September 11: Improvements Still Needed in Availability of Health
Screening and Monitoring Services for Responders outside the New 
York City Area (22-JAN-08, GAO-08-429T).			 
                                                                 
Six years after the attack on the World Trade Center (WTC),	 
concerns persist about health effects experienced by WTC	 
responders and the availability of health care services for those
affected. Several federally funded programs provide screening,	 
monitoring, or treatment services to responders. GAO has	 
previously reported on the progress made and implementation	 
problems faced by these WTC health programs. This testimony is	 
based primarily on GAO's testimony, September 11: Improvements	 
Needed in Availability of Health Screening and Monitoring	 
Services for Responders (GAO-07-1229T, Sept. 10, 2007), which	 
updated GAO's report, September 11: HHS Needs to Ensure the	 
Availability of Health Screening and Monitoring for All 	 
Responders (GAO-07-892, July 23, 2007). In this testimony, GAO	 
discusses efforts by the Centers for Disease Control and	 
Prevention's National Institute for Occupational Safety and	 
Health (NIOSH) to provide services for nonfederal responders	 
residing outside the New York City (NYC) area. For the July 2007 
report, GAO reviewed program documents and interviewed Department
of Health and Human Services (HHS) officials, grantees, and	 
others. GAO updated selected information in August and September 
2007 and conducted work for this statement in January 2008.	 
-------------------------Indexing Terms------------------------- 
REPORTNUM:   GAO-08-429T					        
    ACCNO:   A79971						        
  TITLE:     September 11: Improvements Still Needed in Availability  
of Health Screening and Monitoring Services for Responders	 
outside the New York City Area					 
     DATE:   01/22/2008 
  SUBJECT:   Disease detection or diagnosis			 
	     Federal aid programs				 
	     Federal employees					 
	     Health care programs				 
	     Health care services				 
	     Health hazards					 
	     Interagency relations				 
	     Occupational health and safety programs		 
	     Program management 				 
	     Terrorism						 
	     HHS WTC Federal Responder Screening		 
	     Program						 
                                                                 

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GAO-08-429T

   

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Testimony: 

Before the Subcommittee on Government Management, Organization, and 
Procurement, Committee on Oversight and Government Reform, House of 
Representatives: 

United States Government Accountability Office: 

GAO: 

For Release on Delivery Expected at 10:30 a.m. EST: 

in New York, New York Tuesday, January 22, 2008: 

September 11: 

Improvements Still Needed in Availability of Health Screening and 
Monitoring Services for Responders outside the New York City Area: 

Statement of Cynthia A. Bascetta: 

Director, Health Care: 

GAO-08-429T: 

GAO Highlights: 

Highlights of GAO-08-429T, a testimony before the Subcommittee on 
Government Management, Organization, and Procurement, Committee on 
Oversight and Government Reform, House of Representatives. 

Why GAO Did This Study: 

Six years after the attack on the World Trade Center (WTC), concerns 
persist about health effects experienced by WTC responders and the 
availability of health care services for those affected. Several 
federally funded programs provide screening, monitoring, or treatment 
services to responders. GAO has previously reported on the progress 
made and implementation problems faced by these WTC health programs. 

This testimony is based primarily on GAOï¿½s testimony, September 11: 
Improvements Needed in Availability of Health Screening and Monitoring 
Services for Responders (GAO-07-1229T, Sept. 10, 2007), which updated 
GAOï¿½s report, September 11: HHS Needs to Ensure the Availability of 
Health Screening and Monitoring for All Responders (GAO-07-892, July 
23, 2007). In this testimony, GAO discusses efforts by the Centers for 
Disease Control and Preventionï¿½s National Institute for Occupational 
Safety and Health (NIOSH) to provide services for nonfederal responders 
residing outside the New York City (NYC) area. 

For the July 2007 report, GAO reviewed program documents and 
interviewed Department of Health and Human Services (HHS) officials, 
grantees, and others. GAO updated selected information in August and 
September 2007 and conducted work for this statement in January 2008. 

