[House Hearing, 110 Congress]
[From the U.S. Government Publishing Office]
ANSWERING THE CALL: MEDICAL MONITORING AND TREATMENT OF 9/11 HEALTH
EFFECTS
=======================================================================
HEARING
BEFORE THE
SUBCOMMITTEE ON HEALTH
OF THE
COMMITTEE ON ENERGY AND COMMERCE
HOUSE OF REPRESENTATIVES
ONE HUNDRED TENTH CONGRESS
FIRST SESSION
__________
SEPTEMBER 18, 2007
__________
Serial No. 110-64
Printed for the use of the Committee on Energy and Commerce
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COMMITTEE ON ENERGY AND COMMERCE
JOHN D. DINGELL, Michigan, Chairman
HENRY A. WAXMAN, California JOE BARTON, Texas
EDWARD J. MARKEY, Massachusetts Ranking Member
RICK BOUCHER, Virginia RALPH M. HALL, Texas
EDOLPHUS TOWNS, New York J. DENNIS HASTERT, Illinois
FRANK PALLONE, Jr., New Jersey FRED UPTON, Michigan
BART GORDON, Tennessee CLIFF STEARNS, Florida
BOBBY L. RUSH, Illinois NATHAN DEAL, Georgia
ANNA G. ESHOO, California ED WHITFIELD, Kentucky
BART STUPAK, Michigan BARBARA CUBIN, Wyoming
ELIOT L. ENGEL, New York JOHN SHIMKUS, Illinois
ALBERT R. WYNN, Maryland HEATHER WILSON, New Mexico
GENE GREEN, Texas JOHN B. SHADEGG, Arizona
DIANA DeGETTE, Colorado CHARLES W. ``CHIP'' PICKERING,
Vice Chairman Mississippi
LOIS CAPPS, California VITO FOSSELLA, New York
MIKE DOYLE, Pennsylvania STEVE BUYER, Indiana
JANE HARMAN, California GEORGE RADANOVICH, California
TOM ALLEN, Maine JOSEPH R. PITTS, Pennsylvania
JAN SCHAKOWSKY, Illinois MARY BONO, California
HILDA L. SOLIS, California GREG WALDEN, Oregon
CHARLES A. GONZALEZ, Texas LEE TERRY, Nebraska
JAY INSLEE, Washington MIKE FERGUSON, New Jersey
TAMMY BALDWIN, Wisconsin MIKE ROGERS, Michigan
MIKE ROSS, Arkansas SUE WILKINS MYRICK, North Carolina
DARLENE HOOLEY, Oregon JOHN SULLIVAN, Oklahoma
ANTHONY D. WEINER, New York TIM MURPHY, Pennsylvania
JIM MATHESON, Utah MICHAEL C. BURGESS, Texas
G.K. BUTTERFIELD, North Carolina MARSHA BLACKBURN, Tennessee
CHARLIE MELANCON, Louisiana
JOHN BARROW, Georgia
BARON P. HILL, Indiana
-------
Professional Staff
Dennis B. Fitzgibbons, Chief of Staff
Gregg A. Rothschild, Chief Counsel
Sharon E. Davis, Chief Clerk
David L. Cavicke, Minority Staff Director
(ii)
Subcommittee on Health
FRANK PALLONE, Jr., New Jersey, Chairman
HENRY A. WAXMAN, California NATHAN DEAL, Georgia,
EDOLPHUS TOWNS, New York Ranking Member
BART GORDON, Tennessee RALPH M. HALL, Texas
ANNA G. ESHOO, California BARBARA CUBIN, Wyoming
GENE GREEN, Texas HEATHER WILSON, New Mexico
Vice Chairman JOHN B. SHADEGG, Arizona
DIANA DeGETTE, Colorado STEVE BUYER, Indiana
LOIS CAPPS, California JOSEPH R. PITTS, Pennsylvania
TOM ALLEN, Maine MIKE FERGUSON, New Jersey
TAMMY BALDWIN, Wisconsin MIKE ROGERS, Michigan
ELIOT L. ENGEL, New York SUE WILKINS MYRICK, North Carolina
JAN SCHAKOWSKY, Illinois JOHN SULLIVAN, Oklahoma
HILDA L. SOLIS, California TIM MURPHY, Pennsylvania
MIKE ROSS, Arkansas MICHAEL C. BURGESS, Texas
DARLENE HOOLEY, Oregon MARSHA BLACKBURN, Tennessee
ANTHONY D. WEINER, New York JOE BARTON, Texas (ex officio)
JIM MATHESON, Utah
JOHN D. DINGELL, Michigan (ex officio)
C O N T E N T S
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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 Engel, a Representative in Congress from the State of
New York, opening statement.................................... 4
Hon. Mike Ferguson, a Representative in Congress from the State
of New Jersey, opening statement............................... 6
Hon. Marsha Blackburn, a Representative in Congress from the
State of Tennessee, opening statement.......................... 7
Hon. Vito Fossella, a Representative in Congress from the State
of New York, opening statement................................. 8
Hon. Joe Barton, a Representative in Congress from the State of
Texas, opening statement....................................... 9
Hon. John B. Shadegg, a Representative in Congress from the State
of Arizona, opening statement.................................. 11
Hon. John D. Dingell, a Representative in Congress from the State
of Michigan, prepared statement................................ 12
Hon. Henry A. Waxman, a Representative in Congress from the State
of California, prepared statement.............................. 12
Hon. Anna G. Eshoo, a Representative in Congress from the State
of California, prepared statement.............................. 13
Hon. Jim Matheson, a Representative in Congress from the State of
Utah, prepared statement....................................... 14
Witnesses
John Howard, M.D., Director, National Institute for Occupational
Safety and Health, Department of Health and Human Services..... 14
Prepared statement........................................... 15
John Vinciguerra, Fire Department of New York (retired), New
Egypt, NJ...................................................... 29
Prepared statement........................................... 32
Iris Udasin, M.D., associate professor, environmental and
occupational medicine, University of Medicine and Dentistry of
New Jersey, Robert Wood Johnson Medical School................. 34
Prepared statement........................................... 36
Robin Herbert, M.D., associate professor, community and
preventive medicine, Mount Sinai School of Medicine, New York,
NY............................................................. 41
Prepared statement........................................... 44
Cynthia Bascetta, Director, Health Care Issues, Government
Accountability Office.......................................... 54
Prepared statement........................................... 56
James Melius, M.D., administrator, New York State Laborers....... 79
Prepared statement........................................... 80
Edward Skyler, deputy mayor, administration, city of New York, NY 84
Prepared statement........................................... 87
ANSWERING THE CALL: MEDICAL
MONITORING AND TREATMENT OF 9/11
HEALTH EFFECTS
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TUESDAY, SEPTEMBER 18, 2007
House of Representatives,
Subcommittee on Health,
Committee on Energy and Commerce,
Washington, DC.
The subcommittee met, pursuant to call, at 10:00 a.m., in
room 2322 of the Rayburn Office Building, Hon. Frank Pallone
Jr. (chairman) presiding.
Members present: Engel, Weiner, Deal, Shadegg, Pitts,
Ferguson, Blackburn, and Barton.
Also present: Representative Fossella.
OPENING STATEMENT OF HON. FRANK PALLONE, JR., A REPRESENTATIVE
IN CONGRESS FROM THE STATE OF NEW JERSEY
Mr. Pallone. The meeting is called to order. The hearing
today is on ``Answering the Call: Medical Monitoring and
Treatment of 9/11 Health Effects,'' and I now recognize myself
for an opening statement.
Today the subcommittee is meeting to discuss an issue of
great importance, medical monitoring treatment of 9/11 health
effects, which is the first time that the subcommittee is
meeting to hear about these issues. We had originally intended
to hold this hearing last Tuesday on the anniversary of the 9/
11 attacks, but due to the funeral of our colleague, Paul
Gillmor, the hearing was postponed until today.
Now, it is hard for me to believe that it has been 6 years
since the attack on the World Trade Center and the Pentagon. It
was an event that affected our country deeply and continues to
have an impact on all of us, especially those who participated
in the rescue, recovery, and restoration effort.
It is important that, as a Nation, we recognize the
extraordinary sacrifice of everyone who responded to the
terrorist attacks and worked tirelessly in the hours, days,
weeks, and months after 9/11 to help those in need and to begin
clearing the site of the tragedy.
From first responders, to iron workers, to crisis
counselors, Americans from across the country put their lives
on hold and rushed to the site of the World Trade Center on the
day of the attack and stayed for months after in order to
assist with the recovery effort. I happened to be at this site
the Friday after President Bush visited, and I was amazed to
see firefighters from all over. As we were listening to the
President speak, I was standing next to a fire truck from
Hialeah, FL, with all the firefighters from Hialeah. And I
asked them how the truck got there, and they looked at me like
I was an idiot and said well, of course, we drove it up from
Florida. And to me, it was just amazing to see the turnout and
the fact that so many people came.
It's been estimated that more than 40,000 people responded
to the crisis and participated in rescue, recovery, clean up,
or restoration of essential services. And we are clearly
indebted to them for their efforts.
Now, 6 years later these brave men and women who helped
lift our Nation up from one of its darkest hours are now in
need of our help. Many of those who responded to the attacks on
the World Trade Center have since been plagued by health
problems. One of every eight responders has experienced
symptoms of post-traumatic stress. They have developed asthma
at 12 times the rate of other Americans. Nearly one in five has
a respiratory or gastrointestinal illness as a result of their
exposure to toxins.
I have seen the impact firsthand. More than 1,000
responders are currently receiving health services through the
monitoring and treatment clinic in my home district in
Piscataway, NJ. Furthermore, residents, workers, and students
who were in the area at the time of the attack are also
experiencing high rates of health problems. And I want to thank
you, Mr. Engel, Mrs. Maloney, Mr. Nadler, Mr. Fossella.
One of the things that the New Yorkers, I think, have been
particularly adept at pointing out is that not only do we need
to be concerned about first responders, but the people who
lived and worked at the site, of which there may be as many as
400,000 or more from what I understand who also may have been
impacted. And we will hear about that today.
Unfortunately, for too long the concerns of the first
responders have been ignored here in Washington, and that has
to change. As chairman of this subcommittee, I am not going to
let these issues be ignored any longer. I want to be sure that
there are accessible health programs in place for responders
and adequate funding for those programs. We are here today to
ensure that those who are suffering from health problems have
access to the monitoring and treatment services they are
entitled to as a result of the conditions they endured at
Ground Zero.
And I think we should be honest about the task in front of
us. It is a big undertaking for us to ensure that adequate care
is provided for those in need, but that is a responsibility we
must fulfill. The cost of screening for and treating these
illnesses is estimated at $8,000 annually per person, and it is
expected to increase in the coming years. This cost should not
be borne by the thousands of responders, workers, and health
professionals who risked their health to do their job.
And, of course, it is not just our job in Congress. The
Bush administration has an important role to play here as well.
Unfortunately, for the past 6 years, the administration has
been dragging its feet, in my opinion, on this issue. It is sad
to say, but I think that many of those who came to our aid in
the days after 9/11 feel as though Congress and the President
have failed to live up to the promises that have been made over
the last couple years to not leave them behind.
And this is the first year that the administration proposed
funding in its annual budget in the amount of $25 million for
the healthcare needs of World Trade Center responders. The
House does not think that was enough, and we doubled the
President's request to $50 million in our budget.
The administration said the initial $25 million was only
the beginning and that it would propose additional funds once
it had a comprehensive plan in place. That comprehensive plan
has yet to appear, but in a draft plan developed by the
administration, they acknowledge that the current cost estimate
for the program is nearly $200 million a year and that it is
possible the cost could reach $712 million annually based on
what they gave us.
And that's why I joined with members of the New York
congressional delegation and sent a letter to the Health and
Human Services Secretary Mike Leavitt 2 weeks ago asking that
they finalize their plans immediately. We need a comprehensive
plan in place so that we can help treat and monitor all of the
people whose health was impacted by 9/11. We also sent another
letter to new OMB Director Jim Nussle, asking that he live up
to his predecessor's promises and request the necessary funds
to continue the process of helping these workers. And I would
ask that these letters be made part of today's hearing record.
In conclusion, today we will be hearing from a variety of
people about the medical monitoring and treatment of health
effects caused by the exposure to traumatic events and harmful
materials. It is my hope that this hearing will shed some light
on the problem and help us begin rectifying the situation. My
idea is that we develop a legislative proposal that all of us
can support. I know that the New York delegation put together
different proposals. Obviously we want to look at those and we
do need to develop legislation in my opinion so that the people
who had their health affected by the 9/11 attacks are monitored
and treated.
And again I just wanted to thank the witnesses. I know many
people have been trying to have this hearing for some time.
Unfortunately our schedule with S-CHIP and PDUFA and everything
else has made it difficult for us to do it until now. But I do
want to thank all of you, and now I recognize Mr. Deal for his
opening statement.
OPENING STATEMENT OF HON. NATHAN DEAL, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF GEORGIA
Mr. Deal. Thank you, Mr. Chairman. First of all, I would
like to ask unanimous consent that Mr. Fossella, a member of
the full committee, be allowed to participate in this hearing
today.
Mr. Pallone. So ordered.
Mr. Deal. And thank all of the witnesses who will testify
and members of the subcommittee for their presence. Certainly
the tragedy of 9/11 and the aftermath of that event are going
to be with us for a very long time, and today we simply deal
with one of those manifestations of that aftershock.
While some would criticize the administration for not
having done enough, in reality, the reaction and the outpouring
of Federal dollars for this event has been unprecedented in
American history. Truly the event itself, however, was
unprecedented in American history, and none of us wish to
diminish that.
The question is whether or not we have the information upon
to make good decisions as to where we go from this point
forward. One of the real concerns that I have is in the GAO
report. It finds that much of the information relating to the
health effects are unreliable, and the comments that despite
the efforts of HHS to require the necessary information that
much of that information is still incomplete. So to those who
will testify today who are in a position to make that
information available to us and to the administration, I would
certainly call upon them to use their best efforts to do that.
All of us are reminded frequently of this event. In fact,
last week when I was being interviewed by reporter from my
local newspaper, in the conversation, he reminded me that he
was at Ground Zero immediately following the event as a part of
a voluntary group from my church who came to assist with the
efforts of helping people in their time of need. So our country
has reached out. The question is are we now following up on
those efforts. And thank you, Mr. Chairman, for having the
hearing so we can make those inquiries here today. I yield
back.
Mr. Pallone. I recognize Mr. Engel who, like the other
members of the New York delegation, has been very much out
front on this issue. Thank you, Eliot.
OPENING STATEMENT OF HON. ELIOT L. ENGEL, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF NEW YORK
Mr. Engel. Thank you, Mr. Chairman. I want to thank you for
holding this hearing. You and I had discussed this several
months ago, and I requested this hearing and said that I
thought it would be a good idea. And you responded very
positively then, and I thank you for the hearing now.
Six years, Mr. Chairman, as you pointed out, have passed
since terrorism struck at the root of our Nation's soil on
September 11, 2001. As devastating as that day was, there are
few days I've been more proud to be an American than on 9/11.
Now, within minutes of crashes into the Twin Towers, New York's
first responders mobilized to save those trapped in the World
Trade Center. First responders putting themselves in
unspeakable danger, and too many lost their lives that day.
Within days, as you pointed out, Mr. Chairman, over 40,000
responders across the Nation descended upon Ground Zero to do
anything possible to help with the rescue, recovery and
cleanup. I remember those bittersweet days. I was in New York
City when this happened. I was born and bred there, and
remember seeing Americans lined up around blocks to donate
blood. I remember the chaos as no one knew quite what to do,
only that they had to do something, anything to help our Nation
rise up from assault by the terrorists.
And the past 6 years have not been kind to many, so many of
the first responders who put themselves in harm's way. It is
estimated that up to 400,000 people in the World Trade Center
area on 9/11 were exposed to extremely toxic environmental
hazards, including asbestos, particulate matter, and smoke.
Years later, this exposure has left a significant number of
first responders with severe respiratory ailments including
asthma at a rate that is 12 times the normal rate of adult
onset asthma.
Also common are mental health problems including PTSD and
depression. This has all been well documented in scientific,
peer-reviewed published work regarding the long term health
effects of 9/11 by Mount Sinai Hospital, the Fire Department of
the City of New York, and the World Trade Center registry.
People who have been exposed are not only first responders but
people who live in the area. And frankly, I think the behavior
on the part of the Federal officials borders on the criminality
when we in New York were assured that the air quality was OK
and we were assured that we could go to the World Trade Center
area and were assured by Christine Todd Whitman that we had
nothing to fear. That all turned out to be false.
While these illnesses should sadden all of us, I am frankly
outraged that 6 years later our Nation has really failed to
provide the first responders with anything more than a
fragmented and unreliable health care monitoring and treatment
program that forces those who fearlessly volunteered for our
country to fight within a myriad of bureaucracy to receive care
that should be a given, and yet it is a struggle.
The nonpartisan Government Accountability Office has
criticized the U.S. Department of Health and Human Services for
its failure to provide consistent availability of services to
Federal responders through the World Trade Center Federal
Responder Screening Program. Despite starting in 2003, service
stopped between March 2004 and December 2005. It resumed again
in March 2006, but suspended key services between April 2006
and March 2007. It is truly shameful.
GAO has also noted that those brave volunteers and first
responders that came to help New York from other parts of the
country have not had regular access to screening and
monitoring. After years of starts and stops, there are only 10
clinics in seven States where responders can receive services.
It is just unconscionable. We can and must do better. I was
proud to join with my New York City colleagues, lead by
Representatives Maloney, Nadler, and Fossella, who is here with
us this morning, and so many others last night in introducing
the 9/11 Health and Compensation Act.
This comprehensive bill would ensure that everyone exposed
to the Ground Zero toxins has 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. No more excuses. We must and shall do what is right.
In conclusion, let me just say I still feel great sorrow in
our remembrance of the tragedy of 9/11 and obviously will never
forget what happened that day. But we must look forward and
right the wrongs our Nation has perpetuated against our own
heroes and provide them with the care and compensation they so
desperately need and deserve.
Mr. Chairman, I urge all Americans to pause and reflect on
the tremendous loss of life that day and how so many sacrificed
so much for their fellow Americans and make sure that our
future actions are driven by these memories, and also remember
that potentially still hundreds of thousands of people are
being exposed to these toxic substances every day. And the
Federal Government cannot wish that away. We need to respond,
and we need to respond now. Thank you, Mr. Chairman.
Mr. Pallone. Thank your, Mr. Engel. Our next opening
statement is from Mr. Ferguson. Again we have two New Jersey
people here today, one from each party, and I constantly remind
everyone that we in our State, had a lot of people that died
and were seriously wounded, and a lot of first responders as
well. And we also have one of the treatment centers here. One
of the witnesses today is from one of the monitoring treatment
centers. So again we obviously are very concerned about this as
well, in our State. So, Mr. Ferguson.
OPENING STATEMENT OF HON. MIKE FERGUSON, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF NEW JERSEY
Mr. Ferguson. Thank you, Mr. Chairman. Thank you very much
for holding this meeting. I want to thank Mr. Deal as well and
member of the subcommittee and certainly the witnesses for
being here today to address this very important issue regarding
medical monitoring and treatment of September 11, 2001 health
effects on residents and first responders.
Addressing this issue is long overdue, and I am glad that
we are giving it attention that it really does deserve. And the
more that time goes by, the more we are learning about the
after effects and the health effects of those who selflessly
went to attend to this disaster. I am sure that we are going to
be able to gain some valuable information from treatments and
health effects from some of our witnesses today. I am pleased
that we are having this hearing, and my hope is that the
subcommittee will be able to use some of this information to
help address some of the needs of the families who are
suffering.
In addition, we need to find out what went wrong with some
of the information and some of the air quality information
surrounding lower Manhattan and why better information wasn't
made available in a more timely way. Of course, as the chairman
referenced, this issue hits very close to home for many of us
on the subcommittee. I know Mr. Fossella is here as well.
In our district, we lost 81 people on the attacks of
September 11, 2001. And to save others, approximately 40,000
first responders answered the call, including many from New
Jersey on September 11 and the weeks and months that followed,
helping to try and find survivors. We have firefighters and
police officers and construction workers and utility workers,
all folks who were working tirelessly day and night on the pile
in the hopes of finding one more survivor. These men and women
didn't think twice about running into burning buildings or
climbing through rubble to help save the lives of others, and
we owe them the very best information that we have to assist
with the health challenges that they are now facing because of
those sacrifices.
Dr. David Present, the chief medical officer for New York
City's fire department has been studying the health effects on
firefighters since September 11, 2001. In a recent interview
with Katie Couric, he said this about the health effects of
breathing the air at Ground Zero. I quote, ``the biggest
problem was that it was pulverized building materials that wind
up having a very high alkalinity, almost like lye, all right,
or Drano, that when you inhale or swallow it, it's burning your
entire nose and airway and stomach.''
In a study that was published in many of the leading
medical journals, Dr. Present concludes that working on the
pile for an extended period of time decreased an individual's
lung function by an average of 12 years. Six years later, those
same heroes who risked their lives need our help. And we have
to be there to answer their call. We need to make every effort
to find out what is causing their illnesses and what can be
done to treat them.
There is no reason that with today's medical technology
that we shouldn't be able to get some proper treatment to those
who made these sacrifices. In the future, we have to work to
ensure that our first responders are not put in further
unnecessary jeopardy than they are already placing themselves
by their own choice. Our first responders were heroes on
September 11, and we owe them our very best efforts today. Mr.
Chairman, I want to thank you again for holding this hearing. I
yield back.
Mr. Pallone. Thank you. The gentlewoman from Tennessee.
OPENING STATEMENT OF HON. MARSHA BLACKBURN, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF TENNESSEE
Mrs. Blackburn. Thank you, Mr. Chairman, and I thank you
and Mr. Deal for holding the hearing. And I also thank our
members from both sides of the aisle who have been so involved
with this issue and continuing to keep the pressure on with
this issue. I think that we all know what transpired September
11, and we know that we have to be very vigilant going forward
in how we protect our Nation and also how we protect those who
are going to respond to any tragedy that we do have.
There are lots of lessons learned, and, as you've heard in
the opening statements, there is attention to what should be
those lessons learned from members of this panel. And, as my
colleague from New Jersey just stated, you had approximately
400,000 people that were exposed to the environmental hazards,
the asbestos, the smoke, the particulates, 40,000 first
responders that were there on that day.
