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72–879 2012

THE JAMES ZADROGA 9/11 HEALTH AND 

COMPENSATION ACT OF 2009 

HEARING 

BEFORE THE

SUBCOMMITTEE ON HEALTH 

OF THE

COMMITTEE ON ENERGY AND 

COMMERCE 

HOUSE OF REPRESENTATIVES 

ONE HUNDRED ELEVENTH CONGRESS 

FIRST SESSION 

APRIL 22, 2009 

Serial No. 111–30 

( 

Printed for the use of the Committee on Energy and Commerce 

energycommerce.house.gov 


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COMMITTEE ON ENERGY AND COMMERCE 

HENRY A. WAXMAN, California, Chairman 

JOHN D. DINGELL, Michigan 

Chairman Emeritus 

EDWARD J. MARKEY, Massachusetts 

RICK BOUCHER, Virginia 

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 Chairman 

LOIS CAPPS, California 

MICHAEL F. 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 

ANTHONY D. WEINER, New York 

JIM MATHESON, Utah 

G.K. BUTTERFIELD, North Carolina 

CHARLIE MELANCON, Louisiana 

JOHN BARROW, Georgia 

BARON P. HILL, Indiana 

DORIS O. MATSUI, California 

DONNA M. CHRISTENSEN, Virgin Islands 

KATHY CASTOR, Florida 

JOHN P. SARBANES, Maryland 

CHRISTOPHER MURPHY, Connecticut 

ZACHARY T. SPACE, Ohio 

JERRY MCNERNEY, California 

BETTY SUTTON, Ohio 

BRUCE L. BRALEY, Iowa 

PETER WELCH, Vermont 

JOE BARTON, Texas 

Ranking Member 

RALPH M. HALL, Texas 

FRED UPTON, Michigan 

CLIFF STEARNS, Florida 

NATHAN DEAL, Georgia 

ED WHITFIELD, Kentucky 

JOHN SHIMKUS, Illinois 

JOHN B. SHADEGG, Arizona 

ROY BLUNT, Missouri 

STEVE BUYER, Indiana 

GEORGE RADANOVICH, California 

JOSEPH R. PITTS, Pennsylvania 

MARY BONO MACK, California 

GREG WALDEN, Oregon 

LEE TERRY, Nebraska 

MIKE ROGERS, Michigan 

SUE WILKINS MYRICK, North Carolina 

JOHN SULLIVAN, Oklahoma 

TIM MURPHY, Pennsylvania 

MICHAEL C. BURGESS, Texas 

MARSHA BLACKBURN, Tennessee 

PHIL GINGREY, Georgia 

STEVE SCALISE, Louisiana 

PARKER GRIFFITH, Alabama 

ROBERT E. LATTA, Ohio 

(II) 


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(III) 

SUBCOMMITTEE ON HEALTH

FRANK PALLONE, JR., New Jersey, Chairman 

JOHN D. DINGELL, Michigan 

BART GORDON, Tennessee 

ANNA G. ESHOO, California 

ELIOT L. ENGEL, New York 

GENE GREEN, Texas 

DIANA DEGETTE, Colorado 

LOIS CAPPS, California 

JAN SCHAKOWSKY, Illinois 

TAMMY BALDWIN, Wisconsin 

MIKE ROSS, Arkansas 

ANTHONY D. WEINER, New York 

JIM MATHESON, Utah 

JANE HARMAN, California 

CHARLES A. GONZALEZ, Texas 

JOHN BARROW, Georgia 

DONNA M. CHRISTENSEN, Virgin Islands 

KATHY CASTOR, Florida 

JOHN P. SARBANES, Maryland 

CHRISTOPHER S. MURPHY, Connecticut 

ZACHARY T. SPACE, Ohio 

BETTY SUTTON, Ohio 

BRUCE L. BRALEY, Iowa 

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 

MARY BONO MACK, California 

MIKE FERGUSON, New Jersey 

MIKE ROGERS, Michigan 

SUE WILKINS MYRICK, North Carolina 

JOHN SULLIVAN, Oklahoma 

TIM MURPHY, Pennsylvania 

MICHAEL C. BURGESS, Texas 


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

York, opening statement ...................................................................................... 4 

Hon. John D. Dingell, a Representative in Congress from the State of Michigan, prepared statement ...................................................................................... 98 

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

York, prepared statement .................................................................................... 109 

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

prepared statement .............................................................................................. 101 

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

Texas, prepared statement .................................................................................. 106 

WITNESSES

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

New York, prepared statement ........................................................................... 7 

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

York ....................................................................................................................... 9 

Prepared statement .......................................................................................... 12 

Hon. Peter King, a Representative in Congress from the State of New York .... 18 

Edwardo Torres, Resident of Jersey City, New Jersey ......................................... 20 

Prepared statement .......................................................................................... 24 

Jacqueline Moline, M.D., M.Sc., Vice Chair, Community and Preventive Medicine, Director, WTC Medical Monitoring and Treatment Program, Clinical 

Center at Mount Sinai, Director, NY/NJ Education and Research Center, 

Mount Sinai School of Medicine, New York ....................................................... 27 

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

Joan 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, Bellevue Hospital, New York .................................................................................................... 41 

Prepared statement .......................................................................................... 44 

Jim Melius, Administrator, New York State Laborers’ Tri-Funds, Albany, 

New York .............................................................................................................. 51 

Prepared statement .......................................................................................... 54 

Caswell F. Holloway, Special Advisor to New York City Mayor Michael R. 

Bloomberg, Chief of Staff to New York City Deputy Mayor for Operations 

Edward Skyler ...................................................................................................... 61 

Prepared statement .......................................................................................... 64 

SUBMITTED MATERIAL

Hearing memorandum ............................................................................................ 89 


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(1) 

THE JAMES ZADROGA 9/11 HEALTH AND 

COMPENSATION ACT OF 2009 

THURSDAY, APRIL 2, 2009 

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, Engel, Weiner, Barrow, and Deal. 

Staff present: Andy Schneider, Chief Health Counsel; Sarah 

Depres, Counsel; Elana Leventhal, Counsel; Alvin Banks, Special 

Assistant; Alli Corr, Special Assistant; Miriam Edelman, Special 

Assistant; Lindsay Vidal, Special Assistant; Aarti Shah, Minority 

Counsel; Jerri Couri, Minority Professional Staff; Chad Grant, Minority Legislative Analyst. 

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

Mr. PALLONE. The subcommittee hearing will be called to order, 

and today we are having a hearing on the James Zadroga 9/11 

Health and Compensation Act of 2009. First of all, let me say good 

morning to our colleagues who are at the desk there and to all of 

you who are here. I know how important an issue this is not only 

to the New York and New Jersey delegation, but I think also nationwide. 

The bill was introduced by Ms. Maloney, Mr. Nadler, and Mr. 

King. And again I want to thank you for all you have done on this 

legislation. I think actually in my opening remarks I mention the 

hearing that Jerry had, that Mr. Nadler within maybe a month or 

so of the World Trade Center attack, and I remember going to the 

Federal Building—I think it was at the Federal Building—in New 

York, and you were bringing up—you were sort of raising all the 

issues that, at the time, were being denied by the EPA, and it 

turned out to be true. So it is often the case with Mr. Nadler that 

he brings issues to the attention that agencies deny, and then it 

turns out that he was absolutely right from the beginning. 

Last year, the subcommittee had two hearings on this issue to 

examine medical monitoring and treatment programs for those affected by 9/11 diseases and a legislative hearing on a similar bill 


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to the one before us today. Both of these hearings provided us with 

vital information on this issue. 

Eight years ago, as we all know, our country was struck by a 

horrible tragedy. People lost their lives, families were shattered, 

and our Nation responded. And individuals from all over the country rushed to the aid of those in need, not stopping to think about 

the effects on their health or lives. I know I will never forget those 

horrifying days. I was at the World Trade Center site with President Bush. I think the attack occurred on Tuesday, and we were 

there maybe Friday of that week. And, you know, I saw firsthand 

the dedication and determination of the rescue workers and the 

volunteers who pushed themselves to the brink of exhaustion and 

beyond. 

The singular memory that when we arrived, I was standing next 

to a, like a yellow fire truck that was from Hialeah, Florida. And 

I thought, you know, how did that truck get up here in such a 

short time? I mean I guess it is possible to do, but it was people 

literally from all over the country. 

In the month following the 9/11 attacks, I mentioned I attended 

a field hearing with Congressman Nadler in New York City to investigate the presence of hazardous waste and the health implications for those who were exposed. We did not know then if there 

would be any long-term effects or just how debilitating they would 

be. But we now have more in-depth understanding of how the dust, 

the glass fragments, and other toxins released into the air affected 

by responders and community residents. Studies have shown that 

individuals present during and immediately after the attack now 

suffer from new or worsened respiratory disease, gastroesophageal 

disorders, and mental health conditions including post-traumatic 

stress disorder. 

We in Congress have an obligation to our Nation’s heroes and to 

the victims of these attacks. It is our turn to step up to the plate 

and come to their aid, and the bill before us today is a vital step 

in that direction. H.R. 847 would establish a permanent program 

to monitor and screen eligible residents and responders and provide medical treatment for those 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. 

The legislation would build upon the expertise of the Centers of 

Excellence, which are currently providing high quality care to thousands of responders and ensuring ongoing data collection and analysis to evaluate health risks. 

Now, one of these centers is, as you know, is located in my district on the Bush Campus of Rutgers University in Piscataway and 

is run by Dr. Iris Utasin. It is the UMDNJ World Trade Center 

Medical Monitoring and Treatment Program, which was established in January 2003 to study, interpret, and treat medical symptoms commonly occurring in responders and volunteers. The center 

currently—this is the New Jersey center—currently serves approximately 1,370 patients. I visited the center a few times and have 

seen the work that Dr. Utasin and her team are doing to help our 

Nation’s heroes. 


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I know she couldn’t be here today. I think she is not in the country, so she wasn’t able to come today. But at the center, the indepth knowledge of these complex conditions is crucial to all the 

patients, and we must ensure that this program is permanently 

funded so that they can continue providing this excellent care. 

So I just want to thank all the sponsors again for your tireless 

efforts, and Mr. Deal and I know how tireless you are because oftentimes a week does not pass by without you mentioning this 

issue on the floor. We want to thank the witnesses, not only our 

two colleagues, but those who will be on the next panel, in particular Mr. Torres who is from New Jersey and who was one of the 

first responders to the 9/11 attacks. We are going to be hearing his 

story today, and on behalf of everyone, I want to particularly thank 

you also for being here. 

And I will now recognize the 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. Thank you for holding the 

hearing and thanks to our two colleagues for being on the first 

panel. I think we all understand the significance of the events of 

9/11 and as we explore this bill, H.R. 847, we understand the longterm consequences in terms of health to those who rushed to the 

aid of others and to the consequences that they have suffered as 

a result of it. 

My only regret is that, and I have to tell my colleagues as well 

as the other panel members, this just happens to be at the very 

same time that we are holding a full committee hearing on climate 

change of the Energy and Commerce Committee. And for those 

such as myself who are on the full committee but are not on the 

Energy Subcommittee, this is the only opportunity, this hearing 

that is going on right now, to participate in that particular important discussion. So I think that accounts for the fact that you probably will not have very many members here because of the full 

committee hearing on that important issue going on simultaneously. Wish it would have been otherwise, but we deal with the 

time constraints that we have. 

The hearing today, of course, is to assess the current monitoring 

and treatment efforts that have been provided to individuals who 

were involved in the 9/11 catastrophe and to those who were within 

proximity to the World Trade Center on 9/11 and the weeks and 

months that followed. It is my understanding that to date, the federal government has allocated approximately $1 billion toward 

monitoring and treatment of first responders. 

Although this legislation has yet to be scored by the Congressional Budget Office, CBO estimated last year that the impact of 

similar legislation, which was H.R. 7174, upon which the subcommittee held a legislative hearing last summer, that it would 

cost taxpayers over $11 billion within a 10-year timeframe. If the 

majority intends to move this legislation out of the committee for 

a vote, I hope that members on both sides of the aisle will be given 

the opportunity to hold another legislative hearing to receive the 

expert input from CBO regarding the true cost of the legislation. 


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I look forward to continuing to work with the members of the 

committee on this, and once again thank my colleagues for their interest and their attendance here today. I yield back. 

Mr. PALLONE. Thank you, Mr. Deal. And let me reiterate what 

Mr. Deal said about conflicts today. Actually Lisa Jackson, I think, 

you know, was our—the Jersey commissioner now is the EPA administrators, I think, testifying this morning on, you know, on the 

global climate change in the full committee. So we are missing 

that, and I would appreciate the fact that Mr. Engel is here, but 

I—you are doing something with Hillary Clinton this morning, 

aren’t you, in your other committee? 

Mr. ENGEL. Foreign Affairs Committee has a full hearing with 

the Secretary of State. First time she is appearing before any committee, either in the House or the Senate. 

Mr. PALLONE. So there is a lot going on. So forgive us. But even 

with that, Mr. Engel is here. And I want to also acknowledge his 

significant involvement in this legislation as well. Thank you, Eliot. 