What GAO Found: 

In July 2007, following a reexamination of the status of the WTC health 
programs, GAO recommended that the Secretary of HHS take expeditious 
action to ensure that health screening and monitoring services are 
available to all people who responded to the WTC attack, regardless of 
where they reside. As of January 2008, the department has not responded 
to this recommendation. 

As GAO testified in September 2007, NIOSH has not ensured the 
availability of screening and monitoring services for nonfederal 
responders residing outside the NYC area, although it has taken steps 
toward expanding the availability of these services. In late 2002, 
NIOSH arranged for a network of occupational health clinics to provide 
screening services. This effort ended in July 2004, and until June 2005 
NIOSH did not fund screening or monitoring services for nonfederal 
responders outside the NYC area. In June 2005, NIOSH funded the Mount 
Sinai School of Medicine Data and Coordination Center (DCC) to provide 
screening and monitoring services; however, DCC had difficulty 
establishing a nationwide network of providers and contracted with only 
10 clinics in seven states. In 2006, NIOSH began to explore other 
options for providing these services, and in 2007 it took steps toward 
expanding the provider network. 

To view the full product, including the scope and methodology, click on 
[hyperlink, http://www.GAO-08-429T]. For more information, contact 
Cynthia A. Bascetta at (202) 512-7114 or [email protected]. 

[End of section] 

Mr. Chairman and Members of the Subcommittee: 

I am pleased to be here today to discuss our work on the implementation 
of federally funded health programs for individuals affected by the 
September 11, 2001, attack on the World Trade Center (WTC).[Footnote 1] 
Tens of thousands of people served as responders in the aftermath of 
the WTC disaster, including New York City Fire Department (FDNY) 
personnel, federal government personnel, and thousands who came to New 
York City (NYC) from around the country. By responders we are referring 
to anyone involved in rescue, recovery, or cleanup activities at or 
near the vicinity of the WTC or the Staten Island site.[Footnote 2] 
These responders were exposed to numerous physical hazards, 
environmental toxins, and psychological trauma. Six years after the 
destruction of the WTC buildings, concerns remain about the physical 
and mental health effects of the disaster, the long-term nature of some 
of these health effects, and the availability of health care services 
for those affected. 

Following the WTC attack, federal funding was provided to government 
agencies and private organizations to establish programs for screening, 
monitoring, or treating responders for illnesses and conditions related 
to the WTC disaster; these programs are referred to in this testimony 
as the WTC health programs.[Footnote 3],[Footnote 4] The Department of 
Health and Human Services (HHS) funded the programs as separate efforts 
serving different categories of responders--for example, firefighters, 
other workers and volunteers, or federal responders--and has 
responsibility for coordinating program efforts. 

We have previously reported on the implementation of these programs and 
their progress in providing services to responders,[Footnote 5] who 
reside in all 50 states and the District of Columbia. We also 
previously reported that one of the WTC health programs, HHS's WTC 
Federal Responder Screening Program, which was established to provide 
onetime screening examinations for responders who were federal 
employees when they responded to the WTC attack, has had difficulties 
ensuring the uninterrupted availability of services.[Footnote 6] HHS 
established the program in June 2003, suspended it in March 2004, 
resumed it in December 2005, suspended it again in January 2007, and 
resumed it in May 2007.[Footnote 7] We also reported that the National 
Institute for Occupational Safety and Health (NIOSH), the component of 
HHS's Centers for Disease Control and Prevention responsible for 
administering most of the WTC health programs, had begun to take steps 
to provide access to screening, monitoring, and treatment services for 
nonfederal responders who resided outside the NYC metropolitan 
area.[Footnote 8] 

My testimony today is based primarily on testimony we issued in 
September 2007,[Footnote 9] which in turn was based on a report we 
issued in July 2007.[Footnote 10] As you requested, I will discuss the 
status of NIOSH's efforts to provide services for nonfederal responders 
residing outside the NYC metropolitan area. 