Now, there is very little solid, quantifiable data from
which we can operate as we look at the environmental factors
and what the first responders were exposed to during those
cleanups. What we do know is the damage that is there. Its
detrimental physical effects, chronic respiratory,
gastrointestinal conditions, anxiety, and other mental health
problems. And these have severely impacted the lives of those
that were at Ground Zero.
For example, the city health department reports rescue and
recovery workers now develop asthma at a rate 12 times that
found in the general population. Among children that were
exposed to the toxins, 53 percent reported breathing problems
in the 3 years after 9/11. New York City officials estimate
120,000 workers and volunteers and 550,000 other people may or
may eventually need treatment.
And I do commend the State of New York and the U.S.
Department of Health and Human Services for establishing 9/11
programs and resources to treat, track, and provide information
about scientific research and services for people who have
developed health problems as a result of the attack.
However, the GAO does state that the Federal Government has
had difficulty ensuring uninterrupted availability of services
for our Ground Zero responders. We have to be certain that
Federal and State bureaucracy does not prevent responders from
receiving the medical treatment and the tracking that is
necessary for meeting the demands of their illnesses.
I look forward to hearing from our witnesses today. I
welcome our witnesses and thank them for their time in
preparing the testimony for us. And again, Mr. Chairman, I
thank you and the Members who have been so diligent in
continuing to keep the pressure on about the issue, and I yield
back.
Mr. Pallone. Thank you. And then last but not least, the
gentleman from New York or Staten Island, again he has been one
of the people, along with the rest of the New York delegation
that continues to bring this to the attention of the
subcommittee. I don't know, but I would venture to say that
probably a lot of those first responders were from Staten
Island. Mr. Fossella.
OPENING STATEMENT OF HON. VITO FOSSELLA, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF NEW YORK
Mr. Fossella. Well, thank you very much, Mr. Chairman and
Mr. Deal, and thank you for allowing me to participate this
morning on this panel. My colleagues, Mr. Ferguson, Mrs.
Blackburn. Of course, Eliot Engel has been a true champion.
Indeed, I think in Staten Island alone, we lost 78 fireman on
that day. Twenty-two percent of all firefighters and more than
240 people were killed, probably the heaviest toll of any
county per capita in the country.
And we still see the effects 6 years later. There is the
old saying that time heals all wounds, and I think in this
case, time exposes more wounds. And I thank you at the outset,
Mr. Chairman, for shedding light on this issue, for ensuring
that we never forget those who not just sacrificed on those
days, but who continue to suffer. And I thank those in Congress
and the executive branch for helping New York to rebuild the
city, but I think there's a fundamental obligation to call upon
our Federal Government to help people rebuild their lives.
And at the outset, let me thank some individuals. I thank
the panel, Mr. Howard. We will also hear from Deputy Mayor
Edward Skyler, who is here on behalf of the mayor, who has
truly been a good partner in helping us get the resources we
need and, by extension, the fire department and the police
department and Mt. Sinai and all those who are trying to ensure
that New York doesn't shoulder disproportionately the burden
here.
Because we have to remember September 11 wasn't just a New
York problem or a New York/New Jersey problem. It was an
American problem. It was an attack on America, and I think
America has a responsibility to respond in kind.
I would like to thank my colleagues in the New York
delegation, Mr. Nadler, but especially Mrs. Carolyn Maloney who
has really been spearheading these efforts to date. People in
the labor community in particular, Dennis Hughes in the AFL/CIO
who has helped us coordinate and shepherd this legislation
through.
And I remind everyone that this is why we place so much
emphasis on preventing another terrorist attack because one
more exorbitant cost of terrorism is the individuals that we
continue to have to help and treat.
Again the message is never forgetting. We know so many
successes, but the successes have been measured in small steps
rather than giant leaps as critical needs continue to be unmet
after 6 years. We have encountered obstacles along the way, but
as mentioned with Congresswoman Maloney, we have restored $125
million. Of that, $75 million was dedicated for treatment, the
first ever Federal dollars to be directed for that purpose. We
were able to get Dr. Howard to help coordinate and oversee the
Federal response. And in addition, as Mr. Pallone mentioned, we
included $50 million for the federally funded 9/11 health
clinics in the Labor-HHS appropriations bill.
In addition, as was mentioned by Mr. Engel, we introduced
legislation last night that ensures that everyone exposed to
the Ground Zero toxins has a right to be medically monitored,
builds on the Center of Excellence, and expands care to the
entire exposed community and provides compensation for loss by
reopening the 9/11 Victims' Compensation Fund.
And for those, Mr. Deal and Mrs. Blackburn, also asked
some, I think, very pointed questions of where is the
information, what do we need? I can tell you, as someone who
lives in Staten Island and sees young guys in particular who
used to run a 6-minute mile, 7-minute mile, now have difficulty
walking up a flight of steps. I could point to those
individuals with specificity, but the data is just
overwhelming, whether it is from Mt. Sinai or the fire
department, that this is a major problem, a major undertaking
that demands a Federal response. And I think the Federal
Government has an obligation to be at the table with us helping
to coordinate, shepherd, and provide for long-term plan for all
those who are affected.
With that, Mr. Chairman, I thank you very much for holding
this hearing. I yield back.
Mr. Pallone. Ranking member, Mr. Barton, for an opening
statement.
OPENING STATEMENT OF HON. JOE BARTON, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF TEXAS
Mr. Barton. Thank you, Chairman Pallone. I was downstairs
at the Oversight Subcommittee hearing on monitors for nuclear
equipment coming into this country. I appreciate you holding
this hearing today. I appreciate my colleagues on both sides of
the aisle from New York being involved with it.
Before I talk about the specific hearing, I think it would
be appropriate that we all contemplate our dear colleague Paul
Gillmor who passed away several weeks ago. Paul was a
distinguished member of this committee, and was chairman of the
Environment and Hazardous Material Subcommittee in the last
Congress. He took a leave of absence from the committee this
Congress so that some of the more junior members of the
minority side wouldn't have to be bumped off of the committee.
So we are going to miss him, and we wish the best to his family
in their time of sorrow.
As far as the hearing today, I think it is important. We
know what happened on 9/11/2001. Firefighters, police officers,
ambulance crews, and all of the other first responders were
exposed to health hazards because of the attacks on 9/11.
Federal funding has been provided to Government agencies
and to private organizations to screen and monitor responders
for illnesses caused by that catastrophe. This hearing is going
to provide some oversight for those programs. Many who
responded to the disaster and then needed help themselves have
been beneficiaries of various worker compensation, health
insurance, and other Government coverage.
Some say that what has been done is not enough. I don't
really know where to draw the line. I don't know whether the
entities that are legally obligated to provide or pay for
health care monitoring or treatment have done all that they
could to help the victims of 9/11.
I know that we have appropriated Federal money and that we
will continue to do so. I know that Federal dollars have been
spent for the responders who responded on 9/11. Again I'm not
sure exactly the effectiveness of those programs and the
legality of some of those programs and what needs to be done.
So I look forward to the hearing.
Before I yield back, Mr. Chairman, I do think that, since
this is the Health Subcommittee, we should mention something
that has yet to be done, and that is a reauthorization of our
S-CHIP program. Members on both sides of the aisle realize the
importance of S-CHIP. I am introducing a bill today to
authorize a clean bill at existing levels with a slight
increase for inflation until we can work out the details of a
new S-CHIP program. I would hope that my friends on the
majority side would join us in reauthorizing for a short term
the existing S-CHIP program because, as we all know, if we
don't do something in the next 2 weeks, the program legally
expires on September 30, the end of this month.
So while we wrangle over the details of any new
improvements or expansions in the program, if any, we at least
ought to keep the existing program going. And I would hope that
we could move that extension fairly quickly while we tackle the
bigger issue.
If the Democratic leadership in the House wants to accept
the Senate bill, I do hope that this subcommittee would hold a
hearing on that bill, a legislative hearing, where it would be
open. We could look at the details and then have a markup
subsequent to that so that we could actually make some changes
in the bill before it went to the floor.
With that, Mr. Chairman, I yield back.
Mr. Pallone. Thank you, Mr. Barton. I appreciate your
ongoing interest in S-CHIP, and I am about S-CHIP-ped out
today. So I am not going to comment any further. The gentleman
from Arizona.
OPENING STATEMENT OF HON. JOHN B. SHADEGG, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF ARIZONA
Mr. Shadegg. Thank you, Mr. Chairman, and with your
permission, I will insert my written statement in the record. I
simply want to make some brief comments which may be a little
bit different than others have made. I want to commend you for
holding this hearing.
And I want to recognize that, while the focus today is the
technical issue of the care, treatment, and monitoring of the
first responders who have been victimized, I think it is
important to remind everyone at the dais and in the audience
and elsewhere that we are talking about the victims of a
vicious attack on America by radical Islamists who seek to kill
us and who are out there and who want to keep going in their
efforts who make their designs clear every day.
That the people who are suffering--we all kind of
internalize the numbers of those who were killed that day, and
then we can extrapolate from that all the families that were
affected by that attack. But as my colleague from New York Mr.
Fossella pointed out we don't really know the number of
victims. The issue we are looking at today demonstrates there
are more victims being manifest every day by this attack on
America.
And I think it is important for those watching this hearing
who are considering this effort to recognize that this is not a
health problem, though it is a Health Subcommittee. This is the
Nation's response to an attack by its enemies. And we can all
be critical and say we should have responded this way or that
way, or we should not have responded this way or that way.
But at a minimum, I would hope that we can all come to
agreement that when this Nation is attacked and there are
people who suffer, whether it is the loss of life and the
impact on the families, or whether it is ongoing health
problems that manifest themselves months later or years later,
that is something we need to be concerned about as a nation.
That is a cost of failing to do what is necessary to defend
ourselves. And we have an obligation to each of the people who
are suffering as a result of those attacks today because that
is a part of our national defense. That is a part of us
standing together as a nation.
I will just conclude by pointing out when the 9/11 attacks
occurred, my daughter was in college. She now works on the
Senate side, and I talked to her a few days after the event.
And she said that she and many of her friends in college were
going down to the local blood bank to donate blood for the
victims. That is the spirit that we had as a nation when the
attacks occurred. That is the spirit we should have or try to
have as a nation in responding or figuring out the best way to
respond to those who hate us and want to kill us. And that is
certainly the spirit we should bring to this hearing and to
doing the right thing by the people who are being victimized by
this attack now years later.
And with that, I yield.
Mr. Pallone. Thank you. Thank you for those remarks. We are
done now with our opening statements, and any other statements
will be accepted for the record at this time.
[The prepared statements follow:]
Prepared Statement of Hon. John D. Dingell, a Representative in
Congress from the State of Michigan
Mr. Chairman, thank you for holding this important hearing
today. I also want to thank the witnesses who are here to
discuss the health effects of the World Trade Center collapse
on first responders and workers.
One week ago marked the sixth anniversary of the attacks
against our Nation. Nearly 3,000 people perished as a result of
the attacks, and many who participated in the clean up, rescue,
and recovery efforts continue to suffer from lingering physical
and mental health problems directly linked to their work in
downtown New York City. While Congress has taken some initial
actions to deal with this issue, adequate screening, treatment,
and monitoring services for all of those brave men and women
throughout the Nation who came to New York to work in the
cleanup has been lacking.
It is incumbent on our Nation not to forget these
responders who placed their own well-being aside to help
others. The administration's fiscal year 2008 budget request of
$25 million for the current World Trade Center responder
programs fell far short of the amount appropriated in either
2006 or 2007. Over the long term, we must find a way to care
for our heroes who answered the call and subsequently suffered
severe health problems. In the short term, we must provide
enough Federal resources to sustain the current monitoring,
screening, and treatment programs in New York.
I would note with particular concern the intermittent
services provided by the World Trade Center Federal Responder
Screening Program. The program, now run by the Federal
Occupational Health Services, provides Federal responders to
the attacks with screening and referrals to health clinics.
However, the program suspended examinations from March 2004 to
December 2005, and again from January 2007 to March 2007. This
program encompasses Federal employees all across the country
that came to New York in response to the attacks. As new health
9/11 effects continue to emerge from latent conditions, it is
especially important that all Federal employees who were
exposed to the environmental hazards resulting from the WTC
collapse be screened for problems.
Another area of concern is the failure to screen and
monitor those non-Federal workers who reside outside of New
York City. While the National Institute for Occupational Safety
and Health has made two separate attempts to contract with
entities to provide service across the country, only a very
limited number of places in the country have services.
It is imperative that as Congress continues to work on
these issues, we not forget the service our first responders
and workers provided in those dark days following September 11.
I want to thank Chairman Pallone for holding this
important hearing, and I look forward to receiving the
testimony from our witnesses.
----------
Prepared Statement of Hon. Henry A. Waxman, a Representative in
Congress from the State of California
Mr. Chairman, thank you for holding this important hearing
today.
Last week the Nation marked the sixth anniversary of the
terrorist attacks of September 11. As a nation, we mourned all
those people who lost their lives on that day in the attacks on
the World Trade Center and the Pentagon, and the passengers who
died on United Airlines flight 93 in Shanksville, Pennsylvania.
But we also remember those people who continue to suffer
from the attack on the World Trade Center--the men and women
from all over the country who came to lower Manhattan to help
clear the debris and to rebuild the site. Last week, Chairman
Towns, chairman of the Subcommittee on Government Management,
Organization, and Procurement of the Oversight Committee, held
his third hearing on the impact of 9/11 on New York residents
and first responders. We have also had a number of hearings
over the years in the National Security Subcommittee of the
Oversight Committee on the health effects of the 9/11 attacks.
We know from these hearings that Congress needs to craft a
long-term solution to the problem of how we will identify,
treat, and compensate those people who are suffering from 9/11-
related illnesses. The current patchwork approach is clearly
inadequate. That is why I am pleased that we are having a
hearing today in this subcommittee. This is the subcommittee
with legislative jurisdiction over the care of the first
responders and others who continue to suffer because of the 9/
11 attacks. The involvement of this subcommittee is critical to
moving forward on this important issue.
I would like to commend my colleagues from New York,
Representatives Maloney, Nadler, Fossella, who have worked
together, across party lines, to develop a comprehensive
approach to monitoring, treating, and compensating people who
were exposed to the to the potentially toxic effects of the
World Trade Center site. I look forward to working with these
members and this subcommittee to make sure that all of the 9/11
victims are taken care of.
I thank the witnesses for coming today.
----------
Prepared Statement of Hon. Anna G. Eshoo, a Representative in Congress
from the State of California
Chairman Pallone, thank you for holding today's hearing on
the Federal response to the health problems faced by first
responders, construction workers, residents, and others living
and working at or near the World Trade Center site following
the September 11, 2001 attacks on our country.
In the haste to respond to the destruction of the World
Trade Center buildings, the impact on public health was
underestimated and diminished.
In the early days after the attacks, the Federal Government
failed to provide the public with sufficient warnings about
potential risks. After the collapse of the two World Trade
Center towers, the EPA told the public in a September 18, 2001
announcement that the air was ``safe'' to breathe. The EPA
Inspector General later concluded in an August 2003 report that
``[EPA] did not have sufficient data and analyses to make such
a blanket statement.'' The IG report also said, ``The White
House Council on Environmental Quality influenced, through the
collaborative process, the information that EPA communicated to
the public through its early press releases when it convinced
EPA to add reassuring statements and delete cautionary ones.''
Regrettably, as the GAO has reported, there have been
additional missteps in the operation of federally-supported
programs that monitor 9/11 related health problems and treat
victims.
In one case, a screening program was suspended for 5 months
earlier this year when there was a change in the agency
overseeing the WTC Federal Responder Screening Program.
Diagnostic services under the same program were suspended for
11 months because of a contracting problem.
Finally, the GAO notes that affected individuals living
outside the New York metropolitan area have found it difficult
if not impossible to participate in screening and monitoring
programs due to a lack of nearby providers participating in the
program. Getting treatment has been even more challenging.
Although my congressional district is 3,000 miles away from
Ground Zero, this aspect of the public health aftermath of the
9/11 attacks has affected some of my constituents.
The Urban Search and Rescue (USAR) team based in Menlo
Park, California, was one of many to respond in the days after
September 11th. Although members of the team were in New York
for a relatively short time compared to others who worked on
``the Pile'' some have experienced respiratory and other
ailments in the ensuing years.
For my constituents and for other first responders from the
around the country who answered the call after 9/11, I believe
we need a new comprehensive framework that provides the
screening and the treatment they deserve, similar to the
legislation that my colleagues Representatives Maloney, Nadler,
and Fossella have recently introduced.
Today, we'll hear from the witnesses who are attempting to
address the health issues that have emerged after 9/11. I look
forward to hearing their thoughts on getting the services and
care to those who need and deserve them.
Thank you, Mr. Chairman.
----------
Prepared Statement of Hon. Jim Matheson, a Representative in Congress
from the State of Utah
Thank you, Chairman Pallone and Ranking Member Deal.
As many have noted, our world changed forever 6 years ago,
when our Nation was attacked. Thousands of innocent people died
and our national security was shaken to the core. We will never
forget those who lost their lives in New York, at the Pentagon,
and on a Pennsylvania field. We will never forget the heroes--
the first responders--who rushed to Ground Zero with no thought
but to help with the recovery. In my State of Utah, the Salt
Lake Urban Search and Rescue Team--also called Utah Task Force
One--sent 62 people to New York City on September 18, 2001, to
comb through the rubble of the World Trade Center. The team
included specialized firefighters, search dogs and handlers,
two physicians and several structural engineers. The Salt Lake
City and Salt Lake County Fire Departments contributed, as well
as the Rocky Mountain Rescue Dog organization. The Utah task
force is one of 28 teams that participate in the national Urban
Search and Rescue Response System. It's impossible to honor the
victims of 9/11 without also making a commitment to our first
responders who run toward danger while others try to escape it.
Since the attacks, many rescue workers have reported an
increase in illness as a result of exposure to toxic materials
and debris, during their hours on the pile, amid the dust and
soot. Many agency officials will provide testimony here today,
confirming that we need to continue to examine the health
exposure and work to make available physical and mental health
screening programs, which should be available to all exposed
first responders.
I also believe that Congress should continue to support
critical programs that improve access to emergency medical
care. For my part, I have introduced legislation to reauthorize
the Emergency Medical Services for Children (EMSC) Program.
This program is designed to improve emergency medical services
for our children. For more than 20 years, the EMSC program has
improved emergency care facilities that treat sick and injured
children across this country. Through grants to States and to
accredited medical schools, the EMSC program has driven ``best
practices'' in the care provided to kids every day at the scene
of an accident, en route to the hospital and in the E.R. and
other critical care facilities. These efforts also translate
into better care for children when natural or manmade disasters
strike. When disaster strikes, we all want the best care
possible for these small patients--I am working to preserve
this program dedicated to improving emergency medical care for
our children.
I look forward to the testimony today and with that, I
yield back my time.
Thank you Mr. Chairman.
----------
Mr. Pallone. We will now turn to our witnesses, and the
first panel has one person, Dr. Howard. First of all, welcome.
Dr. Howard is the director of the National Institute for
Occupational Safety and Health with the U.S. Department of
Health and Human Services. Let me mention that you may, in my
discretion, submit additional brief and pertinent statements in
writing for inclusion in the record after your comments. And I
welcome you, and if you will begin your statement. Thank you,
Doctor.
STATEMENT OF JOHN HOWARD, M.D., DIRECTOR, NATIONAL INSTITUTE
FOR OCCUPATIONAL SAFETY AND HEALTH, DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Dr. Howard. Good morning, Mr. Chairman, and members of the
subcommittee, and Mr. Fossella. I am pleased to report on the
progress that has been made in addressing the health needs of
World Trade Center responders and volunteers.
In 2002, the Department first funded medical screening for
World Trade Center responders and volunteers. By 2004, medical
evidence showed that periodic medical monitoring was indicated,
and a monitoring program was added. In late 2006, treatment
services were added because a significant portion of the
responders and volunteers were experiencing physical and mental
health problems.
Both monitoring and treatment services are provided to
those responders and volunteers in the New York City/New Jersey
metropolitan area by Centers of Clinical Excellence at a
consortium of five medical centers in New York and New Jersey,
coordinated by the Mount Sinai School of Medicine, and at a
clinic center at the fire department of New York City.
These clinical centers have enrolled over 36,000 responders
and volunteers in medical monitoring and have referred more
than 7,600 of those responders for treatment of physical health
ailments and nearly 5,000 for referral for mental health
conditions. Even today, World Trade Center responders and
volunteers are still coming forward to enroll in the federally
funded monitoring and treatment program.
In addition, over, 1,300 current Federal workers who
responded have been medically screened by the Department's
Federal Occupational Health. And 700 nationwide responders have
received an initial monitoring examination by contractors of
the Mount Sinai Data Coordination Center. Just over 400
nationwide responders have received medical diagnosis and/or
treatment from the Association of Occupational and
Environmental Clinics supported by generous and continuing
funding from the American Red Cross.
Finally, in collaboration with the New York City Department
of Health and Mental Hygiene, the Department of Health and
Human Services funds the World Trade Center health registry.
The registry tracks the health of 71,000 responders, residents,
office workers, students, and school staff, passersby, those in
the area of the World Trade Center on September 11, 2001. The
registry's findings provide an important picture of the long-
term consequences of September 11 on the health of not only
those who responded and volunteered, but also on those living
and working around the World Trade Center site.
Thank you, Mr. Chairman. I would be pleased to answer any
of your questions.
[The prepared statement of Dr. Howard follows:]
Statement of John Howard, M.D., M.P.H.
Good morning, Chairman Pallone and other distinguished
members of the subcommittee. My name is John Howard, and I am
the Director of the National Institute for Occupational Safety
and Health (NIOSH), which is part of the Centers for Disease
Control and Prevention (CDC) within the Department of Health
and Human Services (HHS). CDC's mission is to promote health
and quality of life by preventing and controlling disease,
injury and disability. NIOSH is a research institute within CDC
that is responsible for conducting research and making
recommendations to identify and prevent work-related illness
and injury.
Mr. Chairman, I would like to express my appreciation to
you and to the members of the subcommittee for holding this
hearing and for your support of our efforts to assist those who
were affected by 9/11. I am pleased to appear before you today
to report on the progress we have made in addressing the health
needs of those who served in the response effort after the
World Trade Center (WTC) attack on 9/11 and those in the
affected communities.
Since February 2006, I have served as the HHS WTC Programs
Coordinator. Secretary of Health and Human Services Michael O.
