[House Hearing, 109 Congress]
[From the U.S. Government Publishing Office]
PROGRESS SINCE SEPTEMBER 11TH: PROTECTING PUBLIC HEALTH AND SAFETY OF
THE RESPONDERS AND RESIDENTS
=======================================================================
HEARING
before the
SUBCOMMITTEE ON NATIONAL SECURITY,
EMERGING THREATS, AND INTERNATIONAL
RELATIONS
of the
COMMITTEE ON
GOVERNMENT REFORM
HOUSE OF REPRESENTATIVES
ONE HUNDRED NINTH CONGRESS
SECOND SESSION
__________
SEPTEMBER 8, 2006
__________
Serial No. 109-246
__________
Printed for the use of the Committee on Government Reform
Available via the World Wide Web: http://www.gpoaccess.gov/congress/
index.html
http://www.house.gov/reform
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36-998 PDF WASHINGTON DC: 2007
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COMMITTEE ON GOVERNMENT REFORM
TOM DAVIS, Virginia, Chairman
CHRISTOPHER SHAYS, Connecticut HENRY A. WAXMAN, California
DAN BURTON, Indiana TOM LANTOS, California
ILEANA ROS-LEHTINEN, Florida MAJOR R. OWENS, New York
JOHN M. McHUGH, New York EDOLPHUS TOWNS, New York
JOHN L. MICA, Florida PAUL E. KANJORSKI, Pennsylvania
GIL GUTKNECHT, Minnesota CAROLYN B. MALONEY, New York
MARK E. SOUDER, Indiana ELIJAH E. CUMMINGS, Maryland
STEVEN C. LaTOURETTE, Ohio DENNIS J. KUCINICH, Ohio
TODD RUSSELL PLATTS, Pennsylvania DANNY K. DAVIS, Illinois
CHRIS CANNON, Utah WM. LACY CLAY, Missouri
JOHN J. DUNCAN, Jr., Tennessee DIANE E. WATSON, California
CANDICE S. MILLER, Michigan STEPHEN F. LYNCH, Massachusetts
MICHAEL R. TURNER, Ohio CHRIS VAN HOLLEN, Maryland
DARRELL E. ISSA, California LINDA T. SANCHEZ, California
JON C. PORTER, Nevada C.A. DUTCH RUPPERSBERGER, Maryland
KENNY MARCHANT, Texas BRIAN HIGGINS, New York
LYNN A. WESTMORELAND, Georgia ELEANOR HOLMES NORTON, District of
PATRICK T. McHENRY, North Carolina Columbia
CHARLES W. DENT, Pennsylvania ------
VIRGINIA FOXX, North Carolina BERNARD SANDERS, Vermont
JEAN SCHMIDT, Ohio (Independent)
BRIAN P. BILBRAY, California
David Marin, Staff Director
Lawrence Halloran, Deputy Staff Director
Benjamin Chance, Chief Clerk
Phil Barnett, Minority Chief of Staff/Chief Counsel
Subcommittee on National Security, Emerging Threats, and International
Relations
CHRISTOPHER SHAYS, Connecticut, Chairman
KENNY MARCHANT, Texas DENNIS J. KUCINICH, Ohio
DAN BURTON, Indiana TOM LANTOS, California
ILEANA ROS-LEHTINEN, Florida BERNARD SANDERS, Vermont
JOHN M. McHUGH, New York CAROLYN B. MALONEY, New York
STEVEN C. LaTOURETTE, Ohio CHRIS VAN HOLLEN, Maryland
TODD RUSSELL PLATTS, Pennsylvania LINDA T. SANCHEZ, California
JOHN J. DUNCAN, Jr., Tennessee C.A. DUTCH RUPPERSBERGER, Maryland
MICHAEL R. TURNER, Ohio STEPHEN F. LYNCH, Massachusetts
JON C. PORTER, Nevada BRIAN HIGGINS, New York
CHARLES W. DENT, Pennsylvania
Ex Officio
TOM DAVIS, Virginia HENRY A. WAXMAN, California
R. Nicholas Palarino, Staff Director
Robert A. Briggs, Clerk
Andrew Su, Minority Professional Staff Member
C O N T E N T S
----------
Page
Hearing held on September 8, 2006................................ 1
Statement of:
Bascetta, Cynthia, Director, Health Care, Government
Accountability Office; Joseph Zadroga, Little Egg Harbor
Township, NJ; Steven Centore, Flanders, NY; Lea Geronimo,
New York, NY; and Lawrence Provost, Virginia Beach, VA..... 24
Bascetta, Cynthia........................................ 24
Centore, Steven.......................................... 50
Geronimo, Lea............................................ 66
Provost, Lawrence........................................ 70
Zadroga, Joseph.......................................... 55
Howard, John, M.D., M.P.H., J.D., Director, National
Institute for Occupational Health, Centers for Disease
Control and Prevention, Department of Health and Human
Services; Dr. Robin Herbert, co-director of the World Trade
Center Worker and Volunteer Medical Screening Program, Mt.
Sinai Hospital, accompanied by Dr. Steven Levin; Thomas R.
Frieden, M.D., M.P.H., commissioner, New York City
Department of Health and Mental Hygiene; Nicholas
Scoppetta, commissioner, Fire Department of New York,
accompanied by Dr. Carrie Kelly, head, Bureau of Health
Services, and Dr. David Prezant, chief, Office of Medical
Affairs; and Dr. Joan Reibman, associate professor of
medicine, NYU Medical Center, director, Bellevue Hospital
World Trade Center Health Impacts Clinic................... 95
Frieden, Thomas R........................................ 137
Herbert, Robin........................................... 122
Howard, John............................................. 95
Reibman, Joan............................................ 158
Scoppetta, Nicholas...................................... 145
Letters, statements, etc., submitted for the record by:
Bascetta, Cynthia, Director, Health Care, Government
Accountability Office, prepared statement of............... 27
Centore, Steven, Flanders, NY, prepared statement of......... 52
Frieden, Thomas R., M.D., M.P.H., commissioner, New York City
Department of Health and Mental Hygiene, prepared statement
of......................................................... 139
Geronimo, Lea, New York, NY, prepared statement of........... 68
Herbert, Dr. Robin, co-director of the World Trade Center
Worker and Volunteer Medical Screening Program, Mt. Sinai
Hospital, prepared statement of............................ 124
Howard, John, M.D., M.P.H., J.D., Director, National
Institute for Occupational Health, Centers for Disease
Control and Prevention, Department of Health and Human
Services, prepared statement of............................ 96
Maloney, Hon. Carolyn B., a Representative in Congress from
the State of New York, prepared statement of............... 9
Nadler, Hon. Jerrold, a Representative in Congress from the
State of New York, prepared statement of................... 15
Provost, Lawrence, Virginia Beach, VA, prepared statement of. 74
Reibman, Dr. Joan, associate professor of medicine, NYU
Medical Center, director, Bellevue Hospital World Trade
Center Health Impacts Clinic, prepared statement of........ 161
Scoppetta, Nicholas, commissioner, Fire Department of New
York, prepared statement of................................ 149
Shays, Hon. Christopher, a Representative in Congress from
the State of Connecticut, prepared statement of............ 3
Zadroga, Joseph, Little Egg Harbor Township, NJ, prepared
statement of............................................... 59
PROGRESS SINCE SEPTEMBER 11TH: PROTECTING PUBLIC HEALTH AND SAFETY OF
THE RESPONDERS AND RESIDENTS
----------
FRIDAY, SEPTEMBER 8, 2006
House of Representatives,
Subcommittee on National Security, Emerging
Threats, and International Relations,
Committee on Government Reform,
New York, NY.
The subcommittee met, pursuant to notice, at 10:30 a.m., in
Auditorium, 1st Floor, District Council 37, 125 Barclay Street,
Hon. Christopher Shays (chairman of the subcommittee)
presiding.
Present: Representatives Shays and Maloney.
Also present: Representatives Fossella, Nadler, and Weiner.
Also present: Senators Schumer and Clinton.
Staff present: R. Nicholas Palarino, Ph.D., staff director;
Robert A. Briggs, analyst; and Andrew Su, minority professional
staff member.
Mr. Shays. The Subcommittee on National Security, Emerging
Threats, and International Relations field hearing entitled,
``Progress Since September 11th: Protecting Public Health and
Safety of the Responders and Residents,'' is called to order.
Five years after the cataclysmic attacks on the World Trade
Center, shock waves still emerge from Ground Zero. Diverse and
delayed health problems continue to emerge in those exposed to
contaminants and psychological stressors unleashed on September
11th.
Firefighters, police, emergency medical personnel, transit
workers, construction crews, and other first responders, as
well as volunteers, came to Ground Zero knowing there would be
risks, willing to take those risks, but confident their
community would sustain them and not let them down. Make no
mistake, these individuals did not just go to work on that day,
they went to war. However, as we will hear today, Federal,
State, and local health support has not provided the care and
comfort they need and rightfully deserve.
After the 1991 war in the Persian Gulf, veterans suffering
a variety of unfamiliar syndromes faced daunting official
resistance to evidence linking multiple, low-level toxic
exposure to subsequent, chronic ill health. In part due to work
by this subcommittee, long-term health registrants were
improved, an aggressive research agenda pursued, and sick
veterans now have the benefit, in law, of presumption that
wartime exposures cause certain illnesses.
When the front line is not Baghdad, but Lower Manhattan,
occupational medicine and public health practitioners still
have much to learn from that distant Middle East battlefield.
Proper diagnosis, effective treatment, and fair compensation
for the delayed casualties of a toxic attack require vigilance,
patience, and a willingness to admit what we do not yet know,
and might never know, about toxic synergies and syndromes.
Health surveillance has to be focused and sustained, and new
treatment approaches have to be tried to restore damaged lives
before it is too late.
Today it appears the public health approach to lingering
environmental hazards remains unfocused and halting. The
unquestionable need for long-term monitoring has been met with
only short-term commitments. Screening and monitoring results
have not been translated into timely protocols that could be
used by a broader range of treatment physicians. Valuable data
sets compiled by competing programs may atrophy as money and
vigilance driving September 11th health research wane.
We asked our invited witnesses to discuss how the Federal
investment in World Trade Center health programs has been used
and how these efforts can be better coordinated and more
sharply focused. We value their perspectives, appreciate their
expertise, and look forward to their testimony.
This Monday our Nation will observe a moment of silence for
those who lost their lives on September 11th. We convene today
in remembrance of those lost, and on behalf of those who came
to save them, the first responders who are suffering
physically, mentally, and in some cases who are dying
prematurely, as a result of the toxic terrors unleashed on that
terrible day.
I would like to, before recognizing my fellow member, the
ranking member in this effort, Mrs. Maloney, I would like to
thank my committee staff for the work they have done for this
hearing, the one they did 2 days ago, and the work they are
doing next week on the Gulf war on Monday, Wednesday, and
Friday. We are putting together five hearings in just 9 days,
and I do appreciate what the staff, both the Republican and
Democratic staff, have done.
And then, just to say to my left is Mr. Fossella, who had
requested this hearing, to my right is Ms. Malone is who had
requested this hearing, and if the truth be known she requested
the one before that and the one before that and the one before
that. So I give you Mrs. Maloney.
[The prepared statement of Hon. Christopher Shays follows:]
[GRAPHIC] [TIFF OMITTED] 36998.001
[GRAPHIC] [TIFF OMITTED] 36998.002
Mrs. Maloney. OK. Thank you very much, Chairman Shays, and
I thank you for holding this hearing. I thank our panelists,
and I thank everyone who is attending and pointing a spotlight
on this very important issue.
This is the fourth hearing that has been held on this
issue--four hearings that have been absolutely invaluable to
the September 11th responders and others who are sick.
Amazingly, Chairman Shays is the only chairman to ever call a
hearing on this issue. Now there is a lot of focus on it, but
when I started asking for these hearings there was not, and he
came forward and started building the scientific data and the
support that has moved us forward with our monitoring programs
and our reaction to our heroes and heroines and trying to help
them.
I would also like to take this opportunity to thank DC 37
for allowing us to use their space today, and especially
Lillian Roberts, the head of the union. You should stand and
say hello. She is here in attendance, as well as her health and
safety officer--[applause]--Lee Clarke. They have done such a
great job advocating for a better Federal response to this
issue, and I must say it was Lee Clarke who was the first one
to sound the alarm and tell me and others that the important
$125 million for worker's compensation had been unbelievably
removed from the Federal budget, and we worked very hard
jointly to get that restored.
From the immediate aftermath of September 11th, and now on
the fifth anniversary, DC 37 was not only on the site, but they
have played a very, very important part in helping us move
forward with the Federal assistance. And we are exactly one
block away from where the Twin Towers once stood, and at the
home of so many of the responders who heroically rushed the
workers from DC 37 and were part of it.
On Monday we mark the fifth anniversary of September 11th,
and once again our Nation will pause to remember that tragic
day, and many of us will renew our pledge never to forget. But
as we do this, we must remember that we lost nearly 3,000
people on September 11th, but many, many thousands more lost
their health.
And to this day, not one single Federal dollar has been
spent on the treatment of the health care needs of the heroes
and heroines of September 11th. And our purpose today is to
make sure that every single person who was exposed to the
deadly toxins receives medical monitoring, and every single
person who is sick is treated.
Regrettably, we have seen government running from the sick
victims instead of standing beside them and trying to help
them. And I must mention that with us today is Mr. Zadroga, and
his son James Zadroga died prematurely in the bloom of his
youth, and to this day many people will not acknowledge that
his death was related to September 11th. His lungs, according
to science, weighed three times more than the normal lung, it
was totally black, and it was filled with phlegm. How dare
anyone not acknowledge his heroic efforts and the fact that he
died because of his work saving the lives of others.
I must tell you that my office and other offices, we are
receiving more information, more of our constituents are coming
to us, who are sick years after the disaster. For some the
illness did not emerge until recently, but we have to be there
to help.
I do congratulate the New York delegation, and the
Connecticut delegation, the New Jersey delegation, and really
the entire Congress and our two Senators who worked so hard to
set up the World Trade Center medical monitoring program that
is located at Mt. Sinai, and this week their very important
scientific data that 70 percent of September 11th responders
suffered respiratory problems. and 60 percent are still sick as
a direct result of their work at Ground Zero, 40 percent of
whom have no health care coverage.
This provides a concrete scientific link between the
exposures of the toxins of Ground Zero and the health problems
many are suffering. Earlier this year we learned from the fire
department that the average fire department responder has lost
12 years of lung capacity following their service at Ground
Zero, and that many have been forced to retire or to be
reassigned because of their September 11th illness.
And we know at least seven responders' deaths, according to
the press, are directly related. We believe there are many
more, and we are calling for a fatality investigation to
document what has happened. And I asked the city, how can you
come forward after the heatwave and say authoritatively that 20
New Yorkers died because of the heatwave, yet the city to this
day has not acknowledged one death or taken any steps to affirm
that these heroes and heroines lost their lives because of
their work at Ground Zero.
[Applause.]
Mr. Shays. I need to do something I should have done
sooner, and I understand the applause and the support. This is
not a judicial hearing, but it is a very official hearing of
Congress with a transcriber. And we are going to request that
there be no signs of applause, boos, or whatever. That is
something that we just need to have, and so I would like to do
this.
If I could, I would like to acknowledge--I have already
acknowledge--and I am going to give you back the mic, ma'am--
but I want to acknowledge the presence of Jerry Nadler, who has
been at all of our hearings, and Mr. Weiner as well. And they
have been totally engaged in this effort, and I--and Vito
Fossella, and I would like you to applaud of your members for
what they have done. And if we could do that, and that will be
the last applause of the day. Thank you.
[Applause.]
Mrs. Maloney. Very importantly, today we will hear the
testimony of Dr. John Howard, the Federal coordinator of
September 11th health. Dr. Howard was appointed before our last
hearing back in February when Vito Fossella and I led a push by
the entire New York delegation for his appointment. He has been
very busy.
In April we met with Dr. Howard here in New York, and he
explained to us that he would have a plan of how to take care
of those who are sick by this fall. We look forward to hearing
and seeing this plan. I commend him for admitting that the
funding that has been made available to date will not go very
far, but that it is only one small part of the problem. We need
you, Dr. Howard, and the administration to give us a full
assessment of the need and a commitment to include funding in
the President's budget.
Yesterday, at a delegation meeting with Dr. Howard and
Secretary Leavitt, three Senators were there, our two from New
York and Senator Menendez, and 10 Members of Congress, we
received a commitment from Dr. Howard and Secretary Leavitt
that the $75 million that Congress appropriated last December
will finally start flowing in October, and that all of the
money will be made available for this fiscal year. Now that
does deserve an applause. The first Federal money will be
flowing to help our sick heroes and heroines.
At the meeting yesterday we also received a commitment from
Secretary Leavitt that the long-term needs of those sick from
September 11th need to be met in a coordinated effort.
Secretary Leavitt also announced the creation of a new task
force on September 11th health coordination to be headed by Dr.
John Agwunobi. I welcome this commitment from the Secretary,
but quite frankly the sick responders of September 11th did not
need another task force.
They truly do not need another task force or point person.
What they need is medical treatment and medical monitoring. Our
responders did not wait 5 years before they rushed down to
Ground Zero to help others, and government should not wait 5
years to get the treatment to them.
I, for one, have supported giving Dr. Howard more authority
to do his job. He is the one person in the administration that
has dedicated his time to get to know the problem, and we ought
to let him finish the job. I just hope that he is not getting
pushed aside for speaking the honest truth of how serious the
problem is.
One example of how serious the need for a better response
can be seen in the more than 30,000 individuals who enrolled in
the World Trade Center Registry but are ineligible for any of
the federally funded medical monitoring programs or soon-to-be
treatment programs. That is why I have introduced with Mr.
Shays and Hillary Clinton the Remember the September 11th
Health Act, H.R. 566, back in 2004.
And this legislation would make available medical
monitoring to anyone exposed to the deadly toxins of Ground
Zero, including residents, office workers, children, and
treatment to anyone who is sick. It would also provide for much
needed research and coordination, but I also recognize that we
need to do more than just provide medical monitoring and health
care.
We need to make sure that sick September 11th responders
who have lost their jobs, have no medical care, and cannot pay
their bills, they cannot support their families because of
their selfless service, we need to make sure that they are
taken care of. And that's why I have introduced the James
Zadroga Act with Congressman Fossella to reopen the Victims
Compensation Fund to help these people.
Let us not just call them heroes and heroines. Let us take
care of them. If there was ever a case that demonstrates that
need it is James Zadroga.