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

YORK 

Mr. ENGEL. Well, thank you, Mr. Chairman, and I want to thank 

you for holding this hearing today because you and I have had 

many talks about the importance of the 9/11 Health and Compensation Act. And I appreciate your willingness to hold a hearing 

to—in the midst of all the committee’s work on many things but 

particularly on health reform. So I am glad that you are chairing 

this important subcommittee, and thank you for doing this. 

I am also delighted to see my colleagues Jerry Nadler and Pete 

King, both of whom I have firsthand knowledge, being a colleague 

of theirs from New York, of the work that both of them have done 

in focusing on this very important issue of 9/11 health care, the 9/ 

11 Health and Compensation Act, and all the other things that relate to the devastating attack on September 11, 2001, and particular, Mr. Nadler, the World Trade Center and the attacks are in 

his district, and he has played a front-and-center role on all these 

issues, not just on the health issues, but on all the issues pertaining to the attacks. So I want to thank Mr. Nadler and Mr. King 

for being here this morning. 

You know, as devastating as that day was, there are few days 

I have been more proud to be an American than on September 11. 

I said that in my first statement on the House floor a day or two 

after the attacks where I spoke from the heart, not by reading anything. Within minutes of crashes into the Twin Towers, New York’s 

first responders mobilized to save those trapped within the World 

Trade Center, putting themselves in unspeakable danger. And of 

course, too many lost their lives that day. 

Within days, over 40,000 responders from across the Nation descended upon Ground Zero to do anything possible to help with the 

rescue, recovery, clean up. I remember those bittersweet days. I 

was there in New York City, where I was born and bred. I was 

happy to be in New York City on September 11 and remember seeing Americans lined up around blocks to donate blood. The attack 

was on Tuesday. That Friday, the New York Delegation stood with 


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President Bush at Ground Zero, that very famous picture of President Bush with the firemen and the bullhorn. We were all there 

right by his side. Particularly Mr. Nadler, I remember, flew in the 

helicopter that day. There were things we all remember. 

I remember the chaos as no one knew quite what to do, only that 

we had to do something, anything to help our Nation rise up from 

the assault by the terrorists. I was very, very proud to be in New 

York on that day. 

The past seven years though have not been 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. 

You know it is a funny thing. Those of us in the New York City 

delegation, we kept going back to the World Trade Center, the devastation while we saw people running around. And, you know, they 

gave us these little kind of helmets. None of us wore them, and we 

kept going back. We were assured at the time by Christy Todd 

Whitman that everything was fine. And so even those of us in Congress were exposed to these things. I am not saying that we were 

exposed the way the first responders were who were there every 

day. But we were there, you know, half a dozen times or more, and 

we were exposed to it as well. 

Years later the exposure though to the 400,000 people has left 

a significant number of first responders with severe respiratory ailments including an asthma rate that is 12 times the normal rate 

of adult onset asthma, lung disease, and persistent cough. Also 

common are PTSD and depression. This has all been well documented in a scientific, peer-reviewed published work regarding the 

long-term health effects of 9/11 by Mt. Sinai Hospital, the fire department of the city of New York, and the World Trade Center 

health registry. 

We really don’t know the long-term effects of exposure to the toxins from 9/11. Many of us fear that there may be significant late 

emergent diseases, both in our first responders and members of the 

community, such as cancer, that will require treatment for years 

to come. 

While these illnesses should sadden all of us, what pains me 

most is that our Nation has failed to provide our first responders 

and community members, Mr. Nadler’s constituents, with a sustainable and reliable source of federal funding for a health care 

monitoring and treatment program. The GAO has documented the 

failure of HHS to provide consistent care in multiple reports. It certainly sends a chilling message to those who fearlessly volunteered 

for our country that nearly eight years later, they are still fighting 

for medical care that should just be a given. 

So I am proud to join with my New York colleagues, lead by Representatives Maloney, Nadler, and so many others in introducing 

the 9/11 Health and Compensation Act. This comprehensive bill 

would ensure that those 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 health care, 


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no more excuses. We must and shall do what is right, and I thank 

you, Mr. Chairman, for bringing this to the floor, and I thank my 

colleagues, Mr. Nadler and Mr. King, for coming here today. I yield 

back. 

Mr. PALLONE. Thank you, Mr. Engel. We are going to now turn 

to the first panel, and obviously I am very pleased that you are 

with us here today and all that you have done. I guess I should 

mention—I think we already mentioned it—that Representative 

Carol Maloney could not be here because she has a bill. I think one 

of her other bills is being marked up—credit card bill, another important bill that is being marked up. But we have her statement, 

so without objection, I will ask unanimous consent to submit that 

for the record. 

[The prepared statement of Ms. Maloney follows:] 


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Mr. DEAL. Mr. Chairman, I would ask unanimous consent that 

members of the committee be given five days in which to submit 

their statements for the record in this hearing. 

Mr. PALLONE. Without objection, so ordered. We are going to 

start with the Congressman Nadler. 

STATEMENTS OF HON. JERROLD NADLER, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF NEW YORK; AND 

HON. PETER KING, A REPRESENTATIVE IN CONGRESS FROM 

THE STATE OF NEW YORK 

STATEMENT OF JERROLD NADLER 

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

Ranking Member Deal, members of the subcommittee including my 

fellow New Yorker, Mr. Engel, thank you for convening this hearing and inviting my colleagues and me to testify before you this 

morning. I also want to thank everyone who has worked on this bill 

to help us achieve our long-standing goal of providing a stable, 

long-term program to help the responders, the residents, area 

workers, students, and others who were injured by the attack on 

our country on September 11. 

Representative Maloney and I along with Representatives King 

and McMahon have introduced H.R. 847, the 9/11 Health and Compensation Act of 2009 to ensure that the living victims of the September 11 terrorist attacks have a right to health care for their 

World Trade Center related illnesses and the root to compensation 

for economic losses. 

Now, as many of my colleagues know and as many of us sitting 

in this room know, today’s panelists have come together many 

times since the towers fell almost eight years ago, holding press 

conferences, testifying at hearings, and releasing countless pages of 

information detailing the environmental impacts and health effects 

created by the attack on the United States. 

For eight years, those of us here today have testified about the 

toxins that were inhaled by those near Ground Zero in the days 

and weeks following the attacks. We warned then that the air 

wasn’t safe and that our courageous first responders were not 

being afforded the proper protection from dangerous toxins as they 

were working on the pile. 

But the federal EPA kept assuring everyone wrongly that the air 

was safe. We spent years working to try to convince public officials 

that the asbestos, fiberglass, mercury, manganese, and other toxins 

that traveled far and settled into the interiors of residences, workplaces, and school and that a proper testing and clean-up program 

was required to eliminate the continuing health risks to area residents, workers and students. 

We demanded that the government acknowledge the fact, supported by a mountain of peer-reviewed research, that thousands of 

our Nation’s citizens are today sick because of 9/11 and that many 

more will likely become sick in the future. 

We explained to whoever would listen that our 9/11 heroes were 

struggling to pay health care costs because they could not longer 

work and had lost their health insurance or because they had had 

their worker’s compensation claims contested. We have argued vigVerDate Mar 15 2010 03:42 Apr 13, 2012 Jkt 072879 PO 00000 Frm 00015 Fmt 6633 Sfmt 6633 E:\HR\OC\A879.XXX A879

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orously that the federal response to date has been dangerously limited, piecemeal, and unpredictable, both in terms of preventing further health impacts from potentially persistent indoor contamination, and most notably in terms of a lack of comprehensive longterm approach to providing health care and compensation for those 

already affected. 

Yet each time we presented our case for comprehensive solution, 

we were told better luck next year. Well, a new year has come, and 

we are here again on behalf of those who continue to suffer. Undaunted and due to considerable efforts by all of the stakeholders, 

we have modified the bill to achieve what have been our dual goals 

from the beginning. One, to establish a stable, long-term approach 

that builds on successful existing programs to provide much-needed 

care for those who were affected by the attacks, regardless of 

whether they are first responders or area workers, residents, students, or others. And two, doing this in a fiscally responsible manner. 

We are hopeful that today’s hearing marks the beginning of the 

end of our collective eight-year struggle. We are hopeful that this 

is the first step in finally passing this critical legislation to give 

those men, women, and children who live with the daily reminders 

of that terrible day in 2001 the support and care they deserve. 

Although the devastating 9/11 attacks on the World Trade Center occurred within the bounds of my congressional district, it was 

our Nation as a whole that was attacked. And the ramifications 

stretch well beyond the bounds of my district or indeed of New 

York. Every member in New York’s down state delegation represents hundreds if not thousands of people who live, work, attend 

school, or were otherwise present in lower Manhattan and the affected parts of Brooklyn and were exposed to the toxic brew in the 

air. 

But it doesn’t end there. Because people from all across the country came to New York City to help, there are now citizens in every 

state, in fact, in 431 congressional districts that we know about— 

431 out of 435 who were exposed to the toxic fumes of 9/11 and 

were concerned enough about it to register with the World Trade 

Center health registry. 

So this is not just a problem for members from New York and 

New Jersey. This issue should concern every member of the House. 

Because this is unquestionably a national problem, it has always 

required a national response. Yet the previous administration declined to develop a comprehensive plan to deal with the growing 

public health problem, forcing the New York delegation year after 

year to come to Congress to test its luck during the annual appropriations process. 

Thankfully with growing bipartisan support for that funding, we 

have had some key successes. And with those funds, we have seen 

some critical first steps in federally funded health care programming, but quite simply this disjointed and unpredictable approach 

to securing critical funding is not a tenable course of action. 

Both our heroes and the excellent health care programs that are 

now in place to serve them deserve better. Passage of the 9/11 

Health and Compensation Act would mark an end to this problematic approach and ensure that a consistent source of funding is 


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available to monitor and treat the thousands of first responders 

and community members already affected by World Trade Center 

related illnesses as well as those who illnesses may become apparent in the future. 

And it would ensure that no matter where an affected individual 

lives in the future, he or she could get care. Building on the expertise of the Centers of Excellence, the bill would fill gaps in how we 

are currently providing treatment and monitoring. The bill would 

also provide for substantial data collection regarding the nature 

and extent of related illnesses. This is a particularly critical provision as there is still much we have to learn about these illnesses 

and how they affect different exposure populations. 

And finally, as you know, this legislation would provide an opportunity for compensation for economic damages and losses by reopening the 9/11 Victims’ Compensation Fund. As you will hear 

from the other panelists, the needs here are abundantly clear. 

About 16,000 first responders are currently being treated for illnesses, and about 40,000 more—and more than 40,000 are being 

monitored through a consortium of providers lead by Mt. Sinai 

Hospital and the New York City Fire Department. 

And we already have nearly 3,400 sick community members 

being treated by a program funded in part by the federal government, the World Trade Center Environmental Health Program at 

Bellevue Hospital. As you may know, the bill has been modified 

several times in order to ensure that those in need receive the care 

they deserve and that the cost is feasible and responsible. 

First, the bill limits the radius, the geographical radius within 

which individuals who reside go to school or work would be eligible 

for services. Second it caps the total number of new treatment slots 

to 35,000, which incidentally is the same level as the responder 

program. Finally, the bill creates contingency funds with strict dollar limits and caps other kinds of spending. 

Today every member of the subcommittee has an opportunity. 

You can decide that you are going to join with those of us in this 

room who have been fighting for this funding for eight long years, 

with those back in New York and throughout the country who continue to grapple with the consequences of the 9/11 attacks. 

With your help, we can finally give the heroes and victims of 9/ 

11 the peace of mind they deserve by providing for their health 

needs and other losses. I urge you to please join us in supporting 

the 9/11 Health and Compensation Act and helping us to move this 

important legislation forward so that it can finally be brought to 

the whole House for a vote. 

Thank you again, Mr. Chairman, and members of the subcommittee for holding this hearing, and I look forward to the testimony of my colleagues and other witnesses today. I yield back the 

balance of my time. 

[The prepared statement of Mr. Nadler follows:] 


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Mr. PALLONE. Thank you, Congressman Nadler. And next is Congressman Peter King, and again thank you for your major efforts 

on this legislation. And of course you also make it bipartisan, 

which is very important. Thanks. 

STATEMENT OF PETER KING 

Mr. KING. Thank you, Mr. Chairman. I will thank you and the 

ranking member for holding this hearing today. Obviously I see 

Congressman Weiner is here, Congressman Engel, who know firsthand just how devastating this attack has been on New York and 

New Jersey, but as Congressman Nadler said, on the entire Nation. 

Also let me commend Jerry Nadler and Carolyn Maloney because 

they really have been there from the start. If I could just add one 

humorous note in a very serious issue, passage of this bill protects 

so many members in the House floor from being accosted by Jerry 

Nadler. After seven and a half years, if he spots anyone standing 

still, he comes up to them and urges the adoption of this bill. So 

there is a very selfish interest in passing this legislation. 

But seriously Congressman Nadler and others have worked so 

hard on this because it is such a vital issue. And it is really an 

issue whose time has come. It actually came many years ago, and 

there really is no excuse at all for going further with this. And on 

a bipartisan note, I am a Republican on this bill, but also Dr. Burgess on your committee has been very helpful. And I know he 

strongly supports this bill. I saw him this morning, and he asked 

me to point that out. 

What Congressman Nadler said about the thousands and thousands—also Congressman Engel—of first responders who went to 

the scene that day and stayed there for the next eight, nine, ten 

months, I mean day in and day out working in some cases almost 

around the clock at the time without real concern for their safety. 

