, they can go 

to the centers or—— 

Mr. HOLLOWAY. Well, under the bill they can go to the centers 

that exist, and by the way the bill also sets criteria to establish additional centers that the point is to make sure that you have the 

expertise at treating WTC related conditions and the city has actually expanded its program from Bellevue to other HHC facilities, 

Elmhurst and Gouverneur. 

I think it is important to note before drawing distinctions between the programs that there is a lot about them that are the 

same and everybody works in collaboration to see what are we seeing. Bellevue and the Mount Sinai program and the FDNY work 

together to develop treatment protocols. They meet all of the time. 

People who come in, once you are determined to be eligible for the 

program, you go through and you receive a detailed medical 

workup and then you are treated and a lot of the conditions that 

are being seen, there are some variations which is really important 

and interesting for learning, what are the effects of the attacks, but 

the respiratory ailments, lower intestinal GERD—I am not a doctor 

so I am not going to go too deeply into that except to say that a 

lot of the things that are seen are the same. 

In terms of the mechanics of the programs, there are some differences right now. The Mount Sinai FDNY programs—first if you 

are in the FDNY you are eligible for the program. About 95 percent, or more, of FDNY active members who and retired members, 

who came and worked on the site, are now in that program. They 

have had an incredible rate of retention for both monitoring and 

treatment, so they are monitored on a cyclical basis. 

For the community program the standards are a little different 

in terms of getting in. You present with a symptom and then once 

you are in, you are monitored periodically and then you are treated. And what they have found is about one-third get well, about 

115 

one-third will probably be there for the long-term and then onethird will be there over some medium period, but Dr. Reibman is 

also here. 

Mr. PALLONE. What I guess I am trying to say—maybe I should 

ask you. Let me give you an example, I live in my hometown, Long 

Branch, New Jersey, OK. I may have been working in the World 

Trade Center on the day, on 9/11, or I may have left the Fire Department at Long Branch and went up there to help for a week or 

two. In either case, under this legislation, can I go to the place at 

Rutgers and be treated or what if I am in San Francisco and I am 

in one or two of those categories, where do I go? 

Ms. SEMINARIO. That is a very good question. The way the program is structured right now is it builds on what exists, and so for 

the responders, what that means is the program at FDNY in the 

Mount Sinai consortium is the base program, all right? For the 

community, for people who are not in the responder population, the 

base program is the World Trade Center Environmental Health 

Center at Bellevue. But what the program—and then also there is 

provisions in the bill to have a program of national providers for 

those individuals who are outside the New York/New Jersey area 

where the program administrator essentially designates and finds 

providers that have the qualifications, who have expertise in these 

kinds of diseases and they become designated providers that participate in the program. 

The bill also provides for the program administrator to add additional clinical Centers of Excellences to these base programs. So, in 

moving forward, the bill provides for the head of the program to 

say ‘‘well we don’t have enough capacity here at Bellevue because 

this program is growing and we have also got a number of individuals who are in this area who are, they are living in Staten Island, 

so we want to start a center there.’’ And so, again, the bill uses the 

bases that are established but it doesn’t limit it to this. 

Mr. PALLONE. In other words, just to get going back to my example, if I am in Long Branch, New Jersey and I was working at the 

World Trade Center on 9/11 or I went there as a fireman for a 

week or two, I can definitely go to the Rutgers center, right, in either case? 

Ms. SEMINARIO. Yes, right. 

Mr. PALLONE. And if I am in San Francisco and I happen to have 

work there and move to San Francisco or first-responded and 

moved to San Francisco I could certainly travel back to the New 

York/New Jersey metropolitan area, but if I can’t do that, you are 

going to have somebody in San Francisco that would be, hopefully, 

eligible to take me and attend to my concerns. 

Ms. SEMINARIO. Yes, absolutely, and that was one of the questions that was raised by Representative Capps as a concern in California. One of the frustrations in the current system is that HHS 

has been very, very slow to get that national program up and 

going. There was a system of clinics that were in place, trying to 

provide some of these services, but it was recognized it needed to 

be more robust and wide spread and it is only in the last couple 

of weeks that, finally, a contract has been let to provide those services. So this is an area that really needs to be expanded under the 

116 

legislation, and actually needs to be expanded under the current 

program, as well. 

Mr. PALLONE. OK, thank you. Do you have any questions? 

