September 11: HHS Has Screened Additional Federal Responders for World Trade Center Health Effects, but Plans for Awarding Funds for Treatment Are Incomplete
Published: 2006-09-08T00:00:00

Fast Facts:

Highlights:
section_title: Why GAO Did This Study
paragraphs: Responders to the World Trade Center (WTC) attack--individuals involved in rescue, recovery, or cleanup--included New York City Fire Department (FDNY) personnel, federal government workers, and others from New York and elsewhere. They were exposed to numerous hazards, and concerns remain about the long-term effects on their physical and mental health. In February 2006, GAO testified that four of the five key federally funded programs that were monitoring health effects in responders had made progress but that the Department of Health and Human Services' (HHS) WTC Federal Responder Screening Program, implemented by the Office of Public Health Emergency Preparedness (OPHEP), lagged behind (GAO-06-481T). GAO also reported that the Congress appropriated $75 million in December 2005 to HHS's Centers for Disease Control and Prevention (CDC) for monitoring and treatment for responders and that CDC was deciding how to allocate the funds. This statement updates GAO's February 2006 testimony. GAO examined (1) progress made by HHS's WTC federal responder program and (2) actions CDC has taken to award the $75 million appropriated. GAO reviewed program documents and interviewed HHS officials and others involved in WTC monitoring and treatment programs.
section_title: What GAO Found
paragraphs: The WTC federal responder program has registered and screened additional federal responders since February 2006, and arrangements are being developed to screen responders who are former federal workers residing outside the New York area. An additional 1,385 federal responders have registered for screening, including 1,134 current federal workers and 251 former federal workers, bringing the total number registered as of late August 2006 to 1,762, including 283 former federal workers. Because the total number of federal responders is uncertain, the proportion of the total who have registered is unknown. As of late August 2006, Federal Occupational Health Services (FOH) had completed screening of 907 federal workers, 380 of whom were screened since February 2006. Under an OPHEP agreement with CDC's National Institute for Occupational Safety and Health (NIOSH), former federal workers are being screened through the worker and volunteer WTC program, one of the five key federally funded programs. As of July 31, 2006, the worker and volunteer WTC program provided screenings to 13 former federal workers and scheduled 11 more, and 139 former workers had been screened by FOH as part of the 907 workers. Most of the former federal workers reside outside the New York area, where the worker and volunteer WTC program is located, and NIOSH is working to establish a national network of providers to screen these workers. CDC has awarded a small portion of the $75 million appropriated for screening, monitoring, and treatment and plans to make decisions about treatment coverage before awarding most of the funds. The agency plans to award the $75 million to the five organizations that the law identified as having priority for funding. CDC officials expect to make awards to the WTC Health Registry, the Police Organization Providing Peer Assistance (the POPPA program), and the New York City Police Foundation's Project COPE over a 3-year period and to award funds to the FDNY WTC and worker and volunteer WTC programs in response to the treatment costs they incur. CDC officials have a proposed spending plan that allocates about $53.5 million for the latter two programs' treatment costs, but the officials told GAO that because they are uncertain about how quickly treatment costs could deplete the available funds, they may need to make adjustments. Officials from the FDNY WTC and worker and volunteer WTC programs told GAO that they anticipated that their estimated portion of the funds would be depleted well before the end of 3 years. As of August 2006, CDC awarded about $4.5 million of the $75 million: about $1.9 million to the WTC Health Registry, $1.5 million to the FDNY WTC program, and almost $1.1 million to the worker and volunteer WTC program. In addition, CDC expects to award $1.5 million to the POPPA program and $3 million to Project COPE in September 2006. CDC is waiting to make further awards until it has reached certain decisions about the coverage of treatment services, such as which prescription drugs would be covered. CDC expects to begin making further awards around February 2007.

section_title: Letter
paragraphs: Thank you for inviting me to participate in today’s hearing on programs  that monitor and provide treatment for health effects of the World Trade  Center (WTC) terrorist attack on September 11, 2001. My testimony today  updates information we reported to you in February 2006. An estimated  40,000 people served as responders in the aftermath of the WTC disaster,  including New York City Fire Department (FDNY) personnel, federal  government personnel, and other government and private-sector workers  and volunteers from New York and elsewhere. By responders we are  referring to anyone involved in rescue, recovery, or cleanup activities at or  near the vicinity of the WTC or Staten Island site. These responders were  exposed to numerous physical hazards, environmental toxins, and  psychological trauma. Five years after the destruction of the WTC  buildings, concerns remain about the long-term physical and mental health  effects of the attack on responders as well as other affected individuals,  including residents and workers.