To assess the status of NIOSH's efforts to provide services for 
nonfederal responders residing outside the NYC metropolitan area, we 
obtained documents and interviewed officials from NIOSH. We also 
interviewed officials of organizations that worked with NIOSH to 
provide or facilitate services for nonfederal responders residing 
outside the NYC metropolitan area, including the Mount Sinai School of 
Medicine in NYC and the Association of Occupational and Environmental 
Clinics (AOEC)--a network of university-affiliated and other private 
occupational health clinics across the United States and in Canada. In 
our review of the WTC health programs, we relied primarily on 
information provided by agency officials and contained in government 
publications. We compared the information with information in other 
supporting documents, when available, to determine its consistency and 
reasonableness. We determined that the information we obtained was 
sufficiently reliable for our purposes. We conducted our earlier work 
from November 2006 through July 2007, updated selected information in 
August and September 2007, and conducted work for this statement in 
January 2008. We conducted this performance audit in accordance with 
generally accepted government auditing standards. Those standards 
require that we plan and perform the audit to obtain sufficient, 
appropriate evidence to provide a reasonable basis for our findings and 
conclusions based on our audit objectives. We believe that the evidence 
obtained provides a reasonable basis for our findings and conclusions 
based on our audit objectives. 

In brief, as we testified in September 2007, NIOSH has not ensured the 
availability of screening and monitoring services for nonfederal 
responders residing outside the NYC metropolitan area, although it has 
taken steps toward expanding the availability of these services. As a 
result of our assessment of the WTC health programs, we recommended in 
our July 2007 report that the Secretary of HHS expeditiously take 
action to ensure that screening and monitoring services are available 
for all responders, including federal responders and nonfederal 
responders residing outside of the NYC metropolitan area. As of January 
2008, the department has not responded to this recommendation. 

Background: 

The tens of thousands of individuals[Footnote 11] who responded to the 
September 11, 2001, attack on the WTC experienced the emotional trauma 
of the disaster and were exposed to a noxious mixture of dust, debris, 
smoke, and potentially toxic contaminants, such as pulverized concrete, 
fibrous glass, particulate matter, and asbestos. A wide variety of 
health effects have been experienced by responders to the WTC attack, 
including injuries and respiratory conditions such as sinusitis, 
asthma, and a new syndrome called WTC cough, which consists of 
persistent coughing accompanied by severe respiratory symptoms. 
Commonly reported mental health effects among responders and other 
affected individuals included symptoms associated with post-traumatic 
stress disorder, depression, and anxiety. Behavioral health effects 
such as alcohol and tobacco use have also been reported. 

There are six key programs that currently receive federal funding to 
provide voluntary health screening, monitoring, or treatment at no cost 
to responders.[Footnote 12] The six WTC health programs, shown in table 
1, are (1) the FDNY WTC Medical Monitoring and Treatment Program; (2) 
the New York/New Jersey (NY/NJ) WTC Consortium,[Footnote 13] which 
comprises five clinical centers in the NY/NJ area;[Footnote 14] (3) the 
WTC Federal Responder Screening Program; (4) the WTC Health Registry; 
(5) Project COPE; and (6) the Police Organization Providing Peer 
Assistance (POPPA) program.[Footnote 15] The programs vary in aspects 
such as the HHS administering agency or component responsible for 
administering the funding; the implementing agency, component, or 
organization responsible for providing program services; eligibility 
requirements; and services. 

Table 1: Key Federally Funded WTC Health Programs, June 2007: 

Program: FDNY WTC Medical Monitoring and Treatment Program; 
HHS administering agency or component: NIOSH; 
Implementing agency, component, or organization: FDNY Bureau of Health 
Services; 
Eligible population: Firefighters and emergency medical service 
technicians; 
Services provided: * Initial screening; 
* Follow-up medical monitoring; 
* Treatment of WTC-related physical and mental health conditions. 