I really want to make a commitment to everyone that I will
not stop this fight until everyone exposed to the toxins at
Ground Zero is medically monitored and everyone who is sick is
treated. And our true test as a Nation will not be what is the
response today, which is a highly visible, 5-year anniversary,
but what our government's response is 5 years from now, 10
years from now, 30 years from now, when the carcinogens have
turned to cancer and are causing deadly problems to the men and
women who rushed to save the lives of others.
I thank everyone, and particularly the chairman,
Christopher Shays, for his consistent work and attention on the
health care needs of the September 11th responders.
Thank you.
[The prepared statement of Hon. Carolyn B. Maloney
follows:]
[GRAPHIC] [TIFF OMITTED] 36998.003
[GRAPHIC] [TIFF OMITTED] 36998.004
Mr. Shays. Thank the gentlelady. We have heard from the two
members of the committee. I need to ask unanimous consent that
Mr. Fossella, Mr. Nadler, and Mr. Weiner can participate as
full members of the committee. Without objection, so ordered.
And let me take care of this now. If Senators Clinton or
Schumer or Menendez also come to participate, that without
objection they may participate as if they were members.
And at this time, Mr. Fossella, thank you for your work,
and you are recognized.
Mr. Fossella. Thank you, Mr. Chairman, and I would like to
thank you up front, as others have already, for convening this
hearing, the fourth of its kind, and I know it won't be the
last. As my colleague, Mrs. Maloney, has stated, you have
provided a venue and an opportunity for the unsung heroes and
victims of September 11th to continue to tell their story.
And I think it is bearing fruit, and I urge you not to let
up, and I know you won't. So it is greatly appreciated on
behalf of not just so many who suffer from across the city, but
in particular the people I represent in Staten Island and
Brooklyn.
Let me thank my colleagues, in particular Congresswoman
Maloney, who have basically argued I think very effectively in
our Congress to get the attention that it deserves to help
those who have suffered.
We know that there were at least two sets of victims of
September 11, 2001--the dramatic image of those who came with
the burning building whose lives were destroyed, and we
continue to mourn and honor their loss and memory. But there is
another set of victims where their lives are broken, and I
think that our country needs to do everything physically
possible to make their lives more whole.
We forget sometimes that it was not the United States that
was attacked but New York City. In fact, it was America that
was attacked. It happened to be in New York City. And as a
result, that attack on America requires, demands, and deserves
an American commitment, an American response, to those who
didn't ask any questions but rushed to the pile at Ground Zero,
who helped out for months without hesitation at the Fresh Kills
Landfill or other ports around the city, digging and
participating in the rescue and recovery effort.
As they did not ask questions in an effort to save other
lives and to help rebuild the city, our Congress should not be
asking questions on how we are going to go about paying to help
them rebuild their lives. We know over the last several years,
and now substantiated with a report released this week, what
many of us already know--that common sense, anecdotal, just
observation, just reality, that people's lives have been taken
away from them in many ways.
Young men and young women who had no problem running a mile
in 6 minutes now have difficulty walking up a flight of stairs.
We know from the fire department studies how they see young men
constantly leaving way before their prime, because they can't
continue to do the job that they love--helping to save and
rescue others--because they can't take the risk of running into
the burning building, physically and/or mentally.
We know that there are thousands of victims who continue to
suffer and it will only get worse. We have learned to discover
that while there have been attempts to help, it is
insufficient. As Mrs. Maloney has indicated we were successful
to obtain $125 million, $75 million for the first time to go to
treatment from the Federal Government, but there needs to be
more done.
With the appointment of Dr. Howard as the health
coordinator, and now with Secretary Leavitt committing another
task force, we know that action is needed and studies become
less important, although important less important than the
treatment action that will follow.
We know earlier this week that the mayor of the city of New
York has, as he has done for the last several years, constantly
reminded us how important it is not to forget the victims of
September 11th. But let me clear: it should not be just borne
by the city taxpayers or the State taxpayers. We need help from
the Federal Government, which is why these hearings I think
lend a hand.
As we go forward, I know there will be many who want to
point fingers and look back and undo history. We can't. There
will be many who want to say, ``How come we didn't follow this
advice or do this?'' We can learn from that, but I think the
responsible thing we need to do is everybody who responded to
Ground Zero who is suffering today, we need to help them get
their lives back.
We need to keep the Congress and the Federal Government at
the table participating to the fullest extent possible, to
complement the work of the city and the State government, as
well as the non-governmental organizations. And you have our
commitment that we will not rest until that job is done.
Thank you, Mr. Chairman, for convening this. I look forward
to hearing from not just the first panel but others as we
continue to hear those stories of the untold victims of
September 11th.
Mr. Shays. At this time, we would welcome Senator Clinton,
but we will give her a chance to catch her breath, and we will
go to Mr. Nadler. And, Mr. Nadler, thank you for all you do.
Mr. Nadler. Thank you, Mr. Chairman, and thank you for
holding this hearing, and welcome to the 8th Congressional
District.
Mr. Chairman, the barbaric attacks of September 11, 2001,
posed a true test of our collective and individual characters.
Unfortunately, the Federal, State, and city governments failed
the test of September 11th.
The EPA told residents, workers, and school children that
it was safe to return to the area, when clearly it was not,
placing all these people in harm's way. In addition to outright
deceptions, September 11th residents and workers have had to
endure so-called ``cleanup plans'' that are totally lacking in
scientific merit, and inexcusable delays that continue to
endanger the health and lives of countless people.
Beginning just days after September 11th, with EPA
Administrator Christie Todd Whitman's completely false
statement, based on no empirical data, that the air is safe to
breathe and the water is safe to drink, the EPA began
systematically lying to the public about the safety of the
environment. To this day we have still not had the
comprehensive indoor testing and cleanup program that is so
desperately needed to avoid thousands of more people being
slowly poisoned, and that the EPA's own Inspector General
called for 3 years ago.
There is no doubt that people are sick from World Trade
Center contamination. The most recent study to show this
released by Mt. Sinai earlier this week found that 70 percent
of the more than 9,000 first responders studied suffered health
problems related to their work at Ground Zero. But this is not
really news. We have known for years that people are sick.
In fact, this very subcommittee has been holding hearings
on this topic since 2003. And while some funds have been
appropriated for first responder monitoring and treatment, it
is not a fraction of what is needed. It is a national disgrace
that Hollywood has spent more money making and promoting a film
on the World Trade Center than the Federal Government has set
aside for the medical monitoring and treatment of our first
responders--much less of the students, residents, workers, and
tourists whose health was also assaulted.
The President talks about the war on terror. In an earlier
war, President Lincoln spoke of society's obligation to ``care
for him who shall have borne the battle.'' One can only
conclude that the Federal, State, and city governments have
betrayed those who have borne the battle--the residents and
workers caught in the plume on September 11th, or still working
or living today in contaminated spaces, and the 40,000 first
responders, the heroes of September 11th, who worked in a
highly toxic environment for weeks and months without proper
protection. Thousands of these people are now sick and are
being shown the back of the hand when they seek medical or
other assistance.
But events of the last few days show that the 5-year cover-
up is finally rapidly breaking down. On Wednesday Governor
Pataki finally admitted we were misled by the EPA. Yesterday
Christie Todd Whitman and former officials of the Giuliani
administration began pointing their fingers at each other. But
we can sort out the blame--moral, political, probably
criminal--later. The important thing now is to provide
comprehensive medical treatment for all those exposed to World
Trade Center contamination.
That is why yesterday I announced the introduction, along
with a number of other co-sponsors, of the 9/11 Comprehensive
Health Benefits Act, which would provide medical care to all
those suffering adverse health impacts from September 11th in a
sensible, easy-to-access and cost-effective manner through the
Medicare system. This includes mental health benefits where
necessary.
All costs--all costs--including premiums, deductibles, and
co-pays related to September 11th-connected illnesses would be
covered, and the benefits would provide total care. The bill
authorizes the necessary funds to cover these costs, so as not
to impair the solvency of the Medicare Trust Fund.
Under this bill, people will be able to use the long-
established Medicare framework to see their own doctors, or
practically any specialist they feel necessary, without having
to navigate a bureaucracy designed to contest their claims.
The September 11th victims' frustrating experience with the
adversarial bureaucracy of the State worker's compensation
system has shown that we need a very different approach from
one based on worker's compensation. There is no time limit on
Medicare, so people will be able to receive treatment 10 or 20
years down the line when people are no longer focused on this,
should their symptoms persist. And people will be able to
receive treatment when what I am afraid will be thousands of
cases of asbestosis, mesothelioma, and lung and other cancers
begin to emerge in the years ahead.
Medicare has a low overhead and administrative costs of
only 2 percent. And since it already covers over 40 million
people and routinely accepts approximately 2 million new people
each year, it can easy absorb this new population which might
eventually total 50,000 or 60,000 people.
There is no need to reinvent the wheel or create a new
bureaucracy or force September 11th victims to wait until the
Federal Government gets its act together. All we need to do is
give the September 11th victims immediate access to Medicare,
just as we do for millions of other people every year. My bill
would do just that, and I hope that Republicans and Democrats
in Congress, and the Bush administration, will support this
approach.
The bill would also establish a federally funded consortium
of institutions, practitioners, and community-based
organizations with expertise in providing outreach, screening,
monitoring, treatment, and research for September 11th-related
health conditions, and a state-of-the-art clinical facility
would be established in Lower Manhattan.
Recovering from September 11th is not simply a matter of
building skyscrapers, transit hubs, and memorials. It is also
about coping with the long-term health and environmental
consequences of this unprecedented attack on American soil. The
terrorists attacked the United States, and the City and State
of New York should not be expected to shoulder the enormous
financial burdens associated with providing essential health
care. Not to mention the fact that the Federal Government is
largely to blame for sending people back into contaminated
spaces, and for not enforcing occupational safety and health
laws at the World Trade Center site.
Until we adequately protect the health and safety of all
those still at risk from the attacks of September 11th, we
perpetuate and exacerbate the tragedy of that day. It would be
truly a national disgrace if future historians are compelled to
record that dishonest actions by the city and State and Federal
Governments, followed by callous inaction by the Federal and
local governments, ultimately were responsible for more deaths
than was Osama bin Laden.
Thank you for this opportunity to address the committee,
and I look forward to the witness testimony.
[The prepared statement of Hon. Jerrold Nadler follows:]
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Mr. Shays. I thank the gentleman very much. I am torn
between whether I recognize a future President or a future
mayor of this city, but I think protocol will lead me to
recognize our Senator, and to thank you, Senator Clinton, for
all that you do and your concern about this issue. And thank
you for honoring this House committee with your presence.
Senator Clinton. Thank you, Congressman, but I am not
running for mayor. [Laughter.]
I want to thank my colleagues in the House of
Representatives, Congressman Shays, Congresswoman Maloney,
Congressman Fossella, Congressman Nadler, and Congressman
Weiner. They have been part of our bipartisan New York regional
team to bring this issue to public attention and to work until
we obtain support for those who are suffering the consequences
of their exposures to the toxic stew at the World Trade Center
site and at Fresh Kills.
I also want to thank Lillian Roberts, Executive Director of
DC 37, for welcoming us to your home, all the labor leaders who
are here who have been absolutely instrumental in pursuing this
struggle to get attention to the needs of so many thousands of
responders, workers, volunteers, and residents, and all of the
people who have been directly affected, those who did respond,
those who worked, those who live, those who volunteered. Thank
you for being here and being part of this important hearing.
I also want to recognize and thank some of the people with
whom I have worked on this for now nearly 5 years. I see Dr.
Carrie Kelly, Dr. David Prezant in the audience. They were
among the very first to sound the alarm on behalf of the fire
department, the firefighters, and fire officers. I will never
forget Dr. Kelly's extraordinarily vivid testimony before a
committee in the Senate on which I sat within weeks of
September 11th about what the physical and mental challenges
and stresses confronting the firefighters would be going
forward because of their experiences.
I also want to thank Dr. Robin Herbert and Dr. Steven Levin
who were among the very first to take up this cause, working
out of Mt. Sinai to try to help create a system to conduct the
monitoring and screening that would give us the evidence that
we needed to support what we could see, feel, smell, and taste
ourselves, that what happened with the collapse of the
buildings, with the implosion and sending into the atmosphere
the pulverized concrete, the minuscule glass shards, the
asbestos particles, and so much else, was going to impact over
many years the health and well being of thousands and thousands
of men and women.
We are about to have the fifth anniversary of this horrible
event, and we will rightly recognize and honor the sacrifice
and commitment of our first responders who conducted the
greatest rescue mission in the history of the world. It is not
in any way an overstatement to suggest that probably 25,000
people's lives were saved because we had brave men and women
who went into danger on behalf of others.
It is also going to be a time for us to take stock in our
country as to what lessons we have learned, what work we are
doing to ensure our safety going forward, and whether we are
honoring our commitments to those who were affected, directly
and directly, by the events of September 11th.
The work that commenced from the very moment the first
plane hit was hazardous and different. And for as long as 9
months, you had first responders, trade and construction
workers, and others who were working amidst the dust and the
fog and the smog, a toxic mix of debris, smoke, and chemicals.
From the very first visit that I made, within 24 hours of
the attacks, I met people who were emerging from that dark
curtain of hell covered with the results of the collapse of the
buildings. Standing there with other public officials I could
feel and smell what they were working in. It was clear to us
that these were not healthy working conditions and that the air
was not safe to breathe.
Unfortunately, different assurances were provided, and
there wasn't a concerted effort to try to convince obviously
committed workers on that pile to where whatever respiratory
protective devices were available.
Starting in October 2001 I began, with the support of
people like those whom I have mentioned, along with Dr. Phil
Landergen, one of the Nation's experts in the environmental
impacts of various working conditions and exposures on people's
health, to agitate for a program to monitor and screen those
who had been exposed, and to make sure that the fire department
had the resources it needed to conduct its own monitoring and
screening, which was fully appropriate because they had the
information available from before September 11th that they
could compare to post-September 11th health conditions.
I was very grateful that we were able to secure $12 million
in December 2001 to establish the World Trade Center Worker and
Volunteer Medical Screening Program at Mt. Sinai. When it was
obvious that money was woefully inadequate, we all worked
together to get an additional $90 million to expand the number
of workers and volunteers who were eligible.
This week the report was released, and it confirmed our
worst fears, and it confirmed an earlier report from the fire
department's study that also confirmed our worst fears.
Thousands, I would say tens of thousands, of first responders,
workers, volunteers, and residents have experienced mental and
medical health problems. You know the litany all too well--
asthma, bronchitis, persistent sinusitis, laryngitis--and for
these individuals their illnesses are a constant reminder of
that terrible day and of the days and weeks and months later.
But so many had much more serious illnesses develop, and we
are only beginning to understand the extent of those. You will
hear from some witnesses on the first panel who will tell their
stories or the stories of their loved ones. And the prayers and
love and compassion that were offered in the wake of September
11th were a wonderful tribute to our spirit and our resilience,
but it is not enough.
It is not enough to say we stand with our police officers
or our firefighters or our iron workers or our laborers or
anyone else. Words at this point, nearly 5 years later, are
really inadequate. That is why we must stand up for and obtain
the support and the resources required to treat those who are
suffering.
I was proud to work with DC 37 and others who formed a
coalition to fight to get the resources we thought we needed.
We secured money, more than $100 million, for medical screening
and health monitoring, and then there was a dispute over the
money, the $125 million all together. We made an allocation,
$50 million for workers comp claims related to the September
11th attacks, and $75 million for long-term medical and mental
health needs.
Just yesterday the group before you, along with some other
of our colleagues, met with Secretary Leavitt. He made a
commitment to us that the $75 million which has been sitting in
the Federal treasury that has been designated to get out to
help people will finally be delivered. And we are going to hold
him to that promise. We have heard these promises before. If
promises counted for anything, everybody would be taken care of
by now, because we have had more than our fill of them.
And we have to make sure that this time the money is
delivered, and I want to thank Dr. John Howard, who was put
into the position of helping to move this along at the Federal
level, given no staff, no budget, and he, despite some
considerable obstacles, has been a real support to those of us
waging this struggle.
So we hope out of this hearing will come a greater
awareness even than we have now, a greater commitment than we
have had until now, and an absolute rock-solid decision that we
are going to get the help we need from all levels of government
for everyone who requires it.
There is nothing we can do to turn the clock back. There is
nothing we can say to comfort those who have lost loved ones.
And there is very little we can say to healthy young men and
women who on September 10th 5 years ago were running marathons
and lifting weights and just feeling full of vigor and vitality
who today can hardly breathe.
But one thing I know for certain is that we cannot rest
until we put into place a system to take care of every single
person who was affected by September 11th. And I thank my
colleagues, and I particularly thank the witnesses and all of
those who have worked so hard to make the progress on this
important issue for what we have done up until now, but let us
keep going, because we have a long way to go, we have miles to
go and promises to keep.
Thank you very much.
Mr. Shays. Thank you very much, Senator. And at this time
we will have Mr. Weiner be our closer, and to thank him for his
patience and to thank him for all his good work on this issue
over so many years.
And then, we will get to our witnesses, and I will just say
to our witnesses, this is part of the process of members going
on the record beforehand, your listening to the comments we are
making and, of course, hearing what we are saying may want to
include in your comments, references that you agree or disagree
with comments that were made by us.
So at this time, Mr. Weiner, thank you so much for being
here.
Mr. Weiner. Thank you very much, Mr. Chairman, and I won't
take the full time allotted. So much of the foundation has been
laid, and we are eager to hear from the witnesses. I want to
thank you for continuing to do what I think we haven't done
enough of in this process, and that is vigorous oversight.
It is customary to call hearings like this fact-finding
hearings. But, in fact, the facts have largely been
established. It is a fact that thousands of New Yorkers, in
fact thousands of citizens from the entire country, rushed to
Ground Zero to rescue, to recover, and to help honor those who
were the targets of this attack. We are joined in the room by
Secretary--by Commissioner Scoppetta of the fire department,
343 were lost that day, many of those in my district.
It is also now a fact that thousands of people are sick,
getting sicker, and tragically dying for the service that they
gave to their country and to their neighbors. This is not
speculation. This is not an anecdote from a neighbor. These are
now the facts as we have seen this week.
It is also, I would say, a fact that it is the Federal
Government's responsibility, both for the sickness that they
are experiencing and to help them recover. Former Secretary
Whitman we learned yesterday is engaged in a Herculean effort
in behind-covering about her actions. It has now become a fact
that Secretary Whitman has lied.
She either was telling the truth on September 12, 2001,
September 14, 2001, September 16, 2001, September 18, 2001,
when she repeatedly told the public, told those that were down
at the rubble, told members of government, told average
citizens that it was safe to be there, or, alternatively, she
is lying on September 7, 2006, when she said that she knew
better.