As we testified in September 2004, in the aftermath of the WTC attack,  five key federally funded programs were implemented to assess the short- term, and in some cases long-term, effects on the physical and mental  health of WTC responders. These programs are the FDNY WTC Medical  Monitoring Program; WTC Medical Monitoring Program, which we refer to  as the worker and volunteer WTC program; New York State responder  screening program; WTC Health Registry; and the Department of Health  and Human Services’ (HHS) WTC Federal Responder Screening Program.
We provided information on the progress of these monitoring programs in  our February 2006 testimony. We noted that federal employees who  responded in an official capacity in the aftermath of the WTC attack were  eligible only for the federal responder program but that it had  accomplished little and lagged behind the other four programs. The other  programs had provided thousands of health screenings and collected  information that could contribute to better understanding of the health  consequences of the attack and improve treatment for affected individuals.  Officials of the three programs that planned to conduct long-term health  monitoring—the FDNY WTC program, the worker and volunteer WTC  program, and the WTC Health Registry—told us they were concerned,  however, that federal funding for their programs could end before  sufficient monitoring occurred to identify all long-term health problems  related to the WTC attack, some of which, such as cancer, might not  appear until decades after exposure to a harmful agent. We also reported  that HHS’s Centers for Disease Control and Prevention (CDC) had recently  received a $75 million appropriation to fund programs providing health  screening, long-term monitoring, and treatment for WTC responders and  was deciding how to allocate those funds.
My testimony today revisits these issues. I will discuss (1) progress made  by HHS’s WTC Federal Responder Screening Program, and (2) actions  CDC has taken to award the $75 million that the Congress appropriated to  the agency in December 2005 for programs that provide screening,  monitoring, or treatment for WTC responders.
To assess progress made by HHS’s WTC Federal Responder Screening  Program, we obtained and reviewed program data and documents from  HHS, including applicable interagency agreements and budget documents.  We interviewed officials from the Agency for Toxic Substances and  Disease Registry (ATSDR); CDC’s National Institute for Occupational  Safety and Health (NIOSH); Federal Occupational Health Services (FOH);  and the Office of Public Health Emergency Preparedness (OPHEP). To  determine actions taken by CDC to award funds from the $75 million  appropriated, we obtained documents and interviewed officials from  NIOSH and ATSDR. We also interviewed officials from organizations  implementing programs designated in the appropriations act as having  first priority for receiving the funds—including the Mount Sinai-Irving J.  Selikoff Center for Occupational and Environmental Medicine, one of the  clinical centers of the worker and volunteer WTC program; FDNY’s  Bureau of Health Services (FDNY-BHS); the New York City Department of  Health and Mental Hygiene; the Police Organization Providing Peer  Assistance (the POPPA program); and the New York City Police  Foundation’s Project COPE—and officials from the American Red Cross,  which has funded treatment services for responders. We relied on data  provided by agency officials and contained in government publications  and did not independently verify the data we obtained. Although we could  not independently verify the reliability of all of this information, we  compared it with other supporting documents, when available, to  determine data consistency and reasonableness. Based on these efforts,  we believe the information we obtained is sufficiently reliable for this  report. We conducted our work from July 2006 to September 2006 in  accordance with generally accepted government auditing standards.
In summary, since February 2006, HHS has registered and screened  additional federal responders, and arrangements are being developed for  screening responders who are former federal workers residing outside the  New York metropolitan area. An additional 1,385 federal responders have  registered for screening examinations, including 1,134 current federal  workers and 251 former federal workers, bringing the total number  registered on the WTC Federal Responder Screening Program Web site as  of late August 2006 to 1,762, including 283 former federal workers.  Because the total number of federal responders involved in the WTC  disaster is uncertain, it is not possible to determine what proportion of the  total number of federal responders have registered. As of late August 2006,  FOH had completed screening examinations for a total of 907 federal  workers; 380 of the 907 were screened since February 2006. Under an  OPHEP agreement with NIOSH, screening examinations for former federal  workers are to be provided through the worker and volunteer WTC  program. As of July 31, 2006, the worker and volunteer WTC program  provided screening examinations to 13 former federal workers and  scheduled 11 more. Most of the former federal workers reside outside the  New York metropolitan area, where the worker and volunteer WTC  program is located, and NIOSH is working to establish a national network  of providers to screen these workers.