Program: NY/NJ WTC Consortium; 
HHS administering agency or component: NIOSH; 
Implementing agency, component, or organization: Five clinical centers, 
one of which, the Mount Sinai-Irving J. Selikoff Center for 
Occupational and Environmental Medicine, also serves as the 
consortium's Data and Coordination Center (DCC); 
Eligible population: All responders, excluding FDNY firefighters and 
emergency medical service technicians and current federal employees[A]; 
Services provided: * Initial screening; 
* Follow-up medical monitoring; 
* Treatment of WTC-related physical and mental health conditions. 

Program: WTC Federal Responder Screening Program; 
HHS administering agency or component: NIOSH[B]; 
Implementing agency, component, or organization: HHS's Federal 
Occupational Health Services (FOH); 
Eligible population: Current federal employees who responded to the WTC 
attack in an official capacity; 
Services provided: * Onetime screening; 
* Referrals to employee assistance programs and specialty diagnostic 
services[C]. 

Program: WTC Health Registry; 
HHS administering agency or component: Agency for Toxic Substances and 
Disease Registry (ATSDR); 
Implementing agency, component, or organization: NYC Department of 
Health and Mental Hygiene; 
Eligible population: Responders and people living or attending school 
in the area of the WTC or working or present in the vicinity on 
September 11, 2001; 
Services provided: * Long-term monitoring through periodic surveys. 

Program: Project COPE; 
HHS administering agency or component: NIOSH; 
Implementing agency, component, or organization: Collaboration between 
the NYC Police Foundation and Columbia University Medical Center; 
Eligible population: New York City Police Department (NYPD) uniformed 
and civilian employees and their family members; 
Services provided: * Hotline, mental health counseling, and referral 
services; some services provided by Columbia University clinical staff 
and some by other clinicians. 

Program: POPPA program; 
HHS administering agency or component: NIOSH; 
Implementing agency, component, or organization: POPPA program; 
Eligible population: NYPD uniformed employees; 
Services provided: * Hotline, mental health counseling, and referral 
services; some services provided by trained NYPD officers and some by 
mental health professionals. 

Source: GAO analysis of information from NIOSH, ATSDR, FOH, FDNY, the 
NY/NJ WTC Consortium, the NYC Department of Health and Mental Hygiene, 
the POPPA program, and Project COPE. 

Note: Some of these federally funded programs have also received funds 
from the American Red Cross and other private organizations. 

[A] In February 2006, HHS's Office of the Assistant Secretary for 
Preparedness and Response (ASPR) and NIOSH reached an agreement to have 
former federal employees screened by the NY/NJ WTC Consortium. ASPR 
coordinates and directs HHS's emergency preparedness and response 
program. In December 2006 the Office of Public Health and Emergency 
Preparedness became ASPR. 

[B] Until December 26, 2006, ASPR was the administrator. 

[C] FOH can refer an individual with mental health symptoms to an 
employee assistance program for a telephone assessment. If appropriate, 
the individual can then be referred to a program counselor for up to 
six in-person sessions. The specialty diagnostic services are provided 
by ear, nose, and throat doctors; pulmonologists; and cardiologists. 

[End of table] 

The WTC health programs that are providing screening and monitoring are 
tracking thousands of individuals who were affected by the WTC 
disaster. As of June 2007, the FDNY WTC program had screened about 
14,500 responders and had conducted follow-up examinations for about 
13,500 of these responders, while the NY/NJ WTC Consortium had screened 
about 20,000 responders and had conducted follow-up examinations for 
about 8,000 of these responders. Some of the responders include 
nonfederal responders residing outside the NYC metropolitan area. As of 
June 2007, the WTC Federal Responder Screening Program had screened 
1,305 federal responders and referred 281 responders for employee 
assistance program services or specialty diagnostic services. In 
addition, the WTC Health Registry, a monitoring program that consists 
of periodic surveys of self-reported health status and related studies 
but does not provide in-person screening or monitoring, collected 
baseline health data from over 71,000 people who enrolled in the 
registry.[Footnote 16] In the winter of 2006, the registry began its 
first adult follow-up survey, and as of June 2007 over 36,000 
individuals had completed the follow-up survey. 