Either way we know that the Secretary of the Environmental
Protection Agency, whose job it was on that day, was not to
rush into a burning building like the heroic firefighters, was
not to help dig out their neighbors and friends from the
rubble, her job was to answer a simple question: is it safe
down there? And she didn't say it once, she didn't say it
twice, she said it at least four times, including at least
twice after evidence had emerged within our own agency, that
led all of us to know, and especially her to know, that what
she was saying was not true.
Now to reveal after the fact, 5 years later, as her
contribution to honoring those lost, to her contribution to
furthering the discussion about how it is we make those people
whole who are sick and dying, her contribution was today that
she whispered into the ear of government officials, ``Oh, by
the way, disregard what I have said publicly, disregard what I
have said repeatedly, I am telling you, it might not be so
safe.''
She was either lying then, or she is lying today. Either
way it is a scandal, and I believe it might be criminal.
So now that we have established those facts we need to
focus on what we are going to do about it. The studies have ben
done, the facts are clear, now, how do we act? Congressman
Nadler has suggested we fold these workers into Medicare. That
is an excellent idea. It allows us to act quickly with an
established infrastructure.
The Daily News and Congresswoman Maloney and others have
suggested we create a compensation fund similar to that we did
in the Feinberg Commission. This time we have to recognize
having a one- or 2-year statute of limitations is simply not
going to work. Tragically, there are people who are walking
around today who might feel healthy, who may find out in 6
months or a year or 5 years that they are not, but the fact is,
the final fact is, that we have to act soon.
The President, Secretary of Health, met with us yesterday
and say they are putting in the A team. We are gratified for
that, but it is not enough just to say we are going to do $75
million. We have to make a commitment that we are going to make
those people who are sick--as much as we can we have to honor
what they have done. That is the fact.
And I yield back the balance of my time.
Mr. Shays. I thank the gentleman. At this time I--before
recognizing the witnesses, I want to just thank District
Council 37 for allowing us to conduct our oversight hearing in
their auditorium. Ms. Lillian Roberts, Executive Director of DC
37, as well as her staff, have provided the subcommittee with
all of the resources and tools necessary to conduct this field
hearing, and their help has been very, very, very appreciated.
At this time I do want to recognize the witnesses. I need
to swear our witnesses in, so I will wait until we have all our
witnesses here. But I recognize Ms. Cynthia Bascetta, Director,
Health Care, Government Accountability Office; Mr. Joseph
Zadroga, Little Egg Harbor Township, NJ; Mr. Steven Centore,
Flanders, NY; Ms. Lea Geronimo, New York, NY; and Sergeant
Lawrence Provost, from Virginia Beach, VA.
I will--I am going to do what I don't usually do and just
have you, Ms. Bascetta, start your testimony before you are
sworn in. But when we have all our witnesses, I will be
swearing all our witnesses in at the same time. So we will
start with you.
STATEMENTS OF CYNTHIA BASCETTA, DIRECTOR, HEALTH CARE,
GOVERNMENT ACCOUNTABILITY OFFICE; JOSEPH ZADROGA, LITTLE EGG
HARBOR TOWNSHIP, NJ; STEVEN CENTORE, FLANDERS, NY; LEA
GERONIMO, NEW YORK, NY; AND LAWRENCE PROVOST, VIRGINIA BEACH,
VA
STATEMENT OF CYNTHIA BASCETTA
Ms. Bascetta. Thank you, Mr. Chairman, members of the
subcommittee, and Senator Clinton.
Mr. Shays. Here is what I am going to--these are the kind
of mics that singers tend to use. They have to be a little
closer to you.
Ms. Bascetta. How is that?
Mr. Shays. Yes, that is better. I am sorry. They are not
the ones that you can keep further away.
Ms. Bascetta. OK. I am pleased to participate in this
hearing on programs that monitor and provide treatment for
people whose health was adversely affected by the September 11
attack on the World Trade Center. Our work for you has focused
on the estimated 40,000 responders, who include New York City
firefighters and police officers, Federal Government personnel,
and other government and private sector workers and volunteers
from New York, and many other areas, who risked their lives to
help in the rescue response and cleanup operations.
Ongoing studies of the health effects experienced by these
responders documents the serious long-term physical and mental
health toll resulting from their heroic efforts. The results of
the Mt. Sinai study published yesterday are especially
sobering.
This February we testified that officials from the fire
department, the worker and volunteer program, and the registry
were concerned that Federal funding may run out before
monitoring could identify all long-term health problems. We
also reported that the program for Federal responders had
accomplished little and lagged behind programs for other
responders.
In revisiting these issues today, I will discuss actions
CDC has taken to award $75 million appropriated to it in
December 2005 to support responder programs. As you've noted,
this appropriation provided the first Federal dollars for
treatment in addition to continued support for screening and
monitoring.
But first I will update you on the status of HHS's Federal
responder program. Since it began, HHS has registered more than
1,700 Federal responders. About 1,400 of the total have been
registered since your February hearing, including about 1,100
current Federal workers and 250 former Federal workers.
Unfortunately, we don't know the percentage of Federal
responders this represents, because the total remains
uncertain. For those registered, Federal occupational health
have completed screening examinations for just over 900 by late
August, 380 of them since February. The worker and volunteer
program is now screening former Federal workers under an
agreement with NIOSH, and as of July 31st had provided exams
for about 13 former Federal workers and scheduled 11 more. Most
of the former Federal workers reside outside the New York Metro
area, but NIOSH has not yet completed making arrangements with
providers to screen and provide treatment for them.
Turning to the appropriations, the law gave priority for
funding to the existing programs that provide screening,
monitoring, and treatment services. So far, as you have noted,
CDC has awarded less than $5 million, beginning with $2 million
for the registry. A few weeks ago in August CDC made two
emergency awards, $1\1/2\ million to the fire department for
leasing treatment space, and $1.1 million to the worker and
volunteer program to hire administrators and a medical
assistant, as well as an additional physician to help reduce
the 3 to 4-month waiting time that recently developed at the
Mt. Sinai Clinical Center.
The waiting time was caused by a spike in people seeking
monitoring who had seen media reports about illnesses and
responders, and notably because the proportion of responders
who needed to be referred for treatment had increased. CDC also
expects to award a total of $4\1/2\ million this month to the
POPA program and Project Hope to help meet the mental health
needs of responders.
CDC's proposed spending plan shows that the bulk of the
funds, more than $50 million, will be awarded to the fire
department and the worker and volunteer programs. Until
yesterday CDC had not expected to make awards until February
2007 after it had reached certain decisions about the coverage
of treatment services such as which prescription drugs would be
covered.
The proposed spending plan showed that about 63 percent of
the funds would have been awarded in fiscal year 2008. During
the course of our work this summer it became clear that CDC did
not know how quickly treatment costs may deplete the available
funds, but the fire department and the worker and volunteer
program officials told us that they expected that the funds
would be depleted well before the end of 2008.
In summary, the results of the study released yesterday
suggest an upward trend in the costs for responders due to the
chronic nature of the health effects they sustained in the
aftermath of the September 11th attack. CDC has proposed a plan
to award the $75 million appropriation it received last year,
but it still hasn't made decisions about what treatment
services will be covered by Federal funds.
Moreover, responders who live outside the New York City
area, including former Federal workers, continue to have
limited access to services, because screening arrangements for
them are still incomplete. Resolving these issues in a timely
manner is critical, so that the funds appropriated will be
available to help ensure that the responders who risked their
lives have access to the treatment services they need.
That concludes my comments.
[The prepared statement of Ms. Bascetta follows:]
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Mr. Shays. Thank you very much.
At this time, I would like all of you--and if you, Mr.
Centore, are able to stand as well, I would like all of you to
stand. We will be swearing you in.
The only person I never swore in the 10 years I have been
chairman--I chickened out--is the senior Senator from West
Virginia. [Laughter.]
[Witnesses sworn.]
Mr. Shays. Mr. Centore, you will need to put that mic
fairly close to you, and probably on this side of you, since
you are looking at us in this direction.
STATEMENT OF STEVEN CENTORE
Mr. Centore. Thank you. My name is Steve Centore. I am a
member of the U.S. Department of Energy. During the September
11th period I was the Regional Response Coordinator for the
Radiological Assistance Program. All this should be covered in
the testimony that I sent out to Bob Briggs, and he was
supposed to put it in your handout.
Let me just say it is a privilege and an honor to be here
today in front of you and participate in this hearing. And I
have nothing but the utmost respect for this panel.
However, having said that, there is always a disclaimer. My
mother is a little Scottish woman from the hills of West By God
Virginia. My father is a little Italian fellow from the Bronx.
So, you know, even tempers running--[laughter]--you know,
stretching throughout my family. So if I have a tendency to get
a little excited when we get to certain topics, you will
understand why.
In your letter that you sent out, your invitation, there
was two questions that you asked. One you wanted to know how
effective were the medical screening and monitoring programs
for individuals that responded to the World Trade Center
disaster. You know, and right now I feel like I have been set
up, because I am sitting next to a member from HHS, and I am
probably one of the few Federal emergency responders that----
Mrs. Maloney. Point of clarification, she is not from HHS,
she is from the General Accounting Office, an independent arm
of government.
Mr. Centore. Oh, OK. I am sorry. That takes a load off my
mind. [Laughter.]
Because they were No. 1 on my list to talk about.
I spent the first 4 months at Ground Zero in a HAZMAT
support role, providing support to New York City FDNY/NYPD,
after which I was reassigned to covert ops in different parts
of the country doing different things which I can't go into.
It took about 4 years I believe before we ever got our
first letters from FOH, the Federal Occupational Health, about
medical screening. Me and my team, the five guys on my team, we
got our letters around November/December timeframe last year,
2005. I finally got an opportunity to go to my medical
screening in I believe it was April 2006, and I thought, oh
boy, this is great, because I had already been diagnosed with
PTSD, anxiety disorder, my liver was failing, my gallbladder
was almost completely shot, my spleen was enlarged, my lungs,
my throat, I had varices, I had bursitis, and I have bone
narrow----
Mrs. Maloney. Could you pull your microphone a little
closer? People are having difficulty hearing.
Mr. Centore. Sorry. That is a problem I have now, I have
lost my memory.
Mrs. Maloney. You were talking about going to get your
screening.
Mr. Centore. Right, yes.
Mrs. Maloney. Federal screening.
Mr. Centore. So I went to--I went to the satellite office
that FOH opened up in Islip at the Federal Building. And when I
went in, you know, the nurse started taking my data, and one of
the things she had mentioned was, ``You know, there is no
treatment. We don't provide any treatment. We don't provide any
reimbursement of expenses or anything.''
And I got to thinking about it for a while and I said, ``So
I am just a data point for you on the map.'' And she said,
``Yes, basically.'' I said, ``So when I die, I become a second
data point for you.'' And she said, ``Unfortunately, that is
right.'' And I am like, well, why am I wasting my time here?
I had already engaged my own local doctors to provide, you
know, medical treatment for me. At the time I was seeing an
internist, a GI specialist, hematologist, a psychologist, and a
psychiatrist. All of this I paid for out of my own pocket. I
had to use up all my own sick leave and my own annual leave,
and I couldn't figure that out, how you could get injured on
the job. Now that you are injured on the job, it is my
responsibility, you know? I mean, I was made to feel like a bad
guy, like I did something wrong. And for the longest time I had
a guilty feeling, and I couldn't understand why. I still don't.
But anyhow, to get back to your--the issue that you want to
discuss, is this program working? The program is doing exactly
what it was supposed to do--collect data. Is it helping
anybody? No. Not one bit.
[The prepared statement of Mr. Centore follows:]
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Mrs. Maloney. Thank you for your very moving testimony.
Thank you.
Mr. Zadroga.
STATEMENT OF JOSEPH ZADROGA
Mr. Zadroga. First of all, thank you for inviting me, and I
agree with your committee reference to you have an independent
study, I would really like to see a Grand Jury with subpoena
powers and charge people criminally for what occurred that day.
Senator Clinton, I would like to personally thank you. You
are one of the few people that called the day that my son
passed and gave condolences. Actually, you were the only one
from New York that gave condolences to my family when my son
passed, and I thank you for that. That was very well received.
My wife would like to be here today, but unfortunately she
had to stay home and take care of Tylerann. And sometimes she
has the way of saying things, if you are reading a paper, she
gets to the point a little too fast. And, you know, as I always
say you can take the girl out of the north, but you can't take
the north out of the girl. So we decided to leave her home for
the day.
As you know, my name is Joseph Zadroga. I was a police
officer for 27 years in North Arlington, and I was also Chief
of the Bergen County Police Academy for 6 years.
Jimmy worked for 13 years with the New York City Police
Department. He worked in the Sixth Precinct for 6 years, and he
worked on street crime for 6 years. He was well respected
within the department, and in street crime he was one of the
highest performers in the Street Crime Unit.
He was very street-wise, and he knew how to speak to people
and get them to break--to confess to their crimes. And because
of that he was transferred to the apprehension squad within the
homicide squad, and I really believe he had a true future in
the New York City Police Department, because someone with 13
years on, without any rabbis or hooks, don't get transferred to
homicide squad.
They really had a future set for him, because he was really
well liked and he knew what he was doing out there. And he
wasn't one to brag either. He had over 40 citations, which I
never knew about until the day of his funeral when his partner
told me.
On September 11th he arrived home to speak--just prior to
the buildings collapsing, and he knew he was going to go right
back again. He woke up his wife just as he arrived in the
house, told his wife what was occurring, and then started
packing up his clothes to leave. And she says, ``Where are you
going?'' He says, ``I am going back to the city to help.'' And
she said, ``No, no, you have to stay here.'' And he said, ``No,
it is my job. I have to go back. And this is what I do for a
living, and this is what I want to do.''
However, he did say it was the hardest thing in his life to
back down the driveway with his wife, who was 7 months
pregnant, kneeling in the driveway crying, asking him not to
go, but he went. His wife passed away several years later from
the stress of taking care of the household and taking care of
him and his 2-year old daughter.
So then he had to move in with us, and obviously, you know,
that is very difficult, for an adult to move back in with their
parents. But there was no way that he could live alone by
himself with his medication, and so forth.
When he passed, we were very fortunate that Dr. Breton, the
medical examiner in Ocean County, requested an autopsy, because
I am sure if we were in New York City I don't think that would
have occurred. And the doctor basically stated that his lungs
were very severely damaged, and they were black, they were--he
had black lung disease, besides several other diseases. He had
all types of chemicals in his lungs, bone particles, and dust
and sand and glass.
Since Jimmy's passing, his mother and I felt that the best
thing we could do was help make aware how all these other
heroes are being treated by the NYPD and the government. He
never received any assistance from the city. All he received
was more stress, and he was treated like a dog. And if a dog
was--someone observed a dog being treated the way he was, they
would have been arrested.
I just want to read a brief statement that he wrote the
first year anniversary to his father-in-law, who was a minister
in Florida. It is a three-page letter, but I am just going to
read a brief sentence. ``To this day, I can still hear the mass
confusion from the first day to the engine sirens that came
afterwards.'' He said, ``My nights will never be the same.
Everyone praises the dead as heroes, as they should, but there
are more living suffering than dead.''
And I will pass up a little further where he said, ``Yes,
they remember the dead, but they don't want to acknowledge the
sick or living. I am not the only one out there. There are many
suffering similar, if not the same, symptoms as myself. The
city doesn't care about any of their employees, and it is sad
not to mention that 90 percent of Americans that we know are
sick.''
``I just wish for once that the city would open their eyes
and help the living and stop getting political feedback from
the dead, get more personal, not political, on how can this
make us money. That is all the city cares about. If you ever
meet a New York City copy, a firefighter, or an EMS, just tell
them thanks, because that is all that you will ever get.''
I know I am running short on time, so I am just going to--I
was asked to give some suggestions.
Mr. Shays. Mr. Zadroga, you just go as long as you want to
go, sir.
Mr. Zadroga. Oh, OK. Thank you. Jimmy worked close to 500
hours at the World Trade Center, with the only protection a
paper mask. Within weeks he developed a cough that would later
be known as the World Trade Center cough. He also developed
short-term memory loss, acid reflux, high fevers, and would go
into spells where he would sleep for days without eating or
moving. He had severe breathing problems and was placed on
oxygen 24/7, all this while the police department refused to
admit that he was sick and attempted to return him to work
continuously.
Jimmy's wife Ronda, as I said, passed 2 years after his
illness due to the cowardice approach of the city and all the
stress that she was under. She was just--she was like a
daughter to me, and she was a lovely person, and she just
couldn't take the stress of--could not believe that people
could treat other people that way. I honestly believe that is
what killed her.
We watched him progressively get worse until he died at
home on the floor in his bedroom with his daughter sleeping on
the bed. I found him that morning, as I always expected to when
he didn't come down for his medication, lying on the floor. As
soon as I opened the door, I knew he was gone. I laid down
beside him. He had his baby's bottle in his hand. At that time
I woke up the baby, and the baby said--I said, ``Your father is
gone.'' The baby said, ``No, he is just sleeping. You always
said that.''
I heard him during the night. I heard him getting the
bottle. And I heard him fall, but he always does that, and he
usually wakes up. I had to convince her that he was gone, and
her words to me was, ``I knew he was sick, but I didn't think
it would be this fast.'' This is a 4-year old girl saying this.
Dr. Breton, the medical examiner, reported that James died
of a severe lung condition, and making him the first police
officer whose death was diagnosed to be a direct result of
working at the World Trade Center, yet the city still refused
to recognize his cause of death was related to September 11th.
The city even proceeded to belittle Dr. Breton in the press.
Since Jimmy's passing, his mother and I felt the best thing
we could do, and what we felt that Jimmy would want us to do,
was help make aware of how all these heroes are being treated
by the NYPD and the government. We need our government to do
the just and proper thing here and help these heroes. We can't
do anything for our son now, but we want to make sure that the
other workers get the treatment that they need when they are
sick. They all deserve a real commitment from our
representatives to provide for long-term monitoring and
treatment.
This statement was--my wife and I tried for 4 years prior
to his passing to get his treatment, and yet we could not get
doctors to treat him. Now that we have everyone's attention as
a result of our son's death, we feel we have the right to make
suggestions to help the surviving heroes.
And as some of the panel said, we must make priority first
the treatment of our heroes to improve their health. This study
should be secondary to priorities. I used to answer the phone
for Jimmy, because the last 2 years he didn't even want to talk
on the phone. He was so depressed and had post-traumatic
stress.