CDC plans to award the $75 million appropriated for screening,  monitoring, and treatment to the five organizations that the law identified  as having priority for funding. CDC officials expect to make awards to the  WTC Health Registry, Project COPE, and the POPPA program over a   3-year period and to award funds to the FDNY WTC and worker and  volunteer WTC programs in response to their treatment costs. CDC  officials have a proposed spending plan that allocates about $53.5 million  for the latter two programs’ treatment costs, but the officials told us that  because they are uncertain about how quickly treatment costs could  deplete the available funds, they may need to make adjustments. Officials  from the FDNY WTC and worker and volunteer WTC programs told us that  they expected that their estimated portion of the appropriated funds  would be depleted well before the end of 3 years. As of August 2006, CDC  awarded about $4.5 million of the $75 million. The agency awarded about  $1.9 million to the WTC Health Registry, $1.5 million to the FDNY WTC  program, and almost $1.1 million to the worker and volunteer WTC  program. In addition, CDC expects to award $1.5 million to the POPPA  program and $3 million to Project COPE in September 2006. CDC is  waiting to make further awards until it has reached certain decisions  about the coverage of treatment services, such as which prescription  drugs would be covered in the FDNY WTC and worker and volunteer WTC  programs. CDC expects to begin making further awards around February  2007.
subsections: section_title: Background
paragraphs: When the WTC buildings collapsed on September 11, 2001, an estimated  250,000 to 400,000 people in the vicinity were immediately exposed to a  noxious mixture of dust, debris, smoke, and potentially toxic  contaminants in the air and on the ground, such as pulverized concrete,  fibrous glass, particulate matter, and asbestos. Those affected included  people residing, working, or attending school in the vicinity of the WTC  and thousands of emergency responders. Subsequently, an estimated  40,000 responders who were involved in some capacity in the days, weeks,  and months that followed, including personnel from many government  agencies and private organizations as well as other workers and  volunteers, were also exposed.
subsections: section_title: Health Effects
paragraphs: A wide variety of physical and mental health effects have been observed  and reported among people who were involved in rescue, recovery, and  cleanup operations and among those who lived and worked in the vicinity  of the WTC. Many health effects have persisted or worsened over time.
Physical health effects included injuries and respiratory conditions, such  as sinusitis, asthma, and a new syndrome called WTC cough, which  consists of persistent coughing accompanied by severe respiratory  symptoms. Almost all firefighters who responded to the attack  experienced respiratory effects, including WTC cough. A recent study  suggested that exposed firefighters on average experienced a decline in  lung function equivalent to that which would be produced by 12 years of  aging.
Commonly reported mental health effects among responders and other  affected individuals included symptoms associated with posttraumatic  stress disorder—an often debilitating disorder that can develop after a  person experiences or witnesses a traumatic event, and which may not  develop for months or years after the event. Behavioral effects such as  alcohol and tobacco use and difficulty coping with daily responsibilities  have also been reported.
section_title: Monitoring Programs
paragraphs: The five programs that were created for monitoring the health of WTC  responders vary in aspects such as the implementing agency (i.e., federal,  state, or local governments or private organizations) and eligibility  requirements. (See table 1.) Each program received federal funding, the  majority of which was provided by the Department of Homeland Security’s  Federal Emergency Management Agency (FEMA), as part of the  approximately $8.8 billion in federal assistance that the Congress  appropriated to FEMA for response and recovery activities after the WTC  disaster. FEMA is authorized to use a portion of its WTC-related funding  for screening and long-term monitoring of responders. With regard to  treatment, however, FEMA may generally fund only short-term care after a  disaster, such as emergency medical services, and not ongoing clinical  treatment. FEMA entered into interagency agreements with HHS to fund  most of the health monitoring programs. OPHEP, which coordinates and  directs HHS’s emergency preparedness and response program, entered  into separate interagency agreements with FOH to implement the federal  responder screening program for current federal workers and with NIOSH  to implement the screening program for former federal workers.