In addition to providing medical examinations, FDNY's WTC program and 
the NY/NJ WTC Consortium have collected information for use in 
scientific research to better understand the health effects of the WTC 
attack and other disasters. The WTC Health Registry is also collecting 
information to assess the long-term public health consequences of the 
disaster. 

In February 2006, the Secretary of HHS designated the Director of NIOSH 
to take the lead in ensuring that the WTC health programs are well 
coordinated, and in September 2006 the Secretary established the WTC 
Task Force to advise him on federal policies and funding issues related 
to responders' health conditions. The chair of the task force is HHS's 
Assistant Secretary for Health, and the vice chair is the Director of 
NIOSH. 

NIOSH Has Not Ensured the Availability of Services for Nonfederal 
Responders Residing outside the NYC Metropolitan Area: 

NIOSH has not ensured the availability of screening and monitoring 
services for nonfederal responders residing outside the NYC 
metropolitan area, although it has taken steps toward expanding the 
availability of these services. Initially, NIOSH made two efforts to 
provide screening and monitoring services for these responders, the 
exact number of whom is unknown.[Footnote 17] The first effort began in 
late 2002 when NIOSH awarded a contract for about $306,000 to the Mount 
Sinai School of Medicine to provide screening services for nonfederal 
responders residing outside the NYC metropolitan area and directed it 
to establish a subcontract with AOEC.[Footnote 18] AOEC then 
subcontracted with 32 of its member clinics across the country to 
provide screening services. From February 2003 to July 2004, the 32 
AOEC member clinics screened 588 nonfederal responders nationwide. AOEC 
experienced challenges in providing these screening services. For 
example, many nonfederal responders did not enroll in the program 
because they did not live near an AOEC clinic, and the administration 
of the program required substantial coordination among AOEC, AOEC 
member clinics, and Mount Sinai. 

Mount Sinai's subcontract with AOEC ended in July 2004, and from August 
2004 until June 2005 NIOSH did not fund any organization to provide 
services to nonfederal responders outside the NYC metropolitan 
area.[Footnote 19] During this period, NIOSH focused on providing 
screening and monitoring services for nonfederal responders in the NYC 
metropolitan area. In June 2005, NIOSH began its second effort by 
awarding $776,000 to the Mount Sinai School of Medicine Data and 
Coordination Center (DCC) to provide both screening and monitoring 
services for nonfederal responders residing outside the NYC 
metropolitan area.[Footnote 20] In June 2006, NIOSH awarded an 
additional $788,000 to DCC to provide screening and monitoring services 
for these responders. NIOSH officials told us that they assigned DCC 
the task of providing screening and monitoring services to nonfederal 
responders outside the NYC metropolitan area because the task was 
consistent with DCC's responsibilities for the NY/NJ WTC Consortium, 
which include data monitoring and coordination. DCC, however, had 
difficulty establishing a network of providers that could serve 
nonfederal responders residing throughout the country--ultimately 
contracting with only 10 clinics in seven states to provide screening 
and monitoring services.[Footnote 21] DCC officials said that as of 
June 2007 the 10 clinics were monitoring 180 responders. 