Leavitt determined that there was a ``critical need to ensure
that programs addressing the health of WTC responders and
nearby residents are well-coordinated,'' and charged me with
this important task. Since receiving this assignment I have
traveled to New York City (NYC) and Albany, New York, to assess
the status of the existing HHS programs addressing WTC health
effects, and meet with those we serve. Participating in these
dialogues has enabled me to better understand the needs of
those affected, and the steps we can take to meet those needs.
As the HHS WTC Programs Coordinator I work to coordinate the
existing programs and ensure scientific reporting to provide a
better understanding of the health effects arising from the WTC
attack. Today, I will focus my remarks on the progress we've
made toward these tasks.
WTC Responder Health Program--Monitoring and Treatment
Since 2002, agencies and offices within HHS have been
dedicated to tracking and screening WTC rescue, recovery and
clean up workers and volunteers (responders).
In 2004, NIOSH established the national WTC Worker and
Volunteer Medical Monitoring Program to continue baseline
screening (initiated in 2002), and provide long-term medical
monitoring for WTC responders. In fiscal year 2006, Congress
appropriated $75 million to CDC to further support existing HHS
WTC programs and provide screening, monitoring and medical
treatment for responders. Since these funds were appropriated,
NIOSH has established a coordinated WTC Responder Health
Program to provide annual screenings, as well as diagnosis and
treatment for WTC-related conditions (e.g. aerodigestive,
musculoskeletal, and mental health) identified during
monitoring exams. The WTC Responder Health Program consists of
a consortium of clinical centers and data and coordination
centers that provide patient tracking, standardized clinical
and mental health screening, treatment, and patient data
management.
To date, the WTC Responder Health Program has screened
approximately 36,000 responders. The New York City Fire
Department (FDNY) manages the clinical center that serves FDNY
firefighters who worked at Ground Zero. As of July 31, 2007,
FDNY had conducted 29,203 screenings, including 14,429 initial
examinations and 14,774 follow-up examinations. The Mt. Sinai
School of Medicine's Center for Occupational and Environmental
Medicine coordinates a consortium of clinics that serve other
response workers and volunteers who were active in the WTC
rescue and recovery efforts. These clinics have conducted
21,088 initial examinations and 9,101 follow up examinations.
Of the 36,000 responders in the WTC Responder Health Program,
7,603 have received treatment for aerodigestive conditions,
such as asthma, interstitial lung disease, chronic cough, and
gastro-esophageal reflux, and 4,868 have been treated for
mental health conditions.
In conjunction with these activities, CDC-NIOSH has funded
the NYC Police Foundation's Project COPE and the Police
Organization Providing Peer Assistance to continue providing
mental health services to the police responder population. The
availability of treatment for both physical and mental WTC-
related health conditions has encouraged more responders to
enroll and continue participating in the WTC Responder Health
Program, which will enable us to better understand and treat
the long-term effects of their WTC exposures.
WTC Federal Responder Screening Program
In fiscal year 2002, the HHS Office of Public Health
Emergency Preparedness (OPHEP)--which is now the Office of the
Assistant Secretary for Preparedness and Response (ASPR)--
received $3.74 million through the Federal Emergency Management
Agency (FEMA) to establish the WTC Federal Responder Screening
Program to provide medical screening for all Federal employees
who were involved in the rescue, recovery or clean up efforts.
Current Federal employees in this program are screened by the
HHS Federal Occupational Health (FOH), a service unit within
HHS. FOH has clinics located in areas where large numbers of
workers are employed. As of August 31, 2007, FOH had screened
1,331 Federal responders. In February 2006, CDC-NIOSH and OPHEP
(now ASPR) signed a Memorandum of Understanding to monitor
former Federal workers via the WTC Responder Health Program.
Since then, former Federal workers have been enrolled in the
WTC Responder Health Program and served by the Mt. Sinai Data
and Coordination Center and national clinic partners.
Nationwide Scope
HHS is working with its partners to ensure that the
benefits of all federally-funded programs are available to all
responders, across the nation. Those responders who selflessly
came to the rescue of NYC from throughout the country at the
time of the WTC disaster should receive the same high quality
monitoring and treatment as those who reside in the NYC
Metropolitan Area. Enrollees in the WTC Responder Health
Program who are not located in the NYC Metropolitan Area,
receive monitoring and treatment via a national network of
clinics managed by QTC, Inc. and the Association of
Occupational and Environmental Clinics (AOEC), respectively. To
date, 698 responders outside of the NY Metropolitan Area have
been screened by the WTC Responder Health Program.
Achieving such nationwide coverage for WTC responders is
challenging; however, we are committed to serving all
responders, regardless of their location or employment status.
I am actively working with the medical directors of the WTC
Health Program, the WTC Federal Responder Screening Program,
QTC, Inc. and the AOEC to ensure that the services available to
responders are uniform across programs.
WTC Health Registry
In addition to the WTC Responder Health Program, the Agency
for Toxic Substances and Disease Registry (ATSDR) maintains the
World Trade Center Health Registry. In 2003, ATSDR, in
collaboration with the New York City Department of Health and
Mental Hygiene (NYCDOHMH), established the WTC Health Registry
to identify and track the long-term health effects of tens of
thousands of residents, school children and workers (located in
the vicinity of the WTC collapse, as well as those
participating in the response effort) who were the most
directly exposed to smoke, dust, and debris resulting from the
WTC collapse.
WTC Health Registry registrants will be interviewed
periodically through the use of a comprehensive and
confidential health survey to assess their physical and mental
health. At the conclusion of baseline data collection in
November 2004, 71,437 interviews had been completed,
establishing the WTC Health Registry as the largest health
registry of its kind in the United States. The NYCDOHMH
launched the WTC Follow-up survey in November, 2006. As of
August 31, 2007, 39,703 adult paper and web surveys had been
completed for nearly 60 percent response rate (58.7 percent).
NYCDOHMH has begun a third phase of the follow-up survey to
reach the registrants through direct interviewing by telephone,
as well as initiated a separate mailed survey of registrants
who are younger than 18 (approximately 2,200).
The WTC Health Registry findings provide an important
picture of the long-term health consequences of the events of
September 11th. Registry data are used to identify trends in
physical or mental health resulting from the exposure of nearby
residents, school children and workers to WTC dust, smoke and
debris. Two journal articles recently published reported
findings on 9/11 related asthma and posttraumatic stress
disorder (PTSD) (Environmental Health Perspectives, 8/27/2007;
and American Journal of Psychiatry, 2007; 164:1385-1394) among
rescue and recovery workers. Newly diagnosed asthma after 9/11
was reported by 926 (3.1 percent) workers, a rate that is 12
times the norm among adults. Similarly, the overall prevalence
of PTSD among rescue and recovery workers enrolled on the WTCHR
was 12.4 percent, a rate four times that of the general U.S.
population. By spotting such trends among participants, we can
provide valuable guidance to alert Registry participants and
caregivers on what potential health effects might be associated
with their exposures.
The WTC Health Registry also serves as a resource for
future investigations, including epidemiological, population
specific, and other research studies, concerning the health
consequences of exposed persons. These studies can assist those
working in disaster planning who are proposing monitoring and
treatment programs by focusing their attention on the adverse
health effects of airborne exposures and the short- and long-
term needs of those who are exposed. The findings will permit
us to develop and disseminate important prevention and public
policy information for use in the unfortunate event of future
disasters.
Funding
I want to reaffirm the Department's commitment to work with
the Congress to provide compassionate and appropriate help to
responders affected by the World Trade Center exposures
following the attacks.
As you know, the Department of Defense, Emergency
Supplemental Appropriations to Address Hurricanes in the Gulf
of Mexico, and Pandemic Influenza Act of 2006 (P.L. 109-148)
provide $75 million for the treatment, screening, and
monitoring of the responders. With less than one month
remaining in the fiscal year (FY) we are confident this funding
will last at least until the end of fiscal year 2007.
The President's fiscal year 2008 budget requests $25
million for World Trade Center responders and in May 2007, the
President signed the U.S. Troop Readiness, Veterans' Care,
Katrina Recovery, and Iraq Accountability Appropriations Act of
2007 (P.L. 110-128), which included an additional $50 million
to support continued treatment and monitoring for World Trade
Center responders. This funding will be awarded, as needed, to
support continued monitoring, care, and treatment of responders
through fiscal year 2008.
From July 1, 2006, through June 30, 2007, the Federal
grantees have reported to NIOSH spending approximately $15
million total for treatment for World Trade Center related
illnesses. This includes $6 million from American Red Cross
funds and $9 million from the $42 million total Federal grants
awarded in October 2006. Of this $9 million, the grantees have
actually ``drawn down'' only $2 million in payments on the
Federal grants.
Over $90 million in appropriated funds remains available--
including the balance of the treatment funds appropriated in
fiscal year 2006 and the $50 million appropriated in fiscal
year 2007--before adding the $25 million included in the
President's fiscal year 2008 budget request. HHS is gathering
additional financial data from the Federal grantees in order to
better understand the healthcare cost issues of the responders.
Additional data will help inform our policies, ensure that the
current program operates efficiently and effectively, and
maximize the available resources to meet responders' medical
needs. HHS will continue to monitor the work of the grantees as
part of the fiscal year 2009 budget process.
Since 9/11, HHS has worked diligently with our partners to
best serve those who served their country, as well as those in
nearby communities affected by the tragic attack. We have had
great success in expanding our monitoring program to include
treatment, which has encouraged more responders to enroll and
receive needed services. We will continue to forge ahead in
providing coordinated medical monitoring and treatment
services, supported by the recent $50 million appropriation.
Likewise, the WTC Health Registry continues to paint a picture
of the overall health consequences of 9/11, including the
effects experienced by the residents, school children and
office workers located in the vicinity of the WTC. While we
have made much progress, we must continue to gather and analyze
data that will enable us to better understand the health
effects we have observed so that we may better treat those
affected. I appreciate your support of our efforts and look
forward to working with you in the future as we continue to
serve this deserving population.
Thank you for the opportunity to testify. I would be happy
to answer any questions you may have.
----------
Mr. Pallone. Thank you, Dr. Howard. I am going to recognize
myself for some questions.
You are familiar with the letters that myself and the New
York delegation have sent to both Secretary Leavitt and Office
of Management and Budget? Have you seen those?
Dr. Howard. I think I have seen letters to the Department.
I am not sure I have seen those you----
Mr. Pallone. OK. Well, I mean essentially if I could
summarize the concern, I mean the concern is that the
administration had promised a comprehensive plan to deal with
this. As you know, the New York delegation has submitted
legislation which, I guess, could be intended to put together a
comprehensive plan. But we were supposed to get something like
that from the administration.
We continue to be concerned about the level of budget
requests that come from OMB, so we sent a letter to OMB. And
the concern I have, and I guess the criticism is that the
administration would appear to be dragging their feet. We don't
have a comprehensive plan.
We have budget requests that seem to be inadequate. I did
get a draft, I guess, that I mentioned in my opening statement
that has the figure, that the current cost estimate for the
program is nearly $200 million per year. And yet there is an
acknowledgement in the draft that it could cost as much as $712
million annually. And yet the President's budget for fiscal
year 2008 request is only $25 million. And I know that one of
the administrators for this task force resigned, and no new
person has been appointed.
So I guess the question would be, one, what is happening
with this comprehensive plan? Are we still getting it? Is it
being held up because you don't have a person to replace the
person who was the chair of the task force? And when are we
going to get some real cost estimates because I think you would
agree that the $25 million wasn't adequate.
Dr. Howard. Mr. Chairman, let me start with the beginning
of that list of questions. I think all of them are extremely
important. I don't think there should be any doubt in anyone's
mind that Secretary Leavitt of the Department of Health and
Human Services is dedicated to this program and ensuring that
these individuals who are being monitored and treated are not
abandoned. That will not happen on his watch.
I think one of the more serious issues with regard to
developing a comprehensive plan, a multi-year plan, as opposed
to a day-to-day operational plan, which we do in NIOSH every
day with the grantees.
The biggest problem with that, I think, from the point of
view, not being a budget accountant et cetera, is being able to
project over time what the true costs are. Right now on the
monitoring side, it is very easy to do. We know that it costs
$1,150 to monitor an individual. You tell me the number of
individuals you want monitored. We do the math, and it comes
out. Right now, we have 37,000 under monitoring, $1,150 per
year. That's about a figure of $43 million. Easy to figure out.
March that out to how many years you want.
On the treatment side, that is the real conundrum. We put
out the money for the treatment services in October 2006. It
took a few months for the grantees to get capacity up and
running. Probably around February or March, the grantees really
started treating individuals. So we have a very limited amount
of time right now to assess from an actuarial sense the costs
of treatment because each individual is generating different
costs, and there are different costs associated with treating
physical health effects and mental health effects.
So that is an extremely unstable number, and I think again
from my point as a physician--I am not a professional in this
area--but I think it challenges people who are looking at
projecting costs through the years.
Mr. Pallone. I only have 5 minutes even though I am the
chairman. I just really want to know you are agreeing with me
that there is a problem. The GAO report, that is the next
panel, they agree that there is a problem. But I just want an
answer to simple questions. Is the administration still going
to give us a comprehensive plan so we don't just have to
operate ad hoc? When? Is there a problem because there is
nobody in charge of this anymore because the person resigned?
And I mean just answer that. Are we going to get a
comprehensive plan, yes or no?
Dr. Howard. I would like to answer all three. Yes.
Mr. Pallone. OK, when?
Dr. Howard. We are developing comprehensive plans.
Mr. Pallone. Can we have a date?
Dr. Howard. The task force that Dr. Agwunobi reported to
the Secretary in April. The conundrum, I think, we have, which
I think has to be recognized is that we don't have solid cost
estimates to do a comprehensive long-term plan at this point in
time.
Mr. Pallone. But can you give me an approximate date?
Dr. Howard. In October at the end of this grant period for
the treatment program, we will have exact numbers from the
grantees about what they have spent in this first grant year.
That will be extremely helpful for a comprehensive plan.
Mr. Pallone. So can we get this comprehensive, in the next
few months?
Dr. Howard. Well, that I will take back to the----
Mr. Pallone. Yes, I would like to have it, if possible,
right after October 1. And then is there going to be a new
person appointed to head this task force?
Dr. Howard. The Secretary at this time--I am co-chair of
that task force, so I am stepping in from the day-to-day
operational standpoint to be able to fill that role.
Mr. Pallone. So you don't know then?
Dr. Howard. The Secretary will designate a chair at some
point.
Mr. Pallone. All right, well why don't you take it back to
him that we would like that person sooner rather than later?
Dr. Howard. Yes, sir.
Mr. Pallone. OK. Mr. Deal.
Mr. Deal. Thank you. Dr. Howard, talking about the
treatment side of the issue and whether or not appropriate
funds are available, just looking at your written testimony, I
believe there is like $90 million in appropriated funds that
remain available, including the balance of the treatment funds
appropriated in the fiscal year 2006 and $50 million
appropriated in fiscal year 2007, and that is before adding the
$25 million that was included in the President's fiscal year
2008 budget. I assume that is correct since it is in your
testimony?
Dr. Howard. Those numbers are generally correct. The $90
million, because we have monies for monitoring, and then we
have monies for treatment. So the $90 million is on the
monitoring side, which was appropriated in 2003. The fifth year
of that is coming up in fiscal year 2008. Otherwise, the
numbers are perfectly correct.
Mr. Deal. OK, so there is money that has already been
appropriated that is not currently been expended. But the
projection is it will be expended over the next several years?
Dr. Howard. There is no doubt in my mind that medical
treatment will be expend all the money that we have. The issue
is the timing. As I mentioned to the chairman, we are looking
at right now at the end of this fiscal year, September 30, we
are looking at the certainty that we will have enough money to
fund monitoring and treatment fully for anyone who needs it as
of the end of this fiscal year.
When we look to that fiscal year 2008, which I think is
where you are looking, looking at approximately maybe $24 or
$25 million carried over from fiscal year 2007, plus the $50
million that the Congress generously appropriated us in the
Iraq supplemental. So that is nearly $75 million. That is not
counting the money that is currently in consideration by the
Congress, which I think on the House side was $50 million.
So we are entering fiscal year 2008 with funds, and again
we will continue to monitor this very closely. The Department
keeps a very close eye on this because, as I said, the
Secretary's intention is that these patients are not abandoned.
They do not run out of money. The programs will continue.
Mr. Deal. Now, as I understand it, most of the money and
the programs that you put in place go to grantees to carry out
various functions of the overall picture. Is that correct?
Dr. Howard. Yes, sir.
Mr. Deal. And one of the criticisms that apparently GAO has
made is the lack of documentation. Do you depend on those
grantees to furnish the numbers and the documentation to you?
Is that part of the grant function?
Dr. Howard. Yes, sir. A grant is an unusual vehicle, and
it is money given to grantees. They decide how to spend it.
There are some deliverables that are attached, but the data
really depends on the good working relationship between the
funder, the Federal Government, and the grantee. It is not
exactly like a contract, which is a little tighter deliverable.
Mr. Deal. And in order to make projections for future
needs, it would seem that you would need the kind of
demographics and the data that the grantees presumably would
have access to, but it appears in the GAO report that maybe
that information is not being funneled back up through the
system.
Dr. Howard. No, I would say the grantees are bending over
backwards to provide us with as much data at any time we ask.
The issue is that within large hospital medical centers, it is
not so easy to get actual cost accounting data from systems in
any health care system. So you are talking about five large
medical centers in the New York/New Jersey area. So our
grantee, which is providing the services, must access large
systems to be able to do that.
And as you know and we all know, sometimes health billing
isn't in real time. So there may be some lag, if you will, in
getting that data. So we are working on setting up alternative
systems so that we are able to set data in real time. Because
that is the question, as the chairman asked, as my Department
asked, as others in Congress asked. What is your cost estimate?
We want to know that with some certainty.
Mr. Deal. But it appears though that the effort to
determine who is out there and who has needs as a result of
this event of 9/11, the screening process is the largest search
screening process that has ever happened in the history of this
country in terms of outreach, is it not?
Dr. Howard. Exactly right. We have never undertaken, to my
knowledge, in the Federal Government this kind of process,
either on a registry side with 71,000 registrants that the city
is doing for us, or on the clinical side, the monitoring and
treatment. We have never run this kind of system.
And if I could add, sir, the 40,000 figure that is often
quoted, an early figure in 2001 and 2002 for the denominator of
responders and volunteers, is often used. But as you see, we
are nearly up to that 40,000 figure in registered, enrolled
responders and volunteers right now.
It gives us some pause that that may not be the accurate
total denominator. And in fact, the city Department of Health,
utilizing estimation method with Research Triangle Institute in
North Carolina has a number, an estimated number,
mathematically estimated, but around 90,000.
So somewhere between this 40,000 of enrolled individuals
that we have now in our program and this theoretical 90,000, we
will found out exactly how many because, as some of you have
noted, we do not know exactly how many people responded to the
World Trade Center disaster. We have no census track for those
individuals.
Mr. Deal. Thank you. Thank you, Mr. Chairman.
Mr. Pallone. Mr. Engel.
Mr. Engel. Thank you, Mr. Chairman. Dr. Howard, you heard
my opening statement. I am wondering if you could respond to
the criticism by the GAO that HHS has failed to ensure the
uninterrupted availability of screening services with Federal
responders. They have also commented that you failed to truly
provide screening and monitoring to people in other areas of
the country who came to Ground Zero. And, as you know, GAO said
that NIOSH has only been able to establish a network of
nationwide providers with 10 clinics in only seven States.
Do you believe HHS has acted appropriately in providing
services to responders? Because the evidence would seem not.
Dr. Howard. I am certainly not going to dispute the fact
that historically, as we have gone through establishing these
programs for responders that are not physically in the New York
City/New Jersey area, that we have had significant challenges.
But right now, I think we are on a good trajectory with a
contract through Mount Sinai for a large nationwide provider of
monitoring services called QTC.
So indeed, sir, I would agree that GAO has pointed out
historically a lot of fits and starts that we have had with
both the Federal screening program as well as the nationwide
program. We have done a lot of work lately, and I am hoping
that we are on the final trajectory to make sure that those
individuals have monitoring and treatment services. Now, the
treatment services, as I mentioned in my statement, are not
federally funded. The generous support of the Red Cross through
AOEC supports treatment.
Mr. Engel. Let me ask you this, Dr. Howard. In September
2006 Secretary Leavitt established an internal task force on
what you said to provide him with an analysis of the data and
options on how to address the health effects at Ground Zero.
In April of this year, the task force briefed the Secretary
on eight options that could be undertaken. We in Congress have
yet to hear about these various options. Can you please tell us
what the eight options are and if a decision has been made on a
long-term comprehensive plan to care for those who are sick
from 9/11?
Dr. Howard. Well, I think that all of us know the ways
health care is provided in the United States. I think we could
all probably sit down and make a list of Medicare, Medicaid,
the VA system, in addition to our own grant system through our
Centers of Excellence. Those are the kind of ideas that were
put in front of the Secretary. There are not any hidden ideas.
There is no magic bullet here. And all those types of systems
that are the systems by which health care is provided are ones
that the Secretary is considering.
Mr. Engel. And let me ask you a funding question. In July,
the New York Times reported on an internal HHS document, which
estimated yearly cost for the current World Trade Center
Medical Monitoring and Treatment Program at $195 million per
year. It also says that the costs will probably rise to $428
million per year. Let me ask you. How much do you anticipate
that the Medical Monitoring and Treatment Program will cost per
year?
Dr. Howard. First of all, as I emphasized to the chairman,
a lot of costs right now are highly speculative. You have to
start out with some assumptions. If we start out from the
grantee data, and this is grantee data that we have. We don't
have our own independent data.
We rely on the grantees, but if the grantees are spending
about $8,000 per patient per condition that they are treating,
pharmacy costs, diagnostic costs, treatment costs. You multiply
that times the number of people that are under treatment right
now, which is about 12,000, you get to the figure of about $90
or $100 million. So you build on those kinds of figures that
the grantees are producing.
By October, I am hoping that we will have more solid
estimation, but even for treatment at $100 million without
hospitalization--you have to add then hospitalization costs--
you can see that health care in America is not cheap whether it
is for responders or anyone else.
Mr. Engel. Well, let me ask you one final question with the
chairman's indulgence. You mentioned Mount Sinai. I know we
have people from New York City in the next panel. How does the
manner in which Congress is currently funding the World Trade
Center Medical Monitoring and Treatment Program, its piecemeal,
its year-to-year funding, how does that affect the ability of
grantees like the New York City Fire Department, Mount Sinai
and others to collect medical and cost data? And how does it
affect NIOSH's ability to administer the program in general?