We reported in February 2006 that four of the five monitoring programs  had made progress in screening and monitoring affected individuals and  gathering data. (See table 1.) These four programs—the FDNY WTC  Medical Monitoring Program, the worker and volunteer WTC program, the  New York State responder screening program, and the WTC Health  Registry—had collected information that monitoring officials said could  be used by researchers to help better understand the health consequences  of the attack and improve treatment, such as by identifying which types of  treatment are effective for specific conditions. In contrast to the progress  made by the other programs, the HHS WTC Federal Responder Screening  Program had lagged behind and accomplished little. The program was  established to provide free voluntary medical screening examinations for  federal workers whom their agencies sent to respond to the WTC disaster  from September 11, 2001, through September 10, 2002, and who were not  eligible for any other WTC health monitoring program. Through March  2004, the program—which started about a year later than the other WTC  monitoring programs—completed screenings of 394 federal workers.  HHS put the program on hold in January 2004, when it stopped scheduling  new examinations, because it wanted to resolve several operational issues,  including HHS’s determination that FOH did not have the authority to  provide examinations to people who are no longer in federal service.  Under an agreement between OPHEP and FOH that was established in  July 2005, the program resumed providing examinations for current  federal workers in December 2005, and in February 2006, OPHEP  executed an agreement with NIOSH calling for NIOSH to arrange for the  worker and volunteer WTC program to provide examinations to former  federal workers.
Many participants in the monitoring programs required additional testing  or needed treatment for health problems that were identified during  screening examinations. The FDNY WTC Medical Monitoring Program  referred participants to the FDNY Bureau of Health Services, but the other  programs primarily referred participants to their primary care physician or  to privately funded programs available to responders, such as treatment  services provided by the Mount Sinai clinical center that are funded by the  American Red Cross. We previously reported that officials told us that  finding treatment services for such participants was an important, but  challenging, part of the programs’ responsibility. For example, officials  from the worker and volunteer WTC program stated that identifying  providers available to treat participants became a major part of their  operations, and was especially difficult when participants lacked health  insurance.
section_title: New Federal Funding for Monitoring and Treatment
paragraphs: In December 2005, the Congress appropriated $75 million to CDC to fund  programs providing baseline screening, long-term monitoring, and health  care treatment for emergency services and recovery personnel who  responded to the WTC disaster. The law required CDC to give first priority  to programs coordinated by the FDNY-BHS, Mount Sinai-Irving J. Selikoff  Center for Occupational and Environmental Medicine, and New York City  Department of Health and Mental Hygiene, which have existing monitoring  programs, and to programs coordinated by the POPPA program and  Project COPE. The mission of the POPPA program, which offers peer-to- peer mental health counseling to New York City Police Department  (NYPD) officers, is to reduce unresolved emotional trauma that can result  in problems ranging from poor performance to suicide. The POPPA  program counseled over 5,000 NYPD officers in the 10 months following  the WTC attack. Project COPE, a collaboration of the New York City  Police Foundation and Columbia University Medical Center, uses a hotline  and outreach efforts to encourage NYPD uniformed and civilian  employees to obtain mental health services, which are provided by  Columbia University Medical Center and private providers. As of August  2006, over 18,000 employees had attended educational sessions held at  police facilities, and over 5,000 had received individual counseling or  therapy consultations.
section_title: HHS Has Registered and Screened Additional Federal Responders, and Arrangements for Screening Former Federal Workers outside the New York Metropolitan Area Are under Development
paragraphs: Since February 2006, an additional 1,385 federal responders have  registered for screening examinations, bringing the total number  registered on the WTC Federal Responder Screening Program Web site to  1,762 as of late August 2006, including 283 former federal workers.  Because the total number of federal responders involved in the WTC  disaster is uncertain, it is not possible to determine what proportion of the  total number of federal responders have registered. HHS’s efforts to  conduct outreach to federal agencies resulted in the identification of 2,200  federal responders. As of late August 2006, FOH had completed screening  examinations for a total of 907 federal workers, 380 of whom were  screened since February 2006. Through OPHEP’s agreement with NIOSH,  the worker and volunteer WTC program has provided screening  examinations to 13 former federal workers and scheduled 11 more. Most  of the former federal workers reside outside the New York metropolitan  area, where the worker and volunteer WTC program is located, and NIOSH  is working to establish a national network of providers to screen these  workers.
subsections: section_title: HHS’s Outreach Resulted in Registration of Additional Federal Workers Involved in WTC Disaster Response
paragraphs: HHS reported that as of late August 2006, a total of 1,762 federal  responders had registered for screening examinations on the WTC Federal  Responder Screening Program Web site, including 1,479 current federal  workers and 283 former federal workers. Of the 1,762 federal responders  who registered, 1,385 had registered since February 2006, including 1,134  current federal workers and 251 former federal workers. It is not possible  to determine what proportion of the total number of federal responders  involved in the WTC disaster have registered because the total number  involved is uncertain. In determining the total number of individuals  eligible for its program, the WTC Health Registry developed an estimate of  8,621 federal responders, based on information from 31 federal agencies in  the New York area and information from FEMA on 22 Urban Search and  Rescue teams that were deployed to the WTC area. This estimate does  not account for all federal responders from other geographic areas.