And I would just like to do one conversation that I had
with one of these monitoring boards that called, and they
wanted to see how he was. They used to call every 6 or 8
months. And the phone call went like this, ``Hello,'' he said,
and then, ``James Zadroga?'' He said, ``Speaking.'' They said,
``How are you feeling today?'' He would say, ``I am feeling
terrible. I never felt worse in my life.'' ``How is your lung
capacity?'' ``My lungs, they hurt so much that I can't believe
it. I can't take the pain. I am on heavy medication.''
``How do you feel mentally?'' ``I feel like I want to kill
myself. I want to bite the bullet and get it over with. But the
only reason I am staying here is because of my daughter.'' And
she said, ``Oh, thank you for the information, and then hung
up.'' And that was the help that we got.
Again, I agree, we should not worry about what it costs or
what kind of money we are going to need to help these heroes
with their health. I can't understand how this country can
place value--such little value on life for heroes that worked
for them.
In my 30 years working in government, I have yet to see
where politicians that wanted to get something done, no matter
how much they complained that they didn't have the money, but
they wanted to get it done for their own pet project, they
always found the money. So the money is out there.
We should recruit the best doctors in the city, if not the
world, to help these people. Obviously, their illnesses are
different from any others. We could never get a doctor to treat
James. Someone--and I don't know if it was in the government or
if it was the health care, would always call and tell them to
get him out of the hospital as quick as they could, so they
would shoot him up with steroids and send him home.
I had two doctors tell me they wouldn't treat him because
of a phone call, and I had one doctor tell me they wouldn't
treat him because they felt the insurance wouldn't pay. In the
future I know we are going to need organ donors and transplants
for these heroes. And I think we should at this time set up a
bank for the heroes, set up a donor list for organs that are
going to be needed for them.
I know the police, fire, EMS, and the good people of New
York would gladly sign up. Matter of fact, I will be the first
one to sign up on the list. My son was just going for a lung
transplant--well, I shouldn't say going for a lung transplant.
We went to Philadelphia, and the doctor felt concerned up
there. He was the only one that really gave any concern for
Jimmy's health, and he told us when we come back the next time,
which was January 10th, he was going to introduce Jimmy to the
lung transplant team. Unfortunately, he passed on the 5th.
I also strongly recommend that the Federal Government must
reinstitute the comprehension fund. Jimmy used the
comprehension fund, and that did help him pay his doctor bills,
his past bills from his credit cards, and his hospital bills
that were well over $50,000 prior to receiving that money.
And by reestablishing this compensation fund I believe it
also will reduce the lawsuits that we are talking about.
Everybody is worried about these lawsuits out there. I for one,
I don't worry about lawsuits. There are many ways of handling--
the government could handle these lawsuits. I feel that if they
are going to the compensation fund, these people could be
helped immediately rather than wait 10, 15 years down the line
for court settlements.
And that is about all I have to say. I thank you for having
me here today.
[The prepared statement of Mr. Zadroga follows:]
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Mr. Shays. Mr. Zadroga, we are so grateful you came today,
and I know it hasn't been easy for you to give your testimony.
But the reason why we have you as our first panelist, that we
want everyone who follows to know what you all are saying.
Mr. Centore, we get your message loud and clear, and we
know what you are asking for, and what you are asking for needs
to be met. And we thank you as well for your testimony.
Ms. Geronimo, welcome, and thank you for being here.
STATEMENT OF LEA GERONIMO
Ms. Geronimo. Good afternoon.
Mr. Shays. Good afternoon.
Ms. Geronimo. My name is Lea Geronimo, and I wanted to
thank you for the opportunity to finally speak up after 5 years
of waiting. I am resident of the Lower East Side of Manhattan,
and I also work just three blocks away from where the World
Trade Center stood.
The September 11 disaster has changed my life forever. I am
here today to share my story as one of the forgotten victims of
that tragic day. The toxic World--the toxic World Trade Center
dust was not contained just at the Ground Zero site on
September 11th. For more than a year it permeated my office as
well as my neighborhood. But as a result of repeated assurances
by the Federal Government stating that the air was OK, I had no
choice but to go back to work less than a week after the
disaster.
Whether at home or at work I could not escape the dust and
the fumes. Within months of September 11th I developed
bronchitis. What I thought was just a random occurrence is now
a chronic problem. Since September 11th I have had bronchitis
nine times.
Nine months after September 11th I developed constant
menstrual bleeding that continued every day for 5 months. I was
given a sonogram, but the doctors could not explain why I was
going through this. Last year I developed lesions and polyps on
my cervix and my uterus, and I had them removed, and to this
day my doctors still do not know why I had these problems at
such a young age of 35.
Additionally, I started to get small psoriasis spots like
this one on my elbow. There are others on my scalp and my back,
and recently my thighs and my scalp broke out in dozens of new
spots, painful, very painful. I had to use a combination of
various prescription medicines, including two different creams
to use on my face and my body, as well as a prescription
shampoo and a scalp medication.
Additionally, over the last 3 months I have had to receive
UV light treatments three times a week in order to treat the
spots all over my legs and torso. These treatments and the
medicine regimen are not only taxing but they are costly. To
date, even with my limited health insurance, I have paid more
than $15,000 out of pocket. To make matters worse, I have had
to take a 10 percent salary cut. I have also started to get
deductions from my salary to pay toward my health insurance.
Today I face worsening health problems, skyrocketing
medical expenses, and shrinking health care. But my story is
not unique. In fact, it is increasingly the norm for countless
of families and low income workers in the Lower East Side and
Chinatown.
As a member of the Beyond Ground Zero Network, a coalition
of grass roots organizations, legal and health care advocacy
groups, we recognize the mounting health crisis brewing in our
community. Within weeks of September 11th we began outreach and
surveyed over 2,000 residents and workers who put their health
as the No. 1 priority.
We found thousands of residents and local workers suffering
from new and worsened cases of asthma, severe breathing
problems, and intense coughing. Today whole families suffer
from asthma, respiratory problems, skin problems, and
gastrointestinal problems.
Without any funding we launched a collaborative, a
September 11th treatment program with Bellevue Hospital. This
pilot program got off the ground with intense community
participation by the Beyond Ground Zero Network and has just
expanded over the last year. Today we have a backlog of over
700 residents and workers representing the tip of the iceberg.
As the only September 11th treatment program for residents
and local workers in Lower Manhattan, our collaborative
treatment program is only the smallest step toward addressing
the existing health crisis within our local community. There is
no excuse for taking small steps on the fifth anniversary of
September 11th. Our health, my health, has been destroyed, and
I can't get this back. Our lives will never be the same, and we
will not tolerate any half-measures and the whisper of a
promise.
We demand reparations for the lies about the toxic air. We
need immediate compensation, because we can no longer work due
to these health problems. We need a comprehensive long-term
treatment and study program to provide medical care for
residents and workers in Lower Manhattan, and to continue
investigating the complex, emerging September 11th health
problems.
We demand from the Federal Government today. Our lives
depend on it. Now is the time to act.
Thank you for your time.
[The prepared statement of Ms. Geronimo follows:]
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Mr. Shays. Thank you, Ms. Geronimo, very much.
Sergeant Provost.
STATEMENT OF LAWRENCE PROVOST
Mr. Provost. Good afternoon, and thank you for inviting me
to come. First, I have to say that anything I say here today
does not represent the opinions of the Department of Defense or
the U.S. Government. However, it is as a soldier that I
volunteered to respond to the attack on our Nation on September
11, 2001.
I arrived at the World Trade Center site on my own
initiative, in uniform, after gaining clearance from my
military unit to do so, to assist in the search and rescue and
remained there for the first 7 days. On September 11, 2002, my
Army Reserve Unit landed in Afghanistan, and we returned home
to New York on March 11, 2003. In September 2004, my team again
went overseas to Iraq, and we arrived home on March 11, 2005.
Much has happened in the past 5 years, but it is impossible
not to forget that what has happened to all of us these past 5
years has been more or less because of September 11th. Our war
began at home, and our war ultimately must be fought and won at
home.
Speaking as a member of two groups in the September 11
community--the military volunteers at the World Trade Center
site and the so-called undocumented victims, those who did not
work for the city or State of New York--we are faced with three
major issues in regards to September 11 illnesses--emotional,
physical, and spiritual health.
I am not ashamed to admit as a person in uniform that it
has been a very tough road mentally because of September 11th.
The severe PTSD issues that I have faced have been a major
burden on my family, my friends, my job, and it has been hard.
You know, and there is a real stigma that exists because of
that, because you are a person in uniform, whether you are in
the military or a police officer or a firefighter, or even in
everyday society I think we still see that.
I was even penalized in one of my evaluation reports
because I went and sought help from a military clinic regarding
my World Trade Center emotional health issues, and I am still
fighting this evaluation but it is going to remain forever in
my file. I probably will not be promoted again, and this is
just very symptomatic of what is going on with so many people.
And, unfortunately, it is sad to say that I have it pretty easy
compared to other people, frankly.
In regards to the physical health issues, there are many of
them. On September 14, 2001, at the site I began to develop
severe rashes on my arms, back, and neck. These continue to
this day, and you can probably see many of the red blotches
that are across my face now. I was treated onsite, but because
I did not go to the hospital I was denied Federal compensation
related to September 11th. The victims comp fund said you had
to be treated at a hospital within the first 48 hours.
Well, when we were onsite, one, we didn't care about going
to a hospital; second, there was no place to sign in. You know,
we just went ahead and we did what we had to do.
At age 27, I am much weaker physically now than I was
before September 11th. And though I do not experience--and as I
said, I do not experience most of the symptoms the others have,
at least as far as yet--I have it easy, because I am not dying.
Bernie Gidfried, a friend of mine, whose ambulance corps was
contracted to the city of New York but was not a part of the
FDNY, she was buried twice that day, once by each tower. She is
on 22 different medications now.
Father Lyndon Harris, he gave me permission to say this,
most people don't know, but he is the priest who ran St. Paul's
Relief Operation. Father Harris is sick. He has severe PTSD,
and his lungs are deformed. He was told this by the Mt. Sinai
Medical Institute. What are we to say to heroes like Father
Harris who gave--who literally gave their all for all of us
rescue workers down there?
My battle buddy, who was only onsite for 2 days, is on a
respirator day and night. I was there 7 days. He was there 2
days, and he has to suffer because of this.
People from out of the State came, and they have already
died. Lieutenant Dave Michael, another Army Reservist who came
as a part of his police department from the Midwest, he only
worked at Fresh Kills, and he has died in his forties recently.
I feel as thought preventative treatment from the beginning
would have helped many of the chronically, critically, and
terminally ill have a longer life span. And many of the
monitoring program's specific toxins are identified while
strain on the heart and the atrophy of the organs continues.
As I said before, Father Harris' lungs are currently
deformed, and he has a history of coughing. He has not received
workman's compensation. He is about to lose his medical
insurance. I mean, I just--it is mind-boggling, and there are
so many of these stories. I mean, this is--this is like what
happened to John Lindsay before he died. You have a great
individual who does so much, and then it is like nothing. You
have no medical insurance, and you are going to die alone.
Governor Pataki's recent bill was for city and State public
servants, not people such as on this panel. In New York City,
49 percent of emergency medical services are volunteers, are
private ambulance services, that are not covered by the FDNY.
If you were down there giving to your country, you should be
given treatment. And what about the downtown residents whose
only crime was living and working in the greatest city in the
world?
We have seen little assistance from the mayor and the
Governor. Each is in a power grab for their piece of the most
valuable real estate in the world, the World Trade Center site,
while neglecting first the families of the victims, the
developer, and now the first responders and residents of Lower
Manhattan.
The mayor's administration has not declared war on first
responders and residents, but its actions in effect have sent
the message for us to drop dead and to stop being a nuisance.
What they have not realized by their actions is that what they
are doing is not in the best interest of the city, it is not in
the best interest of the soul of the Nation. They have not yet
realized that the billions they will inevitably spend on
lawsuits would have made it more profitable for them to save
people than to let them be killed by terrorists.
And I don't think that this is the stronger and better New
York that Mayor Giuliani spoke of. And I do believe this leads
to the issue of our spiritual health. And while our government
cannot compel State-sponsored religion, any program that the
Federal Government does develop does have to take into account
the faith component and the faith healing.
Again, we saw what happened over at St. Paul's Chapel where
people of all faiths went. That is just something that in any
program, especially for people who are dying, who are getting
ready to meet their maker, these are issues that we definitely
have to confront.
In regard to spiritual health, as a military reservist I
feel terrible in knowing that there are remains of our military
brothers and sisters in the garbage dump at Fresh Kills
Landfill, and even today around the World Trade Center site,
where hundreds of remains have been found in the Deutsche Bank
Building over the summer.
I saw it here, I saw it in Afghanistan, and I saw it in
Iraq. Remains can be, and usually are, everywhere. I can
guarantee that there are remains from September 11 in other
places in Lower Manhattan, in air ducts, in roofs, in vents.
And I don't believe it is good for the spiritual well being of
our city knowing that there is a continuing graveyard down at
the World Trade Center site.
We are at war, and the only way to win wars is by total
immobilization of the national government in all areas to
defeat the enemy, and this includes the area of September 11
help. Many suspect that the attack on the World Trade Center
itself will never actually be considered anything more than the
result of a criminal conspiracy, but our definitions of war are
too far outdated.
The fact is, those attacks on September 11 were coordinated
by a foreign non-State enemy, and people, whether they liked it
or not, were automatically thrust into the role of being a
soldier, a sailor, an airman, or a marine that day. A Federal
law to cover all affected and treat them as victims of an
attack by a foreign entity is certainly called for.
We live in a strange world with many different and often
conflicting interests, but putting September 11 under the
umbrella of the Federal Government is the best guarantee that
no one is left behind and creates a win situation for all
parties concerned. Any solutions to be taking place have to
cover all military volunteers at all sites related to September
11, including military mortuaries, but this only addresses part
of the problem.
All downtown residents and people from out of State must
also be covered by any Federal program, and I believe Mr.
Nadler's bill is a great place to start. In future disasters,
you will also have to take new account that volunteers will not
be sitting at home. They will, in fact, run toward sites, and
that is something that also has to be addressed. Data bases
need to be set up beforehand, and comprehensive programs need
to be in place beforehand to respond to these disasters.
Congress should enact reforms immediately to discourage the
military culture which penalizes those who admit they need any
sort of physical or psychological assistance relating to the
war on terror, including September 11th.
And I don't want to take up too much time, because we have
a great deal many questions, but I just want to say this is the
greatest country in the world. We are at war despite the issues
that we are being faced. I believe the best of humanity is in
this room. I believe that going together that we can succeed,
and that we can make sure that those who have died and,
frankly, those who are continuing to die, that they will not
have died in vain. And I believe perhaps in that way that
America can prevail, and we need your help.
Thank you.
[The prepared statement of Mr. Provost follows:]
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Mr. Shays. I thank you all very, very much. The line of
questioning would be from me ordinarily, and then from Mrs.
Maloney, and then I would go to Senator Clinton, and then to
Mr. Fossella, and then to Mr. Nadler and Mr. Weiner. I am going
to speak at the very end, ask questions at the very end, and
give my time to Mr. Fossella.
Mr. Fossella. Thank you, Mr. Chairman. Thank you all for
your testimony. It was very moving, and, again, just a strong
reminder of why we are all here and why we can't go away.
Now, for Ms. Bascetta, I think it is a consensus here that
the Federal Government needs to be fully behind this effort
with money now and resources for treatment, among others,
continued monitoring. But one thing that we often ignore is the
fact that many people who have lived in New York City and the
surrounding area have moved already to other parts of the
country, and will continue to move.
And I think many of us--and it has been confirmed by people
like Dr. Howard and others--that this is a 20, 30, 40-year
commitment that needs to be made as we monitor and treat those
who suffered.
So along those lines, in your study or professional
opinion, does GAO have any recommendations on how to better
coordinate existing efforts to address what we believe is a
health crisis as we go forward? Do you have any suggestions how
we can start down the path of determining, in conjunction with
the non-governmental organizations, as well as governmental
organizations, how many affected, the cost of treatment, and
what we can expect in the coming years?
Ms. Bascetta. We are, of course, very concerned and
troubled most by the fact that 5 years later there have
obviously been many lost opportunities, starting with the fact
that there was no roster of who helped. A very obvious lesson
learned is that we need to know that from day one in the future
and not to be trying to reconstruct that after the fact. It is
very expensive, and, frankly, we will probably never know how
many people participated in the cleanup and rescue operations.
Another lesson that we need to learn is that we need one
program for everybody. A multiplicity of programs isn't the
optimum clinical treatment, because people are people. It
doesn't matter whether you are with the city, the State, or the
Federal Government, if you were exposed you ought to be treated
the same from a clinical standpoint.
In addition, for the long-term monitoring, you want to have
the most robust epidemiological evidence you can have, and that
would require there again to be one program, one set of uniform
standards, that will be applied to people regardless of whether
they were volunteers or workers from an array of different
agencies.
Mr. Fossella. Is there a model that this country is--or
other parts of the country have--we can point to, given the
scale and size?
Ms. Bascetta. I am not sure about that. I would have to
give that some additional thought. Certainly, we were hoping
that even though it was 5 years later that the appointment of
Dr. Howard as the Federal coordinator of all this could at
least make up for some last time and--lost time and lost
opportunities to perhaps, you know, begin to lay out what the
parameters of a model might be to deal with future situations
like this.
Mr. Fossella. Any sense on how long that process would
take, that one particular program at least you have in your
mind?
Ms. Bascetta. Setting up the parameters, do you mean? Well,
you know, I think there is lots of good science, both clinical
and statistical, that could be brought to bear immediately to
fashion a program. You also asked me about cost. There is
certainly, you know, a wealth of expertise that could be
brought to bear to combine the epidemiological evidence that we
have now with various statistical and economic programs that
could cost out a range of scenarios, the best case and the
worst case, depending on, you know, how the health of the
responders evolved over time.
But I think Chairman Shays had said in his opening
statement that requires vigilance and patience, and certainly
that is the case.
Mr. Fossella. Is there any way that GAO can undertake that
responsibility?
Ms. Bascetta. We would do whatever the Congress asked us to
do.
Mr. Fossella. I yield back. Thank you, Mr. Chairman.
Mr. Shays. Thank you. At this time the Chair would
recognize Mrs. Maloney.
Mrs. Maloney. I thank all of you for your very moving
testimony. You certainly have pointed out what we need to do.
And I thank, again, the chairman for this hearing. I yield my
time to the junior Senator from New York.
Senator Clinton. Well, I thank my friend and colleague, and
I want to thank all of our witnesses for their moving and
eloquent and helpful testimony. I think that there are several
action items that have to come out of this hearing. Obviously,
one is that we need to expedite not only the $75 million but
begin to put together a budget request for money in addition to
the $75 million.