They just wanted to get the job done, and when the time limit for 

the Victims’ Compensation Fund expired, most of these people had 

no idea of the underlying illnesses that they had. 

But we have seen thousands coming forward. I mean so many 

firefighters know of serious pulmonary illnesses, men who were 

really in the prime of life, absolutely perfect physical condition. 

Now some of them can barely breathe, and you just see the impact 

it has had. And it has all come in the last two, three, four years. 

Just the other night—this is anecdotal, but I happened to be at 

an event. There were two police officers there, and they did not 

even work around the clock at the World Trade Center. They were 

there the day of the attack, and they were in charge of bringing 

dignitaries and government officials to the site over the next six or 

seven months. They both came down with the same type of serious 

sinus disorder, and, you know, the odds are—of that happening, of 

two people being struck with that type of—and it is a rare type of 

sinus disorder. So I just said anecdotally. And there are so many 

other stories like that we hear, and there is really no reason to 

delay this any further. 

We have an obligation to the country. We have an obligation to 

those who came forward. We have an obligation to the contractors 

who also put a lot on the line when they came down there. And, 

you know, it happened in New York now. It could happen in any 


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other state in the country at any time. And I believe when a situation like this happens, it is imperative and it is incumbent upon 

the country to come together. 

And as Jerry said, 431 congressional districts in this country 

have been affected by this, and I would just hope that people not 

see this as a New York issue or a New Jersey or a Northeast issue. 

It really is an American issue. And also as Congressman Nadler 

said, this bill has been refined. It has been, I think, finely tuned. 

But if there is any specific objection that anyone has or question, 

I would just we resolve that and not put this on the back burner 

again and not come back to it next year or the year after. 

We are so close to the finish line right now, so close to getting 

this done, and we really—I think it would be outrageous and disgraceful not to complete the job and not to get it done. We owe it 

to those who were there that day. Jerry, of course, knows firsthand 

the people in his district who suffered. But as I said, in the entire 

region, in the entire country, so many others put their lives on the 

line and did it unquestioningly. They deserve this type of response. 

And we owe it also to future generations if, God forbid, something like this should ever happen again. So let people know that 

America does stand by those who respond to the call of duty. 

So with that, I thank you for holding this hearing today and really also thank, you know, the men and women who are here to testify, the men and women who have done so much, and the men and 

women who have really never stopped sacrificing for their country 

and unfortunately are still suffering because of that sacrifice. And 

with that, I yield back. Thank you, Mr. Chairman. 

[The prepared statement of Mr. King was unavailable at the time 

of printing.] 

Mr. PALLONE. Thank you, Congressman King. Thank you both. 

We normally don’t ask questions of our colleagues, so unless someone objects, I am going to move on. But thank you so much really. 

And you know we do intend to move the bill. I mean we are not 

just having a hearing as you know. 

Mr. NADLER. Thank you, Mr. Chairman. 

Mr. KING. Thank you, Mr. Chairman. 

Mr. PALLONE. Could the next panel come forward? We will get 

the nametags so you know where to sit, but I guess it doesn’t matter. You can sit wherever you like. We are missing a chair? You 

have to come up. We will get you a chair. Yes, Mr. Torres, sorry. 

I don’t know what happened to the nametags, but hopefully we will 

have some. There is a problem with the printer, so I think we are 

going to start without the nametags. Can we just—can we remove 

the ones that are there? He is going to do it, Charlie? Thank you. 

Thanks, Charlie. Thank you. All right, they may not be—here we 

go, OK. 

Now we will warn you that you are not sitting in the order that 

I have, so I am going to follow the order that I have in terms of 

your testimony. So let me introduce each of you, and the way I introduce you is the order that you are going to speak. OK, first is 

Mr. Edwardo Torres from Jersey City, who is over on my right. 

And then there is Dr. Jacqueline Moline, who is vice chair, Community and Preventative Medicine Director of the WTC Medical 

Monitoring and Treatment Program Clinical Center at Mt. Sinai 


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and also director of the New York/New Jersey Education and Research Center at Mt. Sinai School of Medicine in the School of New 

York. 

Then we have Dr. Joan Reibman, who is associate professor of 

medicine and environmental medicine, director of the NYU Bellevue Asthma Center and director of Health and Hospitals Corporation for the World Trade Center Environmental Health Center at 

Bellevue Hospital in New York City. And then we have Dr. Jim 

Melius who is administrator for the New York State Laborers’ TriFunds in Albany, New York. And finally is Caswell Holloway, who 

is special advisor to New York City Mayor Michael Bloomberg and 

chief of staff to New York City Deputy Mayor for Operations Edward Skyler. A long resume here for many of you. 

So I think you know it is five minutes opening statements. We 

are going to try to keep to that if possible. And if you want to submit, you know, testimony for the record, you know, we will do that 

as well. And then we will have questions after by members of the 

panel. And we will start with Mr. Torres. Thanks for being here. 

You need a mike. Just turn that that way and then just press the 

button until the light comes on there. That should do it. Maybe 

move it a little closer to him. It might be a little—yes. 

Mr. TORRES. How is that? Can you hear me? 

Mr. PALLONE. Yes, even a little closer. 

Mr. TORRES. OK, how is that? 

Mr. PALLONE. That is good. 

STATEMENTS OF EDWARDO TORRES, RESIDENT OF JERSEY 

CITY, NEW JERSEY; JACQUELINE MOLINE, M.D., MSC, VICE 

CHAIR, COMMUNITY AND PREVENTIVE MEDICINE, DIRECTOR, WTC MEDICAL MONITORING AND TREATMENT PROGRAM, CLINICAL CENTER AT MOUNT SINAI, DIRECTOR, NY/ 

NJ EDUCATION AND RESEARCH CENTER, MOUNT SINAI 

SCHOOL OF MEDICINE, NEW YORK; JOAN 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, BELLEVUE HOSPITAL, 

NEW YORK; JIM MELIUS, ADMINISTRATOR, NEW YORK 

STATE LABORERS’ TRI-FUNDS, ALBANY, NEW YORK; AND 

CASWELL F. HOLLOWAY, SPECIAL ADVISOR TO NEW YORK 

CITY MAYOR MICHAEL R. BLOOMBERG, CHIEF OF STAFF TO 

NEW YORK CITY DEPUTY MAYOR FOR OPERATIONS EDWARD 

SKYLER. 

STATEMENT OF EDWARDO TORRES 

Mr. TORRES. Thank you, Mr. Chairman Pallone, members of the 

committee. Good morning and thank you for the opportunity to testify before you today. My name is Edwardo Torres. I am 47 years 

old, and I am a resident of Jersey City. I am a construction worker 

and a trade member of the Plumbers Local Union 14 AFL/CIO 

based in Lodine, New Jersey. I am testifying before you today in 

support of the James Zadroga 9/11 Health Commission Compensation Act of 2009. 

I come before you this morning as a citizen wanting to do my 

part to assist the victims of 9/11 terrorist attack of the World Trade 


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Center and assist their responders. But now I am suffering from 

serious health effects due to the exposure of Ground Zero toxins 

and the breathing of the toxins and the pulverized building materials. 

My story begins in September 2001. I arrived at Ground Zero 

from New Jersey at 11:00 a.m. Workers were being recruited from 

my job site and my local union to assist the rescue efforts. Upon 

the arriving to Manhattan from New Jersey, I immediately began 

to assist the police, firemen, and rescue attempts of possible survivors trapped in the ruble of the World Trade Center and to move 

debris from the pile. 

I was assigned to the bucket brigade, which slowly and painstakingly removed debris from certain areas via a long line of people 

passing one bucket after another. And I performed this task up to 

8:00 p.m. that evening. I returned to the pile on September 13, 14, 

and 15, and over the course of those four days, I performed the 

same exact task for approximately 60 hours. 

The first day on the pile, I wore a simple dust mask and a hard 

hat. The three following days, I wore a two-canister filter respirator 

and a hard hat. Through this time, we dug through the pile by 

hand because shovels simply didn’t work well. The entire time I 

was filling up buckets and we were instructed to carefully sift 

through and review the material and attempt to identify remains. 

Although the environment I was working in was surreal, the 

weather was actually—couldn’t have been nicer out. It was clear, 

sunny, and shiny. The first day, the level of dust that appeared to 

the naked eye had been reduced, although the smoke and the smell 

of the fumes were intense at times. There was a false sense of security and the frenzied dedication of the workers sometimes forced us 

to remove our respirators. We also removed them when we ate or 

drank water, both of which occurred right on the pile. 

I was completely unaware of the health hazards presented in the 

air, and although the dust appeared to be minimal, I would be reminded of the massive amount of dust in the air when I washed 

my face on an hourly basis. And when I would dry with a paper 

towel I would see heavy grey cover on it. I wiped massive amounts 

of soot from my face on a regular basis. 

When I went to Ground Zero on September 15, I was proud to 

volunteer every ounce of my energy over the last four days helping 

victims of the attacks. That day was the last day that I went to 

volunteer at Ground Zero. 

I returned to my home that Saturday, and I attempted to go back 

to the pile on September 16, but there was no longer running ferries from New Jersey and much of the workers and so less volunteers were being recruited. I returned to work on Monday, September 17. 

It is important to note I never had any health problems prior to 

9/11. In fact, I considered myself to be in great shape. I jogged approximately three times a week, and I never had any problems 

breathing. For the first four months after 9/11, I had no symptoms 

or health problems of any kind. 

That changed with what I would describe as an on-again-offagain sore throat starting from February of 2002 in which I would 

lose my voice on occasion. 2002, I started having stomach pains, 


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not comfortable but pains similar to a worse type of acid reflux or 

heartburn. And I had no stomach problems at all prior to 9/11. 

This persisted and got consistently worse in the course of the 

next three years. 2005, my throat, my stomach problems were consistently more problematic at the time of receiving a physical at 

March of 2005. 

The worst came in November of 2005, a period of time, I could 

no longer walk up more than one flight of stairs. Work was becoming much more difficult. The winter, I lost about six or seven days 

of work because it was too cold in the weather that simply I 

couldn’t breathe. In fact, at one point during the dance performance, my chest pains and ability to breathe forced me to stop performing. 

There are days that I couldn’t even run with my kids, participate 

in sports, and sleep cycles have been disturbed due to my respiratory problems. The only medicine I had at this time was acid 

reflux, but symptoms got worse. And at the time, I visited a lung 

specialist who performed a PET scan. On March 2006 and October 

of 2006, I was diagnosed with having modules in my lungs resulting in lung opacity and lung scarring. The doctors however did not 

say it was a result of my exposure. 

After finding this problem and recognizing in my opinion that 

they were a result of my working at Ground Zero, I decided to attend Mt. Sinai Medical Monitoring Program for examination and 

was accepted into the program in May of 2006. 

At this time, I was diagnosed with two World Trade Center-related conditions—gastro-esophageal reflux disorder (GERD) and 

chronic respiratory restriction. My treatment began at this time, 

and I was taking prescription medicine to treat the constant throat 

pain that I was suffering. Eventually I had surgery which was paid 

for by the Medical Monitoring Fund in October of 2006. And the 

surgery removed a mass or polyp on my throat. It was not cancerous. After the surgery, I was out for six weeks of work. 

I found the caregivers of the World Trade Center Monitoring Program very compassionate. Also, unlike my first doctor, they had a 

thorough understanding of the context in which the medical examinations and treatments were required. These caregivers understood 

the 9/11 association and how to treat these problems specifically. 

The program also performed an extensive breathing analysis, or 

a PFT test, pulmonary function test. Every 3 months I received a 

checkup and a CAT scan, and I met with doctors. Since May of 

2006, I have been to the program 24 times. The program pays for 

the treatment and the monitoring. My insurance through my union 

pays for the CAT scans. I have never paid anything out of pocket 

with the exception of prescription drug co-payments. And they have 

a program in Piscataway, but prefer the one in New York City because it is a shorter drive for me. 

Under the James Zadroga 9/11 Health and Compensation Act of 

2009 legislation, I will continue to receive medical monitoring since 

both of my diagnosed conditions are on the list of identified World 

Trade Center conditions specifically in this bill. 

This would allow me to continue the course of the medical treatment paid for but would also assist other affected workers who are 

currently struggling. For workers like me and others participating 


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in this program, the monitoring of treatment is essential. Furthermore, under this bill, we would be allowed to receive non-treatment 

core services such as education on my condition, counseling and advice on how to identify and obtain benefits if needed from workers’ 

compensation, health insurance, disability insurance and public, 

private and social service agencies. 

In closing, I would like to repeat a question a nurse gathering 

research from me had asked at Mt. Sinai Hospital and ask you to 

put this in context as you deliberate this legislation. I was asked 

on August 2008 during a checkup at the monitoring program if I 

understood the health effects resulted from your Ground Zero volunteering, would you still have gone? And I responded yes before 

she could even have a chance of finishing the question. Despite all 

the pain that it has caused me, I would not have changed a day. 

Those people needed me. My country needed me. I had to do the 

right thing. And now respectfully I ask you to respond to the 

health needs by also saying yes when this bill comes up to vote. 

Thank you. 