As we reported previously, in the aftermath of the WTC disaster, HHS did  not have a comprehensive list of all federal agencies and federal  responders who were involved. In an effort to develop such a list, OPHEP  and ATSDR entered into an agreement in April 2005 for ATSDR—which  had developed the WTC Health Registry—to identify and register federal  responders. Under the agreement, ATSDR, through a contractor,  contacted federal agencies, developed a list of WTC federal responders,  and conducted outreach to encourage the responders to register on the  new Web site that the contractor established. As a result of this effort, 46  federal agencies were identified and provided contact information for  2,200 federal responders.
The agreement between OPHEP and ATSDR expired on April 30, 2006,  ending the outreach efforts to federal agencies. Under an agreement with  OPHEP, NIOSH assumed responsibility for maintaining the WTC Federal  Responder Screening Program Web site through   December 31, 2006.
section_title: HHS Has Screened Additional Current Federal Workers
paragraphs: As of late August 2006, FOH had completed screening examinations for a  total of 907 of the federal workers who had registered; 380 of the 907  were screened since February 2006. Under its agreement with OPHEP,  FOH is responsible for regularly retrieving from the registration Web site  requests for screening examinations for current federal workers and for  assigning individuals to a provider for screening. FOH officials told us  that they contact the individual and the provider to inform them of the  need to arrange an appointment for screening. The program relies on  individuals to call the designated provider and schedule their appointment.  FOH officials told us that individuals who have registered do not always  contact the provider to schedule an appointment or may not keep an  appointment or call to reschedule it. FOH officials said that they have  attempted to contact such individuals but often received no response.
We reported in our February 2006 testimony that under the July 2005  agreement FOH clinicians can refer current federal workers for follow-up  care if the screening examination—which includes a medical  questionnaire, clinical tests such as a chest X-ray, and a full physical  examination—reveals significant physical or mental health symptoms. On  July 31, 2006, FOH told us that it had referred 39 current federal workers  with mental health symptoms to an FOH employee assistance program  (EAP) for counseling; 24 to ear, nose, and throat specialists; 19 to  pulmonary medicine specialists; and 1 to a cardiology specialist.
section_title: Screening of Former Federal Workers Has Resumed, but Group Is Widely Dispersed and Nationwide Network of Providers Is Still Being Established
paragraphs: As of late August 2006, 283 former federal workers had registered to  receive screening examinations, which under OPHEP’s agreement with  NIOSH are to be provided by the worker and volunteer WTC program.  Under the agreement, former federal workers receive a one-time  examination comparable to the examination that FOH is providing to  current federal workers. As of July 31, 2006, 13 screening examinations  had been completed and 11 were scheduled. These completed and  scheduled examinations are in addition to the 139 former federal workers  that FOH screened after the WTC Federal Responder Screening Program  resumed because FOH thought they were current federal workers.
A key challenge in providing screening examinations to former federal  workers has been that a large number do not reside in the New York  metropolitan area, where the worker and volunteer WTC program is  based. The 283 former federal workers who have registered for screening  examinations reside in 40 states, and about 240 of them reside outside the  New York metropolitan area. NIOSH officials said that making  arrangements to screen these widely dispersed responders has presented  challenges, such as ensuring that the arrangements comply with federal  privacy protections. NIOSH is negotiating with the Association of  Occupational and Environmental Clinics (AOEC) in an effort to establish  a national network of providers to screen these federal workers.