Dr. Howard. Sir, I think it is a challenge. Institutions
would like consistent funding more than year to year despite my
personal assurances and the assurances of my Department that
the programs are not going to go away. If you are a CEO of
Mount Sinai or another medical center and you are looking at
space considerations, infrastructure development, they would
like some idea that the program is more than just that year. I
think that is a real challenge. We have to constantly reassure
them the program is not going away despite the current year-to-
year funding. But it is a challenge, sir.
Mr. Engel. Thank you, Doctor. Thank you, Mr. Chairman.
Mr. Pallone. Thank you. Mr. Ferguson. I'm sorry. I
apologize. Mr. Barton goes first.
Mr. Barton. Well, Mr. Ferguson was here before me. I don't
mind.
Mr. Pallone. No, I think the rules are since you are the
ranking member, I am supposed to call on you first.
Mr. Barton. Well, thank you. I will try not to take my
entire 5 minutes. Is the problem, the health problem with the
World Trade Centers in New York, is it a scope problem? It's
just the catastrophe was so large that it has overwhelmed the
healthcare system? Or is there something unique about the
problem itself from a health standpoint at the collapse of the
Trade Center Towers?
Dr. Howard. If I understand your question, sir, I don't
think that it is overwhelming. We have responded, and when I
say we, the entire family of grantees have responded I think
magnificently to the challenge of developing infrastructure to
be able to see this number of individuals in a monitoring
program and then refer those who need help to treatment. We
have some backlogs it is true, but I think the response from
infrastructure development is extremely positive.
On the issue of the uniqueness of the problem, I think we
have an entire body of data very consistent from multiple
investigators published in multiple peer review medical
journals that looks at a very limited number of conditions.
Chiefly those of the respiratory system, upper and lower
respiratory system. Chiefly that of mental health issues, post-
traumatic stress disorder, anxiety, depression, some
musculoskeletal disorders, some gastrointestinal disorders.
That is really what we have seen consistently in elevated
concentrations in these populations. So it is not a scope that
we cannot deal with. One of the issues with regard to
respiratory conditions is we don't exactly know what the nature
of the respiratory condition is in many cases, and we don't
know what the course is going to be. We don't know exactly how
to treat them. So I think that is a medical challenge.
Mr. Barton. But this WTC cough, is that just a
colloquialism that is used in New York but it is not a unique
condition caused by the specific type of environmental hazard
at the Trade Center?
Dr. Howard. Well, the World Trade Center cough was a name
that was acquired very early in the course of this disaster. It
really refers to one particular type of symptom that an
individual manifests. But lung disease in general, lower lung
disease in the lower part of the respiratory track always seems
to have cough as a symptom. So there is nothing specific or
unique about it.
Mr. Barton. There is not a unique disease or condition
associated with that specific location?
Dr. Howard. We don't know that for sure because a lot of
conditions that result in fibrosis of the lung, called
interstitial fibrosis of the lung, you look at a medical
textbook, there are 200 causes of it. Each one can be unique in
terms of the cause. So in that sense, we are not far enough
along the medical research line to be able to answer your
question fully.
Mr. Barton. OK, in terms of legal liability, is there a
specific problem between the Federal responders, the non-
Federal responders, the city of New York, in terms of legal
liability for work-related occupational accidents or conditions
that resulted as a result of responding to that disaster?
Dr. Howard. Sir, I am not sure I am qualified to address
that issue.
Mr. Barton. Well, that appears to be one of the primary
issues that we are trying to--at least the people that come
into my office, the private contractors have an indemnification
problem. They claim that they went and did the work and were
told by the city officials that they would be indemnified. And
now after the fact, they are finding they have not been
indemnified, and there are some potential lawsuits. And there
are requests for some Federal legislation to indemnify them. I
thought that was one of the primary reasons we are holding this
hearing, but maybe I am mistaken in that regard.
Dr. Howard. There are indeed lawsuits that are pending
against the city and its contractors, but I don't know any----
Mr. Barton. But I mean is there a generic Federal OSHA
regulation on that?
Dr. Howard. Not to my knowledge.
Mr. Barton. OK. Thank you, Mr. Chairman.
Mr. Pallone. Thank you. Let me just mention we have three
votes coming up, and we have about 10 minutes left. So Mr.
Ferguson will ask questions, and then we will recess Dr. Howard
and come back maybe half an hour or so. And we will have a few
more questions. Mr. Ferguson.
Mr. Ferguson. Thank you, Mr. Chairman. Thank you, Dr.
Howard, for being here. Your written statement appears to say
that there are millions of dollars in funds that are still
available under some of the Federal health programs. Is that a
correct interpretation of your written testimony?
Dr. Howard. Right, as I have indicated, we will probably
know for certain at the end of the grant period, October 30,
2007, how much money we will have expended and how much we will
have that will be carried over to fiscal year 2007. Right now,
we are estimating about $20 to $24 million will be carried
over. We have $50 million from the Iraq supplemental. So
already we have on hand $74 million. So we are not going to
enter 2008 without funding.
Mr. Ferguson. What is your best estimate as to when we will
know if that is going to be sufficient to meet some of the
health treatment requirements and challenges that these victims
are facing?
Dr. Howard. Exactly, and this is the question that
everyone wants to know, and my answer is often inadequate
because what I say is with time, as we gain more experience
with the true cost, the average cost per patient for treatment,
we are going to be able to give you a better number. Right now,
it is hovering around $8,000 per patient.
If you are seeing about 25 percent of the monitored
patients that are in treatment, then you can estimate those
costs. But they are relatively unstable right now. I would like
to see some more time take place at least until our grant
period at the end of October, maybe towards the end of the
fall, until we have some more stable numbers.
You can calculate any estimate at any time, but the
stability of that estimate from actuarial level is often
elusive.
Mr. Ferguson. What is being done in terms of R&D on new
treatments for some of these ailments? It seems like some of
the ailments that first responders and others are dealing with
are new and more difficult than perhaps other health challenges
that have typically been faced by a large number of people.
What sorts of new treatments are being developed? What are you
aware of in terms of those efforts underway?
Dr. Howard. We have no funds right now targeted
specifically to research. All of our funds that we have
appropriated go to monitoring and treatment. The grantee
institutions, many of them are academic medical centers, and
they have been very creative in looking at their clinical
findings and trying to figure out the best ways to treat.
But specifically, they do not have money to spend in
research per se, and that is something that we hope in fiscal
year 2008 to be able to utilize some of the already
appropriated money to be able to give to the grantees to engage
in research activities per se.
Mr. Ferguson. That was going to be my next question. What
is--do you have any specific recommendations at this point, or
are those sort of informal conversations you are having with
folks? I mean are we going to need to reprogram funds? What is
your sense of how that can happen? It sounds like you believe
it ought to happen.
Dr. Howard. Yes.
Mr. Ferguson. Do you have any further--kind of any more
specific recommendations at this point, or are you developing
those now?
Dr. Howard. Well, within the day-to-day measurement
structure that we do, our own plan that I administer, we are
trying to set aside targeted funds so that grantees can look
into some issues with regard to what is the exact nature of the
respiratory conditions and how are they best treated.
But we don't have money appropriated by the Congress
specifically for that purpose; although, everyone that I have
talked to within the Department, within Congress, of course, is
very attuned to that issue. And I think the grantees might be,
Mt. Sinai and others that are here on the other panel, might be
best to ask about their efforts because they have done heroic
efforts with very little money thus far to move the medical
science along.
Mr. Ferguson. Just in closing, Mr. Chairman, it seems like
that might be an area that we really would want to examine
further if we are experiencing these very significant health
problems, if these folks are experiencing these very
significant health problems. Perhaps we should also be looking
at new and different ways of treating them in addition to just
simply plowing resources into the current treatments that we
have which may or may not be as effective as they need to be.
Perhaps some of our efforts should be focused on some different
and better treatments and some research into, perhaps we can
take this terrible situation and create some good from it in
terms of finding new treatments for ailments and illnesses and
symptoms that maybe we otherwise wouldn't have an opportunity
to find.
Dr. Howard. Exactly, and in my subcommittee of the
Secretary's task force, the Science Subcommittee, we have
recommended a number of studies along those lines. So that is a
very important point that you are making.
Mr. Ferguson. Thank you. Thank you, Mr. Chairman.
Mr. Pallone. Thank you. Dr. Howard, we are going to take
about a half an hour recess to vote on the floor, and then we
will have some questions when we come back. We won't have a
second round though. We will just go through everybody.
Everybody will have a chance, and then we will go to the second
panel. Thank you. The subcommittee is in recess.
[Recess.]
Mr. Pallone. The subcommittee will reconvene.
Dr. Howard, we left off with Congressman Fossella asking
questions.
Mr. Fossella. Thank you, Mr. Chairman, and thank you again,
Dr. Howard, and thank you for all you have done. I know in your
capacity you have been very vigilant and a very bright light, I
think, within efforts to try to reconcile what we have been
trying to reconcile for 6 years.
And I could just characterize, maybe if you will for lack
of a better phrase, the perception that--and I speak this on a
personal level, and perhaps I speak for others--is there is a
sense that we are constantly sort of dragging folks to the
table. From securing just less than 2 years ago the Federal
funding for treatment, to your appointment, to Dr. Agwunobi's
I guess there is a perception that--I won't say perception.
There is an understanding that we would love for, in this case,
the executive branch to be more out front leading the charge.
And what has happened in the last 6 years from the private
sector to the health care centers to the Centers for Excellence
to the mayor's office is just an understanding of this is too
big and too important to wait for an answer and wait for the
cavalry to come. So they have been doing the job.
For example, we talk about the inability to truly estimate,
and we are always going to have disagreements on the margins
and whether the number is 50,000 or 51,000, 52,000. But I find
it curious as to how New York City could estimate what
treatment would cost.
The mayor, if my understanding is correct, has committed
$100 million until 2011. Why is it that the Federal Government
can't come forward and say this is what we are going to commit
until 2011 for the sake of argument? I recognize the nuances of
the annual appropriations process. But wouldn't it be so much
better if the cavalry came in and said whatever it is going to
cost over the next 2, 3, 4, 5 years, until we get a sense of
reliable data, it is going to happen?
And along those lines, April 3 is our understanding
pursuant to the letter Mr. Pallone cited. Did the task force
provide recommendations to HHS regarding what they have
determined to date?
Dr. Howard. With regard to the latter question, the task
force was divided into two groups, a finance group and a
science group. I headed the science group, and we made
recommendations to the Secretary from both of the
subcommittees, from the finance side and from the science side.
A lot of the science issues we are trying to
operationalize, looking at research opportunities to move the
science forward with the current grantees. From the finance
side, I think again despite those issues of policy that you
talked about, the Department is extremely interested in the
stability of cost estimates so that they are able to be able to
project beyond just this last 6 months that we have. I know
that is a big issue in the Department.
Budget people, which I am not one, want some certainty in
those budget estimates. With regard to the policy options that
you mentioned, they are beyond my task, and I will certainly
take that back to the Department.
Mr. Fossella. Well, because I think there has been a vacuum
in a way, and it is being filled in different ways. It is an
ultimate collaboration, especially, I think, reflecting the
legislation we introduced last night. And we would love to have
a comment from sort of HHS as to whether they would support,
let us say, that legislation. Have you had a chance to review
the legislation or at least an outline of it?
Dr. Howard. No, I haven't had a chance to read the
legislation, and, of course, the administration's position on
legislation is decided at a level different than my own.
Mr. Fossella. Well, we would love again some dialog. If the
goal--and you heard it in a bipartisan way here from those who
just declare it as an emergency and it demands a national
response. To me, national dictates a Federal response.
And it would also free up personnel and people at the city
level, the municipal level. There is more litigation taking
place. Why can't we get these individuals out of the courtroom,
get the lawyers out of the courtroom and settle this case?
I do think that with a strong Federal commitment, a lot of
that would find its way to a swifter conclusion if there was a
notion that the city of New York would not have to shoulder so
much a burden. And likewise and most importantly again I get
back to the insurance of monitoring and treatment that Mr.
Ferguson brought up, and I think you would concur, the notion
that research--why should we be 6 years later just talking
about whether we should be providing funding for research? I
mean it is a shame.
One just quick question. Do you think--and maybe you have
answered it, but if there is any other way you can answer it
that will elaborate--the biggest problem adjustment the
Department would recommend at this time to improve the health
monitoring treatment program? You talked about the grantees.
You talked about more data, more information.
Is there any other thing that we should be doing in a
legislative mechanism to free up flexibility at your end to get
the answers or solutions we are looking for?
Dr. Howard. From the scientific side, I have always said
that the money that we have had to date goes to monitoring
services and now treatment services because it is small amounts
of money, and we are always trying to make sure that we have
enough to get from year to year.
We have not expended any significant amount of money on
real research into the causes of some of these diseases or
their best treatments because we have been trying to shepherd
the money for services. So I think that is one area that we
have spoken about already that, from my point of view as
heading the Science Subcommittee that made recommendations to
the Secretary, this is a really important issue. Otherwise, we
are not going to know exactly what the contours of the problems
are and how best to treat these people.
Mr. Fossella. Mr. Chairman, again I would like just on a
personal level thank Dr. Howard. He is very passionate about
what he does, and again I said the bright light because you
have been terrific in helping us all shepherd through this. And
we would love to get more folks seeing it your way.
Thank you, Mr. Chairman. I yield back.
Mr. Pallone. Thank you. Thank you, Dr. Howard. We are done
with your questions.
Dr. Howard. Thank you.
Mr. Pallone. And we appreciate this, and I know this is
going to be an ongoing concern so. I will just repeat again we
do want a plan from the administration, and we also would like
to see someone appointed as the head of that task force as
quickly as possible.
Dr. Howard. Thank you.
Mr. Pallone. If you will send that back. Thank you. And I
will ask the second panel to come forward please.
Thank you all for being here today. Let me just introduce
everybody. Starting on my left is Mr. John Vinciguerra from the
fire department of New York, although it says that you actually
live in New Egypt, New Jersey. That is a long commute. And then
we have Dr. Iris Udasin who is associate professor of
environmental and occupational medicine at the University of
Medicine and Dentistry, New Jersey, the Robert Wood Johnson
Medical School. It is always a lot to say all that. She is
actually from the clinical center that is in my district in
Piscataway. Thank you for being here, and thank you for all
that you do. And then we have Dr. Robin Herbert who is
associate professor of the community and preventative medicine
at Mount Sinai School of Medicine in Manhattan. And we have Ms.
Cynthia Bascetta, who is director of health care issues for the
Government Accounting Office for the GAO. Dr. Jim Melius who is
administrator for New York State Laborers. And Mr. Edward
Skyler who is the deputy mayor for administration in the city
of New York, representing the mayor of New York.
So let me mention again that each witness has 5 minutes for
their opening statement. Obviously your written statements will
be submitted for the record. So we would like to have you keep
to the 5 minutes if you could. You may, if you wish, submit
additional brief and pertinent statements in writing for
inclusion into the record later as well. And I will start with
you, Mr. Vinciguerra. Thank you for being here, and thank you
for all that you have done.
STATEMENT OF JOHN VINCIGUERRA, FIRE DEPARTMENT OF NEW YORK
(RETIRED), NEW EGYPT, NJ
Mr. Vinciguerra. Good morning. Thank you for having me. I
was glad to hear the testimony from Dr. Howard. It was nice to
sort of be reassured that the money is not going to be running
out tomorrow. I would just like to read my testimony and take
any questions you might have.
My name is John Vinciguerra. I am 39 years old and a father
of four. On January of this year, I was forced to retire as
lieutenant with the fire department, New York City, EMS
command, due to the lung damage that I sustained during the
World Trade Center disaster rescue and recovery effort.
It was one of the saddest days of my life when I had to
turn in my badge and end an 18-year career. Prior to becoming
ill, I was in good health, able to carry equipment and victims
both up and down many flights of stairs. I love to be able to
help people and felt I had one of the best jobs in the world.
September 11 started like any other day. I picked up an
overtime shift on the night tour. Left work early that morning.
I went home, hopped into bed, tried to get a nap because I had
the rest of the day off. Wanted to have time to spend with my
family. My wife came up and woke me up to tell me what was
happening. We watched the second plane hit the towers on TV. I
was wide awake in an instant.
Along with my wife, who was also an EMT, we grabbed our
gear and drove to the city. I was told to report to my station
just over the Brooklyn Bridge, began transporting equipment and
personnel back and forth to Ground Zero. I worked at the World
Trade Center site for many days, both on the piles as part of
the bucket brigade, treating people who were injured at the
site and supervising EMS crews from around North America.
I averaged twice a week doing 16- to 24-hour shifts each
time until about January 2002. At that point, it was just too
difficult to be there anymore.
While I do truly feel blessed to be here and be able to
talk to you, and I know there are many others in much worse
condition than myself, I also know that this has affected me in
three major ways, both physically, mentally, and financially.
As far as physically, like many others, I developed the World
Trade Center cough. I was given medication by the fire
department doctors, which was changed by my private doctor.
When my breathing continued to deteriorate, another medication
was added. I continued to work and watch my lung volumes drop
on my annual physicals and became more and more run down but
wanted to try to work through it.
On April 30, 2005, that came to an end. After suffering at
home for 24 hours hoping I just had a bad virus, I was taken to
Robert Wood University Hospital in Hamilton. I was hospitalized
for severe respiratory distress and admitted to the ICU in it.
A scan in my lungs revealed a spot, and the oxygen profusion in
my body was so poor that they thought I had a pulmonary
embolus, which is a blood clot on my lungs.
Unfortunately, this was not the case. What was happening
was that the scarring in my lungs from breathing in all the
toxins had become so bad that I was no longer able to move
enough air, and my body was suffocating. I was also told that I
know had high blood pressure, and I had stopped breathing
several times during the night.
I was loaded up with steroids, antibiotics, and many other
medications, and discharged a few days later. I currently
cannot walk up a flight of stairs without running out of
breath. My lung volumes run between 30 to 60 percent of what
they should be. I cannot run and play outside with my children.
I need to be cautious when temperature or humidity changes. I
am very sensitive to dust, pollen, and pollution, and I spend
most of my time indoors with a hepa filter that is my best
friend.
I have to take at least seven medications a day every day
that cause both fatigue and weight gain. Due to my sleep apnea,
I now have to wear a mask over my face at night that blows air
into my nose to keep my airway open. Every time I put it on, I
feel my ears pop as if I am on an airplane. And it has also
greatly diminished my sense of smell, but it is much better
than the prospect of suffocating in my sleep and stopping
breathing.
Since becoming ill, I have been diagnosed with anxiety and
depression, both related to post-traumatic stress disorder. I
have tried medications, but the side effects only seem to make
matters worse. Luckily for me, I have a strong marriage, and my
wife has been there for me. But the stress this has put on me,
my marriage, and our family is enormous.
After I first reported of my illness to the city of New
York, my claim was denied. I was told that since more than 2
years has passed since September 11, I was no longer eligible
for file a Worker's Compensation claim. As you could imagine, I
was despondent. The thought of being left on my own. I felt
that I had done all I could to help this city and this country
in its time of need, and now I was being abandoned.
Fortunately, the New York media was relentless in reporting
both my case and the plight of others in similar situations.
Legislation was introduced and passed in New York to extend the
deadline to file for a claim. Fifteen months after becoming
sick, as legislation was taking effect, on July 26, my case was
finally approved on appeal. This event lead the way to me being
retired and the end of my career. It was not how I pictured
that it would end, and it is certainly a disappointment to me.
Financially, here there is a light at the end of the
tunnel, but things are going to get worse before they finally
get better. Since it took 15 months for my case to get
approved, I was responsible for all my doctors' visits and
medication copays. I was not working and was unable to pay all
the bills and continue to put food on the table. I was forced
to sell my home to try to keep my head above water, and it
didn't take long for the creditors to start circling.
Even now, it has been over 2 years since I first became ill
and a year since my case has been approved. But the New York
City Law Department has still not paid the bills that have
accumulated. My original pulmonologist told me a year ago that
he would not be able to see me anymore because he has not been
paid and still has not been paid to this day.
In May 2007, I applied for Social Security disability.
After following up with several phone calls, I was told in
August that despite all the documentation and the fact that I
was forced to retire from my respiratory problems, I would have
to be sent for an anxiety evaluation. And the earliest
appointment that was available was the end of September, the
end of this month.
On top of all this, although I was granted a pension, I
will not come off payroll for the fire department until
September 26 of 2007. Then I will have to wait until November
to get my first pension check, and when that does come, it is
only going to be a partial payment until they get the numbers
spooled up, and they can adjust them.
Since I have a biweekly pay mortgage, I am trying to work
with my bank so that I won't be missing too many payments. I
have also tried to take a pension loan, but since I am so near
to retirement, it is not considered a disbursement. Since it is
a disbursement, I can't take it until after my retirement date.
After that, it won't arrive--they won't cut the check until
after my retirement date and will take another 30 to 45 days to
arrive on top of that. I also looked to refinance my current
mortgage, but due to late medical bills, the banks want over 10
percent for a new mortgage. It would be a long time before I
recover financially.
While I feel good that hearings such as this are taking
place and it is comforting to know that so many people are
concerned with me and my fellow recovery workers, there still
remains much to be done. More money is needed, not just for
monitoring, but for treatment of symptoms and conditions that
are discovered. Financial assistance needs to be provided for
those in need of help, whether temporary or permanently. An
advocate should be appointed to help cut through the red tape
that is facing not just the responders but also the residents
and school children that were affected. Because what good is a
program if the people that need it most don't know it is there
and can't get it to work for them?
Also the World Trade Center Captive Insurance Fund should
be abolished and replaced with a compensation fund or another
program that will put money to use where it is needed. It is
disgraceful that the lead administrator is being paid $300,000
a year to run a hostile fund that is throwing tens of millions
of dollars at lawyers to prevent giving financial support to
those it was created for. Thank you very much for your time and
consideration.
[The prepared statement of Mr. Vinciguerra follows:]
Statement of John Vinciguerra
My name is John Vinciguerra. I am 39 years old and a
father of four. January of this year I was forced to retire as
a Lieutenant with the FDNY EMS command due to lung damage
sustained during the World Trade Center disaster rescue and
recovery. It was one of the saddest moments of my life when I
had to turn in my badge and end an 18 year career. Prior to
becoming ill I was in good health and able to carry equipment
and victims both up and down many flights of stairs. I loved to
be able to help people and felt I had one of the best jobs in
the world.