[The prepared statement of Mr. Torres follows:] 


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Mr. PALLONE. Thank you, Mr. Torres. Thank you for relating 

your story, which I am sure is very much like what a lot of other 

responders have been going through. Thank you. Dr. Moline. 

STATEMENT OF JACQUELINE MOLINE 

Dr. MOLINE. Chairman Pallone and Ranking Member Deal and 

members of the committee, I would like to thank you for inviting 

me to present testimony today. My name is Dr. Jacqueline Moline. 

I am an occupational medicine specialist at Mt. Sinai School of 

Medicine in New York City, and I direct Mt. Sinai’s Clinical Center 

of the World Trade Center Medical Monitoring and Treatment Program. 

We are the flagship of a regional and national consortium that 

is supported by NIOSH, the National Institute for Occupational 

Safety and Health through February 28, 2009 has diagnosed and 

treated nearly 27,000 World Trade Center responders throughout 

this country. I am here today to testify in support of H.R. 847, 

which in my view is the best vehicle to meet the need for continued 

medical care of the responders and ensure that the 9/11 responders 

receive the high quality medical care they rightfully deserve. 

On or after September 11, 2001, an estimated 60,000 to 70,000 

traditional first responders and not-so-traditional responders came 

from every state in the Nation, including tens of thousands from 

the New York metropolitan area, working for days, weeks, and 

months in and around Ground Zero. Their hard work and bravery 

got New York and our Nation back on its feet, and we owe them 

tremendous gratitude. 

They were exposed to a complex and unprecedented mixture of 

toxic chemicals including dust, glass shards, and carcinogens like 

benzene, asbestos, and dioxin. The collapse of the towers in the 

morning and then a third building in the afternoon created a dust 

cloud turning a bright sunny day into night. The pulverized cement 

had a pH equivalent to lye. Fires burned for three months. Rubble 

operations, removal operations lasted through May 2002, repeatedly exposing these workers to dust. 

In addition to the physical exposures, they had extreme psychological stress. They came upon human remains. Their stress was 

compounded by fatigue as they worked hour after hour, day after 

day. Among those most affected have been the non-traditional responders, those not trained for any emergency, let alone a disaster 

the scale posed by 9/11. Mt. Sinai, through its Center for Occupational and Environmental Medicine designed and developed what 

stands today as the federal government’s health response to 9/11, 

a model based on experience and expertise of academic physicians 

with specialty training in occupational medicine, surrounded by 

specialists in various disciplines. 

Our regional consortium of clinical Centers of Excellence in New 

York and New Jersey, together with the national program that initially was coordinated by Mt. Sinai and is now coordinated by LHI 

has provided 46,858 monitoring exams to 26,651 responders in all 

50 states. Mt. Sinai alone has provided over 30,000 of these exams 

to over 17,350 responders. 

Since the New York and New Jersey Metropolitan Area Consortium treatment programs began, we have provided nearly 90,000 


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physical, mental and social work services in our consortium. Even 

now, approximately 150 new eligible responders join our program 

every month. Many of these responders continue to suffer health 

effects with attendant social and financial effects. We have seen 

asthma, sinus problems, GERD. Breathing tests still are abnormal 

in 25 percent of our patients. Mental health consequences are at 

rates seen in our returning veterans from Afghanistan. 

If we look at six months of conditions in approximately 4,400 patients undergoing treatment in our programs, we see GERD or 

reflux in 53 percent. 35 percent have mental health problems. 

Lower respiratory conditions in 46 percent, upper respiratory conditions in 69 percent, social disability, no health insurance in 22 

percent, and 64 percent have multiple medical conditions. Some 

have responded, but thousands have received treatment and still 

require care. 

One of my patients, Mr. S, is a carpenter. He worked for a New 

York City agency and was in great health. Never had a health 

problem. Never had shortness of breath. He developed GERD, reactive airways, sinus problems, anxiety, couldn’t work in a dusty environment and thus could no longer be a carpenter. He lost his 

health insurance, fell behind on his bills, couldn’t obtain worker’s 

compensation because it controverted his case. He couldn’t afford 

medication, his necessary tests. 

Through this program, he is receiving the care he needs, and his 

health is stable. He is not back to normal. He can’t work anymore, 

but at least he is able to care for himself and his family. 

We know that new conditions, things marked by longer latency, 

will emerge among 9/11 responders since they were exposed to carcinogens, neurotoxins, and other chemicals toxic to the respiratory 

track in concentrations and combinations never before encountered. 

The future health outlook for responders remains uncertain, and 

the long-term consequences of an unprecedented mixture of toxicants is not known. All of us must remain vigilant for these problems. 

Through the medical findings I have summarized this morning 

and the persistence of illness that we are seeing in a substantial 

number of responders, we must have stable, predictable federal 

funding for a medical program for the responders. We establish 

these programs. We have established ties with our patients, gained 

their trust in our care for them, and we hope to continue doing this 

without interruption of care. 

We are also coordinating data. This is the only way we are going 

to know what has happened to the 9/11 responders. We, in real 

time, collect data on the outcomes, looking for medical trends, patterns of disease. We can assess the efficacy of treatments. We can 

inform the medical community, the scientific community, and the 

legislative community of these findings. We disseminate these regularly in medical journals, and this will provide essential guidance 

in helping us in any future disasters. 

All of the good work is impossible without the Centers of Excellence. We are providing state-of-the-art medical care to men and 

women who risk everything for us in a time tantamount to war. 

Our goal in these programs is simple: we want to provide the best 

care possible to these men and women and not worry we won’t be 


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there if they need care for World Trade Center related diseases. 

Passage of H.R. 847 will ensure that the heroes of 9/11 are never 

forgotten. Thank you. 

[The prepared statement of Dr. Moline follows:] 


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Mr. PALLONE. Thank you, Dr. Moline. Dr. Reibman is next. 

STATEMENT OF JOAN REIBMAN 

Dr. REIBMAN. Good morning, Chairman Pallone, Ranking Member Deal, members of the committee. My name is Joan Reibman, 

and I am an associate professor of medicine and environmental 

medicine at New York University. And I am an attending physician 

at Bellevue Hospital, a public hospital on 27th Street in New York 

City. 

I am a specialist in pulmonary medicine, and for the past 17, almost 18 years now, I have directed the NYU/Bellevue Asthma Center and am pleased to be able to testify on behalf of the local workers, the residents, and the students of downtown New York who 

are exposed to World Trade Center dust and fumes. 

I am very pleased to be here today to support H.R. 847, The 

James Zadroga 9/11 Health and Compensation Act which would 

provided needed long-term funding for the monitoring and treatment of those members of the community exposed to toxic substances as a result of 9/11. Many of these individuals unfortunately 

have become patients with long-term health needed related to respiratory as well as other physical and mental health illness. 

Let me talk a little bit about populations at risk. You have heard 

a lot about the heroes who helped in the recovery of our city and 

our country. I would like to tell you a little bit about the people 

that we serve, the local workers, residents, and the students exposed to the World Trade Center dust and fumes. On the morning 

of 9/11, about 300,000 individuals were at work in the area or in 

transit to their offices. Many were caught in the initial massive 

dust cloud as the buildings collapsed. We now call these people the 

dust cloud people. These are the thousands whom you saw in the 

videos and the still photographs coated in white running for their 

lives. 

In the great outpouring of pride and patriotism after 9/11, many 

local workers returned to work one week later. The massive World 

Trade Center cleanup and rescue operation still in full force and 

not all the buildings completely cleaned or decontaminated. 

As you also know, lower Manhattan is a dense residential community. Almost 60,000 people of diverse race and ethnic backgrounds live south of Canal Street. They are economically diverse, 

some living in large public housing complexes, others in new coops. Lower Manhattan is also an educational hub. 

There are almost 15,000 or more school children, large numbers 

of university and college students. Many of these students were 

locked in their building. Others were told to run for their lives. The 

dust of the towers settled on streets, playgrounds, cars, and buildings, entered apartments, schools, and office buildings through windows, building cracks and ventilation systems. The World Trade 

Center buildings burned through December. Each of these groups 

have potential for exposure to the dust, both indoors and outdoors, 

and to fumes from the fires that continued to burn. 

So what were the initial health effects in these populations? As 

pulmonologists in a public hospital, we sought to determine whether the collapse of the buildings posed a health hazard, and we 

worked to monitor the effect on the local residents in collaboration 


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with the New York State Department of Health and with funds 

from the Centers for Disease Control and looked at the rate of new 

respiratory symptoms in the local residents after 9/11. 

This first study was completed just over a year after 9/11 and 

has also been reported in three peer-reviewed publications. We 

were able to document that individuals who lived near the area 

compared to those who lived away from the area had a more than 

three times the number of reported incidents of eye irritation, 

nasal irritation, sinus congestion, nosebleeds, headaches, a threefold increase in lower respiratory symptoms including cough, shortness of breath, a six and a half fold increase in wheezing. These 

are people who were previously healthy, and this was also associated with an almost twofold increase in unplanned medical visits 

and use of medications prescribed for asthma. 

Residents reporting a longer duration of dust or odors or multiple 

sources of exposure had greater risk for symptoms compared to 

those reporting a shorter duration. Data from a New York City Department of Health and Mental Hygiene World Trade Center registry further documented adverse health effects in building evacuees, school children, and support our original findings. 

What do we now know about these populations and their illness? 

After 9/11, we began to treat residents who felt they had World 

Trade Center related illness in our Bellevue Hospital asthma clinic. 

We then developed a community collaboration and together began 

an unfounded program. We were subsequently awarded American 

Red Cross liberties disaster relief grant in 2005 to set up a medical 

treatment program. And a year later, we received major funding 

from the city of New York. 

In the last year, we have just received our first federal funding 

support for five years for a treatment program from the National 

Institute for Occupational Safety and Health. I am sorry, providing 

three years of support. We know have an interdisciplinary medical 

and mental health program that has evaluated and is treating approximately 3,500 patients. We continue to receive inquiries each 

week. Most come from local people; however, we have received calls 

from individuals living in about 20 other states. 

To enter our program, one has to have a medical or now mental 

health complaint. We are not a screening program for asymptomatic individuals. To date, our patients are almost equally men 

and women of diverse race, ethnicity, and many, although not all, 

are uninsured. Some have never sought medical care. Some have 

been unable to seek care for lack of insurance. Others have been 

seeing doctors for years since 9/11 with recurrent bronchitis, pneumonia, sinusitis, or unexplained shortness of breath. 

As described in an article that we have just published, these individuals, residents, local workers, as well as cleanup workers and 

a few responders in our program have symptoms that include persistent rhino-sinusitis, asthma-like symptoms of cough, shortness of 

breath or wheeze, for which they continue to need care more than 

seven, almost eight years after 9/11. 

Thirty percent have shortness of breath that is at a level consistent with significant activity limitation. Ten percent have the 

highest score on a standardized scale of breathlessness used for 

disability assessment. These are people who report that they were 


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previously working and functional. Many report that they had been 

highly physically active, some training even for marathons. Over 50 

percent of our population continues to have persistent post-traumatic stress disorder. 

There are a lot of questions about this population. What respiratory disease are we treating? We now believe that the exposure 

resulted in several respiratory illnesses with varied patterns. Many 

of our patients have irritant-induced asthma. Although we can 

treat this, these individuals require prolonged courses of inhaled 

corticosteroids and bronchodilators, sometimes even oral steroids. 

Many will require these medications for years, if not for life. 

Others show a process in the lungs that may consist of a type 

of inflammation, a granulomatous process that is like an illness 

that is called sarcoid. Others have lung diseases that affect not 

only their airways or breathing tubes, but also the air sacs that 

allow for the exchange of oxygen and carbon dioxide. Some have 

pulmonary fibrosis, characterized as scarring or permanent damage 

in the lungs and are awaiting lung transplants. 

How do we know whether an illness is World Trade Center induced? We often hear that these diseases are common in the population anyway. How do we know that these people are sick from 

World Trade Center exposure? 

Mr. PALLONE. Dr. Reibman, I hate to interrupt you, but you have 

basically used about as much as the others. But looking at your 

written statement, you are not even halfway through. So I don’t 

know if you could summarize from now on. 

Dr. REIBMAN. I would be pleased to summarize. 

Mr. PALLONE. Thank you. 

Dr. REIBMAN. I would just like to say that without these centers, 

we will not understand what we are treating, who we are treating, 

and how to treat. We would not understand why some people are 

sick and others aren’t. We would not understand if there are going 

to be late emergent diseases not only in the responder population 

but also in the community population. And therefore we think it is 

very important, and we very strongly support this bill that provides 

support not only for the responders but also for the community. 

And I would like to thank you very much. 

[The prepared statement of Dr. Reibman follows:] 


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Mr. PALLONE. Thank you, and I apologize. Your whole written 

testimony becomes part of the record in any case, but I am just trying to keep the time to a minimum if we can. Next is Dr. Melius. 

STATEMENT OF JIM MELIUS 

Dr. MELIUS. Thank you, Chairman Pallone and Representative 

Weiner. I greatly appreciate the opportunity to appear before you 

at this hearing this morning. I am an occupational physician epidemiologist, currently work for the New York State Labor of 

Health and Safety Trust Fund in New York. And I also served the 

last several years as chair of the steering community for the medical monitoring and treatment program. 