In early 2006, NIOSH began exploring how to establish a national 
program that would expand the network of providers to provide screening 
and monitoring services, as well as treatment services, for nonfederal 
responders residing outside the NYC metropolitan area.[Footnote 22] 
According to NIOSH, there have been several challenges involved in 
expanding a network of providers to screen and monitor nonfederal 
responders nationwide. These include establishing contracts with 
clinics that have the occupational health expertise to provide services 
nationwide, establishing patient data transfer systems that comply with 
applicable privacy laws, navigating the institutional review 
board[Footnote 23] process for a large provider network, and 
establishing payment systems with clinics participating in a national 
network of providers. On March 15, 2007, NIOSH issued a formal request 
for information from organizations that have an interest in and the 
capability of developing a national program for responders residing 
outside the NYC metropolitan area.[Footnote 24] In this request, NIOSH 
described the scope of a national program as offering screening, 
monitoring, and treatment services to about 3,000 nonfederal responders 
through a national network of occupational health facilities. NIOSH 
also specified that the program's facilities should be located within 
reasonable driving distance to responders and that participating 
facilities must provide copies of examination records to DCC. In May 
2007, NIOSH approved a request from DCC to redirect about $125,000 from 
the June 2006 award to establish a contract with a company to provide 
screening and monitoring services for nonfederal responders residing 
outside the NYC metropolitan area. Subsequently, DCC contracted with 
QTC Management, Inc.,[Footnote 25] one of the four organizations that 
had responded to NIOSH's request for information. DCC's contract with 
QTC does not include treatment services, and NIOSH officials are still 
exploring how to provide and pay for treatment services for nonfederal 
responders residing outside the NYC metropolitan area.[Footnote 26] QTC 
has a network of providers in all 50 states and the District of 
Columbia and can use internal medicine and occupational medicine 
doctors in its network to provide these services. In addition, DCC and 
QTC have agreed that QTC will identify and subcontract with providers 
outside of its network to screen and monitor nonfederal responders who 
do not reside within 25 miles of a QTC provider.[Footnote 27] In June 
2007, NIOSH awarded $800,600 to DCC for coordinating the provision of 
screening and monitoring examinations, and QTC was to receive a portion 
of this award from DCC to provide about 1,000 screening and monitoring 
examinations through May 2008. According to a NIOSH official, QTC's 
providers began conducting screening examinations in summer 2007. 

Concluding Observations: 

Screening and monitoring the health of the people who responded to the 
September 11, 2001, attack on the World Trade Center are critical for 
identifying health effects already experienced by responders or those 
that may emerge in the future. In addition, collecting and analyzing 
information produced by screening and monitoring responders can give 
health care providers information that could help them better diagnose 
and treat responders and others who experience similar health effects. 

While many responders have been able to obtain screening and follow-up 
physical and mental health examinations through the federally funded 
WTC health programs, other responders may not always find these 
services available. Specifically, many responders who reside outside 
the NYC metropolitan area have not been able to obtain screening and 
monitoring services because available services are too distant. 
Moreover, HHS has repeatedly interrupted its efforts to provide 
services outside the NYC area, resulting in periods when no such 
services were available. 

HHS continues to fund and coordinate the WTC health programs and has 
key federal responsibility for ensuring the availability of services to 
responders. HHS and its agencies have taken steps to move toward 
providing screening and monitoring services to nonfederal responders 
living outside of the NYC area. However, these efforts are not 
complete, and the stop-and-start history of the department's efforts to 
serve these responders does not provide assurance that the latest 
efforts to extend screening and monitoring services to them will be 
successful and will be sustained over time. Therefore we recommended in 
July 2007 that the Secretary of HHS take expeditious action to ensure 
that health screening and monitoring services are available to all 
people who responded to the attack on the WTC, regardless of where they 
reside. As of January 2008, the department has not responded to this 
recommendation. 

Mr. Chairman, this completes my prepared remarks. I would be happy to 
respond to any questions you or other members of the subcommittee may 
have at this time. 

Contacts and Acknowledgments: 

For further information about this testimony, please contact Cynthia A. 
Bascetta at (202) 512-7114 or [email protected]. Contact points for our 
Offices of Congressional Relations and Public Affairs may be found on 
the last page of this statement. Helene F. Toiv, Assistant Director; 
Hernan Bozzolo; Frederick Caison; Anne Dievler; Anne Hopewell; and 
Roseanne Price made key contributions to this statement. 