September 11, 2001 started for me like any other day. I
had picked up an overtime shift on the night tour and left work
in the early morning. I went home and climbed into bed to grab
a quick nap. My wife came and woke me up to tell me what was
happening, and we watched the second plane hit the towers. I
was wide awake in an instant. Along with my wife who is also an
EMT, we grabbed our gear and drove to the city. I was told to
report to my station just over the Brooklyn Bridge and began
transporting personnel and equipment back and forth to ground
zero. I worked at the WTC site for many days on the pile as
part of the bucket brigade, treating people who were injured at
the site, and supervising EMS crews from around North America.
I averaged about twice a week doing 16-24 hour shifts each time
until January of 2002. After that, it was just too difficult to
be there. And while I truly feel blessed to be here and able to
talk to you, and I know that there are many others in much
worse condition than myself, I also know that this event has
effected me in three major ways, physically, mentally, and
financially.
Physically; like many others I developed the ``World Trade
Center Cough'', and was given medication by the FDNY doctors.
This was quickly changed by my private doctor. When my
breathing continued to deteriorate, another medication was
added. I continued to work and watch my lung volumes drop at my
annual FDNY physicals. I became more and more run down but
wanted to work through it. On April 30 2005 that came to an
end. After suffering at home for 24 hours hoping I just had a
bad virus, I was taken to Robert Wood University Hospital in
Hamilton NJ. I was hospitalized for severe respiratory distress
and admitted to the intensive care unit. A scan of my lungs
revealed a spot, and the oxygen perfusion in my body was so
poor that they though I had a pulmonary embolus, or blood clot
in my lungs. Unfortunately this was not the case. What was
happening, was that the scaring in my lungs from breathing in
all of the toxins had become so bad that I was no longer able
to move enough air, and my body was suffocating. I was also
told that I now had high blood pressure, and I had stopped
breathing several times during the night. I was loaded up with
steroids, antibiotics, and many other medications, and
discharged a few days later. I currently cannot walk up a
flight of stairs without running out of breath. My lung volumes
run from between 30 percent to 60 percent of what they should
be. I can not run and play outside with my children, I need to
be cautious when the temperature or humidity changes, I am very
sensitive to dust, pollen, and pollution, and I spend most of
my time in my room with a hepa air filter which is my new best
friend. I have to take at least seven mediations a day that
cause both fatigue and weight gain. Due to my sleep apnea I
have to wear a mask over my face at night that blows air into
my nose and keeps my airways open. Every time I put it on it
causes my ears to pop as if I were on an airplane, and it has
greatly diminished my sense of smell. But it is much better
than the prospect of suffocating in my sleep.
Mentally; since becoming ill, I have been diagnosed with
anxiety and depression. Both related to post traumatic stress
disorder. I have tried medication but the side effects only
seemed to make matters worse. Luckily for me I have a strong
marriage and my wife has been there for me. But the stress that
has been put on me, our marriage, and our family is enormous.
After I first reported my illness to the City of New York, my
claim was denied. I was told that since more than two years had
passed since Sept 11, 2001, that I was no longer eligible to
file a workers compensation claim. As you could imagine, I was
despondent at the thought of being left on my own. I felt that
I had done all I could to help the City, and this country in
its time of need, and now I was being abandoned. Fortunately
the New York media was relentless in reporting both my case and
the plight of others in similar circumstances. Legislation was
introduced and passed in New York to extend the deadline to
file a claim. Fifteen months after becoming sick and as
legislation was taking effect, in July 2006 my case was
approved on appeal. This event led the way to retirement and
the end of my career. This was not how I pictured that it would
end and is certainly a disappointment to me.
Financially; here there is a light at the end of the
tunnel, but things are going to get worse before they get
better. Since it took fifteen months for my case to get
approved, I was responsible for all my doctors visits and
medication co-pays. I was not working, and I was unable to pay
all of the bills and continue to put food on the table. I was
forced to sell my home to try to keep my head above water. It
didn't take long for the creditors to start circling. Even now
it has been over two years since I became ill, and a year since
the case has been approved, but the New York City Law
Deptartment still has not paid the bills that accumulated. My
original Pulmonologist told me a year ago that he would not be
able to see me anymore because he had not been paid and he
still has not been paid to this day. In May 2007 I applied for
Social Security Disability. After following up with several
phone calls, I was told in August that despite all of the
documentation and the fact that I was forced to retire for my
respiratory problems, I would have to be sent for an anxiety
evaluation, and the earliest appointment was the end of
September. On top of all of this, although I was granted a
pension, I will not come off of payroll for the FDNY on
September 26, 2007, then I will have to wait until November
2007 to get my first check from the pension department. And
when it does arrive, it will only be a partial payment (less
than half) for the first 3 to 6 months until the final numbers
can be adjusted. Since I have a bi-weekly pay mortgage, I am
trying to work with my bank so as not to miss two payments. I
tried to take a pension loan, but since I am so near
retirement, It is now considered a ``disbursement'' and I
cannot take it until I retire. On top of that, it needs to be
sent out as a check and will not arrive for 30-45 days. I also
looked into refinancing my current mortgage, but due to the
late medical bills, the banks want over 10 percent for a new
loan. It will be a long time before I recover financially.
While I feel that it is a good thing that hearings such as
this are taking place, and it is comforting that so many people
are concerned with me and my fellow recovery workers, there
still remains much to be done. More money is needed not just
for monitoring, but for treatment of the symptoms and
conditions that are discovered. Financial assistance needs to
be provided to help those in need whether temporary or
permanently. An advocate should be appointed to help cut
through the red tape that is facing not just the responders,
but also the residents and school children that were also
effected, because what good is a program if the people that
need it the most don't know it is there or cannot get it to
work for them. The WTC Captive insurance fund should be
abolished and replaced with a compensation fund or another
program that will put the money to use where it is needed. It
is disgraceful that the lead administrator is being paid
$300,000.00 per year to run a hostile fund that is throwing
tens of millions of dollars at lawyers to prevent giving
financial support to those it was created for. Thank you very
much for your time and consideration.
----------
Mr. Pallone. Thank you so much really. I would like to ask
Dr. Udasin to go next if you would. Is there a concern?
Ms. Udasin. Yes, I had some slides.
Mr. Pallone. You have some slides?
STATEMENT OF IRIS UDASIN, M.D., ASSOCIATE PROFESSOR,
ENVIRONMENTAL AND OCCUPATIONAL MEDICINE, UNIVERSITY OF MEDICINE
AND DENTISTRY OF NEW JERSEY, ROBERT WOOD JOHNSON MEDICAL SCHOOL
Dr. Udasin. Chairman Pallone, Ranking Member Deal, and
honorable members of the Energy and Commerce Health
Subcommittee, I am Iris Udasin, associate professor at UMDNJ,
Robert Wood Johnson School of Medicine, and New Jersey
principal investigator of the World Trade Center Medical
Monitoring and Treatment Program.
I am board certified in internal and occupational medicine.
My experience includes more than 20 years of practice as a real
doctor, diagnosing and treating occupational and environmental
illnesses. I have personally examined approximately 1,000
patients who responded to the tragedy.
The complex mixture of contaminated material present at the
site has resulted in an unprecedented incidents of illness.
Submitted with my testimony is a magnified dust particle, up
there, that was collected at the site. Scientists from my
institution were involved in characterizing this material. Even
6 years after the tragic event, our patients present with
significant respiratory and gastrointestinal illnesses
complicated by mental health disorders. In order to fully
appreciate the diseases in this population, I direct your
attention to the photographs of Deputy Chief Lacey Wirkus and
the other members of the Elizabeth Fire Department that
responded to this tragic event.
These photographs illustrate the roots of exposure and
explain the mechanism of illnesses sustained by the population.
Though the individuals in this photograph and the next one had
respiratory protective equipment, the masks became weighted
down by contaminated material and perspiration and did not
offer sustained protection.
As depicted in the picture, there were huge amounts of dust
and smoke debris on his face, clothing, hair, and skin. The
material was absorbed by breathing, skin contact, and
ingestion, as workers were contaminated even as they ate and
drank at the site.
Most of our patients continue to work today despite
suffering from conditions such as asthma, bronchitis,
sinusitis, laryngitis, and gastroesophageal reflux. They have
persistent shortness of breath, wheezing, cough, chest pain,
sinus pressure, sore throat, indigestion, heartburn, decreased
exercise tolerance. Many suffer from post-traumatic stress
disorder and depression.
Some have lost or limited health insurance benefits or
financial hardship from loss of income. Uninsured patients
clearly need the services of the medical monitoring and
treatment program as they have minimal or no medical care.
However, despite the fact that the majority of patients seen in
New Jersey are insured, at least 60 percent are either
untreated or undertreated for complicated medical and mental
health illnesses.
Furthermore, typical health insurance has insufficient
coverage for mental health. In order to correctly diagnose
World Trade-related illnesses, health professionals spend
several hours evaluating the medical, occupational exposure and
psychological histories and perform detailed physical and
mental health assessments. These assessments require more time
than insurance typically allows for these encounters.
Specialized testing may be needed to appropriately diagnose
our patients who have unusual presentations of asthma and other
respiratory illnesses. Many community physicians do not have
access to these tests or may lack of the knowledge of the
unique aspect of diseases in this population.
The diagnostic dilemmas we face can be appreciated by the
following patient presentations. Patient No. 1 is a 31-year-old
man who presented with a dry cough, sore throat, anxiety, and
decreased ability to exercise. He was being treated for anxiety
and had a nasal spray that didn't work and an asthma medication
that he took occasionally. Further examination showed the
presence of severe sinusitis and asthma.
His respiratory symptoms have improved after sinus surgery
and proper treatment of the asthma. His anxiety level has
improved but still requires prescription medication. His
exercise tolerance has returned to baseline.
Patient 2 is a 46-year-old with severe coughing and
heartburn. He took several cough medicines and nasal sprays
with no relief. His examination and baseline breathing tests
were normal, but his methacholine challenge test was diagnostic
for asthma. And his endoscopy showed gastroesophageal reflux.
He responded well to treatment but requires five prescription
medications.
Patient 3 is a 39-year-old previously healthy man who was
extremely short of breath and had a chronic cough. His original
diagnosis was pneumonia, which did not respond to antibiotics.
Biopsy of his lungs showed sarcoidosis. He currently takes
three prescription medications but is disabled from his work as
a New York City police officer.
Once the diagnosis is made, treatment can be complicated
and frequently require several prescription medications. Even
in patients who do have insurance, many have prohibitive copays
or insurance constraints which prevent them from receiving
brand name medications. Beyond the above conditions, there is
concern about the possibility of life-threatening, long-term,
chronic illnesses such as pulmonary fibrosis, sarcoid, cancer,
and heart disease. The monitoring program provides the
opportunity for early detection and intervention to potentially
lessen the severity of these illnesses.
It is our goal to improve the treatment of acute and
persistent health problems, enabling a decrease in future
illness and disability and hopefully more productive lives. As
a concerned physician, I implore you to support the 9/11 Health
and Compensation Act and continue the funding by NIOSH of a
program which allows experienced physicians to treat these
complicated illnesses as well as provide adequate diagnostic
testing and prescription medications. We want to continue to
provide physical and mental health care for those people who
willingly took care of all of the rest of us.
Thank you for the opportunity to appear before the
committee.
[The prepared statement of Dr. Udasin follows:
Testimony of Iris G. Udasin, M.D.
Chairman Pallone, Ranking Member Deal, and honorable
members of the Energy and Commerce Health Subcommittee. I am
Iris G. Udasin, M.D., associate professor of Environmental and
Occupational Medicine at University of Medicine and Dentistry
of New Jersey-Robert Wood Johnson School of Medicine and New
Jersey Principal Investigator of the World Trade Center Medical
Monitoring and Treatment Program. I am board certified in
internal medicine and occupational medicine and serve as
director of employee health for the University, and course
director for the medical student course in clinical prevention.
My experience includes more than 20 years of clinical practice
as a ``real doctor'' diagnosing and treating occupational and
environmental illnesses. I have personally examined and treated
approximately 1,000 patients who responded to the tragedy at
the World Trade Center.
The complex mixture of contaminated material present at the
WTC site has resulted in an unprecedented incidence of illness.
This material was highly alkaline, leading to the absorption of
large particles of cement, glass, asbestos, and other fibrous
materials as well as toxic gases from combustion. Submitted
with my testimony is a magnified picture of a dust particle
that was collected from the WTC site. It is noted that
scientists at EOHSI (the Environmental and Occupational Health
Sciences Institute, a joint project of UMDNJ and Rutgers
University) were involved in characterizing this toxic
material. Even 6 years after the tragic event, at least two
thirds of our patients present with significant respiratory and
gastrointestinal illnesses complicated by mental health
disorders. In order to fully appreciate the diseases that are
now prevalent in this population, I direct your attention to
the photographs of Deputy Chief Lacey Wirkus and some of the
other members of the Elizabeth, New Jersey Fire Department that
responded to the tragic event. These photographs (see appendix)
illustrate the routes of exposure to the toxic material and
help to explain the mechanism of the illnesses sustained by the
responders. Chief Wirkus donated these photographs for the
purpose of representing all of the responders who included
construction workers, communication workers, law enforcement,
health care workers, as well as all of the paid and volunteer
rescue and recovery personnel. Though the individuals in this
photograph had respiratory protective equipment, you can see
that the masks became weighted down by the contaminated
material and did not offer sustained protection from the toxic
material. As depicted in the picture, there were huge amounts
of dust and smoke debris on his face, clothing, hair, and any
other unprotected skin. The work was physically demanding, but
these workers persisted, working shifts of 12 hours of more in
the days that immediately followed the tragedy.
The toxic material was absorbed by breathing, skin contact,
and ingestion, as workers were contaminated even as they ate
and drank at the site. This population continued to work at the
site, and most of them continue to work today despite suffering
from conditions such as asthma, bronchitis, sinusitis,
laryngitis, rhinitis, and gastroesophageal reflux. They have
persistent symptoms including difficulty breathing, shortness
of breath, wheezing, chronic cough, chest pain, head
congestion, sinus pressure, sore throat, indigestion, and
heartburn. Some patients present with decreased exercise
tolerance and fatigue, which potentially could disable them
from sensitive law enforcement, fire fighting and construction
work. Many of our patients suffer from post traumatic stress
disorder and depression. Some of our patients are now not able
to work, or are working at lower status jobs. Many have lost or
have limited health insurance benefits as they are not able to
work at their chosen jobs, or were forced to take early
retirement.
Uninsured patients and those without prescription benefit
plans clearly need the services of the WTC Medical Monitoring
and Treatment Program as they have minimal or no medical care.
However, despite the fact that the majority of patients seen at
our New Jersey site have at least some health insurance and do
have primary care physicians, at least 60 percent of our
patients are either untreated or under treated for complicated
and comorbid medical and mental health illnesses. Furthermore,
typical health insurance covers mental health issues separately
and often has insufficient reimbursement rates, rendering
mental health care extremely difficult to afford. In order to
correctly diagnose these illnesses, it is necessary for the
health professionals to spend significant amounts of time
simultaneously evaluating the medical, occupational, exposure,
and psychological histories, as well as performing a detailed
physical and mental health examination. These medical
monitoring assessments can take several hours to result in
proper diagnosis of our patients, far longer than what
insurance covers for typical community encounters. In many
instances additional testing is necessary; including spirometry
with flow volume loops, x-rays, and laboratory testing. Often
specialized testing such as methacholine challenge testing,
rhinolaryngoscopy, endoscopy, and overnight polysomnography is
needed to appropriately diagnose our patients. The purpose of
these specialized tests is to identify and treat unusual
presentations of asthma and other respiratory illnesses which
are described in the examples below. Many community physicians
do not have access to these tests, while our UMDNJ specialists
have built up a substantial hands-on knowledge of the unique
aspects of routine diseases in this population. Additionally,
because of the atypical presentations of our patients, it is
difficult to assess these combination of conditions, even for
physicians with extensive experience in the individual
conditions.
The diagnostic dilemmas faced by examining physicians can
be appreciated by the following patient presentations:
Patient 1 is a 31 year old man who presented with a dry
cough, sore throat, anxiety, and decreased ability to exercise.
He was being treated for anxiety and had a nasal spray that
didn't work and an asthma medication that he took occasionally.
Further examination showed the presence of severe sinusitis, as
well as asthma. His respiratory symptoms have improved after
sinus surgery and proper treatment of his asthma. His anxiety
level has improved, but still requires prescription medication
for his anxiety and asthma. His exercise tolerance has returned
to previous levels.
Patient 2 is a 46 year old man with severe coughing and
heartburn. He had been on several prescription cough medicines
as well as numerous nasal sprays with no relief. His physical
examination was normal, as was his baseline breathing test.
However, his methacholine challenge testing was diagnostic of
asthma or reactive disease, and he responded well to
prescription strength asthma medication, but does require three
asthma medications on a daily basis and one medication on an as
needed basis. He was also diagnosed with gastroesophageal
reflux, and requires prescription strength medication.
Patient 3 is a 39 year old previously healthy man who was
extremely short of breath and had a chronic cough. His original
diagnosis was pneumonia. He received several courses of
antibiotics without relief. Biopsy of his lungs was consistent
with sarcoidosis. He currently takes three prescription
strength medications, but is unfortunately disabled from his
work as a police officer.
Once the diagnosis is made, treatment is also complicated
and frequently requires the use of several prescription
medications. This is clearly a burden to patients who do not
have prescription drug coverage. Even in patients who do have
coverage, many have prohibitive co-pays, or have insurance
constraints which prevent them from receiving brand name
medications which might better treat their illnesses.
Beyond the common upper and lower respiratory conditions
that affect the majority of our patients, there is concern
about the possibility of life-threatening long term chronic
illnesses such as pulmonary fibrosis, sarcoidosis, cancer, and
heart disease. The monitoring program provides the opportunity
for early detection and intervention to potentially lessen the
severity of these illnesses. It is our goal to improve
treatment of the acute and persistent health problems seen now
in our patients, enabling a decrease in future illness and
disability and hopefully more productive lives.
In order to continue to allow experienced physicians to
treat these complicated illnesses as well as provide adequate
diagnostic testing and prescription medications that are
needed, as a concerned physician I implore you to continue the
funding of the program by the National Institute for
Occupational Safety and Health. We continue to provide physical
and mental health care for those people who willingly care for
all of the rest of us.
Thank you for this opportunity to appear before the
subcommittee.
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Mr. Pallone. Thank you, and again thank you so much for all
that you have done. Next we have Dr. Robin Herbert from Mount
Sinai. Thank you.
STATEMENT OF ROBIN HERBERT, M.D. ASSOCIATE PROFESSOR, COMMUNITY
AND PREVENTATIVE MEDICINE, MOUNT SINAI SCHOOL OF MEDICINE, NEW
YORK, NY
Dr. Herbert. Thank you. Chairman Pallone and other esteemed
members of the committee, thank you so much for inviting me to
testify today. I want to thank the New Yorkers on the
subcommittee, Congressman Weiner, Mr. Engel, and other members
from New Jersey, Congressman Ferguson in addition to the chair.
Finally I would like to extend my thanks to Congressman
Fossella as well as Congresswoman Maloney and Congressman
Nadler and the entire New York delegation for their steadfast
support of World Trade Center responders.
I direct the data and coordination center of the World
Trade Center Medial Monitoring and Treatment Program. This is a
consortium of five clinical Centers of Excellence in New York
and New Jersey. The WTC Monitoring and Treatment Program
diagnoses, treats, documents, and tracks the illnesses that
have developed and the workers and volunteers who responded to
9/11.
We perform this work along with our sister Center of
Excellence at the New York Fire Department. In the days, weeks,
and months that followed September 11, 2001, more than 50,000
hardworking Americans from across the United States came to
serve selflessly without concern for their health and well
being. These responders included both traditional responders,
such as firefighters and law enforcement officers, as well as
many non-traditional responders, such as members of the
building trades, utility workers, building cleaners, and a vast
array of other working groups. And when I talk about
responders, I am talking about this broad array of workers and
volunteers.
In the months after the terrorist attacks, concerns grew
about the potential health effects among the responders. In
2001, as we began to see individuals who appeared to have
developed illnesses after performing World Trade Center
response work, Congress authorized funding to establish a
medical screening program to identify possible World Trade
Center related illnesses among responders.
That funding lead to creation of a program that provided
free comprehensive medical examinations to over 11,400 World
Trade Center responders in the New York, New Jersey, and
throughout the Nation. Between 2002 and 2006, as the monitoring
and health needs of responders became clearer with the support
of Congress, the medical monitoring program consortium,
coordinated by Mount Sinai and the Fire Department of New York
program, expanded and most recently in fall of 2006, received
Federal funding to add comprehensive treatment services.
Thus with your support over time, the programs have evolved
into comprehensive, highly skilled centers of excellence for
monitoring and treatment of World Trade Center responders. The
goals of these monitoring treatment program Centers of
Excellence are one, to provide free comprehensive monitoring
examinations at regular intervals for responders. Two, to
provide medical and mental health treatment for all responders
with World Trade Center related illnesses, regardless of
ability to pay. And three, to document and track diseases
possibly related to exposure sustained at the World Trade
Center.
With Federal support, the Mount Sinai coordinated Center of
Excellence has provided initial comprehensive medical and
mental health monitoring examinations to over 22,000
responders. Over 6,300 responders have received 47,000 medical
and mental health treatment services through our New York and
New Jersey consortium Centers of Excellence since 2003.
Demand for these programs remains great today. Even now, 6
years after September 11, about 400 new responders register on
a monthly basis via the Mount Sinai phone bank to participate
in the program. And in August 2007, 771 new participants signed
up for the program.
In September 2006, last year, our consortium published a
paper in the highly respected, peer review journal
``Environmental Health Perspectives.'' This detailed our
findings from 9,442 responders who we examined between 2002 and
2004. Key findings included--and this paper is appended to my
testimony--46.5 percent reported experiencing new or worsened
lower respiratory symptoms during their response work, and 62.5
percent had new or worsened upper respiratory symptoms, with
overall rates of upper and lower symptoms at 68.8 percent.
At the time of examination up to two and a half years after
the rescue and recovery efforts, 59 percent of responders were
still experiencing upper and/or lower respiratory symptoms.
One-third of the responders had abnormal breathing tests, and
these are objective tests. And among non-smokers, the rate of
abnormal breathing tests was double what was expected.