Mr. FOSSELLA. Yes, again, just to dispel the notion that it is concentrated exclusively in New York City, and or New Jersey, for example. And ironically, those who may be skeptical of the legislation 

are the ones whose constituents will probably suffer the most. By 

that I mean the reference to just go see a family doctor. If you are 

in the middle of California or in the middle of Texas and you went 

and responded and you are suffering just as someone else was suffering, say who lives in Staten Island, who has access to some of 

the programs that exist in New York City, or live in New Jersey 

and have access to Rutgers, but if you are in the middle of Texas, 

you are on your own, or more likely that you are on your own. You 

go to see a family doctor and they may treat you with antibiotics, 

not knowing the true harm that is being done to one’s body. 

I would like you just to, for the record, let me know as a 

healthcare professional—anyone else? I know Cas, you are not, 

but—is that something that we should consider as this national 

scope as Ms. Capps pointed out earlier, and others who may be unaware of the implications of their own constituent’s plight. 

Dr. MOLINE. Well I think one of the points you raise is that going 

to your family physician, if you are outside the New York area, 

they may not even know to ask. And that is something that we 

hope to do a better job of providing continuing education and actually have been asked by NIOSH to develop some medical education 

materials that we can provide throughout the country through various venues, so that providers throughout the country will have a 

better understanding of World Trade Center related health effects 

through our New York/New Jersey Education and Research Center, 

which we will be doing in the next several months to make sure 

that there is greater awareness of the healthcare problems. 

But we do need, for the national responders, those who aren’t living in the metropolitan area, to have a place they can go to where 

they are, essentially, satellites of our Centers of Excellence. They 

are using similar diagnostic tools. They have ways of finding out 

what may—what to look for, and how they should be treated. What 

are the best practices? There has to be a robust program that isn’t 

piecemeal, that isn’t stopped and started, switched—you can go 

here, but wait you have to wait awhile to get in treatment. You responded, you came to New York City from, whether it was from a 

construction site on 23rd Street in Manhattan or from San Francisco as part of a USAR team. You came, you responded, everyone 

should be able to have access to the same type of healthcare regardless of their environment. And it is important that the national 

program—there is a national program that is tied in, very closely, 

to the metropolitan area program that provides the same level of 

care as those folks in New York are able to get. 

Ms. SEMINARIO. Could I just add to that? I think over time this 

is going to become more important because as people age and these 

health problems continue and they retire and they move—I mean 

there is mobility in the population, and so insuring that there is 

a very high quality national program and that people know how to 

access it, that we don’t keep it secret as to who these providers are, 

117 

so that people have some knowledge and they also have some confidence that when they go to those providers, they are going to get 

care that is going to be part of the integrated care—an overall program is really, really critical and important, and that hasn’t happened to date. 

Mr. HOLLOWAY. And to add an additional detail—I mean, we 

know from the Fire Department, the Police Department, the agencies that responded that those populations migrate toward retirement. A lot stay in the area, but as, I am sure you know, they 

move all over the place—down to Florida and other places and 

15,000 people have retired in the Police Department who actually 

are in the World Trade Center database at the Department, of the 

34,000 who participated in some way in the operations, so this is 

critically important for the city, as well. 

Mr. PALLONE. Mr. Engel. 

Mr. ENGEL. Thank you, Mr. Chairman. I just have two questions. 

Let me start with Mr. Holloway. You heard Mr. Nadler’s testimony 

and I said in my opening statement that I was persuaded that, 

while we need to, obviously, help the first-responders the greatest 

way we can, there are community people who were told, erroneously, that the air quality was fine after the days of 9/11 and 

stayed in the community and may not even know that they are 

going to get sick in the future. 

There is a cap of 35,000 people on the number of new community 

members who can come into the program. I am concerned about 

that. I would like your take on that. Do you think it is enough, not 

enough? How do you explain the number? I know we are all trying 

to keep costs down, but it just would seem to me if someone is legitimately sick, as a result of breathing in that air, why would we 

devise a program to deny them, at some point, if they get sick after 

the cap has—the number of people—the claims have happened. 

I mean, we really just don’t know. Some people have gotten sick 

immediately. Some people have gotten sick many years later and 

we don’t know, in years to come, if people will get sick and I am 

very troubled by formulas that keep people out of a system who are 

legitimately—who have legitimately gotten sick as a result of 9/11. 

Mr. HOLLOWAY. Let me start by saying, as I noted earlier, line 

drawing and making limitations in this context is clearly a very 

difficult thing to do. I think what the city tried to do, in working 

with people here and all of the people who have been working on 

this bill is to say, ‘‘well what do we know now and can we reasonably make an estimation to set this kind of a limitation.’’ And so, 

let me just talk a little bit about what we did. 