I believe that Drs. Moline and Reibman have already presented 

a good description of some of the illnesses that people are suffering 

that were exposed to the World Trade Center. I don’t want to repeat that information. Only indicate it is certainly remarkable how 

many of the people are. The numbers sometimes get lost when one 

thinks what a high percentage is, as both of them have presented 

here today. 

We have a lot of sick people, and there are many that are disabled and many that are continuing to need intensive medical care. 

I would like to focus briefly on why do we need the federal program and what are some of the features of this legislation that I 

think deserve support here in Congress. We need the federal funding for this program because other funding just is not available. 

Health insurance does not cover work-related health problems. So 

they automatically get turned down. That includes Medicare. 

Many of the people in the community don’t lack health insurance. All the problems that, I think, actually this subcommittee 

may be dealing with in terms of health care reform. We have major 

problems there. So those two together, I think, make health insurance a very—you know, provides very limited help for these people. 

One would think that worker’s compensation would be a logical 

place that would support these kinds of illnesses. To the extent 

that they are work-related, it certainly could be. The problem is 

that worker’s compensation is not very good at handling new kinds 

of illnesses, new kinds of findings, and takes a long time. The average claim takes over three years to make it through the system. 

And then even then it can be contested for many more years. If 

there are changes in treatment, regimen, something, the insurer 

can also contest that. So it is not a system that provides for good 

medical care for the kind of intensive medical care that these people require, and one that is complicated, one that is constantly 

changing as the Centers of Excellence learn more about that. 

So I think, just to be clear, the legislation provide for some recovery of whatever funding might be available for health insurance or 

worker’s compensation, but that will never be able to provide the 

kind of comprehensive funding that is needed for these medical 

programs. 

So what has been devised in H.R. 847, which I strongly support, 

is a mechanism that provides where the federal government would 

provide funding set up so it goes to Centers of Excellence. Well, 

why Centers of Excellence? Because we need centers such as the 

ones that Dr. Reibman and Dr. Moline run that have significant 


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core of expertise and experience in dealing with World Trade Center medical problems. 

As we have heard Mr. Torres say, when he first went to Mt. 

Sinai, he finally found a medical care provider that understood his 

problems and was able and ready to provide the kind of care that 

he needed. And the Centers of Excellence can do that, that by seeing large numbers of people with these conditions, they can understand the problems, develop the appropriate treatment, appropriate 

ways of diagnosing these problems. And they can standardize the 

diagnosis and care of that. 

They can also collect the data that is needed to learn not only 

what is happening to these people and what the findings are, but 

also are new diseases going to emerge. The list of covered conditions currently in the bill cover those that we know about now, that 

have a sound scientific basis in the medical literature, the asthma, 

post-traumatic stress, and other diseases that have been mentioned 

here. But we may very well see other kinds of illnesses, cancer. We 

just don’t know going forward. 

By having the data collection place, we will be able to recognize 

those as they appear. There are already studies underway looking 

at this, and there are mechanisms in the bill both on an individual 

basis and on a collective basis to be able to take care of people with 

health conditions that aren’t yet recognized but may be. But those 

would only be triggered if there is significant scientific and medical 

evidence saying that those conditions should be covered. 

There are also provisions in the bill that provide for significant 

oversight by the federal government in all aspects of this program. 

Certification that people are eligible for program, certification that 

they are eligible for treatment, that they have a World Trade Center condition that should be treated. 

Oversight over the quality of the medical care, oversight over the 

reimbursement for that medical care and I think the mechanism 

that parallels other federal programs in terms of providing a good 

oversight of this program. So it is not something that, you know, 

where the money will be carelessly spent. It will be very carefully 

spent and very carefully monitored by the federal government. 

And finally it also sets up a mechanism for recovery from health 

insurance and from worker’s compensation insurers where that is 

appropriate for medical care treatment costs. So if, for example, in 

worker’s compensation. If there is a claim that has been recognized 

or if a claim that is in process eventually gets recognized in the 

system, there will be a program in place for the federal government 

to recover the reimbursement that was already spent, the medical 

care costs that the federal government has already spent. 

And I think that will make a significant difference in terms of, 

you know, a fair share from those sources of funding the same time 

without impeding or unnecessarily delaying the medical care for 

the responders or for the community residents that are in this program. 

I think this bill as it is presently developed here, the medical 

program is—it has the right safeguards. I think it will provide excellent medical care, a way for us to provide what these people deserve for the sacrifices they made to our country and one that without the federal assistance just would not be provided for them. 


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It has already been going on eight years, and I think it is, you 

know, time we try to get this program in place on a more permanent basis and provide a good sound and excellent medical program 

for these people. Thank you, and I would be glad to answer any 

questions. 

[The prepared statement of Dr. Melius follows:] 


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Mr. PALLONE. Thank you, Dr. Melius. Mr. Holloway. 

STATEMENT OF CASWELL F. HOLLOWAY 

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

Ranking Member Deal, Representative Weiner, for convening this 

hearing on this important bill, the H.R. 847, the 9/11 Health and 

Compensation Act. I also want to thank Speaker Nancy Pelosi and 

the New York delegation for making it a priority to enact legislation to establish a sustained, long-term 9/11 health program. 

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. I was also an executive director of a 

panel convened by Mayor Bloomberg at the fifth anniversary of the 

attacks to assess the health impacts of 9/11. 

That report called for sustained, long-term program to provide 

monitoring and treatment to address the health impacts of 9/11 

and for the reopening of the Victims’ Compensation Fund. Since 

that time, Mayor Bloomberg, myself, and many others of the members of the mayor’s administration have traveled here to Washington to make the case for sustained federal funding. In fact, as 

you may recall, last July, I testified before this subcommittee. And 

it is a privilege to appear before you again. It is also a privilege 

to appear here with Mr. Torres and these distinguished doctors 

who are involved in the treatment of these conditions. 

As members of this committee know, a tremendous amount has 

happened since I last appeared before you. In terms of this bill, the 

city has engaged in extensive discussions with stakeholders, including people at this table, and some of the issues that existed in the 

prior version of the bill have been addressed. In terms of the city’s 

economic outlook, we are still in the throes of an economic crisis 

that has resulted in the highest unemployment rate in New York 

City since October 2003 at a projected budget gap of $3.2 billion 

in fiscal year 2011 that could grow to $4 billion and more in future 

years. 

Mayor Bloomberg has moved aggressively since well before the 

scope of this current crisis became apparent to save for tough times 

and cut costs. But even with these measures, the city will have to 

make deep cuts. 

I mention these statistics not merely because they are timely, but 

because the city’s finances are severely strained. We must concentrate resources on providing the essential services New Yorkers 

and visitors to the city need and on getting the economy running 

again. With respect to H.R. 847, the version of the bill currently 

before this committee is an important step forward, and in its 

broad strokes achieves what the city has long been seeking: sustained funding to treat those who are sick or who could become 

sick because of 9/11, and it reopens the Victim Compensation Fund 

so that those who were harmed can be fairly compensated quickly 

and efficiently without having to prove that the city, its contractors, or anyone but the terrorists were at fault. 

But there are two important issues that, in the city’s view, must 

be addressed. First, the bill requires the city to pay 10 percent of 

the entire treatment and monitoring costs for anyone eligible under 

the bill. Based on the best information we have to date, which 


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Chairman Pallone mentioned from CBO—I am sorry, Ranking 

Member Deal—this translates into approximately $50 million per 

year and $500 million over 10 years. 

And it is unfair for New Yorkers to bear so much of what we believe is clearly a national obligation. Moreover, particularly at a 

time when the city is being forced to make deep cuts including to 

essential services, this cost share is simply too high. 

Second, regardless of what the city’s cost share ultimately turns 

out to be, the bill does not give the city adequate oversight of the 

programs it is expected to fund. This issue can be easily addressed 

by the inclusion of a right-to-audit or similar mechanism in the 

bill, and it should be included to make sure that we can oversee 

the program appropriately. We are confident that these issues can 

be addressed before this committee and in this legislative process, 

and the members of the committee have heard a lot of the detail 

about the scope and impacts of 9/11. 

So I won’t repeat that except to say that what the mayor’s report 

established when it came out in 2007, I think beyond question, was 

that this is a serious problem, that people are suffering serious 

mental and physical illnesses as a result of 9/11, and that additional people continue to get sick, that it is imperative that those 

people get treated, that there continues to be research to fully understand the impacts, and that the funding be sustained. That is 

why we are here, and that is what we are seeking. And the research that has come out since the mayor’s report, which Dr. 

Reibman, Dr. Moline and others have continued to produce, continues to validate these facts. 

I just want to mention quickly a couple of programs that haven’t 

been mentioned here today. Most importantly the FDNY’s program, 

which is also a Center of Excellence and has involved 14,000 of the 

firefighters who are being monitored and several thousand who are 

being treated. 

In addition to that, with the federal government’s assistance, we 

have also started back in 2003 the World Trade Center health registry which is without a doubt the best source of research that we 

are going to have in addition to the clinical research that we get 

out of the Centers of Excellence to ensure that we fully understand 

the impacts of 9/11. 

Now, the city hasn’t waited for federal funding in order to address the needs that we found in our report. And in fact, the city 

is the primary funder of the Health and Hospitals Corporation 

Center of Excellence that Dr. Reibman runs. However, this program and many other programs are in jeopardy because the city 

took up the funding obligation to run these programs based on a 

need and also on an assumption that the federal government would 

ultimately come to the table and help us to get fully engaged and 

cover these costs. That is why is it so important that this bill be 

passed. 

As Dr. Melius explained, this bill provides long-term funding and 

has controls in it that we think are appropriate and ensure that 

money will only go to those who have actually been affected and 

are ill because of 9/11. So I won’t repeat that. 

And I think to sum up, the—pardon me for one second. To sum 

up, the bill has important controls. It establishes the long-term 


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funding that the city is seeking and is required to ensure that this 

problem, which we know is long term and we know can’t be properly sustained by year-to-year ad hoc appropriations, can continue 

so that those who are injured as a result of 9/11, which was an attack on the Nation and not merely on New York City, can get the 

treatment they need. 

And it is important to note when we talk about the registry and 

as Representative Nadler and King mentioned in their testimony, 

this is not just a New York City problem. The World Trade Center 

health registry contains representatives for nearly every congressional district in the country. Ranking Member Deal, there are several hundred from Georgia who participated and a few from your 

district. And I am sure, as you know, Chairman Pallone, many 

thousands from the state of New Jersey and your district. 

As I mentioned at the outset of my testimony, there are the two 

issues that the city believes needs to be addressed and can be addressed in this legislative process. That is the cost share issue, and 

the issue of oversight if the city is going to be expected to fund programs that it doesn’t control. 

And I do want to say importantly the city is not opposed to a cost 

share at all. In fact, Mayor Bloomberg fully embraced an earlier 

version of this bill in which the city was going to be required to 

pay a 5 percent share of the Centers of Excellence that are run by 

the city, which is the Health and Hospitals Corporation and the 

one treating community members. We think this is important because it gives the city the incentive that is needed to ensure that 

funds are spent carefully and wisely. 

However, the share that is in the bill, which could cost New York 

City taxpayers alone up to half a billion dollars is simply too high. 

However, we are hopeful that these issues will be addressed, that 

we can fully support a bill and that it will be presented for the 

President’s signature before another anniversary of the attacks 

passes. Thank you very much, and I will be happy to answer any 

questions. 

[The prepared statement of Mr. Holloway follows:] 


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Mr. PALLONE. Thank you, Mr. Holloway. Thank all of you. We 

now are going to have questions from the panel, and since there 

are only three of us, we may actually have two series of questions. 

We will see if anyone else joins us. You know I guess I am sort of 

following up on what Mr. Holloway said in the sense that, you 

know, if you wanted to be devil’s advocate, and I guess I shouldn’t 

be devil’s advocate because I am from New Jersey and I would like, 

you know, this to be as robust as possible since so many of my New 

Jersey residents are impacted. 

But, you know, I guess one could argue, you know, the program 

exists. Obviously you have described how effective it is. To my 

knowledge, nobody is being turned away at this point. But we are 

really here with this legislation is making a permanent authorization for a program that basically does exist and has been funded 

for the last few years. 

And my questions are more along the lines of, you know, why do 

we need to make it permanent? And is this the time to do it? You 

know part of the problem that we have had with all of this is 

knowing how many people are going to be impacted, how many disorders are going to come forward. It does seem that as time goes 

on, there are more people that come forward and more people that 

are being seriously affected in terms of their health. And if that 

trend continues or accelerates, you know, we may have even more 

people that we anticipate because, you know, you have the caps 

right now in the program. I guess it is 15,000 responders and 

15,000 residents beyond those that are already in the program. 

So I guess I would start first with Dr. Melius or any of the doctors. You know you mentioned, I think, that there is a list of identified World Trade Center related health conditions in the bill. Do 

you expect that those additional diseases will emerge as the World 

Trade Center related, you know, conditions have more of an impact? And under the bill, how are additional conditions added to 

the list? Let us at least start with that. 

Dr. MELIUS. OK, I think we all would expect that there will be 

additional conditions added. 

Mr. PALLONE. Right. 