If there is a supplemental request before the end of this
year from the administration to fund matters such as the war in
Iraq, or continuing help for people along the Gulf Coast
because of Katrina, or to deal with the drought in Iraqi
Mountain West, whatever the reason is we will work very hard to
get additional money in that for the treatment that is so
desperately needed.
We will also begin to work to get a budget item in the
President's budget. This is an ongoing Federal Government
commitment, and it needs to continue year to year without the
kind of fits and starts that unfortunately we have experienced
over the last several years.
I think it is also first and foremost the responsibility of
the Federal Government to take care of Federal employees. And,
Mr. Centore, I am so sorry. I just cannot express strongly
enough my sympathy for what you have been through as a Federal
employee and someone who has given a lifetime of commitment to
our country.
And as we heard from Ms. Bascetta, the Federal Government
has failed on many levels, but it has miserably failed in
taking care of its own workers. And that has to be addressed
with renewed commitment.
Additionally, we have to set up systems to deal with this
going forward, and I appreciated Congressman Fossella's line of
questioning. I have introduced legislation, bipartisan
legislation, in the Senate with Senator Voinovich from Ohio.
Why? Because there was a team of people from Ohio who came to
help us in New York.
When they returned home, they got sick. And it was the same
kind of problem that we began seeing with our people, and so
we, along with several other of our colleagues in the Senate
and with my colleague, Congresswoman Maloney, in the House have
introduced the Disaster Area Health and Environmental
Monitoring Act, which would give the President authority to
carry out a program for the protection, assessment, monitoring,
study of the health of people exposed to harmful substances,
and then simultaneously we need something along the lines of
what--Congressman Nadler or Congressman Maloney has a different
approach. We need some kind of system to guarantee the
treatment.
Now, I can't help but add--you might expect this from me--
if we had a health care system in America that took care of
everybody we would not be talking about creating special little
programs to take care of people. We wouldn't have, you know,
Mr. Zadroga, being turned away for treatment as we heard his
father describe to us.
This is something that, you know, is long overdue in our
country, and eventually we are going to have to get around to
doing it. We are wasting billions of dollars, and we are
destroying lives because we won't face up to the fact that we
are not fulfilling our responsibility as the richest country in
the world to provide quality, affordable health care to every
single American, especially to those people who are harmed
because of an attack on our country.
So I think there is a lot of work ahead of us, and I just
want to, you know, end by underscoring the fact that we do need
to understand what went wrong, because we cannot learn those
lessons if we are not courageous and honest enough to face
them. And a lot of things went wrong.
But that should not be an additional excuse for not taking
care of the people who need our help now. And I really believe
that the testimony we have heard from each of our witnesses on
this first panel does more than any of us up here can to
underscore the continuing responsibility we all feel.
And I recall that we had a hearing like this in February
2002. It was a hearing that I called that the Senate had, and
we began hearing these stories then. And it was very hard to
get people's attention. I will never forget the testimony of
one of the representatives from the cit. When we said, ``Well,
who is responsible for the air?'' and the response was, ``We do
water; not air.''
And there was just this I think feeling that, oh my gosh,
we have so many other things to worry about, we are just not
going to be able to focus on this yet. Well, finally we are
focused. The need is obvious, and we have a lot of work ahead
of us. And I think I can speak for all of the Members of the
congressional delegation is that we will remain working
together in a bipartisan fashion until we get answers to the
money for the treatment, the systems that need to be set up,
and then policies to try to make sure this never happens again.
And I thank our conveners for holding this hearing.
Mr. Shays. I thank the Senator from New York. Mrs. Clinton,
thank you very much. And at this time, I would recognize Mrs.
Maloney for your time.
Mrs. Maloney. I thank the gentleman for yielding, and I
thank our two Senators for their commitment and dedication to
this issue. Just yesterday they joined Vito Fossella and myself
at a meeting with Secretary Leavitt, and their presence and
commitment helped us secure Secretary Leavitt's and John
Howard's commitment to release the $75 million by October 1st.
It cannot help Mr. Zadroga's son, but it can help others, and I
thank them for their leadership.
I yield my time to the senior Senator from New York.
Senator Schumer. Well, thank you, Carolyn. I want to thank
you for your really exquisite leadership on this issue, along
with Vito Fossella and my colleague, Senator Clinton, who has
taken such a lead on this issue in the U.S. Senate.
I also want to thank Chris Shays for holding this hearing
in a timely fashion here in New York yards from the scene of
both the terrible tragedy and the countless acts of heroism
right during the attack and in the days, weeks, and months
afterwards.
And let me just say this. We came together as a society in
a really amazing and refreshing way after September 11th. The
partisan differences, the geographic differences vanished. We
were all New Yorkers. We were all people who had been injured
by what happened. And what we are doing--what we are talking
about here is a test. Has our society forgotten about what
happened?
The victims we have heard from and heard about were injured
every bit as much as those who were hurt immediately as a
result of the planes crashing into the Twin Towers. It is only
their symptoms that emerged later, and it took too long, just
really until the last week, until the views of so many that
damage occurred, real damage, although its effects would not be
known 5 years, 10 years, even 20 years later, were real.
And we have to summon the same energy, the same focus, and
the same unity in helping these folks as we did in helping
those who were injured immediately thereafter. That is our job.
Make no mistake about it, $75 million isn't going to be close
to enough. And when we met with the Secretary yesterday, a
number of us were a little skeptical I guess I would say
because he wouldn't give an unequivocal commitment that
everyone would be taken care of. We need that commitment.
We need that commitment now. It is, we all believe, a
Federal responsibility. Just as helping those who were injured,
and the families of those who perished in the Twin Towers, was
agreed to be a Federal responsibility. And there are going to
be other--there are going to be several different approaches
that are taken. The real answer is simply to get the treatment,
the health care, the help for the people who need it.
And I wanted to come by and apologize to everybody, because
I had so many other prior commitments, to tell this panel in
particular, but everyone here, that I will join in the effort
to do everything that we can to see that what happened to those
who helped early on, but show symptoms of illnesses that came
from that help years later are treated every bit as fairly as
those who were hurt on that terrible day, 9/11/01.
Thank you, Chris, and thank you, Carolyn, for yielding your
time.
Mr. Shays. Thank the gentleman very much. I appreciate his
being here to speak in unity with this effort.
At this time, the Chair would recognize Mr. Nadler. And as
the gentleman rightfully pointed out, I think we are in his
district.
Mr. Nadler. We are indeed. Thank you very much, Mr.
Chairman. First of all, I said in my opening statement that I
felt that the Federal, State, and city governments have
betrayed the first responders and the people who came to help
and the people who live in downtown Manhattan. I think the
testimony we have heard strengthens that statement.
So as a member of the Federal Congress, not the
administration or anything but the Congress, let me apologize
to those of you who were--who live downtown or are--or were
responders and have gone through what you have gone through,
for the betrayal by the Federal Government. And we will try to
reverse that, to the extent we can now, and that is the purpose
of this hearing.
Second of all, Mr. Centore, you testified about--that when
requesting Federal assistance you talked about how you couldn't
get real help. And when requesting Federal assistance such as
workman's compensation or disability retirement, you had
various problems. Could you elaborate a bit on the problems and
frustrations that you have had or that you know that others
have had in trying to get help from the Federal worker's comp
system?
Mr. Centore. I can only speak from, you know, my own
experience. I can back it up with hearsay from other parties.
But the biggest concern in the last letter that I received from
Department of Labor concerning workman's comp was, ``How do we
know you were there?'' And I am like, well, I have eight or
nine pictures with me on the pile, and they said, ``Well, they
could have been doctored up.''
I said, ``You work for the Federal Government, don't you?''
because I know where this is going. I mean, this was--you know,
it was just mind-boggling that the man would question my
integrity like that.
Mr. Nadler. We have heard the same thing from other people,
but go ahead.
Mr. Centore. OK. No, that is all I am going to say. That
was the biggest----
Mr. Nadler. In other words, it is an adversarial system
where they seem to try to avoid certifying you as someone who
ought to get help?
Mr. Centore. Well, if I can be candid----
Mr. Nadler. Please.
Mr. Centore [continuing]. I feel like it is a contest
between me and them. It is a contest to see if they are going
to give in first or I am going to die first. And I have made a
solemn promise to myself that I am going to collect that one
nickel, just one nickel, before I go anywhere. It is like--it
is insane. My doctors don't believe that I still have to go to
work, even in my condition.
Mr. Nadler. So do you think, given your experience, that it
would be a good idea to make the major means of first
responders and others with--the people who live or work
downtown who have gotten sick as a result of September 11th, do
you think it would be a good idea to make the major means of
access to Federal help, to medical treatment, the worker's comp
system? Or should we try something else?
Mr. Centore. Well, I do, but, you know, I think you have to
start at the very beginning. And if you read the paper that I
submitted to the committee, the very first thing I said that we
have to do is somebody has to stand up and say, ``Yes, this is
attributable to the September 11th incident.'' And that
somebody has to be the Federal Government. I mean, that is the
power that, you know, speaks for the entire country.
If the Federal Government is willing to stand up and say
that, I think you will have more doctors and more people in the
medical community finally stepping forward. I have--right now I
have as many doctors as I have pills, which scares me. But they
all treat all of my illnesses in a traditional manner, with the
exception of a few who have been--had some experience dealing
with other September 11th responders.
And I am like, I don't know where you get this information
from. You know, that is the first step. Somebody has to admit
that this was caused by September 11th. And then, second, which
it is going to be a lot longer, is we have to educate local
medical communities on symptoms and diagnoses of having to deal
with situations such as the World Trade Center.
Mr. Nadler. Thank you. I have a couple questions which I
wanted to ask Mr. Centore and Mr.--Sergeant Provost. And to the
extent that Mr. Zadroga has information from his son, I would
ask you to answer this, too, but it may not apply in any case.
The first question is, when you served on the pile--I will
ask Mr. Centore first, and then Mr. Provost, and, Mr. Zadroga,
if you want to--were you issued a respirator?
Mr. Centore. I am glad you brought that question up. We
started off with the paper mask. The problem with that was----
Mr. Nadler. That is useless. Were you issued----
Mr. Centore [continuing]. They got clogged up. You couldn't
breathe, so you were either going to suffocate and your lungs
were going to be OK, or you took the doggone thing off so you
could breathe, but you run the risk of, you know, developing--
--
Mr. Nadler. Let me just say that we have had testimony on
other occasions that the paper mask was useless to protect
anyone's health anyway.
Mr. Centore. Right.
Mr. Nadler. But, so were you issued a respirator?
Mr. Centore. Eventually. Near the end, a friend of mine,
actually he is my counterpart in the EPA, I ran into him. He
was doing monitoring for the EPA down on the pile, and he
begged me and pleaded with me, he said, ``Hey, if you go back
down to the pile, make sure you wear at least the half-face, if
not a full-face, respirator.''
Mr. Nadler. Because of health hazards.
Mr. Centore. Oh, yes.
Mr. Nadler. OK. And were you told that it was the law under
the Occupational Safety Health Act that you must wear a
respirator?
Mr. Centore. No, sir. What we were told was we went over
the schoolhouse, and they would put up a sign that--when
respirators were required. So 1 day they would have the sign
up, next day they would take the sign down.
Mr. Nadler. OK.
Mr. Centore. Next day they would have the sign up.
Mr. Nadler. And did you see--and did you see EPA or OSHA
officials enforcing the Federal occupational safety laws?
Mr. Centore. No, sir.
Mr. Nadler. Walking around the site to see whether people
were wearing respirators?
Mr. Centore. Not until they were able to get a handle on
the situation.
Mr. Nadler. OK. And my final question, and then I will ask
Sergeant Provost the same questions, did anyone tell you that
you were not allowed on the site without proper protection
gear?
Mr. Centore. No, sir.
Mr. Nadler. Thank you. The reason I am asking these
questions is that Christie Todd Whitman has said that they told
workers to wear their gear, and that at the Pentagon, the
cleanup at the Pentagon, the law was enforced and no one was
allowed on the site without wearing respirators.
I will ask if Sergeant Provost can give shorter yes or no
answers to the same questions. I will repeat the questions.
Were you issued a respirator?
Mr. Provost. No, sir.
Mr. Nadler. Were you told of the health hazards of working
on the site?
Mr. Provost. No, sir.
Mr. Nadler. Were you told of OSHA requirements to wear
respirators or any other protective gear?
Mr. Provost. No, sir.
Mr. Nadler. Did you see EPA or OSHA officials enforcing
Federal occupational safety laws?
Mr. Provost. Never, sir.
Mr. Nadler. And did anyone tell you that you were not
allowed on the site without wearing proper protective gear?
Mr. Provost. Never, sir.
Mr. Nadler. Thank you. Mr. Zadroga, do you have any
information on this that you could give or----
Mr. Zadroga. Yes. All my son was ever issued was a paper
mask, and he was never told that he had to wear a respirator.
Matter of fact, at one point he asked to have a respirator from
a lieutenant that was walking by carrying 10 of them, and the
lieutenant refused to give it to him and said, ``It is for the
higher command only.''
Mr. Nadler. Thank you. Let me just add one thing, and that
will finish my questioning. Actually, I have finished the
questioning. I wanted to make one comment with this panel,
because Congressman Fossella I think it was, maybe it was
someone else, I don't--I think it was Congressman Fossella
earlier commented that respirators could have been
requisitioned from the Army, that they could have been gotten
somewhere.
At the ombudsman's hearings, the EPA ombudsman at my
request held hearings downtown in February and again in March
2002 on very much the same topics we are holding hearings on
4\1/2\ years later. Because of his conclusions, EPA ombudsman's
office was later dismantled by Christie Todd Whitman, but at
those hearings we had testimony from police officers--and this
is February 2002--we had testimony from police officers that
they requested respirators, that they were not available, that
they were not made available, that thousands of them were in
National Guard armories all over the metropolitan areas,
including New York City, and never requested, never
requisitioned, and never used, because no one thought to do it
apparently.
But those who requested respirators, at least from those
police officers who testified, it was never made available to
them.
I thank you very much. And, again, on behalf--I can't say
on behalf of the Federal Government, but on my own behalf I
certainly apologize for the terrible treatment that your
country has extended to you.
Mr. Shays. I thank the gentleman very much for his
questions, and at this time the Chair would recognize Mr.
Weiner.
Mr. Weiner. Thank you, Mr. Chairman, and I thank the panel.
And I want to echo what Congressman Nadler said. We have said
you are heroes, we have said we are grateful, it is time for
the United States to say we are sorry and we are going to make
it up to you.
I would like to ask you all a question about the comments
that the Secretary of the Department of Environmental
Protection made in the period after September 11th. I remember
the comments and questions, among many others, were: is it safe
to be living in New York during that time, given what was in
the air?
My office was in Sheep's Head Bay, Brooklyn, and there were
embers that were falling that far away from Ground Zero. When
on September 13 the Secretary--when Christie Whitman said,
``The EPA is greatly relieved to have learned that there
appears to be no significant levels of asbestos dust in the air
in New York City.'' Mr. Centore, did you read that?
Mr. Centore. No, sir, but I can--I can tell you that is not
true, because I was--we were stationed at the corner of
Chambers and West Side, and I could feel all the silica fibers
clinging to my skin.
Mr. Weiner. Mr. Centore, those of us in public life who
didn't spend weeks down there but spent hours just seeing the
site, when we went home we had dust on our shoes, things coming
out of our nose from 15 or 20 minutes of exposure.
Mr. Zadroga, when on September 14 Christie Whitman said,
``The good news continues to be that air samples have taken--
have been taken, have all been at levels that caused no
concern.'' You were there, your son was there, can you tell us,
had you heard those comments from the Secretary? Did you take
some relief in them?
Mr. Zadroga. Mr. Shays. Well, sir, I wasn't there. My son
was there. But I did hear those statements, and I couldn't
believe they were saying that. It was just totally unacceptable
as far as I was concerned. I knew there was asbestos in that
building, because one of my friends that I grew up with, he
told me they had asbestos in that building on like the first--
he told me first 40 or 50 floors.
Mr. Weiner. Ms. Geronimo, you who live in the area, this
must have been of monumental concern, seeing what was going on
in the neighborhood you lived and worked. When you heard on
September 16 Christie Whitman say, ``There is no reason for
concern,'' did that set your mind at ease? Did you at least
feel that the Federal Government was checking and was giving it
a clean bill of health?
Ms. Geronimo. To be quite frank, no. I knew she was lying.
We were given paper masks in our office also. But you have to
understand, the way that our office receives air, it gets the
air from the outside, filters it backs through the building,
and gets it in. And for over a year, especially during the
summer, there were times there was no air in the building at
all, because they had to shut all the air vents.
But I was still expected to walk through all of the
military barricades, I was still expected to walk through all
the debris that was still flying in the air for weeks to come,
and there is a smell that none of us will ever forget that was
made out of human remains, the crushed concrete, the glass, the
asbestos, and other toxins that I am sure of were created from
all of those fires that day.
Mr. Weiner. Mr. Provost, on September 18 when Christie
Whitman said, ``Given the scope of the tragedy from last week,
I am glad to reassure the people of New York and Washington,
DC, that their air is safe to breathe, that their water is safe
to drink.'' When she said that, since then it has now become
clear and now become the fact that she herself and the EPA knew
that was not true, but did you believe her based on what you
were seeing?
Mr. Provost. No, sir, I didn't, because I had to leave the
site the day before because of all the rashes and the physical
issues that I was already having based on being there only a
week. So I knew it was a lie.
Mr. Weiner. Well, I just want to wrap up by asking the
panel yes/no, do you believe, Mr. Centore, that Christie
Whitman was honest with you?
Mr. Centore. Remembering that I am still under oath, and I
just--I know you want a yes/no answer, but it is not that
clearcut. What I started to allude to before was my counterpart
with the EPA was part of one group that was doing air
monitoring on the pile, and I said, ``But you guys gave us a
clean bill of health. You said that the air was OK.'' That was
the second team that was sent somewhere north of NoHo to take
air samples. I said, ``There is nobody up there.'' And that is
what--those were the samples they were using to decide whether
we had to have respirators on or not.
Mr. Weiner. Mr. Zadroga, do you believe that Christie
Whitman and the EPA has been honest with you and your family?
Mr. Zadroga. No.
Mr. Weiner. Ms. Geronimo, do you believe Christie Whitman
and the EPA has been honest with you and your family?
Ms. Geronimo. No.
Mr. Weiner. Mr. Provost, do you believe that Christie
Whitman and the EPA has been honest with you and your family?