Building on a methodology we used in the Mayor’s report, 

which—and I can—we did a full write up on this, which I will 

make sure I circulate so that the whole members of the committee 

can get it. We looked at—— 

Mr. PALLONE. If the gentleman would yield. I mean, I have to 

admit guilt or responsibility here because you should know that, 

the leadership of the committee, we obviously asked them to cut 

back on the cost, so you understand that they are trying to address 

this because we told them that they have to. I just want you to 

know that. 

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Mr. ENGEL. No, I know and I am sympathetic if we are going to 

sell this program to the rest of the country and the rest of the Congress, we need to be mindful of trying to cut back on costs I certainly am, but my difficulty and my problem is that we are really 

going into uncharted waters here and we really just don’t know 

how many people have gotten sick immediately and how many people have yet to get sick. 

And my concern is that there seems to be a lack of flexibility in 

terms of people who are legitimately sick as a result of 9/11, of 

being shut out of the process. I mean, I fully understand that we 

don’t want to give help to everyone who may claim that they are 

ill as a result of 9/11, when, indeed, some people may not have 

been ill as a result of 9/11, but conversely we don’t want to shut 

anybody out who may get sick years down the road, so that is the 

point I was—— 

Mr. PALLONE. No, I agree, and if the gentleman would yield. I 

mean, I want you to tell us how you figured this out, but I also 

think that in the same way that I asked you to give us some background on the radius and how you decided to make it Brooklyn and 

Manhattan that maybe you could give us some written information. 

Because the kinds of questions that Mr. Engel are asking are going 

to be asked by everybody as we move forward. How did we get to 

these caps? How did we limit the radius, but go ahead. 

Mr. HOLLOWAY. Absolutely, so I will be very brief, just a few sentences. We looked, and by we I mean Dr. Reibman, Dr. Prezant, 

health experts on the city side, looked at what are the rates that 

we are seeing for treatment in the—what do we know from the 

World Trade Center registry? What are the rates that we are seeing, in terms of in the underlying population, make some assumptions about how many of those people—how many of who are where 

the prevalence is there. How many of those people would actually 

present for treatment? And it is a methodology that, clearly, is 

based on a set of assumptions, and it is challenging to do, but I 

will send a full analysis of how we did it. 

There is a method to that number that we looked at the entire 

group of who would be eligible, potentially, under the New York 

City Disaster Area defined in the bill, and then walk through each 

of the conditions and made a series of assumptions. I will make 

sure you get that. 

I want to also note, importantly, though the overall goal is to 

make sure that nobody, whether you are inside those areas, because that is another problem—issue with the bill, not a problem 

with the bill. It is line drawing and what if you are outside? What 

if you are north of Houston Street? Is that—are you shut out? The 

short answer to that is, there is a mechanism for you if you have 

a WTC-related condition that you are diagnosed with, to get treated, there is this defined fund. So that is a safety valve in the bill, 

and then there are reporting requirements. 

We could be wrong, you know we made assumptions and came 

up with an estimate that is reflected in the bill, but there are also 

reporting requirements in the bill. There is an annual reporting requirement on the program, who is being treated, how many people. 

And then the administrator is required to report to Congress if we 

hit or exceed 80 percent of the caps in the bill and then we are 

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going to need to address that because we could be off. There is no 

question about it. 

Mr. ENGEL. Thank you. Thank you, Mr. Chairman. 

Mr. PALLONE. I just wanted to say, again, I know I am not— 

maybe I am prolonging this unnecessarily, but, obviously all of us 

who represent the New York metropolitan area, at some point, are 

going to have to agree on some kind of consensus as to the radius 

and the numbers. And that is not going to be an easy thing. I know 

it wasn’t an easy thing for Carolyn and Jerry Nadler to agree on 

in presenting this bill. But this is part of the consensus that we 

are going to have to work on over the August recess. I would like 

to, if we can, come to a consensus that when we come back in September, we can all sign off and say, ‘‘look, this is what we can live 

with, and this is what will sell, financially, as well as in terms of 

covering people the way they should be.’’ 

It is not an easy task and I appreciate the fact that all of you 

have been involved in this, and helped us get to where we are 

today. But it is important that we do this and come to a consensus 

that we can all agree on and that we do it as quickly as possible 

if we are going to move something before the session ends, so I just 

want to thank you all again. You have done a great job, you really 

have. 

We appreciate it and we have a process whereby we may submit 

additional questions to you. You should hear—if we have any you 

will probably get those within the next 10 days so that you can respond and the clerk would notify you of those procedures. But, 

again, thank you again and without objection, this meeting of the 

subcommittee is adjourned. 

[Whereupon, at 1:10 p.m., the subcommittee was adjourned.] 

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