These findings are very similar to what has been reported
by the Fire Department of New York who have reported on
symptoms in addition to diseases. For example, they reported
that 40 percent of firefighters had persistent lower
respiratory symptoms and 50 percent has persistent upper
respiratory symptoms more than a year after September 11.
I would also like to quickly, if I may, go over by about 1
minute, present a snapshot in time of what we have been seeing
with our consortium clinics in the 3 months from April to June
2007 in a treatment program. During that time period, the
consortium saw 2,323 patients in 4,693 visits. And this is now
the treatment program, not the monitoring. So these are the
people who are sick, who are cared for by Dr. Udasin and my
other colleagues.
Among that group, 40 percent were treated for lower
respiratory conditions. The most common group of conditions
were asthma and an asthma-like condition called RADS. Thirty
percent had those conditions. Fifty-nine percent had upper
respiratory conditions. Thirty-six percent of our patients in
treatment had mental health problems, including post-traumatic
stress disorder in 21 percent and depression in 15 percent.
We also frequently found social and economic disability
among our patients. More than 30 percent of our previously
healthy responders were either unemployed, laid off, or on sick
leave or disability. And 28 percent had no medical insurance at
some time period during the 3 months.
We still have two major unanswered questions about World
Trade Center responders and what their health outlook is.
Number one, we do not know and we need to know if the
respiratory, gastrointestinal and mental health problems that
we are currently observing will continue to persist. If so, for
how long and with what degree of severity and associated
disability.
Second, we need to know if new health problems will emerge
in future years in responders as a consequence of their
exposures to the uniquely complex mix of chemical compounds
that contaminated the air, soil, and dust of New York City and
the aftermath of September 11.
I would like to close by saying that we are very
appreciative that we have had resources provided to serve the
brave men and women who responded to the disaster. We are very
honored to be able to provide treatment and monitoring. We do
believe that these services need to continue into the future.
Thank you very much.
[The prepared statement of Dr. Herbert follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Mr. Pallone. Thank you, Dr. Herbert. From the GAO, Ms.
Cynthia Bascetta.
STATEMENT OF CYNTHIA BASCETTA, DIRECTOR, HEALTH CARE ISSUES,
GOVERNMENT ACCOUNTABILITY OFFICE, WASHINGTON, DC
Ms. Bascetta. Thank you, Mr. Chairman and members of the
subcommittee. I am pleased to be here today to discuss the
implementation of federally funded health programs for
responders who served in the aftermath of the World Trade
Center disaster.
As we all know, these responders were exposed to numerous
physical hazards, environmental toxins, and psychological
trauma, and it is clear from numerous studies that these
exposures continue to exact a toll for many of them 6 years
after the attack.
My testimony is based on our July 2007 report which was
done for Mr. Fossella, Mrs. Maloney, and Mr. Shays, and four
previous testimonies in which we discussed the different
programs set up for various categories of responders and
highlighted that the World Trade Center Federal responder
screening program had accomplished little and lagged behind
programs for other responders.
Today, I would like to focus on the status of three things:
NIOSH's awards for treatment to the World Trade Center health
program grantees, the services provided for Federal responders,
and NIOSH's efforts to provide services for non-Federal
responders residing outside the New York City metro area.
First, last fall NIOSH awarded and set aside funds totaling
$51 million from its $75 million appropriation to pay for
treatment services, the first time Federal funds were awarded
for this purpose. About $44 million was for outpatient
treatment, and about $7 million was set aside for inpatient
hospital care. Most of the funding went to the fire department
and the New York/New Jersey consortium.
In addition to outpatient care, Federal funds paid for 34
hospitalizations of responders so far. NIOSH is now planning
how to use the $50 million emergency supplemental appropriation
made in May 2007 to continue support for treatment in fiscal
year 2008.
Second, we reported this July that HHS has had continuing
difficulties ensuring the uninterrupted availability of
services for Federal responders who have been eligible only for
one-time screening examination. The provision of these
screening examinations has been intermittent. HHS suspended
them from 2004 to December 2005, resumed them for about a year,
then placed the program on hold and suspended scheduling exams
from January to May 2007. The last interruption occurred
because interagency agreements were not put in place in time to
keep the program fully operational.
In addition, the provision of specialty diagnostic services
associated with screening has also been intermittent.
Responders often need further diagnostic tests from ear, nose,
and throat physicians, cardiologists, and pulmonologists. And
the program had referred responders and paid for these
diagnostic services; however, because the contract with the new
provider network did not cover these services, they were
unavailable from April 2006 until the contract was modified in
March 2007.
NIOSH has considered expanding the services for Federal
responders to include monitoring examinations, the same follow-
up physical and mental health exams provided to other
categories of responders. Without this follow-up, health
conditions may not be diagnosed and treated, and knowledge of
the health effects caused by the disaster may be incomplete.
Third, NIOSH has not ensured the availability of screening
and monitoring services for non-Federal responders who reside
outside the New York City area, although it recently took steps
to expand their availability. Similar to the intermittent
service pattern for Federal responders, NIOSH's arrangements
for a network of occupational health clinics to provide
services nationwide were on again, off again. NIOSH renewed its
efforts to expand the provider network, however, and in May of
this year completed about 20 exams.
Mr. Chairman, despite HHS's recent consideration of ways to
add monitoring for Federal responders and to improve the
availability of screening and monitoring services for Federal
and non-Federal responders nationwide, its efforts remain
incomplete.
Moreover, the start and stop history of the Department's
efforts to serve these groups does not provide assurance that
the latest efforts to extend screening and monitoring services
to these responders will be both successful and sustained over
time.
As a result, we recommended in our July 2007 report that
the Secretary take expeditious action to ensure the
availability of health screening and monitoring services for
all people who responded to the attack on the World Trade
Center, regardless of their employer or their residence. To
date, HHS has not responded to our recommendation. That
completes my statement. I would be happy to answer your
questions.
[The prepared statement of Ms. Bascetta follows:
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Mr. Pallone. Thank you. Dr. Melius.
STATEMENT OF JAMES MELIUS, M.D., ADMINISTRATOR, NEW YORK STATE
LABORERS
Dr. Melius. Chairman Pallone, other members of the
subcommittee of Health, I greatly appreciate the opportunity to
appear before you today. I have been involved with health
issues at the World Trade Center since shortly after September
11. Over 3,000 of our union members were involved in the
response and cleanup activities on site, and I would add that
includes many not only from New York, but also our members from
State of New Jersey who came over to assist and who worked at
the site.
For the past 4 years, I have served as chair of the
steering committee for the medical monitoring and treatment
program and have been involved in oversight in working on
outreach and other activities with Dr. Herbert and others with
the New York City Fire Department on this program.
I believe that they have already--the physicians involved
in these programs already talked about some of the medical
problems that people are experiencing. And given the focus of
these hearings, I like to sort of briefly mention two other
issues regarding why it is so important that there be Federal
support for this medical monitoring and treatment program.
One would expect--what are some of the other potential
sources of funding that could pay for this? Well, one possible
source of health insurance coverage; however, I think it is
important to know that all health insurance plans exclude
coverage for work-related injuries and illnesses. This is a
basic part of health insurance. It extends even to the Federal
Medicare program. They do not provide coverage.
If an insurance company finds that a person is applying for
what they believe to be a work-related health problem, they
will deny that claim or certainly raise questions about that
claim. So we cannot rely on it, for that reason, to provide
coverage for everybody who has become ill by this program.
We have also found that, as this program has evolved as
people have sought treatment, that this use of health insurance
today has put a great strain on the health insurance plans that
cover these particular responders. In the case the city of New
York has borne much of the cost through their health insurance
plan to date. The various labor unions in New York, who operate
either their own health insurance plans or provide partial
coverage such as pharmaceutical coverage for their members,
have also experienced severe financial strain from having to
cover the medical costs for many of the responders.
Another alternative to provide coverage is Worker's
Compensation, but I think, as we have already heard today in a
very difficult example of how problematic it is for many of
these responders to obtain Worker's Compensation coverage. It
is long delays in getting that coverage. The coverage is often
incomplete. The coverage often questions the need for follow-up
medical treatment and can involve many, hearings,
administrative proceedings, and especially long delays. Three,
4, 5, years or more before people can initially receive
coverage under Worker's Compensation is not unusual.
To rely on Worker's Compensation for coverage for these
responders also shifts the burden for the cost to their
employers and to the insurance companies involved. We have
already heard the concerns about the contractors involved who
thought they were indemnified for working at the World Trade
Center site, for responding so quickly, and certainly the New
York City itself, which is self-insured in regards to Worker's
Compensation cost would end up picking up these very large and
very significant medical costs if we try to rely only on
Worker's Compensation coverage to cover all the health care
needs.
I believe that we need a comprehensive solution to address
the health needs of these rescue and recovery workers. We
cannot rely on a fragmented system and should not rely on a
system that utilizes private philanthropy, like the Red Cross,
health insurance, line-of-duty disability retirement, and
Worker's Compensation to support the necessary medical
monitoring treatment for the many thousands of people who have
become ill because of their World Trade Center exposures.
If we rely on this fragmented approach, we will inevitably
leave many of these ill and disabled rescue and recovery
workers without the needed medical treatment and will only
worsen their health condition. I think testimony we have
already heard on this panel, I think, illustrates the problems
with a fragmented system that is not responsive to the needs of
these responders.
In my testimony, I have laid out what I think should be the
key points in any Federal legislation that would provide
comprehensive coverage that should extend not only to deal with
the health issues but also to provide compensation for people
who have become disabled because of their exposures at the
World Trade Center.
I believe that the legislation introduced last night by
Representatives Maloney, Nadler, and Fossella and others really
addresses all of these goals and provide the comprehensive
framework needed to address these serious medical problems and
would lay the basis for both comprehensive coverage as well as
the long-term coverage that is required.
I really want to thank Representative Fossella for your
efforts, I think, on behalf of all the labor unions who
represent people involved in this response. We greatly
appreciate your efforts as well as those efforts of
Representatives Maloney, Nadler, and the rest of the New York
delegation to help address this. And I appreciate, Mr. Pallone,
your efforts in holding this hearing. And hope we can move
forward to get a comprehensive legislation that is so badly
needed. Thank you.
[The prepared statement of Dr. Melius follows:]
Testimony of James Melius, M.D.
Chairman Pallone and members of the Subcommittee on Health.
I greatly appreciate the opportunity to appear before you at
this hearing.
I am James Melius, an occupational health physician and
epidemiologist, who currently works as Administrator for the
New York State Laborers' Health and Safety Trust Fund, a labor-
management organization focusing on health and safety issues
for union construction laborers in New York State. During my
career, I spent over 7 years working for the National Institute
for Occupational Safety and Health (NIOSH) where I directed
groups conducting epidemiological and medical studies. After
that, I worked for 7 years for the New York State Department of
Health where, among other duties, I directed the development of
a network of occupational health clinics around the state. I
currently serve on the Federal Advisory Board on Radiation and
Worker Health which oversees part of the Federal compensation
program for former Department of Energy nuclear weapons
production workers.
I have been involved in health issues for World Trade
Center responders since shortly after September 11. Over 3,000
of our union members were involved in response and clean-up
activities at the site. One of my staff spent nearly every day
at the site for the first few months helping to coordinate
health and safety issues for our members who were working
there. When the initial concerns were raised about potential
health problems among responders at the site, I became involved
in ensuring that our members participated in the various
medical and mental health services that were being offered. For
the past 3 years, I have served as the chair of the Steering
Committee for the World Trade Center Medical Monitoring and
Treatment Program. This committee includes representatives of
responder groups and the involved medical centers (including
the NYC Fire Department) who meet monthly to oversee the
program and to ensure that the program is providing the
necessary services to the many people in need of medical
follow-up and treatment. I also serve as co-chair of the Labor
Advisory Committee for the WTC Registry operated by the New
York City Department of Health. These activities provide me
with a good overview of the benefits of the current programs
and the difficulties encountered by responders seeking to
address their medical problems and other needs.
I believe that other physicians involved in the medical
monitoring and treatment program for World Trade Center
responders have already presented the medical findings from
their respective medical program for these responders. The
pulmonary disease and other health problems among both fire
fighters and other responders are quite striking and quite
worrisome. All of the medical programs have done an outstanding
job in establishing their respective monitoring programs and in
providing high quality medical examinations for many thousands
of rescue workers and responders. These programs also
recognized the problems that many of their participants were
having paying for medical care for the conditions diagnosed in
the medical monitoring programs and have made efforts to help
the participants in obtaining necessary assistance. Given the
focus of these hearings, I believe that it may be helpful to
examine the reasons why so many of the participants need
assistance for paying for their medical treatment.
Health Insurance Coverage
The people who worked in the initial response to the
September 11 disaster and the later recovery activities
represented many different types of workers. On the public
safety side, there were fire fighters, police, and emergency
medical services workers. The response and recovery activities
also included construction trades workers, utility workers,
sanitation workers, transit workers, cleaning workers, and NYC
municipal workers from many agencies. Many other people just
volunteered to work at the site especially in the first few
days after September 11th. Despite the diversity of backgrounds
and job duties, these different groups are showing very similar
patterns of illness. The pulmonary changes found in fire
fighters have also been demonstrated in the rescue and recovery
workers being monitored in the Mount Sinai medical program.
Most recently, an independent study conducted by medical
researchers at Penn State University of NYC police officers
responding to the WTC disaster reported similar respiratory
findings among the group that they examined. The other types of
medical and mental health problems documented among WTC
responders also appear to be similar across all groups of
responders.
However, given the diversity of this workforce, it is not
surprising that their health insurance coverage might be quite
variable. I will provide a general overview.
All city workers are covered through the city's general
health insurance plan which provides basic coverage including
retirement coverage for long time workers. However,
pharmaceutical coverage is provided through a different plan
administered through each separate union. Construction trade
workers are usually covered through their labor-management
health insurance fund which provides basic health insurance
coverage and some pharmaceutical coverage. The pharmaceutical
coverage is often quite limited with high deductibles and co-
pays. These health plans require that the participant work a
substantial number of days each quarter or year in order to
maintain eligibility. An ill construction worker can easily
lose their coverage by missing too many work days. Utility
workers have general medical coverage including some
pharmaceutical benefits. Cleaning workers (people who cleaned
the residential and commercial buildings around the WTC) often
worked for contractors who offered no health benefits at all.
The majority of the people in the Mt. Sinai treatment program
up to now have had no health insurance coverage or very limited
coverage.
All health insurance plans exclude coverage for work-
related injuries and illnesses. Even Medicare has an active
program to identify and recover payments for work-related
services. While it is recognized that there may be uncertainty
about whether a condition being diagnosed is work-related or
not, this consideration could easily lead to the denial of
health insurance coverage for many people with WTC-related
health conditions. New York State does have in place mechanisms
for health insurance providers to be reimbursed for medical
expense payments incurred for conditions that are ultimately
determined to be eligible for workers' compensation coverage.
However, these mechanisms are administratively complicated and
do not necessarily prevent the health insurer from denying
reimbursement for WTC-related health expense.
Another problem with health insurance is the limitations on
coverage of many of the health insurance plans that cover the
participants. This is especially critical for pharmaceutical
coverage. Treatment for many of the WTC-related conditions
(asthma, mental health problems, et cetera.) requires
substantial medication costs. These costs commonly range from
$5,000 to nearly $15,000 per year for participants. Many of the
plans covering WTC participants have high deductibles or co-
pays. Co-pays and deductibles can easily cost the participants
with high medication costs several thousand dollars per year.
These costs can severely strain the finances of a person with a
moderate income especially if they have other health care costs
and are missing significant time from their work due to
illness. For those without any health insurance, the financial
impact is even greater. Another potential problem is that many
of these insurance programs have lifetime caps for each
participant. Although these caps seem high ($500,000 to $1
million or more), they can easily be exceeded with a long term
serious illness.
The medical and pharmaceutical costs for WTC-responders
have also severely strained the health insurance plans for many
of the responder groups, especially those providing
pharmaceutical coverage. These funds are already stressed by
the rapidly rising costs of health care. Those plans with a
significant number of members who worked at the WTC response
and clean-up have found that the overall medical and
pharmaceutical costs for their plans have significantly
increased due to the large number of participants with WTC-
related medical costs. This has even led some to consider
cutting back on their benefits for all members in order to
absorb the costs for the WTC group.
Workers' Compensation Coverage
One alternative to health insurance coverage for WTC-
related conditions is workers' compensation insurance. Workers'
compensation is supposed to be a no fault insurance system to
provide workers who are injured or become ill due to job-
related factors with compensation for their wage loss as well
as full coverage for the medical costs associated with the
monitoring and treatment of their condition.
Similar to health insurance, the WTC program participants
are covered by a variety of state, Federal, and local programs
with different eligibility requirements, benefits, and other
provisions. Most private and city workers are covered under the
New York State Workers' Compensation system. New York City is
self insured while most of the private employers obtain
coverage through an outside insurance company. Uniformed
services workers are, for the most part, not covered by the New
York State Workers' Compensation system but rather have a line
of duty disability retirement system managed by New York City.
A fire fighter, police officer, or other uniformed worker who
can no longer perform their duties because of an injury or
illness incurred while on duty can apply for a disability
retirement which allows them to leave with significant
retirement benefits. However, should a work-related illness
first become apparent after retirement, no additional benefits
(including medical care) are provided, and the medical benefits
for even a recognized line of duty medical problem end when the
person retires. Federal workers are covered under the
compensation program for Federal workers. Coverage for workers
who came from out of state will depend on their employment
arrangements with their private employer or agency. However,
volunteers from New York or from out of state are all covered
under a special program established by the New York Workers
Compensation Board after 9/11.
The major difficulty with these compensation systems is the
long delays in obtaining coverage. For example, the NYS
Workers' Compensation system is very bureaucratic. The insurer
may challenge every step of the compensation process including
even diagnostic medical testing. This challenge usually
requires a hearing before a Workers' Compensation Board (WCB)
administrative judge to evaluate the case, and this hearing may
often be delayed for months. Even once the case is established,
the insurer can still challenge treatments recommended for that
individual even for a medication that the individual may have
been taking for many months for a chronic work-related
condition. Thus, it may be many years before the case of a
person with a WTC-related condition is fully recognized and
adjudicated by the compensation system. Meanwhile, the claimant
may not be receiving any medical or compensation benefits or
may have had their benefits disrupted many times.
In order to alleviate some of the problems for WTC
claimants, last year New York State implemented some new
programs that were deigned to improve coverage for WTC
responders by providing medical coverage and salary
compensation for responders while their WCB cases were being
evaluated. However, these provisions must be initiated by the
insurer carrier, and there is uncertainty as to who would be
responsible for reimbursing these costs if the claims are
ultimately denied. To date, these provisions do not appear to
be widely used. There was also legislation passed last year
that allows more New York City workers to obtain disability
retirement benefits for WTC-related conditions. Currently,
there is an advisory task force in place that is examining how
best to implement this legislation. Finally, there was a bill
passed allowing people who worked at the WTC site to register
for Workers' Compensation benefits. Potential claimants were
given a year to submit a registration form to the Board that
makes them eligible to apply for benefits should they later
develop a WTC-related health condition. Prior to that,
claimants who later developed a WTC-related medical condition
were not eligible to file claims because they were judged to
have missed the filing deadline required by law. In addition,
New York State has just passed broad workers' compensation
reform legislation that makes many changes in the current
system. Once implemented, this legislation could help to
alleviate some of the delays in the current system. However, it
will be some time before all of these changes assist WTC
claimants. Meanwhile, claimants continue to face long delays
and many hurdles in obtaining workers' compensation coverage
for any conditions resulting from their WTC exposures. It is
not clear that the recent changes in the system will adequately
address these problems.
I would also add that depending on workers' compensation
and disability retirement systems to cover the medical costs
for the monitoring and treatment program places the financial
burden on the employers and insurance companies. New York City
is self insured and thus would pay directly for all claims. The
private employers involved will also have greater costs either
by directly paying for claims if they are self insured or
through higher premiums due to an increase in their experience
rating.
Comprehensive Solution
A comprehensive solution is needed to address the health
needs of the 9/11 rescue and recovery workers. We cannot rely
on a fragmented system utilizing private philanthropy, health
insurance, line of duty disability retirement, and workers'
compensation to support the necessary medical monitoring and
treatment for the thousands of people whose health may have
been impacted by their WTC exposures. This fragmented approach
will inevitably leave many of the ill and disabled rescue and
recovery workers without needed medical treatment and will only
worsen their health conditions. The delays and uncertainty
about payments would discourage many of the ill rescue and
recovery workers from seeking necessary care and discourage
medical institutions from providing that care.
This is a critical time for the federally funded treatment
programs. Their funding will soon run out, and Federal
officials are already proposing sending letters informing the
participants that they must seek alternative arrangements for
their care. Attempting to provide this care through some sort
of voucher system as is currently being considered by the
Department of Health and Human Services would also be
disruptive. Discontinuing or disrupting this high quality,
coordinated medical treatment would only exacerbate the health
consequences of the 9/11 disaster. Most of the participants in
the monitoring and treatment program have medical conditions
(asthma, mental health problems, etc.) that should be
responsive to medication and other treatments. Hopefully, many
of these people will gradually recover and not become disabled
due to their WTC-related medical conditions. To the extent,
that we can prevent worsening of the medical conditions and
prevent many of these people from becoming too disabled to
work, we can not only help these individuals, but we can also
lower the long term costs of providing care and assistance to
this population.
We need Federal legislation that accomplishes the
following:
Provides long term medical monitoring program for
all WTC responders and other workers exposed in the aftermath
of September 11, 2007
Supports long term medical treatment for those
participants who have developed WTC-related medical conditions
at no cost to the participants. This program should cover WTC-
related medical conditions that are currently recognized as
well as those which might emerge in the future.
Provides that monitoring and treatment at Medical
Centers of Excellence that have the expertise and experience to
provide high quality medical care.
Extends that high quality medical care to WTC
responders from throughout the United States
Provides for the collection and analysis of these
medical data in order to track the health of the participants
and to detect emerging disease patterns.
Establishes a medical monitoring and treatment
program for residents, students, workers, and other people who
were exposed to WTC contaminants in the aftermath to the
September 11 attacks.
Provides for appropriate compensation for those
who have become disabled from their WTC-related illnesses.
Provides administrative mechanisms that provides
prompt and timely determinations and allows the proper
oversight and management of the program.
Provides for meaningful input and participation
from representatives of the affected groups in the development
and management of the program.