Mr. Provost. No, sir.
Mr. Weiner. Thank you, Mr. Chairman.
Mr. Shays. I thank the gentleman. At this time the Chair
would recognize Mrs. Maloney.
Mrs. Maloney. Mr. Chairman, I feel I should yield to you,
since we would not even have these hearings if you had not
responded to my request. But since you have yielded, I would
like to ask Mr. Zadroga, has the city of New York to this day
acknowledged that your son died because of the exposures of the
toxic dusts at September 11th?
Mr. Zadroga. No, they have never acknowledged that. Matter
of fact, they never acknowledged his death. I never received
even a letter of condolence. The only thing I ever received
from New York City was from the Pension Board saying that
``Your son passed away. Would you please sign this paper so we
can send you payment?''
Mrs. Maloney. OK. As you know, I have followed up on one of
your recommendations to open up the victims compensation fund
for the workers and responders.
Mr. Zadroga. Yes, thank you for that.
Mrs. Maloney. Prior to your son's death, was there anything
that the city, State, or Federal Government did to make sure
that your son got the medical attention that he needed? And one
of your statements in your testimony, you said, ``One doctor
was getting ready to treat my son and then he got a phone call
and refused to treat my son.'' Could you elaborate?
Mr. Zadroga. Well, that was actually on, you know, more
than one occasion. We took my son to many different hospitals
and many different doctors seeking help. The one doctor that
refused, he was from Columbia Presbyterian, and he just said,
no, he will not help us. He said because of--he actually never
said a reason.
Dr. Murphy from DeBoer, he----
Mrs. Maloney. OK. Did the city, State, or Federal
Government assist you in any of the medical treatment?
Mr. Zadroga. No.
Mrs. Maloney. Thank you. And, Mr. Zadroga, it appears that
Dr. Howard is responding to a request that Congressman Vito
Fossella and I made to him to make sure that the determinations
of who died from their injuries of Ground Zero, that they come
forward with some type of fatality program so that we can make
the connection between the deaths and the Ground Zero toxins
and exposure.
And they have come forward by saying that they will be
working with the New York City Health Department by setting up
a fatality investigations program together with the New York
City Health Department. Do you have an opinion on this?
Mr. Zadroga. Well, first of all, I did sit with Dr. Howard
when he was first appointed with the DEA for 2 hours, giving
him my son's medical records, autopsy records, and he agreed
with us that--or agreed with me that my son died from a
pulmonary disease.
However, weeks later we went away for a weekend, and then
we came back and we just happened to come across a news article
that one of his first statements to the news was that my son
died from a heart condition. So to me his credibility was
destroyed. I called his office and requested confirmation on
why he would say something like that, and they--the secretary
or whoever I spoke to said, ``He didn't say that.'' I said,
``Well, I have it right in front of me.'' And she said, ``Well,
I will get back to you,'' and never got back to me. The Health
Department never did anything to help my son.
I would also like to say that my son had a biopsy done at
DeBoer of his lungs, and they were sent to two Federal military
bases, and we never received a true biopsy report back from
them. I only received a generic one upon threat of subpoena.
Mrs. Maloney. So is it fair to say that you do not trust
the city of New York or the Federal Government to come forward
with the fatality determination on fatalities from Ground Zero?
Is that a correct analysis of your statement?
Mr. Zadroga. That is correct. And that is why I suggested
that a Grand Jury hearing be established with subpoena powers,
so that we could get the underlings that work for these people
who know what really happened to come forward and say what
happened. I am sure they were told do not treat them, get them
out, because every time we went to the hospital, as I said, he
was just--they told him they would take good care of him, and
then it was like somebody threw a switch, and then they just
threw him out of the hospital.
Mrs. Maloney. Thank you. I would like to ask GAO, Ms.
Cynthia Bascetta, in your testimony I would like to ask a
specific question on payment and funding. And I want to know
from your testimony, you talked about the recent payments to
Mt. Sinai's consortium program and the fire department program.
And in your testimony you said these payments were made on
August 11th.
And it seems to me that based on your testimony, that this
money was not expected, and did they have an explanation for
this funding? And before you answer, remember the question,
because we are under the 6-minute rule, and I want to get some
questions in to the other panelists very quickly.
I want to ask Ms. Geronimo, has there been any assistance
to you in any other area, workers from the city, State, or
Federal Government, to deal with your health problems as a
direct result of September 11th? And how do you feel about the
statutorily requirement that residents cannot be part of the
World Trade Center consortium project? Remember the question,
and I am going to Mr. Provost of the National Guard.
Mr. Provost. Army Reserve.
Mrs. Maloney. Excuse me.
Mr. Provost. I am sorry.
Mrs. Maloney. Army Reserve. Excuse me, Army Reserve. And
have any of your fellow men and women in the Army Reserve, have
any of your people who responded to September 11th been
eligible for any type of long-term medical monitoring or
treatment? And has there been any coordination by the Federal
Government to make sure that you and the others from the Army
Reserve or Navy Reserve or other military areas receive
treatment? And do you think it is wrong that you had to go to
Iraq and Afghanistan in order to get medical treatment from the
Federal Government and to get a response to your concerns?
And finally, Mr. Centore, you are a Federal worker, and
when Mrs. Clinton and I were fighting to establish a medical
monitoring program we tried to include Federal workers, but the
administration countered that they would take care of Federal
workers, and that they would establish their own separate
program for Federal workers. And has that program worked for
Federal workers, or do you believe Federal workers should be
part of the World Trade Center consortium program which is
treating all of the other workers that have been part of the
effort?
My time is up, but you have time to respond, and I would
like to go first to the General Accounting Office.
Ms. Bascetta. Your question was, did they explain the
August awards? And let me give you the context. We were
updating our work. We wanted to be fair to the Department, so
we asked them whether they had----
Mrs. Maloney. Was it expected, or was it a surprise?
Ms. Bascetta. No, it was a surprise.
Mrs. Maloney. It was a surprise.
Ms. Bascetta. They termed them as emergency awards. They
said that they were able to make the awards very quickly,
because they had in contact with the recipients, and because
they had draft applications. But I have worked for the Federal
Government for 28 years. We saw the applications. One was dated
the 10th, and one was dated the 11th, and the payments went
out. The awards were made on the 11th. I have never seen
anything that rapid. It was certainly very unusual, and----
Mrs. Maloney. Never seen anything like it in 28 years.
Ms. Bascetta. No. And, you know, I would make the point
that they obviously were able to change their process, which
was to have all of these awards undergo peer review, so I would
imagine that sets a precedent for them for the process that
they plan for getting the awards out this October.
Mrs. Maloney. Thank you. Ms. Geronimo.
Ms. Geronimo. I believe your question was whether or not I
thought that the government--Federal, State, or city--has given
any attention to the residents that live in Lower Manhattan,
and I say no.
Mrs. Maloney. Do you think the residents, given the health
problems they are exposed to, should be part of the consortium
that many of us have worked to have you be part of that
consortium?
Ms. Geronimo. Of course. There wasn't a bubble over the
Ground Zero site. It is not as if all the toxicities remained
in the area. You know, it went everywhere. It went as far as
Brooklyn, it went uptown. As trucks were being led to the Bronx
or to Staten Island with the debris, it was there.
When there were people being brought--bodies being brought
to the Javitz Center, it was there. It was all over the city,
quite frankly, and it is true--there were many volunteers from
the city and the country that had come here, even if they
helped for only a day or a year and a half, and they were all
affected by this toxic air.
Mrs. Maloney. Remember the September 11th Health Act that I
authored with Congressman Shays that we have had in for several
years would cover everyone exposed to the toxins and treatment
for everyone who was sick. And so I want you to know about that
bill.
Ms. Geronimo. Thank you. But I would also like to give
special thanks to Jerrold Nadler. With his legislation that he
announced yesterday he has acknowledged that grass roots
organizing and the people that live in Lower Manhattan have
helped to work with him to create the criteria as well as the
availability for all people that were affected here, not just
the first responders, the New York City fire department, and
the policemen, not just the military volunteers that came down
and gave their time, but also residents.
I think that is a very big problem, that people in Lower
Manhattan are virtuously invisible when it comes to the people
affected after September 11th, because we have no recourse with
the exception of the program at Bellevue.
Mrs. Maloney. If we could have the answers from Mr. Centore
and from Mr. Provost.
Mr. Shays. And then I am going to take over. We are going
to finish this panel up in like 3 minutes.
Mr. Provost. My colleagues have been told, ``You were never
down there,'' but ironically enough our headquarters for a task
force of about 250 military volunteers was based in then
candidate Bloomberg's campaign headquarters on 340 West Street,
and he even addressed us at our closing ceremony on September
13.
But, again, we are told by the city that we were never
there. I do suggest that the committee look into the records of
the Office of Emergency Management for the city of New York,
because they have an extensive data base of volunteers. They
even issued volunteer tags for people that were down there.
These were the famous red and orange tags that started to be
issued on Friday and Saturday.
And we personally also--I personally have the records of
most of the military volunteers I know that were down there.
But no, we get told that we were essentially never there. And
do I think it is wrong? Yes, I think it is a sin against human
decency.
Mr. Centore. I think I paraphrased the first part of your
question wrong. You asked me about the Federal program, what
I--did I think it was working?
Mrs. Maloney. Well, two parts, whether you think the
Federal program is working, and, second, Senator Clinton and I
tried to get Federal employees covered in the World Trade
Center consortium monitoring program, which is headquartered at
Mt. Sinai, believing that it would be good to have everybody in
one program, yet they insisted on having a separate program.
And is the Federal monitoring program working? And, second, do
you think the Federal workers should be folded into the larger
program that everyone else is in----
Mr. Centore. Well, first----
Mrs. Maloney [continuing]. With the exception of residents
and students?
Mr. Centore. First of all, is the Federal program working?
If you design a program to do nothing and it does nothing, it
is working I guess. [Laughter.]
Mr. Shays. In other words, it is working the way it is
intended.
Mr. Centore. Yes, exactly. You know, I can't argue with
that. I mean, I didn't design it. You know, I just--I saw the
results of it. Do I think that the feds should be rolled into
the consortium? Most definitely, because that way now if you
try to start a separate program with the feds, you have another
whole set of doctors and another whole medical community you
have to try to bring up to speed on dealing with the issues and
the ailments and the sicknesses and everything else that you
already have established and paid for with the first
consortium.
So that would be my--and one other thing I wanted to say to
Ms. Geronimo. I keep a paper bag tacked to my wall in my room,
and on the very first couple of days that we were down at
Ground Zero, before all of the pizza trucks and everything else
came rolling in, the residents took it upon theirself to make
bag lunches and bring it down to the responders, and on there
they would write little messages of hope. And mine says, ``May
God bless you all,'' and I still have that to this day on my
wall.
Mrs. Maloney. Thank you for your very moving testimony.
Thank all of you.
Mr. Shays. With the time that I have, and I am not using
all the time, I know Mr. Nadler has one very quick question for
one witness. So, Mr. Nadler, quickly please.
Mr. Nadler. Thank you. The question is for Ms. Geronimo.
Ms. Geronimo, Christie Todd Whitman yesterday, it is reported
in today's papers, said that all her statements about the ``air
is safe to breathe,'' they were for the entire area except for
Ground Zero itself, that of course she understood that the
people on Ground Zero, on the pile, that they needed
protection, but across the street everything else was OK.
As someone who lives in the Lower East Side, and who works
a few blocks from Ground Zero, is this distinction that the air
was not safe on Ground Zero, but was OK a block away or two
blocks away or across the street, does this make any sense to
you at all?
Ms. Geronimo. Well, I will answer your question like this.
I work for a brokerage house on Wall Street, and the government
and the world economy was not very happy that the Stock
Exchange had to close for 3 days. So in answer to your
question, it didn't matter how bad the air was. I had to go
back to work.
Mr. Nadler. But was there any distinction between the air
on Ground Zero or a block away?
Ms. Geronimo. No.
Mr. Nadler. OK. Thank you.
Mr. Shays. Thank you.
Ms. Geronimo. It was just as dirty at 13th Street where I
live, at Wall Street where I work, and right across the street
from the Ground Zero site.
Mr. Nadler. Thank you very much.
Mr. Shays. I thank the gentleman. Let me say I just want
this panel to know why you are first, because we wanted your
story to be heard first. That is why you are here.
Mr. Zadroga, I want you to know that your story is for me
the symbol of what we need to do, and I want you to be able to
look back in a few years with all the horrible memories you
have of your son's mistreatment, I want you to think of the
beautiful memories you have of your son. And also, my goal is
to have you believe and know for a fact that your testimony
today made a world of difference.
And for you and the other panelists I just want you to know
that it is our determination that there be monitoring and that
there be the health provided to meet whatever need is needing
to be met, and that this has the funds necessary on the
Federal, State, and local level.
And I know that you must say ``been there, heard that,''
but I know we made a difference, this committee made a
difference, with Gulf war illnesses. We had the help of a few
other people like Ross Perot who stepped in, but we know that
if the story gets out, and if the media is listening to people
like you, that there will be a world of difference.
So I just want to thank you for being here today. I want to
thank you for your testimony. I want you to hold this
committee's feet to the fire. And I want to just allow you,
this panel, an opportunity to talk to any press that may want
to talk with you before we start the next panel. So we will
have a 10-minute recess before we begin the next panel, and so
thank you all very, very much.
[Recess.]
Mr. Shays. We have a terrific panel here, and I would like
them to--Commissioner Scoppetta, you are the only one who is
standing. You might want to stay standing, because I am going
to invite all of you to stand, and I am going to swear you all
in.
If there is anyone else that may provide testimony on your
behalf, I would like them to be sworn in as well, even if we
don't call on them. Do we have everyone? Raise your right
hands.
[Witnesses sworn.]
Mr. Shays. We will note for the record that all our
witnesses responded in the affirmative, and if anyone who was
not called on but stood up to be sworn in, if they give
testimony we will make sure the transcriber has their full name
and title.
Maybe we could, Dr. Herbert, have you slide down just a
speck.
Dr. Herbert. Sure.
Mr. Shays. Are we adding--I think what we are going to do
is--I don't like Dr. Howard being so stuck in a corner there.
Can we have you slide down, Dr. Scoppetta, just a bit? Is that
all right, sir? Thank you. Are we making it work here? OK.
OK. Dr. Howard, it is good to see someone smiling in this
room.
Dr. Howard. Thank you.
Mr. Shays. All right. We are going to start just as I
called your names, and as you are lined up on the table. And,
Dr. Howard, we are going to have you start, and we will go from
there.
STATEMENTS OF JOHN HOWARD, M.D., M.P.H., J.D., DIRECTOR,
NATIONAL INSTITUTE FOR OCCUPATIONAL HEALTH, CENTERS FOR DISEASE
CONTROL AND PREVENTION, DEPARTMENT OF HEALTH AND HUMAN
SERVICES; DR. ROBIN HERBERT, CO-DIRECTOR OF THE WORLD TRADE
CENTER WORKER AND VOLUNTEER MEDICAL SCREENING PROGRAM, MT.
SINAI HOSPITAL, ACCOMPANIED BY DR. STEVEN LEVIN; THOMAS R.
FRIEDEN, M.D., M.P.H., COMMISSIONER, NEW YORK CITY DEPARTMENT
OF HEALTH AND MENTAL HYGIENE; NICHOLAS SCOPPETTA, COMMISSIONER,
FIRE DEPARTMENT OF NEW YORK, ACCOMPANIED BY DR. CARRIE KELLY,
HEAD, BUREAU OF HEALTH SERVICES, AND DR. DAVID PREZANT, CHIEF,
OFFICE OF MEDICAL AFFAIRS; AND DR. JOAN REIBMAN, ASSOCIATE
PROFESSOR OF MEDICINE, NYU MEDICAL CENTER, DIRECTOR, BELLEVUE
HOSPITAL WORLD TRADE CENTER HEALTH IMPACTS CLINIC
STATEMENT OF JOHN HOWARD
Dr. Howard. Thank you, Mr. Chairman, and good morning,
everyone. My name is John Howard, and I am the Director of the
National Institute for Occupational Safety and Health in the
Centers for Disease Control and Prevention in the U.S.
Department of Health and Human Services.
I am very pleased to appear in front of you again today to
report on the progress that we have made and the progress that
we still need to make on the health needs of those who served
in response to the World Trade Center attack on September 11,
2001, and the affected communities.
Since February I have been privileged and honored to serve
as the HHS World Trade Center programs coordinator. The
Secretary of Health and Human Services, Michael Leavitt, asked
me to perform this activity and charged me with the important
task of assuring that programs addressing the health of World
Trade Center responders and nearby residents are well
coordinated. I have been to New York a number of times, and I
want to thank everyone in New York for their generosity and
their time in meeting with me and working with me on my
coordination activities.
Participating in these dialogs has enabled me to better
understand the needs of those who have been affected medically
by the World Trade Center disaster, and also to hear
suggestions and comments about those steps that we still need
to do. From the perspective that I have as a medical doctor, I
am also pleased to work with the Secretary's new task force,
which is a policy guidance body in the Department of Health and
Human Services, to bring to them as their eyes and ears of the
Secretary here in New York City.
I am very pleased to be here again. I am pleased to answer
any question that you may have. Thank you very much, Mr.
Chairman.
[The prepared statement of Dr. Howard follows:]
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Mr. Shays. Thank you, Dr. Howard. Dr. Herbert.
STATEMENT OF ROBIN HERBERT
Dr. Herbert. Good morning.
Mr. Shays. Good morning.
Dr. Herbert. Or good afternoon. I am Dr. Robin Herbert,
Director of the Data and Coordination Center of the World Trade
Center Medical Monitoring Program. I would like to--thanks, can
you hear me better?
Mr. Shays. Yes.
Dr. Herbert. Great. I would like to thank the Chair of the
committee, Congressman Christopher Shays, along with
Congressmember Carolyn Maloney of the subcommittee, and the
distinguished Members of Congress who have been here today,
Senators Chuck Schumer and Hillary Rodham Clinton,
Congressmembers Jerrold Nadler, Vito Fossella, and Anthony
Weiner, for having me testify today.
It is particularly an honor to be here after yesterday's
meeting with Secretary Leavitt of Health and Human Services in
which the commitment was made to allocate the remainder of $75
million in Federal funding to support vitally needed treatment
programs for World Trade Center responders.
Given the limited time at this hearing, I have submitted
written testimony. I would like to also add to my written
testimony a copy of our recently published or online paper,
``The World Trade Disaster and the Health of Workers: Five-Year
Assessment of the Unique Medical Screening Program.''