[End of section] 

Appendix I: Abbreviations: 

AOEC: Association of Occupational and Environmental Clinics: 
ASPR: Office of the Assistant Secretary for Preparedness and Response: 
ATSDR: Agency for Toxic Substances and Disease Registry: 
DCC: Data and Coordination Center: 
FDNY: New York City Fire Department: 
FOH: Federal Occupational Health Services: 
HHS: Department of Health and Human Services: 
NIOSH: National Institute for Occupational Safety and Health: 
NYC: New York City: 
NY/NJ: New York/New Jersey: 
NYPD: New York City Police Department: 
POPPA: Police Organization Providing Peer Assistance: 
WTC: World Trade Center: 

[End of section] 

Related GAO Products: 

September 11: Improvements Needed in Availability of Health Screening 
and Monitoring Services for Responders. GAO-07-1229T. Washington, D.C.: 
September 10, 2007. 

September 11: HHS Needs to Ensure the Availability of Health Screening 
and Monitoring for All Responders. GAO-07-892. Washington, D.C.: July 
23, 2007. 

September 11: HHS Has Screened Additional Federal Responders for World 
Trade Center Health Effects, but Plans for Awarding Funds for Treatment 
Are Incomplete. GAO-06-1092T. Washington, D.C.: September 8, 2006. 

September 11: Monitoring of World Trade Center Health Effects Has 
Progressed, but Program for Federal Responders Lags Behind. GAO-06-
481T. Washington, D.C.: February 28, 2006. 

September 11: Monitoring of World Trade Center Health Effects Has 
Progressed, but Not for Federal Responders. GAO-05-1020T. Washington, 
D.C.: September 10, 2005. 

September 11: Health Effects in the Aftermath of the World Trade Center 
Attack. GAO-04-1068T. Washington, D.C.: September 8, 2004. 

[End of section] 

Footnotes: 

[1] A list of abbreviations used in this testimony is in app. I. 

[2] The Staten Island site is the landfill that is the off-site 
location of the WTC recovery operation. 

[3] In this testimony, "screening" refers to initial physical and 
mental health examinations of affected individuals. "Monitoring" refers 
to tracking the health of individuals over time, either through 
periodic surveys or through follow-up physical and mental health 
examinations. 

[4] One of the WTC health programs, the WTC Health Registry, also 
includes people living or attending school in the area of the WTC or 
working or present in the vicinity on September 11, 2001. 

[5] See, for example, GAO, September 11: HHS Has Screened Additional 
Federal Responders for World Trade Center Health Effects, but Plans for 
Awarding Funds for Treatment Are Incomplete, GAO-06-1092T (Washington, 
D.C.: Sept. 8, 2006). A list of related GAO products is included at the 
end of this testimony. 

[6] See GAO, September 11: Monitoring of World Trade Center Health 
Effects Has Progressed, but Not for Federal Responders, GAO-05-1020T 
(Washington, D.C.: Sept. 10, 2005), and September 11: Monitoring of 
World Trade Center Health Effects Has Progressed, but Program for 
Federal Responders Lags Behind, GAO-06-481T (Washington, D.C.: Feb. 28, 
2006). 

[7] See GAO-06-481T and GAO, September 11: HHS Needs to Ensure the 
Availability of Health Screening and Monitoring for All Responders, GAO-
07-892 (Washington, D.C.: July 23, 2007). 

[8] In general, the WTC health programs provide services in the NYC 
metropolitan area. 

[9] See GAO, September 11: Improvements Needed in Availability of 
Health Screening and Monitoring Services for Responders, GAO-07-1229T 
(Washington, D.C.: Sept. 10, 2007). 

[10] See GAO-07-892. 

[11] There is not a definitive count of the number of people who served 
as responders. Estimates have ranged from about 40,000 to about 91,000. 

[12] In addition to these programs, a New York State responder 
screening program received federal funding for screening New York State 
employees and National Guard personnel who responded to the WTC attack 
in an official capacity. This program ended its screening examinations 
in November 2003. 