section_title: CDC Has Awarded a Small Portion of the $75 Million Appropriation and Plans to Make Decisions about Treatment Coverage before Awarding Most of the Funds
paragraphs: CDC plans to award the $75 million appropriated for screening,  monitoring, and treatment to the five organizations that the law identified  as having priority for funding. CDC officials expect to make awards to the  WTC Health Registry, Project COPE, and the POPPA program over a   3-year period and to award funds to the FDNY WTC and worker and  volunteer WTC programs in response to their treatment costs. CDC  officials have a proposed spending plan but told us that because they are  uncertain about how quickly treatment costs could deplete the available  funds, they may need to make adjustments. Officials from the FDNY WTC  and worker and volunteer WTC programs told us that they expected that  their estimated portion of the appropriated funds would be depleted well  before the end of 3 years. As of August 2006, CDC awarded about   $4.5 million of the $75 million—about $1.9 million to the WTC Health  Registry, $1.5 million to the FDNY WTC program, and almost $1.1 million  to the worker and volunteer WTC program. In addition, CDC expects to  award $1.5 million to the POPPA program and $3 million to Project COPE  in September 2006. CDC is waiting to make further awards until agency  officials have reached certain decisions about the coverage of treatment  services, such as which prescription drugs would be covered in the FDNY  WTC and worker and volunteer WTC programs. CDC expects to begin  making further awards around February 2007.
subsections: section_title: CDC Plans to Award the $75 Million to the Five First-Priority Organizations
paragraphs: CDC has decided to award the $75 million for screening, monitoring, and  treatment that was appropriated to the agency in December 2005 to the  five organizations identified as having first priority for funding. The  organizations to which CDC plans to provide funds are  the FDNY WTC program, for monitoring and treatment;  the worker and volunteer WTC program, for monitoring and treatment;  the WTC Health Registry, for monitoring;    Project COPE, for treatment; and  the POPPA program, for treatment.
CDC plans to make awards through cooperative agreements with the  programs. In general, it plans to send letters to the organizations inviting  them to submit applications for funding; the applications would then  undergo a two-stage peer review process. At the first stage a panel of  outside experts would assess the merit of the application, and at the  second stage CDC officials would determine the amount of funding the  applicant would receive.
CDC has made preliminary decisions about how to allocate the $75 million  among the five organizations. As of September 1, 2006, CDC’s proposed  spending plan indicated that awards would be made in the following way:    $53.5 million for treatment and $8 million for monitoring, to be divided  between the FDNY WTC and worker and volunteer WTC programs;    $9 million for the WTC Health Registry;    $3 million for Project COPE; and    $1.5 million for the POPPA program.
CDC officials expect to make awards to the WTC Health Registry, Project  COPE, and the POPPA program over a 3-year period, but are not sure over  what period they will make awards to the FDNY WTC and worker and  volunteer WTC programs. A CDC official told us that the agency would  award funds to the latter two programs in response to the treatment costs  they incur. He said that agency officials are uncertain about how quickly  treatment costs could deplete the available funds, because CDC does not  know how many additional people will seek monitoring and what the  extent of their treatment needs will be. For example, previous media  reports about illnesses diagnosed in responders have resulted in increases  in responders seeking examinations. Officials from the FDNY WTC and  worker and volunteer WTC programs told us that they expected that their  estimated portion of the appropriated funds would be depleted well before  the end of 3 years. CDC has developed a proposed spending plan that  indicates that about 36 percent of the funds would be awarded by the end  of fiscal year 2007 and about 63 percent would be awarded during fiscal  year 2008, although a CDC official told us that, depending on the extent of  treatment needs, the funds could be used more quickly. The current plan is  based in part on an agreement CDC made with the American Red Cross in  April 2006. According to a CDC official, under this agreement, American  Red Cross funds would be used for the treatment services that are eligible  for American Red Cross support—such as basic clinical examinations and  certain tests—for as long as such funds are available and the CDC funds  would be used to cover other program expenses—such as infrastructure  costs, more sophisticated diagnostic tests, and the conversion of medical  records into an electronic format.