Dr. MELIUS. There are a number under investigation already, 

and we know that people were exposed to carcinogens and a lot of 

toxic materials. And so I think looking forward, we would expect 

some. In the bill, I think, it was structured in a way that puts the 

caps in place so that that wouldn’t get out of hand. And in terms 

of the list of covered conditions, we have to handle it without having to come back to Congress and say well, you know, this program 

is going to cover hundreds of thousands of people because they are 

sick, then we ought to rethink how we do this and so forth. 

In terms of the list of covered conditions, you know, the current 

list is based on one of clinical experience, Dr. Reibman and Dr. Moline and others, plus what has been found in the studies. It is a 

well-based risk, and in the current, you know, scientifically sound 

and reviewed multiple researchers that made these findings including some outside the program. 

So I think everyone is confident in what is on the list. Going forward, there is a mechanism to add specific covered conditions, say 

a type of cancer or something that is seen. One, there has to be 


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some amount of scientific evidence available demonstrating that it 

should be covered. 

Secondly there is a process where the federal government, 

NIOSH, would promulgate a regulation to add that condition on 

the list of covered conditions. So they would be required, as with 

any regulation, to justify it, justify the cost, justify, more importantly, the science behind that. There is also provisions in there for 

a scientific advisory committee for the program to also review that 

information and be involved in making that recommendation. 

Mr. PALLONE. Now, in terms of where we are, I mean you—I certainly get the impression from listening to you, and I know this 

may be difficult to answer. But I certainly get the impression that 

as time goes on, we are going to see more people that are affected 

and possibly worsening conditions. I mean is that just inevitable 

because as people age, you know, these symptoms and diseases get 

worse? Or is it possible, you know, that at some point, you know, 

that doesn’t happen because, you know, time is somehow a healer? 

I mean I get the impression the opposite, that we should expect as 

times goes on that we are just going to have more people and worse 

conditions. 

Dr. MELIUS. I will let Dr. Moline and Dr. Reibman follow up, but 

I think it is a mix. There are people newly coming in that develop 

conditions, but there are also people getting better. In fact, one 

thing that has been observed in the responders program is that the 

treatment costs actually appear to be going down per patient on an 

annual basis because patients get stabilized in terms of treatment 

and so forth. A number of them do get better, are able to continue 

to work and so forth. Now, some don’t. And so there is a balance 

there. So I don’t think it is inevitable that these numbers will continue to get bigger and bigger because some people will recover. 

Mr. PALLONE. But let me just ask—— 

Dr. MELIUS. We just aren’t able to predict accurately, I think. 

Mr. PALLONE. Well, then I guess my third question would be— 

and if you want to ask Dr. Moline to answer it—the caps that are 

in place, I mean are they based on projections that, you know, you 

are seeing an acceleration of the numbers? I mean how is that derived at, or is it totally artificial? 

Dr. MELIUS. The caps are—on the responder program, the caps 

are based on an assessment of how many people we know that 

would be eligible for the responder program. We know how many 

people, you know, worked at the cite at least, you know, within, 

you know, several thousand. So we do that, and we have some, I 

think, pretty good idea of how many of those, you know, haven’t 

come forward yet who are eligible and might come forward in the 

future. And then, you know, the assumption that they are not 

going to be any sicker than the people that are already in the program. In fact, there are probably going to be fewer that require 

treatment. So I think it is unlikely that that cap will be reached 

for the responder program. 

For the community program, I think we had less experience and 

maybe Dr. Reibman wants to comment, but it was trying to say 

that given the time when this legislation was being passed, given 

what was coming forward at that time, who we knew at that point 

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munity program, you know, that that was a reasonable number 

that would fit in going forward and at least would for, you know, 

some significant period of time, 10 years or more, would, you know, 

be legitimately capping the program without denying large numbers of people care. It may need to be adjusted we don’t know. 

Mr. PALLONE. OK, gentlemen, I am being a little loose with the 

time here since there is only three of us. I am not going to clock 

any of us here. So if Dr. Reibman or anybody else wants to answer 

some of the questions. 

Dr. REIBMAN. I just want to reinforce what Dr. Melius just said 

which is for the community group, we have very little information 

to go on. We could only go by what we were seeing, data from the 

New York City Department of Health registry where we could sort 

of estimate a burden of illness and also understand that some people will be going to their own physicians. So it was really, with the 

information we had at hand, our best estimate. 

Mr. PALLONE. OK, Dr. Moline. 

Dr. MOLINE. I think if we look at the responders who are coming 

in, about 150 are coming in consortium wide every month. This is 

down from the first two years of our program, beginning in 2002 

to 2004, we have 12,000 responders. 

Mr. PALLONE. So you are actually getting less per month instead 

of more? 

Dr. MOLINE. We are getting far fewer per month because—— 

Mr. PALLONE. Fewer. 

Dr. MOLINE [continuing]. Most people are already in. I mean the 

question is why are some people coming in now. 

Mr. PALLONE. Right. 

Dr. MOLINE. Where have they been? And there are a couple reasons. First and foremost, many people are very stoic. We also know 

that in a population that is overwhelmingly male, the responder 

population, they tend not to access health. They don’t like doctors. 

I don’t know why. 

Mr. PALLONE. Stoic is the same as denial? Or that is a little different I guess? 

Dr. MOLINE. It is both. 

Mr. PALLONE. Yes. 

Dr. MOLINE. It is a nice way of putting it sometimes, but some 

people—you know actually what I have often been amazed at is 

people feel they don’t deserve to come in. Others are sicker than 

they are, and they reach a certain point. Or their wife says, you 

know, you have been coughing for seven years. Can you get it 

checked out finally? Or other health problems. Or their friend is 

getting care, and they say you know what, I am getting care. You 

were with me. Come in. So there are a variety of motivating factors, or they may just have had enough and that is why they are 

coming in. Some people actually haven’t heard about the programs, 

which is surprising to us, but they may not know it is out there, 

and so they are coming in now for the first time. 

Mr. PALLONE. OK, Mr. Deal. 

Mr. DEAL. Well, first of all, thank you all for being here. We do 

have to ask the hard questions, and the first question that comes 

to mind, I think, from somebody who is not from the immediate 

area affected is that if we are asking the taxpayers of this country 


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to pick up a tab that is estimated, from what we have up to this 

point, of at least a billion dollars a year additional federal expenditures for a restricted group of individuals, the first question I think 

that comes to mind is why do we have the stories such as Dr. 

Moline’s illustration of, I believe, the carpenter who said that his 

worker’s compensation claim was controverted and he was not 

being able to receive treatment based on the first line of providing 

treatment, which most people consider to be worker’s compensation? Is the city of New York continuing, Mr. Holloway, to resist 

worker’s compensation claims? And if you are and you are saying 

that the conditions on which you are being asked to compensate 

are not compensable, why should the federal taxpayer pick up 

something the city of New York is not wiling to pay for? 

Mr. HOLLOWAY. Well, the answer to that question has a couple 

of elements to it. First, when it comes down to individual worker’s 

compensation claims, yes, there are cases that are 9/11 related that 

are controverted in the worker’s compensation parlance by the city. 

But the reason for that is really—and Dr. Melius I think will jump 

in later. 

But the reason for that is that the worker’s compensation system 

itself is not equipped to deal particularly well with these types of 

claims. The issues that we are dealing with with 9/11 related illnesses at this point, they are late to arise. They are latent, and so 

important questions of causation and other issues arise in the context of these long tale claims that make it difficult to resolve one 

way or the other without an extended look at what is the medical 

evidence and so forth. 

And the reason for that is because the city does have an obligation through the worker’s compensation system. You can’t simply 

decide that it doesn’t matter. You have to meet the standards in 

the statute. You have to—the city does have an obligation to, you 

know, protect the public. And so the way that the system is set up, 

it is poorly equipped to handle this. 

Now, New York State has made some changes in the worker’s 

compensation law that address a few of these things, and one of 

those is an extended period to put in for a claim so that you don’t 

have the two-year statute of limitations problem and some other 

things. 

But in the main, the system has some structural elements to it 

that make it difficult also. The system itself will compensate certain types of claims, but there are other people who are impacted. 

Uniform services actually get their compensation through—don’t 

get their compensation through worker’s compensation. It is a lineof-duty injury, but similar issues arise, and then community members, residents, and others who are impacted aren’t eligible for 

worker’s compensation. 

One other point is that the bill itself provides that in the event 

worker’s compensation is recovered or it is deemed that it will be 

likely to be recovered, that goes first in terms of paying for the 

claims, which we fully support. So that is a long answer but—— 

Mr. DEAL. Dr. Melius. 

Dr. MELIUS. Can I just elaborate briefly? For the New York State 

worker’s compensation systems required two, at least two pieces of 

legislation to amend that to make it possible that all the World 


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Trade Center claims to be dealt with within that system and had 

a statute of limitations and just the nature of the injury coming out 

or illness coming out of their work. And that has helped somewhat. 

I recently served on a committee and then a task force for the 

state legislature to examine this whole issue. We are issuing a report, which I believe will become public tomorrow on this. Made a 

number of recommendations for actually requiring further legislative changes that we think that we will make this system work better. 

The city of New York has actually agreed with those changes 

even though it will, in some ways, you know, facilitate claims 

against the city of New York. So we are trying to work together to 

address that. It is just hard in a bureaucratic legalistic system like 

the state worker’s compensation system. 

And even when it does, you know, for example, you would have 

a situation where someone is getting compensated for their asthma 

that may not provide help for their sinus condition or some other 

condition. It has to be, you know, a separate claim and follow 

through on. So it is complicated and difficult. All the clinics that 

are involved here, the Centers of Excellence, are also working very 

hard to assist people in filing claims. That was not—help was not 

available up until about two years ago. So there are efforts underway to try to improve that. And I think the city and others are supporting that. But it is still going to be difficult. It will never be, 

I think, an adequate for this particular situation. 

Mr. DEAL. Dr. Moline. 

Dr. MOLINE. For this particular gentleman, his claim was controverted and eventually—it took about three or four years—it was 

judged in his favor. That is a typical delay. During that three or 

four-year period when he was no longer able to work and he lost 

his health insurance, he had no avenue to get health care. The program stepped in. We are now recouping the cost, and they will be 

offset as program income within the monies that we have received. 

So it allows to extend the care that we provide. 

But, you know, in his particular case, we tried to get diagnostic 

testing because he had such horrible reflux that he needed to have 

an endoscopy, a simple test where you look in and to make sure 

that he didn’t have something more serious going on. And that particular test was denied by worker’s compensation. Turned out that 

he had he test, and they found some abnormalities. That was paid 

for by the program. And it allowed us to give him the appropriate 

treatment to get him better. 

As a treating physician, this program has allowed us to provide 

the care for people to make sure that they get better. What we also 

do is we fill out the necessary paperwork to make sure that compensation, if it is there, everyone gets the appropriate medical documentation that they need to make sure these claims go forward 

as well. 

Mr. DEAL. I think your statements have really illustrated the 

point that I am making is that somebody from the outside looking 

at this saying that if this kind of injury or problem resulting from 

exposure does not meet the definition of a work-related condition 

under worker’s compensation law for the state of New York or the 

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compassing definition that the federal taxpayer is required to pick 

up? 

And that is just a problem, and I think trying to refine the statute to address that as best we can is very important because I 

think it is something that you have to convince other people that 

are you not just coordinating this big picnic basket that certain 

groups of individuals can come dip into the federal treasury 

through this mechanism. 

Let me ask one other practical thing, and that is I see the group 

that is here, and many of them have the New York Fire Department EMS shirts on. And one of the things that has been called 

to my attention is that apparently there is no provision for retirees 

or a retiree representative from that group to be on this advisory 

board that the statute creates. I would assume that you are going 

to have a large number of people who are in a retirement status 

that are going to be eligible on an ongoing basis for some of these 

benefits. 

Do any of you know why that retiree group would not have an 

advisor board member? 

Dr. MELIUS. Well, yes, let me answer that. I chair the steering 

committee that, I think, is being referred to here. The steering 

committee was set up with a specific number of labor union representatives beginning and along with representatives from all of 

the participating medical centers. Those representatives, the 

union’s representatives, do represent retirees. The union I work 

with has at least three retiree organizations that are part of this 

program that are consulted. And we provide benefits to those retirees, health and pension. I believe all of the other unions involved 

do the same. 

There are many other union, other groups that potentially could 

be represented on the steering committee. There has to be some 

way of selecting those. The original selection was based on who was 

most involved in the program. It is certainly clear that the people 

in the retiree groups as time goes by and more of these people age 

and get old will be important in terms of representation. We need 

to work out a way for them to be involved in the program. 

There are other ways. Mt. Sinai has its own advisory committee. 

The fire department does. Some of the other clinics do. Dr. 

Reibman has a program. And we also—there are provisions in the 

legislation for additional people to be added to the steering committee, and so that will be worked out over time. 

But there are many groups to choose from so it is not like there 

is one umbrella retiree group that one could select. It has to be 

looked at. Some of those people with concerns I have met with and 

have offered to go out and meet with some more to talk. And we 

want to make sure that their concerns are addressed. 

Mr. PALLONE. Thank you, Mr. Deal. Mr. Engel. 

Mr. ENGEL. Thank you, Mr. Chairman. You know I live about 

eight miles from the World Trade Center. My district begins about 

eight miles. And I remember about five days after 9/11, burnt 

pieces of paper falling from the sky into my district. With my own 

eyes, I remember seeing that. And that is eight miles away. So 

imagine the people who live right on top within a 1.5-mile radius. 