The World Trade Center Medical Monitoring Program,
federally funded through NIOSH/CDC, consists of the data and
coordination center and five clinical centers in New York City,
New Jersey, and Long Island, and we are proud to be the sister
program of the program based at the New York Fire Department.
Our program provides periodic comprehensive clinical
examinations for World Trade Center responders in the New York/
New Jersey metropolitan area and throughout the Nation. We have
examined over 16,500 responders to date. Our patients are a
highly diverse group that includes members of the building
trades, law enforcement officers, utilities and
telecommunications workers, transit workers, public sector
workers, health care workers, and many others.
We serve many immigrant workers. Fully 14 percent of our
program's examinations have been conducted in languages other
than English. The unifying factor among our patients is that
all rushed in to respond to the attack on our Nation. They were
united by their service, and now, sadly, many are linked by the
illnesses they have developed.
As many of you are aware, this past Tuesday we released
sobering findings on the health impact of the disaster on 9,442
World Trade Center responders who underwent medical
examinations between July 2002 and April 2004. This study,
coupled with the findings of other studies, should leave no
doubt that many World Trade Center responders are sick as a
result of their work, and that many--that they will need
ongoing health monitoring and many will need treatment for the
rest of their lives.
Of the patients we reported on, 69 percent developed new or
worsened respiratory symptoms while performing World Trade
Center recovery work, and 59 percent still had symptoms at the
time of their examination as long as 2\1/2\ years after the
attacks. Fully one-third had abnormal breathing tests, and the
rate of the most common abnormality, low forced vital capacity,
was five times greater than the rate expected in non-smokers.
There was a very strong relationship between time of
arrival at the World Trade Center site and the prevalence of
symptoms and breathing test abnormalities strongly confirming
the relationship between the World Trade Center response work
and respiratory disease. Subsequent work will focus on the
mental health consequences of the disaster in this group, and
on characterization of patterns of self-reported diseases such
as interstitial lung diseases and cancers.
Even before our recent study, because early on we saw many
responders who were clinically quite ill but lacked access to
needed specialty medical testing and treatment, at Mt. Sinai we
sought and received philanthropic funding to establish the
World Trade Center health effects treatment program to make
sure responders could obtain the medical care they needed.
At the present time, in addition to the federally funded
monitoring program, Mt. Sinai and the other clinical centers
have World Trade Center treatment programs that have been
funded largely by the Red Cross and other private donors. These
treatment programs have been virtual lifelines for our
patients.
At our program at Mt. Sinai, we see very ill and vulnerable
workers. About half do not speak English. About 40 percent have
no health insurance, and another 40 percent are underinsured.
Among those whom we saw in the past year 84 percent are still
suffering from upper respiratory diseases such as chronic
sinusitis, 47 percent have persistent lower respiratory
problems such as asthma, and 37 percent in our physical health
treatment program have persistent mental health consequences.
Now, as so many World Trade Center responders have become
ill, I hope they will all receive the medical and mental health
care that they need and deserve. We need a comprehensive,
coordinated, and permanent program that guarantees both
lifelong medical monitoring to identify World Trade Center
related illnesses and lifelong treatment for World Trade Center
related illnesses, both physical and mental health.
I hope our Nation will repay the World Trade Center
responders for the sacrifices they made by guaranteeing testing
and treatment for any illnesses they develop as a result of
their sacrifices.
Thank you very much.
[The prepared statement of Dr. Herbert follows:]
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Mr. Shays. Thank you, Doctor. You are the director of the
program, correct?
Dr. Herbert. I am the director of the data and coordination
center, and was co-director with Dr. Levin of the medical
screening program.
Mr. Shays. Dr. Levin, thank you for being here. You will be
here to respond to questions as well, and we thank you for that
very much. Commissioner Frieden.
STATEMENT OF THOMAS R. FRIEDEN
Dr. Frieden. Good afternoon, Chairman Shays, Congresswoman
Maloney, and members of the Government Reform Committee. I am
Dr. Thomas Frieden, Commissioner of the New York City
Department of Health and Mental Hygiene, and I am pleased to be
here today.
September 11th was an unprecedented urban environmental
disaster. In the days and months that followed, millions of
people were affected emotionally, physically, and financially.
Many people have experienced respiratory symptoms and
psychological distress since that time. We share a commitment
with others in this room to do whatever we can to understand
health problems better, so that we can link people in need of
care to effective services.
We are grateful to the New York City congressional
delegation and Mayor Bloomberg for securing funding to support
medical and mental health monitoring treatment programs, and we
partner with these programs, as well as other institutions, as
well as labor and community groups, in this world.
We also appreciate the funding provided for the World Trade
Center Health Registry. However, it is essential that Federal
Government support continue and expand for health monitoring
and treatment, including extension of the registry and
additional funding for health and mental health services.
The city supports legislation introduced by Congresswoman
Maloney, and co-sponsored by Congressman Fossella and many
members of the delegation, to reopen the Federal victims
compensation fund established to support families of those who
died in the attack and those physically injured in the
aftermath.
Earlier this week the mayor announced initiatives
augmenting screening and treatment programs including
establishing a WTC environmental health center at Bellevue
Hospital, expansion of the World Trade Center health unit at
the Health Department, and creation of a Mayoral Review Panel
to ensure maximum coordination among city agencies and
sufficiency of resources.
Bellevue, in collaboration with NYU Medical Center, will
evaluate and treat anyone exposed to the WTC, including people
not covered by existing programs. The initiatives also include
an expanded unit at the Health Department to increase
monitoring for WTC related health conditions, increased
communication with affected individuals, treating physicians
and the public, and expand risk reduction linkage to care and
mental health services.
In the past year, the Health Department has led an
initiative, in collaboration with medical experts from the WTC
Medical Monitoring and Treatment Programs, the Fire Department,
Bellevue, and other specialists to reach consensus on and
disseminate clinical guidelines which update previously
released Health Department guidelines on depression, post-
traumatic stress disorder, and substance abuse disorders as
well as guidelines on the diagnosis and treatment of
respiratory gastrointestinal and sinus diseases previously
developed by Mt. Sinai and fire department physicians.
The World Trade Center health registry is the main platform
to enable us to better understand possible WTC related
illnesses and also a major means of assessing treatment needs,
more than 71,000 people enrolled in the registry, making it the
largest such effort ever in the United States. Since its
establishment, the registry has maintained a frequently updated
resource guide to help both enrollees and the public.
Baseline interviews were completed in November 2004, and we
immediately released preliminary findings. Nearly half of adult
enrollees reported new or worsened sinus or nasal problems,
shortness of breath, wheezing. Persistent cough and throat
irritation were also common, and 2 to 3 years after the event
registrants reported high levels of psychological distress.
We also published an in-depth analysis of physical and
mental health conditions among more than 8,000 registrants from
collapsed or damaged buildings. Those caught in the dust cloud
were twice as likely to report newly diagnosed asthma. This
adds to the growing body of literature suggesting that exposure
to the dust cloud on September 11th in particular was a major
risk factor for respiratory disease.
The first biennial followup survey begins this month, and
will provide critical information on prevalence and persistence
of symptoms, and at least or more importantly will identify and
help address gaps in medical treatment. Collecting information
on 71,000 participants will take at least 9 months. We will
release initial findings as soon as possible upon completion of
the survey, just as we did with our baseline survey, and we
will conduct additional investigations including an examination
investigation for respiratory illness.
Response to WTC involves many levels of government as well
as private institutions. It will also require a long-term
commitment of Federal and State resources. Much more needs to
be done, and if we work together we can make sure that all of
those who experience illness from the attacks on September 11th
have access to appropriate medical evaluation and treatment.
Thank you for your support in these efforts.
[The prepared statement of Dr. Frieden follows:]
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Mr. Shays. Thank you very much. Commissioner Scoppetta.
STATEMENT OF NICHOLAS SCOPPETTA
Mr. Scoppetta. Good afternoon, and thank you for the
opportunity to testify today about the health of our September
11th first responders.
With me today are the Department's two chief medical
officers, Dr. Carrie Kelly, who is head of our Bureau of Health
Services, and Dr. David Prezant, the Chief of our Office of
Medical Affairs. Both have been sworn and are available to
answer questions.
As we approach the fifth anniversary of the World Trade
Center attacks, we continue to remember the tremendous losses
of that day. In a matter of moments, with the collapse of the
two towers, 343 of our members perished, along with 60 first
responders from the NYPD and the Port Authority, and more than
2,300 civilians as well.
New York City's first responders saved others while risking
their own lives, and we continue to commemorate their bravery
and their dedication while mourning their loss.
In the weeks and months following September 11th, our
members worked tirelessly at the site amid the debris and dust
resulting from the towers' collapse. Their rescue and recovery
efforts continued through May 2002. During that time FDNY
workers experienced more exposure at the World Trade Center
site than any other group of workers.
The physical and emotional toll on our members has been
thoroughly documented. Dr. Kelly and her Bureau of Health
Services have been dedicated to ensuring that our members are
regularly evaluated with special attention to members who
continue to experience the adverse effects of September 11th.
In the days following September 11th, virtually all of the
FDNY first responders worked at the World Trade Center site.
More than 11,000 firefighters and fire officers, and more than
3,000 EMTs and paramedics, took part in the rescue, recovery,
and fire suppression efforts. Our work force was exposed to the
physical hazards at the site, and the emotional impact
associated with the recovery of deceased colleagues.
For those working at the site, respiratory issues surfaced
quickly. In recognition of these symptoms, FDNY initiated the
World Trade Center medical screening and treatment program in
October 2001, just 4 weeks after the attacks. Our VHS partnered
with the Centers for Disease Control and Prevention, and the
National Institute of Occupational Health and Safety, to
implement medical screening for the exposed FDNY first
responders.
From October 2001 through February 2002, VHS evaluated more
than 10,000 of our FDNY first responders. Since that time we
have continued to screen both our active and retired members
for a total of almost 14,000 FDNY personnel to date. This WTC
medical monitoring program has been federally funded and has
been a joint labor management initiative.
The program is dedicated to monitoring the health of our
members while the Mt. Sinai consortium addresses primarily the
health issues of non-FDNY responders. Our monitoring programs
work collaboratively, partnering with NIOSH. At this time, more
than 8,000 of our FDNY members have participated in a second
round of medical and mental health monitoring.
In the first few weeks following September 11th, the health
consequences of World Trade Center exposure became apparent as
more and more members sought medical treatment primarily for
respiratory symptoms. More than 2,000 of our members have
sought treatment since September 11th. Most have been able to
return to work, but more than 600 have developed permanent
disabling respiratory illnesses that have led to earlier-than-
anticipated retirement among members of an otherwise generally
healthy work force.
In the first 4 years post-September 11th, we experienced a
four- to fivefold increase in the number of members retiring
with lung problems on an annual basis. Since VHS performs both
pre-employment and annual medical examinations of all of our
members, the World Trade Center medical monitoring program has
used the results of these exams to compare pre- and post-
September 11th medical data. This objective information enables
us to observe patterns and changes among members.
A significantly higher number of firefighters were found to
be suffering from pulmonary disorders during the year after
September 11th than those who suffered from those disorders
during the 5-year period prior to September 11th. Further, the
drop in lung function is directly correlated to the initial
arrival time at the World Trade Center site.
On average, for symptomatic and asymptomatic FDNY
responders, we found a 375 milliliter decline in pulmonary
function for all of the 13,700 FDNY World Trade Center first
responders, but an additional 75 milliliter decline if the
member was present when the towers collapsed. This pulmonary
function decline was 12 times greater than the average annual
decline noted 5 years pre-September 11th.
Over the past 4 years, pulmonary functions of many of our
members have either leveled off, improved, or, unfortunately
for some, declined. More than 25 percent of those we tested
with the highest exposure to World Trade Center irritants
showed persistent airway hyperactivity consistent with asthma
or reactive airway dysfunction, or RADS.
In addition, more than 25 percent of our full duty members
participating in their followup medical monitoring evaluation
continue to report respiratory symptoms. As I noted, many of
our members who were symptomatic have improved with the
treatment provided by Drs. Kelly and Prezant, and the
physicians who work with them and have gone back to work full-
time.
Certain reports in the press, however, do not accurately
portray what our doctors have found through their efforts and
may create needless fears. For example, continued reports of
possible heavy metal poisoning from World Trade Center
exposures is not supported by the science. Everyone should know
that Drs. Kelly and Prezant and many others at the fire
department who worked continually after September 11th to
analyze and protect the health of our members, they did not
stop at performing comprehensive respiratory testing, but also
performed heavy metal screenings for over 13,000 members, and
the results consistently found nothing clinically significant.
The fire department's preliminary analysis has shown no
clear increase in cancer since September 11th. Pre- and post-
September 11th, the fire department continues, however, to see
occasional unusual cancers that require continued careful
monitoring, and, of course, we are obviously aware of the fact
that cancers may take a long time before they surface.
Monitoring for future illnesses that may develop and
treatment for existing conditions is imperative, and, as I will
discuss in a minute, should be funded through Federal
assistance. As our doctors and mental health professionals can
attest, the need for mental health treatment was also apparent
in the initial days after September 11th, that virtually our
entire work force faced the loss of colleagues, friends, and
family.
In the close-knit family of the FDNY, more than 60
firehouses lost members. Nevertheless, those who survived
continue to work in the rescue and prolonged recovery operation
at the World Trade Center site. In recognition of the mental
health needs of our members, the FDNY Counseling Services Unit,
or CSU, expanded from one site to six, and added professional
staff to provide more services.
Thanks to funding from FEMA and Project Liberty, as well as
the American Red Cross, the International Association of
Firefighters, and the National Fallen Firefighters Foundation,
we secured critical resources to provide those additional
services to our members and our families.
Our goal was to reduce and eliminate any barrier to
treatment, so that members could easily be evaluated and
treated in the communities where they live. Additionally, we
sent specially trained peer counselors to the most affected
firehouses, accompanied by professional counselors, to provide
onsite education. We also developed enhanced educational
programs for our members to address coping strategies and help
identify early symptoms of stress, depression, and substance
abuse.
Nearly 14,000 people have sought mental health services
through CSU since September 11th. We developed also programs
for bereaved spouses, parents, and siblings. Now, 5 years
later, some of these groups still need--provide a needed link
for these families. Prior to September 11th, CSU treated
approximately 50 new cases a month. Since September 11th, we
have seen that number increase to 160 new cases at its six
sites each month. That is more than 3,500 clients annually. the
continued stream of clients at the CSU indicates that the need
for mental health services remains strong.
Mr. Shays. Excuse me. Mr. Scoppetta, you have gone 10
minutes now, so you need to really wrap it up.
Mr. Scoppetta. OK.
Mr. Shays. Your full testimony is part of the record.
Mr. Scoppetta. I understand.
Mr. Shays. You are providing us essential information, and
we do thank you for it.
Mr. Scoppetta. Well, let me just say in summary fashion, we
are going to need continued funding for many years to come,
because many of these conditions are not going to surface for
many years, and we really are talking about something that
needs funding for several decades, not for several years.
So going forward, we continue to monitor. We have a huge
registry of people that we monitor. We have objective data,
because we examined pre-September 11th.
And just to conclude, our firefighters continue to answer
the call for help every day, despite the risks they face. And
careful screening, monitoring, and treatment is what will be
essential. Early treatment of symptoms can reduce the
likelihood of disability and restore function in many members.
Thank you. My apologies for running over.
[The prepared statement of Mr. Scoppetta follows:]
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Mr. Shays. You do not need to apologize at all. Your
testimony is very vital, and I will have specific questions to
ask you when my turn comes.
It is Dr. Reibman, is that correct?
Dr. Reibman. Yes.
Mr. Shays. Dr. Reibman, thank you very much for being here.
STATEMENT OF JOAN REIBMAN
Dr. Reibman. Good afternoon, Congressman Shays,
Congresswoman Maloney, Mr. Weiner, and Mr. Nadler. My name is
Joan Reibman, and I am an Associate Professor of Medicine and
Environmental Medicine at New York University School of
Medicine, and an attending physician at Bellevue Hospital, a
public hospital on 27th Street in New York City.
I am a specialist in pulmonary medicine, and for the past
15 years I was the Director of the Bellevue Hospital Asthma
Program. Most of my patients come from Lower Manhattan. As
such, I know Lower Manhattan well, and know that although it is
thought of as an area replete with office towers, it is also a
major residential community. Almost 60,000 residents of diverse
race, ethnic, and economic backgrounds live south of Canal
Street alone.
The destruction of the World Trade Center towers resulted
in the dissemination of dust throughout Lower Manhattan, and
these dusts settled on streets, playgrounds, cars, and
buildings, and entered apartments through windows, building
cracks, and ventilation systems. The fires continued to burn
through December.
Thus, individuals living in the communities of Lower
Manhattan have potential for prolonged exposure to the initial
dusts, to resuspended dusts, and to the fumes from the fires.
As pulmonologists in a public hospital, we naturally asked
whether the collapse of the buildings posed a health hazard for
these residents.
We, therefore, collaborated with the New York State
Department of Health in a study funded by the Centers for
Disease Control to examine whether there was an increase in the
rate of new respiratory symptoms in community residents near
Ground Zero. The study was designed, implemented, and completed
in 16 months after September 11th, and the results have been
reported in two publications.
Community members were actively involved in the design and
implementation of this work, and we surveyed residents in
buildings within 1 mile of Ground Zero, and for purposes of
control other low-risk buildings approximately 5 miles from
Ground Zero. We mailed and hand distributed questionnaires to
apartments in selected buildings and publicized the study at
local events, health fairs, tenants meetings, community board
meetings, and town hall meetings.
Surveys were analyzed for 2,800 residents in the areas.
Approximately 60 percent of individuals in the exposed area,
compared to 20 percent in the control area, reported new onset
respiratory symptoms such as cough, wheezing, or shortness of
breath at any time following September 11th. The more important
question, however, was whether these symptoms resolved over
time or persisted.
We, therefore, examined whether symptoms were present in
the months preceding completion of the study, 8 to 16 months
after September 11th, and defined persistence of the frequency
of symptoms at least twice each week. Such new onset and
persistent symptoms as eye irritation, nasal irritation, sinus
congestion, nosebleed, or headaches, were present in 43 percent
of the exposed residents, more than three times the number of
exposed compared to control residents.
New onset persistent lower respiratory symptoms of any kind
were present in 26 versus 7 percent of exposed and control
residents, respectively, a more than threefold increase in
symptoms. This included an increase in cough, shortness of
breath, and 10 percent versus 1.6 percent of residents had
wheeze.