[13] In previous reports we have also referred to this program as the 
worker and volunteer WTC program. 

[14] The NY/NJ WTC Consortium consists of five clinical centers 
operated by (1) Mount Sinai-Irving J. Selikoff Center for Occupational 
and Environmental Medicine; (2) Long Island Occupational and 
Environmental Health Center at SUNY, Stony Brook; (3) New York 
University School of Medicine/Bellevue Hospital Center; (4) Center for 
the Biology of Natural Systems, at CUNY, Queens College; and (5) 
University of Medicine and Dentistry of New Jersey Robert Wood Johnson 
Medical School, Environmental and Occupational Health Sciences 
Institute. Mount Sinai's clinical center, which is the largest of the 
five centers, also receives federal funding to operate a data and 
coordination center to coordinate the work of the five clinical centers 
and conduct outreach and education, quality assurance, and data 
management for the NY/NJ WTC Consortium. 

[15] Project COPE and the POPPA program provide mental health services 
to members of the New York City Police Department (NYPD) and operate 
independently of the NYPD. 

[16] The WTC Health Registry also provides information on where 
participants can seek health care. 

[17] According to the NYC Department of Health and Mental Hygiene, 
about 7,000 nonfederal and federal responders residing outside the NYC 
metropolitan area have enrolled in the WTC Health Registry. 

[18] Around that time, NIOSH was providing screening services for 
nonfederal responders in the NYC metropolitan area through the NY/NJ 
WTC Consortium and the FDNY WTC program. Nonfederal responders residing 
outside the NYC metropolitan area were able to travel at their own 
expense to the NYC metropolitan area to obtain screening services 
through the NY/NJ WTC Consortium. 

[19] In early 2004, AOEC applied to NIOSH to use its national network 
of member clinics to provide screening and monitoring for nonfederal 
responders residing outside the NYC metropolitan area, but NIOSH 
rejected AOEC's application for several reasons, including that the 
application did not adequately address how to coordinate and implement 
a monitoring program with complex data collection and reporting 
requirements. 

[20] This award and subsequent awards for this purpose were made under 
a 5-year cooperative agreement between NIOSH and Mt. Sinai, which began 
in 2004. 

[21] Contracts were originally established with 11 clinics in eight 
states, but 1 clinic discontinued its participation in the program 
after conducting one examination. The 10 active clinics are located in 
seven states: Arkansas, California, Illinois, Maryland, Massachusetts, 
New York, and Ohio. Of the 10 active clinics, 7 are AOEC member 
clinics. 

[22] According to NIOSH and DCC officials, efforts to provide 
monitoring services to federal responders residing outside the NYC 
metropolitan area may be included in the national program. 

[23] Institutional review boards are groups that have been formally 
designated to review and monitor biomedical research involving human 
subjects, such as research based on data collected from screening and 
monitoring examinations. 

[24] Department of Health and Human Services, Sources Sought Notice: 
National Medical Monitoring and Treatment Program for World Trade 
Center (WTC) Rescue, Recovery, and Restoration Responders and 
Volunteers, SSA-WTC-001 (Mar. 15, 2007). 

[25] QTC is a private provider of government-outsourced occupational 
health and disability examination services. 

[26] Some nonfederal responders residing outside the NYC metropolitan 
area may have access to privately funded treatment services. In June 
2005 the American Red Cross funded AOEC to provide treatment services 
for these responders. As of June 2007, AOEC had contracted with 40 of 
its member clinics located in 27 states and the District of Columbia to 
provide these services. An American Red Cross official told us in 
September 2007 that funding for AOEC to provide treatment services 
would continue through June 2008. 

[27] As of June 2007, DCC identified 1,151 nonfederal responders 
residing outside the NYC metropolitan area who requested screening and 
monitoring services and were too ill or lacked financial resources to 
travel to NYC or any of DCC's 10 contracted clinics. 

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