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I understand the community program would help only the people 

with the 1.5-mile radius. 

I want to talk a little bit about the World Trade Center related 

illnesses experienced by people living in the disaster area. That 

hasn’t received as much public attention as those of first responders, but in many cases, they are just as serious. And I don’t take 

away anything from the first responders. I fight 100 percent for 

them, but there are also people in the area. 

This legislation provides medical monitoring and treatment services for community residents and workers affected by the 9/11 attacks, not just the responders. So Dr. Reibman, can you tell us 

about the kinds of people that the community program treats and 

how they were exposed to the toxic dust from the World Trade Center collapse? 

Dr. REIBMAN. We have a variety of people, and we sort of group 

people by whether they were residents, whether they worked in the 

area, went to school in the area, or were there commuting, for example, people who were stuck in the tunnel at the time of the collapse. 

We also then look at people who were in the initial dust clouds 

of that day or people who came back a week later. And what we 

are finding is that there is a great variety and difference in how 

people’s health responded to these exposures but that many people 

have many of the same illnesses that you are hearing described in 

the responders of chronic grinus sinusitis, that is sinus infections, 

nasal congestion, shortness of breath due to asthma or other lung 

diseases as well as gastroesophageal reflux disorders and clearly a 

lot of mental health issues. 

Mr. ENGEL. You talked a little bit about the kinds of illnesses 

these community members are suffering from as a result of their 

exposures. Can you tell me about the similarities similar to those 

of the responders? What I am trying to get at is that I believe that 

it is just as serious to help the people living in the immediate area 

as well. And do you find that the first responders and the people 

in the area have had similar difficulties? 

Dr. REIBMAN. What you are raising is a very important question, 

which is how do we know whether these illnesses are World Trade 

Center related or not. And we don’t always know except by seeing 

many of the same symptoms over and over and over again in many 

of these people. The severity is clearly variable, and we have people 

who have very, very persistent sinus disease who have required 

surgery for their sinuses on repeated occasions. 

We have people who, for example, used to run a marathon who 

are now on chronic medications. We have people who can no 

longer—had to have their offices moved because their cough was so 

irritating that their workmates couldn’t sit next to them. So that 

there is clearly a variety of severity in these people. 

We think that is due in part to degree of exposure. People who 

were in the dust cloud, for example, on the first day or people who 

had prolonged exposure as well as individual response to these exposures. 

Mr. ENGEL. Dr. Melius, can you explain what role health insurance would play in the community program under this legislation? 


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Dr. MELIUS. Yes, under the current legislation, people that have 

coverage, there would be a billing mechanism set up for the government to be able to, through the clinics, the treating clinics, to recover the cost. So health insurance for those who have it, nonwork-related health problem, health insurance would be essentially 

the first payer. And then what was not covered by health insurance 

would be covered through the federal program. 

Mr. ENGEL. Thank you. Can I ask you also, Dr. Melius, the legislation relies on Centers of Excellence for providing most of monitoring and medical care for the program. Responders and community residents who qualify for the program can only receive services 

at the program’s expense through these Centers of Excellence. 

Now of course, the patients, the way I understand it, they continue to see their personal physicians. But if they want the monitoring and treatment services for the World Trade Center related 

conditions that the program offers them without charge, they will 

have to use the Centers of Excellence. Is that true? Am I right? 

And in your testimony, you defend the continued use of the Centers 

of Excellence. So why do you think that we should continue to rely 

on these centers rather than allow individuals to use their personal 

physicians? 

Dr. MELIUS. Yes, the reason for relying on the centers is because 

given all that we don’t know about what is going to happen to 

these people medically and given the complications of diagnosing 

and treating them, we believe that a better quality overall medical 

care can be provided to them through these Centers of Excellence 

rather than trying to rely on providing that same experience and 

medical information to their personal physicians. 

Now, both Dr. Reibman and Dr. Moline would tell you that they 

coordinate with the personal physicians. So that—who may be 

treating the same person for some unrelated health condition, you 

know, heart disease or something that is not related to the World 

Trade Center. But I think it has been the experience of all the programs that it has not worked well for people to go to their personal 

physicians because they just don’t have the experience in handling 

these types of conditions, and the quality of care is not as good. 

Now, there are also provisions in the legislation to allow for the 

expansion of the Centers of Excellence to bring in new centers and 

so forth. And I am sure, in fact, that the judiciary hearing on 

March 31, the police detective who had serious pulmonary disease 

and had developed before there was a treatment program, was 

being seen by another major medical center in New York City. And 

there is no reason that that medical center could not become part 

of this program, and there are a number that expressed interest. 

So I think we need to expand that out. It is also certainly true 

for the national program, people living in other parts of the country, that there be additional centers and additional physicians 

brought in. But it is trying to strike a balance between getting good 

care and ensuring that there is good follow up and at the same 

time, something that is convenient and practical for the patients. 

Mr. ENGEL. Dr. Moline, did you want to comment? 

Dr. MOLINE. I think Mr. Torres actually told us why a Center of 

Excellence can be essential in his care. He was going to a wonderful physician on the outside, but when he was able to come to a 


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Center of Excellence, they were able to make a connection between 

his illnesses because we have seen thousands of people like Mr. 

Torres with the same constellation of symptoms and knew how to 

treat him in the same manner that we have treated thousands of 

others. 

One other issue related to not having Centers of Excellence is if 

we want to know what the ramifications were from a disaster, a 

manmade disaster, terrorist or otherwise, if the cure is fragmented, 

if it is in—if everyone is not receiving centralized care in a number 

of centers, then we will have no way of knowing the true scope of 

illnesses. There will be no way of being able to scientifically say 

that exposures to—of this sort can cause health problems. So that 

in 20 years when something else happens, we can say that every 

doctor is going to know because it will have been in the literature 

that these are the things you do first. 

And they are in this not only to treat people now, but to be able 

to inform the doctors and the people who might have ailments 

going forward. 

Mr. ENGEL. Mr. Torres, would you want to comment on that? 

Mr. TORRES. Yes, just like the doctor said I already commented 

on my experience. I was going to my doctor almost a year, and I 

had a CAT scan done from my neck down, and they never found 

nothing wrong with my throat, but I was losing my voice. When I 

went to the monitoring program, when they were evaluating me, 

one of the doctors there said well, Mr. Torres, if you have GERD, 

acid reflux and you are having a breathing problem, a lot of people 

need to see an ENT doctor. 

So we are going to make an appointment for you, and they sent 

me to a throat doctor. And when they put the scope down, there 

was a polyp, a mass, in my throat, which wasn’t picked up by a 

CAT scan, which wasn’t picked up by my doctor, which—this might 

sound strange—was a very happy moment for me because I got an 

answer out of a year of no answers. 

And I am one of those males that don’t like going to the doctors. 

I am one of those males that my wife had to force me to go to the 

doctor, and I was so happy to finally get an answer because I was 

tired of going to the doctor and coming back home and not knowing 

what was wrong. And I knew there was something wrong. 

Mr. ENGEL. Well, thank you. It is very good to hear firsthand experiences, Mr. Torres, Mr. Holloway. Let me ask one final question. 

How does the legislation—and perhaps Dr. Melius would be the 

best to answer this, but anybody else can. How does the legislation 

ensure that the care received through a Center of Excellence is coordinated with the care received by a responder or community resident from his or her personal physician? Mr. Torres talked about 

how he wasn’t getting answers. But if someone has gone to a personal physician, how is it coordinated with the Center of Excellence? How does this legislation ensure that it is coordinated? 

Dr. MELIUS. I think there are no specific provisions in the legislation for that, but the normal way that—usual way that these physicians operated in these centers is they focus on World Trade Center 

related conditions. So they are focused on the sinus, on the lung 

disease and so forth. 


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When there are other personal health problems that people may 

have, existing conditions or something else develops that is non 

World Trade Center related, then as any specialist would, they 

would refer back to the primary care physician. They would be 

building off what medical records, what medical information they 

would be in contact with that personal physician in terms of either 

doing referral or direct referral back for further care, and I think 

that is routine in the operation of the Sinai program and the Bellevue program. 

Mr. ENGEL. Right, but what about someone who gets care from 

a private physician and now is going to the Center of Excellence, 

as Mr. Torres said, went to a private physician first and a Center 

of Excellence? What is the coordination? Does the private physician 

reach out to the center? Would the center reach out to the physician? How would we know that it is not duplicative? That is the 

kind of question I am asking. 

Dr. MOLINE. There is a variety of ways at Mt. Sinai we do this. 

First of all, every patient who is in a monitoring program, whether 

it is the fire department’s monitoring program or the consortium 

monitoring program, gets a results letter to bring with them to 

their doctor. And they get a copy of all of their test findings. 

We also ask if they would like copies sent to their doctor. If they 

give us authorization, then we send copies of all of this information 

to their doctor. All of our physicians reach out to these doctors to 

make sure that we aren’t going at cross purposes, we are not both 

prescribing the same medications or medications that might counteract each other, that we are all on the same page in providing 

the best care. 

We are working in many ways as a consultant would to a primary care physician. We are providing care for a number of conditions. In addition to going to your family doctor for your routine 

checkup, you would be referred to—if you had a back problem, you 

would be referred to an orthopedic surgeon. The orthopedic surgeon 

would communicate back to the family doctor to say yes, this is 

what I saw. That is how we work with the private doctors. 

Mr. ENGEL. Well, thank you, Dr. Moline, and thank you for all 

the good work you do. And thank everyone. I want to thank everyone on the panel for the good work you do and for the people who 

have the courage to make their public struggles—their personal 

struggles, to share them with us. 

It is very important that the country understands, as so many 

people have said, that this is a problem affecting all of us. And we 

need a federal response, and that is why we need this bill. New 

York happened to be the place where the terrorists attacked, but 

the terrorists attacked New York because of the symbol of New 

York and what it means. 

And therefore we have a tremendous responsibility. And those 

doctors who were on the front lines, you indeed are first responders 

because you are on the front lines. And those people with the courage to tell us their stories are really making such great progress. 

And finally, Mr. Chairman, I want to commend you because I am 

on this subcommittee, and there are so many related health concerns that we have in this country. And you and I have spoken 

many times about the need to have this hearing, and you have alVerDate Mar 15 2010 03:42 Apr 13, 2012 Jkt 072879 PO 00000 Frm 00087 Fmt 6633 Sfmt 6633 E:\HR\OC\A879.XXX A879

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ways been positive and helpful. And obviously this wouldn’t have 

happened today without your leadership in this very, very important matter. And you and I have discussed this, and I am confident 

with you as chairman we are going to finally move forward and 

break through and pass this legislation, which is so desperately 

needed. 

So thank you again, Mr. Chairman. I want to state on the record 

how helpful you have been. 

Mr. PALLONE. Well, thank you, and we do intend to move forward. Mr. Weiner. 

Mr. WEINER. Thank you, Mr. Pallone, and I want to echo the remarks of Mr. Engel. You and Mr. Deal have been very helpful in 

moving this forward, and it reminds us that when the first Victim 

Compensation Bill was passed, it was unanimous or nearly unanimous, the notion that people who perished in what was essentially 

an act of war deserve not only our gratitude. But they also deserve 

a quick dispensation of the needs of their surviving family members. 

And the universe of people that we talk about today, in fact 

many of them are people who are dying by degrees because of that 

day. And has been remarked in the past, if we knew then that people would be dying years later, there is no doubt in my mind that 

we would have, in a bipartisan fashion, changed the language of 

the bill to make sure that the Victim Compensation Fund took into 

account people like Mr. Torres. 

And Mr. Torres, who speaks for many people, some of whom are 

here, many of whom have gone on with their lives, some of whom 

unfortunately have perished, many of whom are sick. They responded that day because it was a combination of their job and 

their sense of their obligation to their neighbors. They went without being asked to sign forms. They didn’t go with an instruction 

book. If anything, the advice they were getting from many officials, 

as we now know, was wrong. 

We had heard of the EPA at the time saying the air was just 

fine. People were handing them equipment that you wouldn’t use 

to paint your apartment, and they were being asked to wear it 

when they were dealing with the toxic soup that has been described here as unprecedented. 

But let me just ask a question that perhaps can refocus us on 

the broader question. The people with Drs. in front of your name, 

is there any doubt in your mind that people today are dying because of the attacks on September 11 and their proximity to that 

attack? 

Dr. REIBMAN. I think that people are very, very sick because of 

September 11 and their proximity at that time. We certainly hope 

we can prevent them from dying. 

Mr. WEINER. Dr. Melius, is there any doubt in your mind that 

are people who are dying by degrees because of that attack? 

Dr. MELIUS. Absolutely not. 

Mr. WEINER. Dr. Moline, any doubt in your mind that there are 

people who are dying by degrees because of that attack? 

Dr. MOLINE. Absolutely not. 

Mr. WEINER. And, Doctor, I want to take a moment to thank you. 

I have seen your work secondhand as folks who are close to me 


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have turned to you for care and have received it. One of the questions that has come up is that whether or not in addition to us providing a service to the people who are sick, we also send a message 

to future generations of people like Mr. Torres that if they do run 

into the aftermath of these things and try to help out, that we are 

going to be there for them just as we would if they were soldiers. 