section_title: CDC Has Awarded about $4.5 Million of the $75 Million Appropriated
paragraphs: As of August 2006, CDC had awarded a total of about $4.5 million of the  $75 million to the WTC Health Registry, FDNY WTC program, and worker  and volunteer WTC program. According to CDC officials, the WTC Health  Registry applied for about $1.9 million in April 2006 for continuation of its  collection of health data, and CDC awarded the registry $1.9 million in  May 2006 and about $56,000 in July 2006. On August 10 and 11, 2006,  respectively, the worker and volunteer WTC and FDNY WTC programs  submitted applications to CDC for funds related to treatment services. In  response to these applications, CDC made what an agency official termed  emergency awards to the FDNY WTC and worker and volunteer WTC  programs on August 11, 2006. CDC provided $1.5 million to the FDNY  WTC program for leasing treatment space that previously had been  provided by New York City at no cost. CDC provided almost $1.1 million to  the worker and volunteer WTC program to hire an additional physician to  help reduce the 3- to 4-month waiting time for treatment appointments  that recently developed at the Mount Sinai clinical center, as well as to  hire three administrators and a medical assistant. Officials from the  clinical center told us that this waiting time had developed because  additional people were seeking monitoring due to media reports about  illnesses diagnosed in responders and because the proportion of  responders who needed to be referred for treatment had increased.
In addition to having awarded about $4.5 million, CDC plans to award an  additional $4.5 million in September 2006. In spring 2006, CDC invited  Project COPE and the POPPA program, two programs that provide mental  health services to members of the NYPD, to apply for funding through a  peer review process. In their applications, the POPPA program requested  $1.5 million over 3 years, and Project COPE requested funding of   $3 million over 3 years. CDC received their applications in June and July,  respectively, and plans to implement the application review process in  time to be in a position to make awards in September 2006.
section_title: CDC Is Waiting to Award Additional Funds for Treatment Until It Makes Decisions about Coverage
paragraphs: CDC does not plan to award additional funds from the $75 million to the  FDNY WTC and worker and volunteer WTC programs until it makes  certain decisions about the coverage of treatment services. These  decisions include determining which medical conditions will be covered;  developing a prescription drug formulary, that is, the list of drugs that will  be covered; and determining the extent to which inpatient care will be  covered. CDC officials said that they expected to make the coverage  decisions in late 2006 and that they would obtain input from the American  Red Cross and the programs.
A CDC official told us that making decisions about which prescription  drugs to cover could be the greatest challenge CDC and the programs face,  because of the potentially high cost of drugs needed to treat responders.  An FDNY WTC program official said that prescription drug costs are a  looming financial problem for the FDNY WTC program. The CDC official  told us that the most common diagnoses of WTC responders— gastroesophageal reflux disease, obstructive pulmonary disease, and  mental health conditions—frequently are treated with prolonged and  expensive drug therapy. For example, medications for respiratory therapy  can cost $1,000 a month and may continue for a year. The FDNY WTC  program official estimated that 100 percent coverage of prescriptions for  firefighters and emergency medical technicians could cost $10 million to  $18 million per year and potentially consume all of the funding that CDC  would provide to the program. Clinicians at the worker and volunteer  WTC clinical center at Mount Sinai stated that spending on prescription  drugs at their center was increasing by $5,000 to $10,000 each month and  amounted to $60,000 in July 2006.
Another coverage decision that CDC faces is to determine the extent to  which inpatient care will be covered. Currently, the FDNY WTC and  worker and volunteer WTC programs provide only outpatient care, but  officials involved with these programs believe that the treatment funds  from the $75 million should cover some inpatient care, such as when a  responder’s WTC-linked asthma becomes exacerbated to an extent that  requires hospitalization.
CDC officials told us that they plan to reach decisions about treatment  coverage in fall 2006. They also plan to invite the FDNY WTC and worker  and volunteer WTC programs to submit applications for treatment funding  in the fall. If the applications are submitted by December 2006, CDC  officials expect to be able to review them in time to provide funding to the  programs by February 2007.
CDC is also in the process of resolving issues related to providing access  to screening, monitoring, and treatment services for WTC responders,  including former federal workers, who reside outside the New York  metropolitan area. CDC is negotiating with AOEC about possibly using  AOEC clinics around the country to provide these services. CDC officials  told us they intend that monitoring and treatment services available to  responders around the country would be comparable to services provided  by the worker and volunteer WTC program.
Mr. Chairman, this completes my prepared remarks. I would be happy to  respond to any questions you or other members of the subcommittee may  have at this time.
section_title: Contact and Acknowledgments
paragraphs: For further information about this testimony, please contact Cynthia A.  Bascetta at (202) 512-7101 or bascettac@gao.gov. Contact points for our  Offices of Congressional Relations and Public Affairs may be found on the  last page of this statement. Helene F. Toiv, Assistant Director; Fred  Caison; Anne Dievler; Keyla Lee; and Roseanne Price made key  contributions to this statement.
section_title: Appendix I: Abbreviations
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