The legislation just introduced by Representatives Maloney,
Nadler, Fossella, and others addresses all of those goals and
provides the comprehensive framework needed to address the
serious medical problems being experienced by thousands of
people in the aftermath to the September 11 terrorist attacks.
Too often in the past, we have neglected to properly monitor
the health of groups exposed in extraordinary situations only
to later spend millions of dollars trying to determine the
extent to which their health has been impacted. Agent Orange
exposure in Vietnam and the current compensation program for
nuclear weapons workers are only two examples of this problem.
We have left those people to suffer, often without proper
medical care and facing financial hardship due to their
illnesses. We should learn the lessons from these past mistakes
and make sure that we provide comprehensive medical monitoring,
treatment, and compensation for those potentially impacted by
the WTC disaster.
I would strongly urge you to take immediate steps to ensure
that there is adequate Federal funding for the current medical
monitoring and treatment programs and to open up these programs
or similar programs to the affected residents and to other
affected workers. I would also urge you to support the Maloney-
Nadler-Fossella legislation to provide a comprehensive approach
to give WTC workers and residents access to long term medical
monitoring and treatment for their WTC-related medical
conditions and compensation for their losses.
I would be glad to answer any questions.
----------
Mr. Pallone. Thank you, Doctor. Mr. Skyler.
STATEMENT OF EDWARD SKYLER, DEPUTY MAYOR, ADMINISTRATION, CITY
OF NEW YORK, NY
Mr. Skyler. Good afternoon. I want to thank you, Chairman
Pallone, Ranking Member Deal, Congressman Fossella and
Congressman Weiner as well as Congressman Engel who was here
earlier, and other members of the committee for convening this
hearing for those who are still suffering from the effects of
the September 11 attacks.
My name is Edward Skyler, and I am the New York City deputy
mayor for administration. And as the 5-year anniversary of the
attacks approached, Mayor Bloomberg asked me to co-chair a
panel of experts to determine what must be done to fully
address the health impacts of 9/11. The mayor accepted all 15
of the panel's recommendations.
I have shared the report with your staff over the last 7
months, and over that time, we have been working to put them
into action. In particular, the city has been working closely
with New York's congressional delegation, especially
Representatives Maloney, Fossella, and Nadler; and Senators
Clinton and Schumer to incorporate these recommendations into
legislation that establishes a strong and comprehensive Federal
response.
And that is why I am here today. On behalf of Mayor
Bloomberg and the city of New York, I have come to express our
strong support for a piece of legislation that accomplishes
much of what our panel recommended, the James Zadroga 9/11
Health and Compensation Act of 2007. The bill is named after an
NYPD detective who spent hundreds of hours at Ground Zero and
later died too young at the age of 34 from respiratory failure.
If adopted into law, it will provide the Federal funding
needed to care for those who are sick or who may become sick.
The bill would continue vital research that would help us
better understand the health impacts of these attacks, and it
would reopen the Victims' Compensation Fund, which will enable
the city to get out of the courtroom and focus its energies on
helping those who continue to struggle with the aftermath of 9/
11. In short, it recognizes fully and finally that providing
health services to people who are physically injured and
emotionally traumatized by an act of war and terror against the
United States is in fact a national obligation.
We have estimated that more than 400,000 people were
potentially exposed to environmental hazards and psychological
trauma of the attacks. The gross national cost to treat those
people who are sick or who could become sick as a result of 9/
11 is $393 million per year. That estimate covers the entire
potentially exposed population, including the thousands of
rescue workers and others who came to our city to help in our
time of need from all 50 States.
We also estimate that the cost merely to sustain the
current treatment programs in the New York City area at their
present levels and to implement the remainder of the panel's
recommendations is at least $150 million a year--not allowing
for inflation, increased incidence of disease, or the emergence
of new disease.
The funding that this bill will provide is needed for two
critical and interrelated purposes. First, to treat those who
are sick or who could become sick as a result of 9/11. This
bill provides the means to treat anyone anywhere in the country
who was affected by the attacks. A core element of that
treatment is sustained funding for the three Centers of
Excellence that collectively monitor and treat the more than
36,000 responders, residents, and others.
Those Centers of Excellence are the FDNY World Trade Center
program, WTC Monitoring and Treatment program coordinated by
Mount Sinai, and the World Trade Center Environmental Health
Center at Bellevue Hospital, which is the only treatment
program currently open to residents and other non-first
responders. I should note the fire department recently opened a
treatment center on Staten Island in Congressman Fossella's
district to better provide services to those who are injured as
a result of the attacks and make it more convenient for them by
supplying those services in their home borough.
Second, this bill ensures that the critical 9/11 research
continues. Long-term research is the only way we are going to
be able to develop a full understanding of the health impacts
of 9/11. The Centers of Excellence have all contributed to the
research efforts, including studies released by clinicians at
all of them.
The city's health department has also partnered with the
Federal Government to establish the World Trade Center Health
Registry, the largest of its kind, which includes over 71,000
people from every State in the country and from almost every
congressional district. More than a quarter of the people in
the registry, almost 20,000 individuals, are from outside New
York State. This reflects the large number of people from
throughout the country who came to New York's assistance after
the attacks.
Two large studies released last month based on registry
data continue to show how serious the health impacts of 9/11
are. They were referred by Congressman Fossella earlier today,
which is the 3.6 percent of 25,000 previously asthma-free
rescue and recovery workers who developed asthma after working
at the site, which is 12 times the national average. And the 12
percent of rescue and recovery workers, about one in eight, who
developed post-traumatic stress disorder after working at
Ground Zero. The national average is about 4 percent.
This bill will provide the necessary resources to fund all
of these services, but while we wait for Congress to act and
the executive branch to act, the city is not waiting to make
sure that the people get the health care they need. In fact, in
response to the report, the mayor increased city spending for
9/11 health-related programs sixfold to more than $27 million
in the current fiscal year. And in the absence of long-term
Federal support, he committed $100 million to these programs
through fiscal year 2011.
Nevertheless, all of these programs remain in danger of
being discontinued unless they receive a full and reliable and
sustained source of Federal funding which this bill provides.
Finally, let me talk about how this bill will fulfill
another core recommendation of our panel. The urgent need for
Congress to reopen the Victim Compensation Fund. Between 2001
and 2004, under the leadership of Special Master Ken Feinburg,
the fund provided compensation to nearly 3,000 families of
those who were killed or injured on 9/11 or in the immediate
aftermath of the attacks. It was a fair and efficient process
that provided a measure of relief to victims' families.
Now, it is imperative that the fund be reauthorized to take
care of those who are not eligible to benefit from it before it
closed in 2003. The fact that their injuries and illnesses have
been slower to emerge should not disqualify them from getting
the help they need.
Even if we provide them health care, many of these people
have suffered other losses. Some can no longer work or are in
financial distress. They shouldn't be forced to go to court to
get compensation. That not only compounds their pain, it would
result in costly and protracted litigation that is distracting
us from our primary mission of giving real help to those in
need.
The fundamental point is that compensating people who were
hurt on 9/11 shouldn't be based on a legal finding of who is to
blame. We all know who is to blame: 19 savages with box
cutters. I am here today because New York City would rather
stand with those who filed suit than against them in a
courtroom, but we need your help to do that.
There is no reason why people injured on 9/11 should now
have to go to court and prove liability. Proof of harm should
be enough to receive fair and fast compensation. What is more,
reopening the fund would send a clear message that if, God
forbid, America suffers another terrorist attack, the private
sectors and our first responders could respond with the same
kind of determination that we saw on 9/11, knowing that their
Government will always stand with them.
If we leave the issue of compensation to the courts and the
tort system, we risk bankrupting those who responded--either
the individuals or the companies. We simply shouldn't be so
callous to those who responded in the Nation's time of need.
In sum, the James Zadroga Act represents a vital lifeline
to the men and women who risked everything and helped lift our
Nation and our city back onto its feet during its time of need.
That is why it has gained the support of New York State's
entire congressional delegation. That is why Speaker Pelosi,
who met with Mayor Bloomberg and me last week, expressed her
support of it. And that is why Mayor Bloomberg and his
administration are pledging to work with Congress to do
everything possible to make it a reality.
Thank you for your attention. I would be happy to answer
any questions you might have.
[The prepared statement of Mr. Skyler follows:]
Testimony of Edward Skyler
Good morning. I want to thank Chairman Pallone, Ranking
Member Deal, and the other distinguished members of the
Committee for convening this hearing about those who are still
suffering the effects of the September 11 attacks. I also want
to take this opportunity to thank Speaker Pelosi for coming to
New York last week on the eve of the sixth anniversary of the
attacks. Speaker Pelosi met with Mayor Bloomberg to discuss a
number of critical 9/11-related issues, and she expressed her
support for addressing the urgent and unmet health needs that I
will talk to you about today.
My name is Ed Skyler, and as New York City's deputy mayor
for administration, I've been directly involved with the city's
response to 9/11-related medical conditions. As the 5-year
anniversary of the attacks approached, Mayor Bloomberg asked me
and our city's Deputy Mayor for Health and Human Services--
Linda Gibbs--to chair a panel of experts to determine what must
be done to fully address the health impacts of 9/11.
The mayor accepted all 15 of the panel's recommendations--
I gave congressional testimony about them in February--and over
the past 7 months we've been working to put them in action. In
particular, the city has worked closely with New York's
Congressional delegation--especially Representatives Maloney,
Fossella, and Nadler, and Senators Clinton and Schumer--to
incorporate these recommendations into legislation that
establishes a strong and comprehensive Federal response.
That's why I'm here today. On behalf of the city, I've
come to express our strong support for a piece of legislation
that accomplishes much of what our panel recommended, the James
Zadroga 9/11 Health and Compensation Act of 2007. This bill is
named after an NYPD detective who had spent hundreds of hours
at Ground Zero, and later died at the age of 34 from
respiratory failure. If adopted into law, it would provide the
Federal funding needed to care for those who are sick, or who
may become sick.
The bill would also continue vital research that will help
us better understand the health impacts of the attacks, and it
would re-open the Victim's Compensation Fund, which will enable
the city to get out of the courtroom and focus its energies on
helping those who continue to struggle with the aftermath of 9/
11. In short, this bill recognizes, fully and finally, that
providing health services to people who were physically injured
and emotionally traumatized by an act of war against the United
States is in fact a national obligation.
We've estimated that more than 400,000 people were
potentially exposed to the environmental hazards and
psychological trauma of the attacks, and that the gross
national cost to treat those who are sick or could become sick
as a result of 9/11 is $393 million per year. That estimate
covers the entire potentially exposed population, including the
thousands of rescue workers and others who came to our city
from all 50 states.
We also estimated that the cost merely to sustain the
current treatment programs in the New York City area at their
present levels and to implement the remainder of the panel's
recommendations is at least $150 million a year--not allowing
for inflation, increased incidence of disease, or the emergence
of new diseases.
The funding this bill would provide is needed for two
critical, interrelated purposes: first, to treat those who are
sick or who could become sick as a result of 9/11. This bill
provides a means to treat anyone, anywhere in the country who
was affected by the attacks. A core element of that treatment
is sustained funding for three ``Centers of Excellence'' that
collectively monitor and treat more than 36,000 responders,
residents and others.
Those Centers of Excellence are: the FDNY World Trade
Center program; the WTC Monitoring and Treatment program
coordinated by Mt. Sinai; and the World Trade Center
Environmental Health Center at Bellevue Hospital--the only
treatment program currently open to residents and other non-
responders. I should note that the Fire Department recently
opened a treatment center in Staten Island--in Congressman
Fossella's district--to provide better services to those who
were injured as a result of the attacks.
Second, this bill ensures that critical 9/11-related
research continues. Long-term research is the only way that
we're going to be able to develop a full understanding of the
health impacts of 9/11. The Centers of Excellence have all
contributed to research efforts--including studies released by
clinicians at FDNY, Mt. Sinai and the Bellevue program.
The city's Health Department has also partnered with the
Federal Government to establish the World Trade Center
Registry--the largest effort of its kind in history--which
includes over 71,000 people from every state in the country and
from almost every Congressional district. More than a quarter
of the people in the Registry--almost 20,000 individuals--are
from outside New York State. This reflects the large number of
people from throughout the country who came to New York's
assistance after the attacks.
Two large studies released last month based on Registry
data continue to show how serious the health impacts of 9/11
are. One shows that 3.6 percent of 25,000 previously asthma-
free rescue and recovery workers in the Registry developed
asthma after working at the World Trade Center site--12 times
the national average. And a second study shows that more than
12 percent of rescue and recovery workers--about 1 in 8--
developed Post-Traumatic Stress disorder after working at
Ground Zero.
The James Zadroga 9/11 Health and Compensation Act will
provide the necessary resources to fund all of these services--
but while we wait for Congress to act, the city is not waiting
to make sure that people get the health care they need. In
fact, in response to the Panel's Report, the Mayor increased
city spending for 9/11-health related programs six-fold in the
current fiscal year, to more than $27 million. And, in the
absence of long-term Federal support, he committed nearly $100
million to these programs through FY 2011. Nevertheless, all of
these programs remain in danger of being discontinued unless
they receive the full and predictable source of Federal funding
which this bill provides.
Finally, I'd like to address how this bill will fulfill
another core recommendation of our panel: the urgent need for
Congress to reopen the Victim Compensation Fund. Between 2001
and 2004, the Fund provided compensation to nearly 3,000
families of those who were killed or injured on 9/11 or in the
immediate aftermath of the attacks. It was a fair and efficient
process that provided a measure of relief to victims' families.
Now it is imperative that the Fund be reauthorized to take
care of those who were not eligible to benefit from it before
it closed in December 2003. The fact that their injuries and
illnesses have been slower to emerge should not disqualify them
from getting the help they need.
Even if we provide them health care, many of these people
have suffered other losses. Some can no longer work. Some have
lost their homes. They shouldn't be forced to go to court to
get compensation. That would not only compound their pain; it
would also result in costly and protracted litigation that
ultimately would distract us from our primary mission of giving
real help to those in need.
The fundamental point is that compensating people who were
hurt on 9/11 shouldn't be based on a legal finding of who is to
blame. We know who is to blame--19 savages with box cutters. I
am here today because New York City would rather stand with
those who've filed suit, rather than against them in a
courtroom. There is no reason why people injured on 9/11 should
now have to go to court and prove liability. Proof of harm
should be enough to receive fair and fast compensation.
What's more, reopening the Fund would send a clear message
that if--God forbid--America suffers another terrorist attack,
the private sector and our first responders could respond with
the same kind of determination that we saw on 9/11, knowing
that their government will always stand by them. If we leave
the issue of compensation to the courts and the tort system, we
risk bankrupting those who responded--either the individuals or
the companies. We simply shouldn't be so callous to those who
responded in the nation's time of need.
In sum, the James Zadroga Act represents a vital lifeline
to the men and women who risked everything, and helped lift our
Nation back onto its feet during our time of greatest need.
That's why Mayor Bloomberg and his administration are pledging
to work with you all and do everything possible to make it a
reality.
----------
Mr. Pallone. Thank you. I thank you all. I am going to
start with the questioning.
My view, and I think most of you, if not everyone here,
sort of shared the same view, although I don't want to put
words in your mouth, is that if we had a situation where every
one of the first responders, or even those who were not first
responders that might have been victims because they live or
work near the World Trade Center--but at least let us focus on
the first responders, if we had a system where all the first
responders could go to a specialized treatment center, where
they have the expertise like what UMDNJ or Mount Sinai do, and
they could be screened and monitored, and they could be treated
there by those experts who have the expertise, and the
Government was paying for it because there wouldn't be any gaps
because of your private insurance, if you have it or don't,
that would be the best situation.
But the problem with that, of course, is that for
ideological reasons or whatever, our system doesn't work that
way. Everything is done stop-gap, and you have to rely on
private insurance and who has and who hasn't. So if we set
something up like that, although it might be the ideal--there
are all the ideological problems that go with it. So what I
would like to know is how far do you think we need to go?
In other words, we obviously need a comprehensive plan.
Would you argue that this comprehensive plan should allow
everyone who is either a first responder or a victim in some
other way to go to one of these centers? That they should be
fully covered by the Federal Government without any recourse to
private insurance? Is there any other way to help people like
Mr. Vinciguerra without having to go that far?
I mean, this is the committee of jurisdiction that would
have to report out that legislation, and we have some bills out
there that are sort of similar to that. But we also have to
think about what is possible to get passed here.
And so I guess I would just like to ask a basic question
about is that the way we need to go? Is there some way to
continue to rely on private insurance, or let people go to
their individual doctors, or is this really what we are talking
about? And I know it is sort of a broad question. I am not sure
we have time for everybody to answer it, but I would like to at
least ask that of Dr. Udasin, Dr. Herbert and the GAO person in
that order and then we will see. If we can start that way.
Dr. Udasin. Well, I would like to answer that question by
saying that most of the patients in New Jersey actually have
private health insurance, and so many came in with either
incorrect diagnoses or they couldn't get the medications that
they needed because the insurance company said you had to have
this medication, not the one that actually works for what is
wrong with you. I am no expert on figuring out how to fund a
program, but I feel like the people that were there that did
the kind of work that Mr. Vinciguerra did need the kind of
medical care that we are able to provide for them.
Mr. Pallone. And if they can't go to your center, then
there is a danger that they won't get the specialty care,
correct?
Dr. Udasin. That is correct, and we do work with physicians
all over the--actually we work with physicians all over the
country. And we do give a lot of medical advice to people who
can't get into our centers, and at the very least, it is making
the diagnosis that is so complicated that takes such a long
time figuring out what people need. And that is actually where
the trouble is, in my opinion, that a lot of people that do
have correct health insurance are coming in with the wrong
diagnosis. And that is what I feel like we can do for them is
at least get them started on the path to the correct treatment.
Mr. Pallone. See, that is, Dr. Herbert, my concern is that
if you look at Mr. Vinciguerra, he went to Hamilton. Did they
necessarily know what the problem was? It seems to me that if
they are not going to one of your centers and then they are not
being able to get the full monitoring and treatment over a long
period of time under somebody that has the expertise, they are
going to have incomplete care. And, then you get into all the
insurance problems.
Dr. Herbert. I agree exactly with what you said and with
what Dr. Udasin said. The other features of this kind of system
are the ability to track symptoms, physical findings, breathing
test results from the monitoring examination so that we can
identify disease and symptom patterns over time, A. And, B, in
the treatment programs, we have a real-time system to capture
not just the single billable diagnosis that you are going to
find from a private physician but all of the conditions for
which that responder is being treated.
So I think without this kind of center, A, you would lose
the ability to provide the highly specialized treatment that
the responders need. And, B, you would lose the opportunity to
identify the patterns of disease going forward in time, and you
would lose the responders as a group. And that would be a huge
loss.
Mr. Pallone. And I will ask Dr. Melius because my time is
actually up, but the problem that I see is that when you talk
about the insurance, unless the Government is actually saying
we are going to pay for your screening and treatment at one of
these centers, there is going to be just a gap. There is no way
for private insurance to make up the difference. Or is there
some way for us to still rely on private insurance to pay for
some of this?
Dr. Melius. The answer to that is twofold. One is I don't
think it is fair or appropriate to rely on private insurance
because that cost is getting then passed back either to the
victim or his fellow workers who are part of the same plan or
to the employer who is having to provide that.
Second, I don't think it works. It leads to fragmented
care. Mr. Vinciguerra, I think, was a good example of the
problems that that causes. And there are countless other
examples like that in this program. People that delay
treatment, don't get the right medications, uncertainty about
whether it is covered or not.
And I really think the only way to provide timely
comprehensive care is to do it through the system that is
proposed in the legislation, that sets up the Centers of
Excellence, that tracks people, provides the care at Centers of
Excellence or in coordination with Centers of Excellence, and
assures that people get the best care as early and in as timely
a fashion as possible.
Mr. Pallone. And I agree with you, but I mean the problem
is when you try to move a bill like that, you are basically
saying you want a Government sponsored plan, paid-for plan for
these people. And the question is can we accomplish that.
Dr. Melius. Well, this is, I think, extraordinary
circumstances.
Mr. Pallone. Right, thank you.
Dr. Melius. Yes.
Mr. Pallone. Mr. Deal.
Mr. Deal. I would sort of like to follow up on that. Does
anybody know how many of these responders have been provided
care and benefits under their Worker's Compensation plans? Yes,
Mr. Skyler?
Mr. Skyler. I would just point out from the city's
perspective, worker's comp actually doesn't apply to members of
the uniform service, such as police department and fire
department. So, as a matter of course, the 50,000 or so police
officers and firefighters wouldn't get any care through their
worker's comp system.
Mr. Deal. So you don't have any worker's comp system for
your uniformed officers?
Mr. Skyler. Not for our uniformed officers. It only affects
the civilian cohort of the workforce.
Mr. Deal. So what benefits do they have then if they are
injured in the line of duty?
Mr. Skyler. They have different benefits provided by
pension plans, and there are different levels of care depending
on the agency. For example, the Bureau of Health Services was a
part of the fire department set up before 9/11 that monitored
firefighter health before 9/11. They used their data to compare
against the patients that came in after 9/11.
Mr. Deal. So that is why Mr. Vinciguerra had such a hard
time is because the normal processes that would be in place in
most instances that I am aware of across the country,
apparently you didn't have those for a uniformed person injured
in the line of duty?
Mr. Skyler. No, I would submit and I think the doctors on
the panel would agree that the fire department Bureau of Health
Services is one of the Centers of Excellence that has gotten
Federal funding that we want to see funding continued for. The
advantage----
Mr. Deal. Well, I know you wanted the Federal Government to
pick up the tab. My concern is when you have got local folks
who should be covered by some kind of local policy, why is not
that the first line of resources?
Mr. Skyler. Well, it has been the first line, and the mayor
put up money despite a lack of Federal long-term commitment on
this issue--$100 million over the next 3 years.
Mr. Deal. If a fireman is injured in my hometown, he is
covered by an insurance policy. He has got a retirement benefit
plan. Why does a man like this gentleman here have such
difficulty in New York?
Mr. Skyler. I believe Mr. Vinciguerra actually has been
treated by our Bureau of Health Services. One of the gaps that
was exposed was a lack of prescription drug care, which we have
remedied since the panel's report came out.
Mr. Deal. Mr. Vinciguerra?
Mr. Vinciguerra. Yes, if I may, the reason I think there is
some confusion is I worked for the EMS division of the fire
department, and it is sort of considered a civilian component
even though it is a uniformed service now. It works under
compensation, not the pension component.