Mr. Torres, I know that you have said in a couple of places that 

you don’t regret anything about the way you acted and your colleagues, the service that you provided. But certainly there must be 

a time in the still of the night where you think boy, was it worth 

it? Are you concerned that if someone—if you are seeing someone 

else and they say to you, you know it sounds like you got really 

sick from being there on the job and now the federal government 

isn’t responding, that we might be in a circumstance in future attacks where people start to have second thoughts about whether or 

not they should go into that place when called by their neighbors? 

Do you think about that at all that, you know, that all that you 

have gone through—and you must have a lot of brothers and sisters who have situations that are like yours. They must sometimes 

say to themselves you know what? If I knew then what I know 

now, maybe I wouldn’t have raced there to be of help. 

Mr. TORRES. That conversation comes up a lot. At the workplace, 

it comes up. Just two days ago when I was telling my wife about 

this committee, she asked the same question. What will happen if 

they don’t pass this bill? Will people go back out there and help 

again? 

I have a brother who is a fireman in Jersey City. He was out 

there too working. And we talk about it. He will go out there if he 

wasn’t a fireman. I will go out there again. I will go out there. 

Hopefully, God willing, we never have to. But there is not a doubt 

in my mind even with the illness. I don’t regret what I did. I did 

it because it was the right thing to do. 

And so to answer your question, most likely yes, some people do 

have that in their mind. But I think human beings in nature when 

something tragic happens, they respond. 

Mr. WEINER. Right. 

Mr. TORRES. And we saw that at the World Trade Center because it wasn’t firemen and policemen there alone. There was a lot 

of other people working, male, woman, old, young. Jersey City had 

a chain gang filling up tugboats from young people, high school, 

grammar school, anybody helping. 

I want to believe that they will come out again. 

Mr. WEINER. I believe they will, and we should be there for them 

now. Let me just conclude with just this one question. There was 

some opposition that has been voiced about the idea that we don’t 

know for sure when someone comes in, whether they are afflicted 

by the effects of Ground Zero dust and their being in that environment or something else. You know someone comes in with a headache, it could be from anything. 

As you accumulate a larger database of information and see more 

clients and do more research, are you reaching the point where you 

can say, perhaps not with metaphysical certitude, but some certainty when you are dealing with someone who has come before 

you because of a 9/11 related thing? 


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There have been some concerns raised well, it sounds like we 

have this catchall situation if anyone can show they were anywhere 

nearby at any time, they could come in. It might have nothing to 

do with the 9/11 dust. If we can just perhaps start with Dr. Moline, 

and then we will go down the line. Do you have some sense now 

that you have a sufficient body of knowledge, and as it grows, that 

you can allay the fears of some of my colleagues that this isn’t entirely open-ended, that you can tell? We now have some foundation 

on which to draw a conclusion about who was there by the effects 

of 9/11? 

Dr. MOLINE. Well, I think if you look at the medical studies that 

have come out, and studies come out from the fire department, 

from the police department, from the consortium that Mt. Sinai coordinates from Dr. Reibman’s, everyone has the same numbers. 

You look at objection measures like pulmonary function tests. 

Twenty-eight percent have abnormal pulmonary function tests, 

whether it is police officers in a separate study, whether it is a 

group of 10,000 folks that we reported on. Whether it is folks from 

fire department or from Dr. Reibman. When you see this constellation of symptoms in thousands upon thousands of people, that I 

think there can be no doubt that these exposures were the cause 

of many of the ailments we are seeing, if not the specific ailments—— 

Mr. WEINER. Yes, I am asking the inverse of that. I am asking 

we know about the population as a whole. The question is individual citizens that come in and say OK, I want to take advantage 

of the provisions of this bill. I am made sick by 9/11. Do you have 

the ability to be able to allay the concerns of some of my colleagues 

that say you don’t really know. It could have been from something, 

they could have had something predated that could have, you 

know, that you could be seeing. 

Are you at a point now that when you see someone, you look at 

the combination of where that person was, what kind of symptoms 

they have, their profile as, you know—are you at a pretty comfortable place that you can say yes, we are pretty sure. We don’t 

know with absolute certainty, but we are pretty sure this is someone who was made sick by September 11. 

Dr. MOLINE. What you are describing is my specialty, which is 

occupational medicine, which is—— 

Mr. WEINER. You should testify before a hearing or something. 

You would be perfect. 

Dr. MOLINE. Thank you. That is what we do. We say what do you 

do, where were you, what were you exposed to, and find out what 

was your health like before you had these things. And I do that 

every time I see a patient. I was going to be taking care of patients 

this afternoon, but I will be seeing them tomorrow morning. Those 

are the questions that all of them have been posed by me to find 

out on an individual basis. Sure we will publish on the aggregate, 

but on an individual basis, how were you on September 10? What 

was your medical history before that? And now when did you begin 

to have symptoms? What were you doing? Where were you? What 

other things have intervened in between? It might be something 

else. It might not be. How are all of these things affecting your 

health now? 


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Mr. WEINER. And so you have some constant? 

Dr. MOLINE. We have constants. 

Mr. WEINER. And, Mr. Melius, you have a similar sense that you 

pretty much—you can now spot it when you see it and take a look 

at it? 

Dr. MELIUS. I don’t provide the direct care, but I think what I 

would add to what Dr. Moline said is remember that again why we 

have Centers of Excellence is to have standardized approaches for 

addressing and examining people. So they use the same questionnaires, the same types of testing. So that is standardized in everybody. And as I work with these physicians, they pick up on—they 

understand that issue, and they have developed so much experience that I am very confident in—— 

Mr. WEINER. Thank you. Mr. Chairman, I have a vote in the 

other markup, and I want to thank the panel very much. 

Mr. PALLONE. Thank you. We are about to conclude, but I do 

want to ask one or two more questions with the support here of my 

ranking member. I thought you said earlier—this is following up on 

what Mr. Weiner said. I thought you had said earlier, Dr. Melius, 

that you actually have a certification of some sort that a person 

had a World Trade Center disease or disorder? Did I misunderstood? 

Dr. MELIUS. No, right now the—what I was referring to earlier 

was in the legislation, there is now the requirement, which is not 

strictly in place now sort of administratively. But going forward 

that says Dr. Moline, Dr. Reibman would first, you know, they 

would say that when a person is eligible for the program, secondly 

that they have a World Trade Center related condition and so 

forth. They would do that. 

There would then be a certification by NIOSH or whoever is administering the federal agency that, you know, sort of reviewing 

that, making sure that it followed all the procedures, that it was 

correct. 

Mr. PALLONE. So essentially—I mean maybe certification isn’t 

the word. But essentially you would say this person has the disorder, and they are eligible for the program. 

Dr. MELIUS. Yes. 

Mr. PALLONE. And if they weren’t, if they didn’t meet those criteria, you wouldn’t treat them anymore in theory? 

Dr. MELIUS. Correct, and that is currently happening now in the 

program. 

Mr. PALLONE. You do get people that come in that you decide 

don’t have the disorder and then you turn them away essentially? 

Dr. MELIUS. Right, it is a limited number, but there are people. 

And we have actually worked out among all the participating Centers of Excellence a program to sort of make sure that in their process, as patients come in—because everyone is handled slightly differently—that they—if they are suspicious that someone is not 

really eligible or, you know, that they have a way of, you know, 

more intensively following up, you know, demanding that there be 

more documentation that they actually work there. 

And that process is working because I get calls from them, and 

we talk about at the steering committee meetings and so forth. And 

certainly, you know, with people coming in now, you know, seven 


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years later, I think we have to be more careful about it. Though 

again it is not to say that the vast majority of the people coming 

in are—— 

Mr. PALLONE. I mean most people don’t show up if they really 

don’t have a problem. 

Dr. MELIUS. Exactly, yes. 

Mr. PALLONE. All right, and my last question is this, and I kind 

of went back to the beginning. You know in terms of the need for 

a permanent program and authorization, which is what we are all 

about. And let me preface that by saying, you know, we are an authorizing committee, so we don’t particularly like the fact that you 

operate without a permanent authorization because we don’t like 

to do business that way. And certainly for us, that is not the way 

we do things. But the question really is without the permanent authorization, again sort of being the devil’s advocate, I assume that 

you have had problems operating the way you are and that there 

is some inherent benefit in having a permanent authorization. If 

any of you would like to comment on that, I think that might be 

important. 

Dr. MOLINE. You know working in a clinical setting where there 

is uncertain funding year to year, I reach a certain point where I 

begin to draft the letter that is going to go out to say we can’t provide the care that you have been receiving to all the patients. We 

can’t guarantee that they will get the services that they need without having a permanent solution. We are intensely grateful, immeasurably grateful for the monies that have been appropriated for 

us, and it is year-to-year funding. 

I mean we have a staff that is—we are seeing thousands of patients a year at Mt. Sinai. We have an infrastructure that is developed. It is very hard when you don’t know if you are able to sustain 

that every year, and you are worried is this going to be possible. 

Am I going to have to start from scratch again where I have this 

expertise that I have build up? 

And that has been one of the challenges in trying to make sure 

that we have the resources so that we know that if we do have to 

expand, if there are more people coming in or there are new illnesses, that we will be able to handle that. 

We are more worried about whether we are even going to have 

funding for the next year available. 

Mr. PALLONE. Anyone else want to comment because I think that 

is kind of important here. 

Dr. REIBMAN. I would like to agree just to say that it is very important to be able to recruit people, to train people, to get people 

with experience so that they can answer just the questions you are 

asking. How do you know this is World Trade Center? Is this what 

we have seen before? How are we going to approach it? And to 

have—to not know whether you are going to be able to retain people, to have to retrain people all the time makes the program very 

difficult. 

Mr. PALLONE. Mr. Holloway. 

Mr. HOLLOWAY. And just on—we are talking in part about programs that have appropriations, you have to come back and do it 

from year to year. There are also, from the city’s perspective, a 

number of programs that are primarily funded by the city. And alVerDate Mar 15 2010 03:42 Apr 13, 2012 Jkt 072879 PO 00000 Frm 00092 Fmt 6633 Sfmt 6633 E:\HR\OC\A879.XXX A879

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though we have gotten some of the—recently from NIOSH some 

money appropriated there, the HHC program right now is actually 

running at a deficit. 

One of the other programs that we didn’t talk about in detail is 

a mental health program, which actually does reimbursement for 

mental health services that is funded in the bill, also operating at 

a deficit. 

So for some of these programs, you know, the city, as I said 

didn’t wait for Congress to act for us to meet the needs that we 

found when we dug into this. But, you know, the program will be 

subject to the vagaries of the very, very difficult budget choices 

that the city has to make about all of the programs that it provides. And so, you know, this isn’t just a matter of coming back and 

everybody testifying every year about an appropriation. 

You know we would really like to see this go past the point 

where it is a question whether these programs are going to run. 

And we do feel that it is important that, with the city contributing, 

it is a national responsibility. 

Mr. PALLONE. OK, thank you. 

Dr. MELIUS. Can I just add I think it is also very important for 

the participants in the program, and one good recent example is 

one of the individuals, a firefighter, just recently underwent a lung 

transplant. And he and his family were asked well, do you want— 

who should cover this because it is covered out of this program, 

and it was World Trade Center related. Then what is going to happen in the future? Because that individual is going to be on, you 

know, significant medications for the rest of his life, which we hope 

is a long one. And who is going to be able to pay for that going 

forward? 

So knowing that this program had long-term funding would have 

made that decision much more easy for that individual and I think 

for everybody involved here. They often wonder what is going to 

happen with their health insurance. Who is going to take care of 

them in the future? It also has implications for the Victims Compensation Fund portion of this. 

Mr. PALLONE. Sure. Mr. Deal. 

Mr. DEAL. Well, my information is that CDC had, I think, $180 

million carried over that was appropriated for fiscal year 2009, and 

they have obligated just over $16 million through the end of March 

of ’09. And my understanding is that based on those currently appropriated funds that there appears to be adequate funding 

through 2010. So that carryover money, I think, does make a difference. 

Mr. PALLONE. I mean we obviously, you know, you still have to 

go through the appropriations process every year. But there is a 

big difference in terms of having something that is permanently 

authorized that you can count on as, you know, as being authorized 

versus having to, you know, come back every year for the money. 

We can’t avoid that. That is just the annual process. Did you want 

to add anything? Otherwise we are going to conclude. 

Mr. HOLLOWAY. Just one thing to Congressman’s point. There is 

money that carries over. It actually took NIOSH and CDC for 

whatever reason many, many months to actually get an RFP out 

on the street and create a vehicle to access that funding that had 


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been appropriated. And in fact, after this hearing today, I will be 

going to NIOSH to talk about how we can do a better job ensuring 

that the money that has already been appropriated to deal with 

this is best used. 

So any help you can provide would be appreciated. 

Mr. PALLONE. Sure. All right, well thank you very much. You 

may get additional questions within the next 10 days that members 

can submit for the record. And you would respond to us, and the 

clerk would notify you about that. But I just wanted to thank you. 

I thought this was a very good analysis. And as I said, we do intend to move forward with the legislation. So without objection, 

this meeting of the subcommittee is adjourned. Thank you. 

[Whereupon, at 12:20 p.m., the subcommittee was adjourned.] 

[Material submitted for inclusion in the record follows:] 


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