Mr. Skyler. Well, Dr. Melius's testimony here says that
depending on a Worker's Compensation disability retirement
system to cover the medical cost for the monitoring and
treatment programs, placed a financial burden on the employers
and the insurance companies.
Mr. Deal. Well, yes, that is true. Any time you write an
insurance policy or create a system, when you have a claim that
comes forward, whether they be of the magnitude we are talking
about here or even minor claims that same statement could be
true. Let me ask specifically about how we are spending money.
Ms. Bascetta, in your testimony, I am looking at the
portion where you talk about the contracts that NIOSH has
entered into for those outside of the metropolitan area. And
you say in June 2005, they began a second effort by awarding
$776,000 to Mount Sinai School of Medicine to provide screening
and monitoring for non-Federal responders residing outside the
metropolitan area.
And then in June 2006, they awarded an additional $788,000
to provide screening for these first responders. And you
conclude the paragraph by saying that they ultimately
contracted with 10 clinics in seven States and that as of June
2007, 10 clinics were monitoring 180 responders. That is an
awful lot of money for a very few people. Am I reading this
wrong?
Ms. Bascetta. No, you are correct. The system wasn't
working well at all, and in fact to update that, NIOSH has gone
to a different system with a different contract with QTC, I
believe. Dr. Howard referred to that, and they have piloted it.
They have done about 20 exams under that program, but the first
program did not work well at all.
Mr. Deal. OK. Well, let us go to more recent. You say here
in June 2007, NIOSH awarded $800,600 for DCC to coordinate
provisions of screening and monitoring exams, to provide 1,000
screenings and monitoring examinations through May 2008. And
they began the screening process, and by the end of August, 18
non-Federal responders had completed screening and 33 others
had been scheduled. Here again, that appears to be a lot of
Federal dollars for a very few people that are being affected
by it. I mean we would be better off to take that amount of
money and give all those people that amount of money in cash,
wouldn't we?
Ms. Bascetta. It is a very good question. Again that is the
same program that you were just referring to. The money was
there, but the administrative logistics were not in place to
serve the people well. And it didn't happen.
Mr. Deal. And yet we are going to be anticipating the same
kind of funding or even at greater levels for this fiscal year,
are we not?
Ms. Bascetta. Yes, but those funds were for screening and
monitoring, and the discussion that we were just having was
about treatment, which is actually where even more of the funds
would be required. The screening and monitoring are a smaller
proportion, and they are known costs. Once you get the
mechanisms in place to do the screening and monitoring, then
you know per person what that is going to run.
Mr. Deal. But using that same logic, if the cost per person
just to do the screening and monitoring is so exorbitant and
out of kilter it seems to me, then we would expect the
treatment phase of it to be even more exorbitant, would we not?
I mean why is it costing so much to do so little for so few?
Ms. Bascetta. Well, I don't think we know at this point
what the full treatments costs are going to be. One of our
findings was that HHS has just last year begun asking for the
actual cost data from the grantees. Last year was also the
first year that there was Federal money awarded to grantees,
and prior to that, it was all philanthropic funds from the Red
Cross. So there wasn't a requirement for the grantees to be
reporting actual cost data.
We would hope that one of the lessons learned from this
situation is that in the future the requirements for screening
and monitoring, who is responsible for that, where the funding
streams will come from, how those programs will be
administered, and how the various funding streams for treatment
would be made available to pay for treatment if that were
necessary, would be planned in advance to avoid this kind of
situation after the fact.
Mr. Deal. Well, I don't mean to diminish the importance of
what we are all talking about here by my questions, but I do
think that we can't just simply all say take a simplistic
answer of let the Federal tax payer pick up the burden. Let us
forget about asking the private insurers to contribute. They
have been paid premiums for that, but it is too cumbersome to
do that. Let us forget about the Worker's Compensation system
because it takes too long to go through system.
I can assure you that every injured employee in this
country who has a Worker's Compensation claim would tell you
yes, the system does take a while. But just to say let us
forget about that and throw up our hands and ask the Federal
Government to pitch in millions, perhaps billions of dollars, I
think, doesn't show the kind of responsibility that I think all
of these responders showed when the responded to the emergency
before them.
I think there is a responsibility at every level for us to
make sure that we are doing what is best for the people who
need the help and that we are not just throwing dollars out
there that don't seem to wind up in the right place. That is
the concern that I have.
Mr. Pallone. Mr. Engel.
Mr. Engel. Thank you, Mr. Chairman. Let me just say before
I ask my question in view of some of the comments that my
friend Mr. Deal has been making. The President talks a lot
about America being attacked on 9/11 and talks a lot about it
being as part of the overall fight on terror. He mentions Iraq
and everything else and that the United States of America was
attacked.
Well, we in New York don't believe that we were attacked
simply by random. New York was obviously a symbol of the
country, and the terrorists wanted to hit us hard. Therefore,
we believe that the Federal Government has an enormous
responsibility above and beyond. It is not just simply worker's
comp or private insurance plans.
Sure, it would be helpful, but the bottom line for me is
that the Federal Government needs to be responsible. We were
attacked. New Yorkers were killed and maimed and injured, and
the Federal Government needs to have a response. And I think
pushing it off on private companies or whatever--and I am not
trying to absolve them of responsibility, but the bottom line
for me is again that the Federal Government needs to step in.
Mr. Skyler, let me just ask you. I don't know if you were
here when I gave my opening statement, but I talked a lot not
only about first responders but about other New Yorkers and
people from the metropolitan area who were exposed to these
poison toxins, people who live within the area, residents,
students. These people who were exposed to the toxins of Ground
Zero are not eligible for the federally funded World Trade
Center Medical Monitoring and Treatment programs.
We have just introduced a bill lead by Mrs. Maloney, Mr.
Fossella, Mr. Nadler, but many of us also co-sponsored and
signed on, which would help the entire exposed community. I am
wondering if you could give us some of your insights on how
that bill would help and why it is so necessary.
Mr. Skyler. Absolutely, and I think the bill addresses one
of the fundamental challenges, also something that Congressman
Deal essentially stated, which is that we have different
populations, and we have different systems that handle
different populations. But we have the same health effects
caused by the same disaster, an environmental disaster, and I
am not aware of one on American soil that was greater than this
one. It is an environmental disaster, not just a terrorist
attack.
But we have populations where different standards apply
depending on what their pension benefits are, depending whether
they are on worker's comp or not, depending on what union they
are in sometimes, depending on what resources that union has
available, depending on where they live.
So one of the things that the report recommended was to
establish an enhanced funding for a World Trade Center
environmental health center in Bellevue Hospital. It is a
hospital in New York City, Manhattan, that anybody can go to,
whether you are a resident--and there was no treatment program
available for residents before this was established--whether
you are a firefighter or police officer, whether you are a
worker, whether you worked in the cleanup as a contractor or
whether you worked in the building cleaning up the interior of
a building that was damaged.
Anybody can walk in there and get care, and we have had
about 1,600 people go in. And that is a gap that needs to be
filled. There are other gaps throughout the populations that we
have also sought to fill, but that was a huge one that nobody
had focused on. And we are gratified to see that Congresswoman
Maloney's bill, the Zadroga Act, which I am here to support,
actually identifies that population as one deserving funding.
Mr. Engel. Thank you. I think that is very important. Dr.
Herbert, let me ask you something specifically about the Mount
Sinai program. Many of the responders who are now in medical
monitoring programs, these are run by their employer, the fire
department or the police department. And a lot of the problems
are mental health related, and due to the presence of these
issues among the population, might it not be possible that some
of these workers fear sharing this information with their
employer due to potential adverse work consequences and things
like that?
Now, let me ask you about the Mount Sinai program. Should
you be assisting in helping in monitoring those employees who
may be uncomfortable with being monitored by their employer?
Dr. Herbert. Thank you for asking that question. To clarify
with respect to the two federally funded monitoring and
treatment programs for responders, distinct from the additional
program that Mr. Skyler spoke about, one is employer based, the
program for New York firefighters or employees of FDNY is based
at the Bureau of Health Services.
The other federally funded program does exactly what you
have suggested might be important. The way the program works is
that we have exposure-based eligibility criteria. Any responder
can choose the Center of Excellence that he or she prefers to
go to, and the examinations are highly confidential. We are
very well aware that we are collecting very sensitive
information. We adhere to all pertinent HIPA regulations. So,
in fact, I think it is very important, and it is one of the
reasons that I believe--we have had enormous success in
combining mental health screening and treatment with physical
health screening and treatment in a group of workers who
probably would not seek mental health care.
Mr. Engel. Let me ask you this. You have your program, the
fire department's medical monitoring program, the World Trade
Center Health Registry, the World Trade Center responders,
Fatality and Investigation program, and Project Cope to name a
few. All these programs seem to be working within their own
silos. Are there any plans to merge data, save resources, share
expertise, to examine the overall health effects related to the
World Trade Center rather than just limited populations?
Dr. Herbert. Yes, indeed there is, and we think that is
very important. Presently, the New York/New Jersey consortium
group of clinical centers and the FDNY programs use virtually
identical questionnaires for the follow-up visits and the
monitoring program.
Because of a number of privacy issues, it is sometimes
difficult to actually have the same data systems, but we are
collecting virtually identical data. And so we will be able to
compare the experiences of different groups of responders, and
that is essential.
We, in the Mount Sinai consortium, and Dr. Prazant at the
FDNY program are also working very closely both with the World
Trade Center registry and with the New York State fatality
investigation. So we agree that it is critical that resources
be used in as prudent as possible so there is not redundancy.
Mr. Engel. Thank you. Thank you, Mr. Chairman.
Mr. Pallone. Mr. Fossella.
Mr. Fossella. Thank you, Mr. Chairman. I thank the panel
again for your testimony, particularly Deputy Mayor Skyler. And
this gets back to the overarching issue of the city of New York
has stepped in to fill this breach, and many of us feel that it
should have been the Federal Government stepping in immediately
to help fill the breach. And the panel is consisting of people
who have had to deal with the first responders and others, Mr.
Vinciguerra from day one. And I used it before Dr. Howard as we
are waiting for the cavalry.
And there are some legitimate concerns, I guess, one could
point to if they are looking in after the fact and say where
are the problems? And I think we have a responsibility to ask
those questions to make improvements. But if I believe the
Federal Government was up front early on, perhaps we could
avoid asking those questions today because we would have had
them at the table.
If I am not mistaken, with respect to some of the issues
that have been raised, for example, workman's comp is designed
through actuarial tables and doesn't necessarily take into
account the scope and size of this catastrophe, the thousands
and tens of thousands. 400,000 people thought to be affected
would be one of the largest cities in this country, larger than
the population of Minneapolis is, for example, people who have
been affected by this.
So the system design does not, I think, take into account
that radical number. And, in fact, some of the money we secured
last year was helping the workman's compensation system
facilitate and minimize the delays of those who partitioned the
program.
Second, this is not totally unwarranted or unprecedented.
After Pearl Harbor, there were programs that were put in place
to help sailors who were called in to respond and came down
with certain illnesses. So the Federal Government recognizing,
although it took place in Hawaii, that this was a national
catastrophe and demanded national scope.
Similarly, we can make that argument that flood insurance
should be held by everybody or homeowner's insurance. But we
know that major hurricanes, tornadoes, fires, other, FEMA steps
in some way, shape, or form to help people through that system.
And finally there are those, we have noticed--and I would
like to ask the deputy mayor for maybe expounding a little bit
on this--we kept emphasizing that although it took place in New
York City, this is a national problem in scope. You mention
that there are 20,000 people who don't even live in New York
City, again this would be larger than many towns and cities and
villages across this country, 20,000 people.
So if you were a firefighter from Hialeah, FL, as Mr.
Pallone said, or came in from New Orleans or California, and
then went back to work and now suffering, common sense would
dictate that that individual would show the similar signs of
ailments and illnesses and manifestations of those diseases,
let us say, or illnesses as someone who lives in New Jersey or
Staten Island, New York. And yet that person is probably on his
own right now, and we don't even know whether that person
becomes eligible for satisfaction under workman's comp.
So, Deputy Mayor Skyler, can you expand or illuminate,
elaborate if you will, on the number who do not live within New
York City?
Mr. Skyler. The World Trade Center registry, through their
modeling, estimated--and a lot of what we deal with in this
subject is estimates--there are 410,000 people that qualified
for the World Trade Center Health Registry, and that is based
on where they lived, where they worked, where they were that
day. We estimate that of those 410,000, 45,000 of them live
outside not only New York State but New Jersey, which I believe
has the second most members in the registry.
Of the 410,000 that we estimate, we had over 71,000 people
signed up, we believe, of the 410,000 that qualified. And about
10,000 of them live outside New York and New Jersey. And at
least one of them lives in Congressman Deal's district in
Georgia. There is literally at least one person in almost every
congressional district in the country.
So it is absolutely a national problem, and it is not just
because New York was attacked because of its symbolism, because
it is the financial and media center of the country. But people
come to New York. Sometimes they live in New Jersey. Sometimes
they live in Connecticut. Sometimes they are there for the day.
Sometimes they are working there for a couple months or
visiting.
We have a population that is, to some extent, always
changing, and people relocate. And we also had a great amount
of people that came from all over the country to help when we
needed. And this is a recovery that just wasn't a couple of
days or weeks. It was months.
So we believe that the Federal Government has a
responsibility to help the city take care of its own. The city
has stepped up. The city takes care of its firefighters. We
take care of our police officers. We have done the best we can.
What we are asking for is some Federal assistance so we have
the long-term funding in place not only to maintain the great
levels of care that we have established in our centers of
excellence, but make sure that people that aren't parts of
those populations also get the care they need.
If you were hurt because of 9/11, it shouldn't be just
because you worked for the city or responded. If you were hurt
because you lived across the street and breathed in the air
potentially, then you also should be deserving the same
assistance. And we have been hard at work. Since this panel
report came out, there is only, I believe, two or three of the
15 recommendations that fall outside of the city. They are
essentially requests for the Federal Government to help.
One is the Victims' Compensation Fund, which I mentioned
before, that Speaker Pelosi voiced her support for earlier. I
am not sure whether she supports the whole James Zadroga Act. I
would refer you to her office, but she voiced support for the
Victims' Compensation Fund.
The second is getting long-term funding from the Federal
Government. The rest of the report was the city government
taking a hard look at itself and saying it wasn't doing a good
enough job explaining to the city workers what resources were
available, coordinating services, encouraging people to get
checkups, establishing communications within city government,
and establishing protocols so that we have emergencies that
have environmental impacts, whether it is Deutsche Bank
building or the steam pipe explosion, that we have
environmental professionals on scene that can help guide the
emergency response.
So we have tried to learn from this disaster and do what we
can do to improve our response. But what we are also saying is
we are in need of a Federal commitment so that the people that
were hurt don't have their care jeopardized by the fiscal
stability or health of New York City. In tough times, programs
get cut back.
We would like to see an established program, a sustained
commitment, so that people that were hurt continue to get the
care they need. It is possible that some of these illnesses--
doctors could speak better than I could--will improve over
time. It is also possible that things will get worse. We don't
know. There are a lot of illnesses that we would not have a
sense at this point of whether they will materialize. And we
are talking about hundreds of thousands of people here, and it
is unlike something that the country has ever experienced. And
it is impossible for the health insurance mechanism, as set up
now, to absorb it and care for it properly.
Mr. Fossella. Thank you, Mr. Skyler. Thank you, Mr.
Chairman.
Mr. Pallone. Sure. I have to apologize to Mr. Weiner
because he was supposed to go next because Mr. Fossella is not
on the subcommittee. I apologize. Your turn.
Mr. Weiner. Well, I am gratified then that Mr. Fossella did
such a good job in his time. I thank you, Mr. Chairman. I think
that it is very important that we address fully Mr. Deal's
concerns because we want this effort to be one that is
bipartisan. There are a lot of people who are not living with
these issues day to day like we are who perhaps don't
understand the nuance and raise similar questions.
And perhaps, Mr. Skyler, you can expand a little bit on
this notion that the programs that have been set up for the
fire department, for example, take a State program, the
disability insurance program, and say we as New York City
residents, we are going to do even better. We are going to
provide them even better care. We are going to step in and
provide better care.
I don't think that the failure of the fire fighters to go
through the disability program is any way the shirking of New
York City's responsibility. It is taking on in addition. I just
want to make sure that is clear for the record.
Mr. Skyler. Right, the level of care provided by the Bureau
of Health Services, the fire department, is the gold standard.
And if we can provide every person that was affected by these
attacks with that level of care, we would be in a lot better
shape than we are currently.
Mr. Weiner. And I think it is also worth noting one of the
tools that many of the medical community have to determine what
is going on is the monitoring that went on of firefighters long
before September 11 that allow people to look at healthy 20-
year-old lungs and 23-year-old lungs that look like they should
be on a 70-year-old person. That is one of the reasons that
that is available.
I think it is also important that we understand that what
we are suggesting here is exactly what Congress--and I don't
know the record of my colleagues on the committee or Mr. Deal--
I know Mr. Fossella and Mr. Engel's on this. We looked at a
very similar problem when we created the Victim's Compensation
Fund. We said well, how do we deal with what could be long-term
lawsuits that go on ad infinitum. How do we deal with a
community that has so many victims coming from so many places?
How do you deal with them expeditiously, compassionately? How
do we deal with this when the Victims' Compensation Fund was
created?
And with that in mind, I just want to ask--and I will just
go one by one on the panel--is there any doubt based on either
your experience, your friendships with other people, your
research that you write, is there any doubt in your mind--I
will go from left to right--that people today are dying from 9/
11-related illnesses? Why don't we start to the left, just a
quick yes no. Is there any doubt in your mind?
Mr. Vinciguerra. Yes, people are dying.
Mr. Weiner. Doctor?
Dr. Udasin. Yes.
Dr. Herbert. I agree with Dr. Udasin.
Ms. Bascetta. There is a large part of peer-reviewed
literature that documents the health effects.
Mr. Weiner. Doctor?
Dr. Melius. Yes, absolutely.
Mr. Weiner. Mr. Skyler?
Mr. Skyler. I am not a doctor, but clearly there is
tremendous amount of harm that was caused by the attacks.
Mr. Weiner. And the Victims' Compensation Fund was created
for people who died from the attacks. So the only question is
Congress's instinct and Congress's desire to try to figure who
the universe of people is, set up rules and parameters, and
then go out and take care of them. The only thing that the city
is asking is that the one parameter, December 2003, be changed.
And that we know now that there is a whole universe of people
who themselves didn't know that they were dying from September
11 related diseases and figuring out the correct place to place
that December 2003 date.
We are asking essentially--what the city is asking, what
residents are asking us to do--and what the residents of 40 or
so States or all 50 States who are asking who are in this
additional group, to do what all of us voted for. And at the
time, those 2,800 or so that were in the known class of people
that had died at the time, they had insurance. They had
lawyers. They had someone to sue. They had a lot of people to
sue, and we made a decision, you know what, it is probably
better for everyone involved that rather than fighting in the
courts for perhaps the better part of a generation over this,
let us figure out what our responsible role is. And it had
broad bipartisan support in its institution.
And I should say something else. If the Federal Government
says no, Congress says no, we are not going to do any of these
things we are going to do what we can. All of the people who
are here testifying are going to keep doing their good work. We
are going to keep advocating. We are going to do what we can to
embrace one another. We are going to try to figure out a way to
take care of these people.
The question is: Is this the best way to care for people
who are dying because of their heroism or their simple presence
on September 11 at a certain place? Is that the way we want to
respond as a Congress and as a people? Up to now, the American
people, through their Congress, have said no, we don't believe
that we want to respond. And we let people kind of go fend for
themselves. If they are fortunate enough to have good insurance
or to have been further away from the plume or to be a
firefighter that has good monitoring, if that is where--
Congress could wind up being there.
But I want to make it clear that what we are suggesting
here and what sponsors of the bill are suggesting and what
Mayor Bloomberg is suggesting is not this cosmically different
way of looking at the problem. It is the same way that Mr. Deal
and I and others in this Congress looked at it after September
11. We were attacked. Let us figure out a smart, compassionate,
comprehensive way to deal with it.
We are not rewriting everything here. We are not
reinventing the wheel with this legislation. The mayor's desire
to reopen the compensation fund, all of our desire to do that,
is trying to figure out a way--and let me just end--I know I am
a little bit over time.
If you are concerned, as I know so many of my colleagues
are about the courts being clogged up with lawsuits and that us
using the courts as the way we solve even the most basic
disagreement about interpretations--and I know many of my
colleagues on the judiciary committee have that feeling. Well,
the Victims' Compensation Fund is a way, in the words of Mr.
Skyler, to get us working together rather than fighting one
another.
It would be a shame if we are all sitting here in 10 years
talking about and reading about the horrible lawsuits going on
as families sue the city of New York which desperately wants to
try to provide help. And I think the questions that Mr. Deal
asked are exactly the right ones, and that we have to embark on
trying to explain to people what we are doing here is not
transformative. It is just tweaking a system that we have
already created.
The city has taken on an enormous amount of responsibility.
Whoever the next mayor is is going to have to deal with those
responsibilities as well, but it is imperative that we, the
Federal Government, take this opportunity to continue the job
that we began. And I want to commend Mr. Fossella and Ms.
Maloney, Mr. Nadler, Mr. Engel, and the chairman, Mr. Pallone,
for helping us get to that place and for all of you for
testifying here.
Mr. Pallone. Thank you. Let me say before we conclude that
this was just a beginning. This was not a legislative hearing
per se. I mean we didn't have a piece of legislation before us,
but it is my intention, and I think I can hear that there is a
bipartisan concern that the current system is broken in terms
of handling the health concerns of both first responders as
well as other people that may have been impacted because they
lived or worked in the vicinity of the World Trade Center.
So it is our intention to follow up on this and come up
with some legislative initiative. But I think you can all see
that even though, on a bipartisan basis, we realize that the
status quo doesn't work as well as we would like, that it is
difficult to figure out exactly how to put something together.
So we are probably going to rely on all of you and follow
up with phone calls and other things to help us out as we
proceed, but we do intend to try to put something together
legislatively.
And let me just say also that the Members, as always, can
submit additional questions for the record to be answered by
all of you. The questions should be submitted to the clerk
within the next 10 days, and then we would notify you about
those questions. So you may get some follow up in that respect.
And without objection, this meeting of the subcommittee is
adjourned. Thank you all.
[Whereupon, at 1:30 p.m., the subcommittee was adjourned.]