In individuals with new onset persistent respiratory
symptoms, many of them had daily symptoms consistent with
severe disease. The respiratory symptoms resulted in an almost
twofold increase in unplanned medical visits in the exposed
population compared to the control population. Moreover, more
than twice as many exposed residents used medications
prescribed for asthma.
This study was one of the few studies, and particularly one
of the few with a control population, to describe the incidence
of respiratory symptoms among residents of Lower Manhattan
after September 11th. It suggested that many residents had
symptoms in the immediate aftermath, and many have persistence
of symptoms in the year after the event.
Do these symptoms persist today, 5 years after the attack,
and some 3\1/2\ years after our study? When it comes to the
residents, we have little information. The registry, which was
implemented after our study was completed and closed in 2004,
found a similar pattern of symptoms to ours, but did not
address the issue of persistence. We look forward to the
resurvey planned by the registry which should help shed light
on this question.
While we await more survey information, we are cognizant of
what we are seeing in our clinics. After September 11th, we
began to treat residents who felt they had World Trade Center
issues in our Bellevue Hospital asthma clinic. We were then
approached by the Beyond Ground Zero Network, a coalition of
community organizations, and together began an unfunded program
to treat residents.
We were awarded an American Red Cross liberty disaster
relief grant to set up a medical treatment program for World
Trade Center health issues for residents and responders, which
began functioning approximately a year ago. Today we have
evaluated and are treating 570 individuals, including residents
and responders.
Most of our patients have persistent upper or lower
respiratory symptoms for which they are seeking care 5 years
after September 11th. Interestingly, many of these symptoms did
not occur immediately, but either developed or were recognized
1 year or more after the event. We have a backlog of hundreds
of patients waiting to get into the program suggesting that the
need has not abated.
This week Mayor Bloomberg announced new initiatives to
provide for evaluation and treatment of individuals with
suspected World Trade Center related illnesses. This much
needed support will serve to provide evaluation and treatment
for residents, office workers, and individuals caught in the
dust cloud.
I would like to thank Mayor Bloomberg and Members of
Congress for their continuing efforts to provide funding for
monitoring and treatment, and members present for having this
important hearing. It is paramount that the Federal Government
fully fund ongoing monitoring and treatment for all those who
were exposed to the effects of the September 11th attack in New
York City. And, furthermore, we will need funding for research
to understand the new diseases and to guide our treatment.
Thank you very much.
[The prepared statement of Dr. Reibman follows:]
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Mr. Shays. Thank you very much, Dr. Reibman. We will start
out with Mrs. Maloney, and then I will go to Mr. Nadler, Mr.
Weiner, and then I will be asking questions. We are going to do
a 10-minute series of questions, so we can do it in a little
more depth.
I basically view the first panel as kind of stating the
case and the problem, and we need to get into some very
important issues as to how we help folks. And I know that my
focus is going to be not at this hearing, maybe there are other
hearings and investigations, who did what when. I want to know,
what are we going to do to monitor folks, what are we going to
do to provide them health care, what are we going to do not
just in the short run but the long run, and I hope with the
answer to all of our questions that you are going to tell us
what you think that commitment is in both the short and long
run.
So at this time, I would acknowledge that Mrs. Maloney has
10 minutes to ask questions.
Mrs. Maloney. I thank the chairman for yielding. I thank
all of the panelists for their testimony and hard work. I
particularly would like to thank Dr. Howard for working so hard
on a Federal response, attending so many meetings, and
particularly the meeting that we had yesterday with Secretary
Leavitt. And I wanted to go over some of the issues that we
discussed yesterday.
Yesterday, Dr. Howard, you and Secretary Leavitt committed
to releasing the $75 million that the delegation and Congress
secured in the budget, and in December releasing this money for
monitoring and the first money for treatment in October. Is
that correct?
Dr. Howard. That is correct.
Mrs. Maloney. Thank you. You also committed to making this
entire funding with no limitation to spreading it over periods
of time. Is that correct?
Dr. Howard. That is correct.
Mrs. Maloney. Just to be clear, we are going on what you
said yesterday with Secretary Leavitt, and what you are
testifying to today, instead of what was reported to the
General Accounting Office, that the funding would not be
released until February 2007, and that it would be spread over
3 years. Correct? You are not going with that GAO----
Dr. Howard. Correct.
Mrs. Maloney. Thank you. Thank you very much. I would like
to now go to Dr. Frieden, and I want to ask some questions
about the clinical guidelines that thankfully came out last
week. When did the city of New York know that the air around
Ground Zero was not safe and that the Ground Zero dust was
toxic?
Dr. Frieden. I can only refer to my personal experience of
the information on this. Actually, a few days after being sworn
in as Health Commissioner, Senator Clinton's hearing occurred,
at which I testified, and said at that time that we knew--and
this was in February 2002--we knew that there were many people
with short-term health effects. We knew that from other
disasters the likelihood of long-term mental health effects was
certainly present, and we did not know what the long-term
respiratory or other physical health impacts would be.
Mrs. Maloney. And this was your knowledge after being sworn
in in 2002. Is there any way you can find out what happened
earlier with your predecessor, and when did the city of New
York and the Health Department suspect that people were getting
sick from their exposure to the toxins at Ground Zero?
Dr. Frieden. I can certainly look at the literature and get
you any information in the future.
Mrs. Maloney. Could you find out whether or not the city of
New York's Health Department was part of a discussion on
October 2001 to determine if area doctors were seeing a pattern
of illnesses possibly related to September 11th? I know that
NIOSH was there, the World Trade Center consortium was there,
the fire department was there, and I am told that the city of
New York was there. Do you have any knowledge of this meeting
in 2001 discussing the pattern of illnesses?
Dr. Frieden. I am not familiar with the answer, but I can
certainly get it and get back to you.
Mrs. Maloney. Thank you.
Dr. Frieden. We do know that immediately after September
11th, with support of CDC, we implemented a system throughout
area hospitals to monitor for different patterns of complaints.
At that point, as you will recall, there were still concerns
about the potential of a related bioterrorist attack, and that
was the primary purpose of that system of monitoring.
Mrs. Maloney. Was the city Health Department part of a
December 2001 meeting--I am told that they were--where a draft
of World Trade Center clinical guidelines were discussed? And
why did the city's Health Department choose not to disseminate
these guidelines discussed at the December 2001 meeting?
Dr. Frieden. I have seen reference to that, and the
recollection of people from within the Department who were
present at that meeting was that the majority of people at that
meeting felt that it would be quickest and most efficient to
have them post it on the Mt. Sinai Web site. That was done, and
the Health Department has referred clinicians to that Web site.
Mrs. Maloney. Most doctors listen to an official directive
from the New York City government or the Federal Government as
an official directive. I wish you would look back to see why
Mt. Sinai's Web site has more weight and credibility than the
city of New York. I find that astonishing, quite frankly.
And did you mail to doctors the clinical guidelines you did
prepare for September 11th mental health issues?
Dr. Frieden. Yes. As soon as we could produce guidelines
for three different conditions that we suspected or had
evidence were related, specifically post-traumatic stress
disorder, depression, and substance abuse disorders, we
disseminated those guidelines widely to all licensed physicians
as well as other providers in New York City as we are doing now
with an update of those guidelines.
Mrs. Maloney. When did you disseminate it? I was told you
did not disseminate it until last week.
Dr. Frieden. No, that is not correct. In terms of the
mental health effects, as soon as we had evidence, we produced
a publication called ``City Health Information,'' which is
mailed to all licensed physicians as well as other providers in
New York City.
Mrs. Maloney. What year did that go out?
Dr. Frieden. There were three different bulletins produced,
one on post-traumatic stress disorder, one on depression, and
one on substance abuse disorders, and I would have to look up
and give you the exact month and year when those were
published.
Mrs. Maloney. Thank you very much. Dr. Howard, you
testified before this committee and in our meetings in February
that this is a long-term problem, 20 to 30-year problem, is
that correct?
Dr. Howard. Yes.
Mrs. Maloney. In the 6-plus months that you have been on
the job, has there been any actuarial study of just how much
this will cost?
Dr. Howard. No.
Mrs. Maloney. Has the Health and Human Services Department
employed medical economists?
Dr. Howard. No.
Mrs. Maloney. In the letter that you sent Congressman
Fossella and myself yesterday, which I might note is on my Web
site if anyone would like to read along and see his response to
our questions, you have--you talk about 5 years after September
11th, and you say that there is no estimate of the cost or the
extent because of the uncertainties involved. Is that correct?
Dr. Howard. Yes. If I could just expand briefly, I think
what we are looking for now is the experience that we are going
to get when our treatment money is released, which is the
October date that I promised. We have some treatment experience
from the World Trade Center clinical consortium, and from the
fire department based on the limited Red Cross experience.
We would like to see some additional experience, so that we
can do some sound actuarial analysis, to be able to answer some
of the questions that you asked in terms of, what are the 2-
year costs? What are the 5-year costs? What are the 20-year
costs?
Mrs. Maloney. Thank you. Yesterday at our meeting with
Secretary Leavitt, you and the Secretary made a commitment to
work toward a coordinated plan to get health monitoring and
treatment for everyone exposed, residents and rescue workers,
is that correct?
Dr. Howard. Yes, that is correct.
Mrs. Maloney. And I just would like to say I would like to
see more Federal leadership. The city is doing many good
things, the State is doing many good things, the private sector
is doing many good things, but we really have to pull all this
together under one umbrella, and we are counting on your
leadership.
Dr. Howard. Thank you very much. I just want to add in
response to that, the Secretary, as you know, yesterday in the
meeting with the New York delegation pointed out that he is
convening a top-level HHS task force headed by our Assistant
Secretary for Health, Dr. John Agwunobi, and the directors of
the operating divisions of HHS.
He is doing that, recognizing that this issue that we are
struggling with today needs the entire department's policy
guidance. As you know, I have represented myself as a physician
here, as the eyes and ears of HHS on the ground. It has been my
privilege to do that. My agency funds a lot of the medical
activities that are going on here in New York City, and I am
pleased to see that the Secretary is now putting policy
guidance as an important link in that process.
Mrs. Maloney. OK. Thank you so very much. That is
important, and we look forward to your continued participation
in this so-called A team. But as we heard from our first panel,
people are sick, people are dying, and they don't need a task
force, they need treatment money, and they need to get help.
They also are examples of how widespread through many different
areas, from the military to the residents, to the responders,
to the Federal Government employees, that the $52 million that
we got for treatment is just a drop in the bucket, so we need
your leadership on making the estimates of what the cost will
be, so that we can work on getting a line in this upcoming
Federal budget.
But I don't see how you are going to be able to do it if
you haven't hired any medical economists or made any estimates
on how--the extent of the problem.
Dr. Howard. Well, one of the issues that I will tell you
about is within the Department one of the individuals on the
Secretary's task force will be the Administrator of the Centers
for Medicaid and Medicare. I can assure you that those centers
have numerous actuaries and economists who work there, so we
are going to rely on their important contribution, and that for
me extremely important.
As you may know, in NIOSH we are a research agency for
occupational safety and health, so we do not have that
expertise. So I am delighted that we will be able to rely on
the expertise of the Department's actuaries and economists.
Mrs. Maloney. I just want to point out, and the chairman
has told me my time is up, but I just want to point out that in
the letter that you sent Congressman Fossella and myself
yesterday that you noted that you think that there were 50,000
rescue workers who are eligible for treatment, while I think
the city of New York has been using the number of 40,000
responders. Am I right in assuming that we do not really have
any firm grass on the exact number of people on the pile and
those that responded?
Dr. Howard. Well, I think that you are entirely correct. I
don't know of anyone at any level of government that is able to
tell me the exact number. As our GAO witness pointed out, we
don't--we never had a master list. One of the great lessons
learned in terms of large public health disaster preparedness
is we need to know who responds, how to reach them, what their
number is, so that we can contact them after the disaster is
over for medical monitoring purposes. That is one of the most
significant lessons from this experience that I have been able
to acquire in New York City here.
Mrs. Maloney. Thank you all for your work.
Mr. Shays. Thank you. Dr. Howard, it is an amazing comment
you are making, but it strikes us as so obvious times 10 that
it is such an obvious point. Anyway, that needed to be made.
Doctor--excuse me, not Doctor. Mr. Nadler, Congressman
Nadler.
Mr. Nadler. Thank you. I chose to be a politician, not a
physician, but thank you very much, Mr. Chairman.
Mr. Shays. And it is probably a good thing for all of us.
[Laughter.]
Mr. Nadler.
At both ends.
Mr. Shays. In both respects. [Laughter.]
Mr. Nadler. Thank you, Mr. Chairman. Let me start by
saying--by making two comments. First, to Dr. Howard, I simply
want to note and congratulate him for being one of the very few
people in the executive branch of government that I have found
in the 5-years that I have been working on this problem who
have honest and forthcoming and as helpful as possible. It is a
very small list at this point.
Second, I want to disagree with what my colleague
Congresswoman Maloney and Dr. Howard were saying a moment ago.
It is interesting to get a cost analysis, but I don't think it
is all that important. What is important is to have a
commitment to spend whatever is necessary and rapidly and to
appropriate the money as necessary.
We never had a decent cost estimate for Iraq, and whatever
you think of the Iraq war, the fact that we didn't have a
decent cost estimate was not a central issue. We are spending
whatever the administration thinks we ought to spend. We can
second-guess whether we agree with them, but the fact is that
if we agree that there is a major problem here, we ought to
start--we are going to have a program to treat everybody, and
whenever the bills come in pay them. Let me just make that off
the top of my head.
Second, I have a series of questions for Dr. Howard first.
Doctor, do you believe there is any doubt that people are sick
as a result of exposure to World Trade Center contamination?
Dr. Howard. You know, certainly from the medical studies
that our department has funded, both for the responder
population as well as those studies that have been funded that
Dr. Reibman talks about in the resident population, I don't
think there is any doubt about the level of symptomatology. We
still have some question about whether it is persistent in the
resident population, and we are looking very much forward to
the Health Department's World Trade Center health registry's
first followup survey to look at that persistent issue, which
is still an open issue.
Mr. Nadler. But in other words----
Dr. Howard. And in the responder treatment program, the
responder monitoring program, the research that has come out of
that program is fairly clear to me.
Mr. Nadler. So the answer is there is no doubt.
Dr. Howard. There is no doubt.
Mr. Nadler. OK. Thank you. Second, does the administration
accept any responsibility because of the fact that people are
now sick from World Trade Center contamination given that the
EPA told people it was safe when it had no basis for saying
that, and even when it had data to the contrary, and that many
first responders were not provided respirators and OSHA rules
were not enforced on the site? Because of all those facts, does
the administration accept any responsibility for the level of
sickness at this point?
Dr. Howard. I am not the one to respond to that question,
Mr. Nadler.
Mr. Nadler. OK. I accept that answer. Thank you. And as you
may know, as you obviously do know, there is no currently--
there is--currently, there is no federally funded program
except for that $75 million as a first instance to provide
medical treatment for anybody. There is no program to provide
medical treatment to residents, to people who work in the
surrounding office spaces, or children who go to school in the
impacted area.
Many of these people went back to their homes and offices
because they were told by Federal EPA it was safe, and they
were told--and, frankly, the city Department of Health told
them to clean up World Trade Center contamination with a wet
mop or a wet rag.
Does the administration support providing all necessary
funds for actual medical treatment, not just screening, for
residents who were affected as well as for first responders?
And not just residents, residents, workers, anyone who was in
the area then, or may have been made sick by being in the area
subsequently.
Dr. Howard. Again, I think that is one of the issues as a
physician looking at the medical reports that we funded here in
New York, and the findings of Dr. Reibman and others, the World
Health Center registry's findings, those are the kind of things
that I will bring back to the Secretary's policy guidance task
force to be able to wrestle with that issue.
Mr. Nadler. OK. Thank you. And one final question: will all
of the treatment programs at the participating clinical centers
provide uniform services in terms of covered conditions, levels
of services, in-patient versus outpatient, and provision of
benefits counseling?
Dr. Howard. That is certainly our goal. I must say that it
is challenging to bring all of these different provider
agencies together on that point, but that is our goal.
Mr. Nadler. Thank you. Dr. Frieden, I have a number of
questions for you. Does the city, in light of all of the recent
study results, does the city administration now believe that
people are indeed sick as a direct result of exposure to World
Trade Center contamination?
Dr. Frieden. There is a lot that we know, and there are
some things we don't know. Some of the things we know is that
most people exposed to the dust cloud, and many others exposed
less intensely, had acute symptoms. We know that some people,
either because of the intensity of their exposure or other
factors, developed very severe respiratory illness. There are
at least three such cases that are well documented in the
medical literature.
We know that people who were more exposed appeared to be
more ill, and in particular presence in the dust cloud is
predictive of longer term health problems. We know that many
people with pre-existing illnesses, such as asthma, would have
had those conditions exacerbated, and that some people who did
not have pre-existing conditions would have had new onset
illness.
As Commissioner Scoppetta mentioned, hundreds of
firefighters have developed severe enough respiratory illness
to become disabled as firefighters. We also know that many, and
probably most, people who had acute symptoms had improvement of
those symptoms, but many continue to have symptoms. So, yes,
we----
Mr. Nadler. Can I take that as a yes?
Dr. Frieden. Yes.
Mr. Nadler. The city agrees that this has led to many
people being ill.
Dr. Frieden. Yes.
Mr. Nadler. Despite the mayor's comments.
Dr. Frieden. I believe that some of the mayor's comments in
the media were taken out of context.
Mr. Nadler. OK. That is good--yes. I am sorry, go ahead.
Dr. Frieden. There is no doubt from our point of view, the
city's point of view, that there are people who are ill as a
result of exposures to the WTC disaster.
Mr. Nadler. And that includes people who live, work, or go
to school in the area, or those who may be exposed to
contamination inside buildings, not just first responders.
Dr. Frieden. As I was saying in my response, I believe
there is a gradient of exposure, and some of the things we
don't know are the proportion ill in different groups and what
the future course will be of illness. But the strongest
evidence is the evidence that comes from the examinations on
the first responders.
That is not to say that there isn't illness among others.
It is just that the published evidence so far is strongest for
the first responders.
Mr. Nadler. Do you believe there is some illness among
others?
Dr. Frieden. I have no doubt that there is mental illness
among others.
Mr. Nadler. Physical?
Dr. Frieden. I believe, depending on the level of exposure,
that there may well be illness among others.
Mr. Nadler. May well be. OK. Thank you.
Commissioner, immediately following September 11th, your
department, Department of Health, advised residents, put it on
its Web site--and I know that it stayed there for at least a
number of years, it may still be there for all I know, I
checked on it about 2 or 3 years later, it was still there--
advised residents returning to the area to clean up asbestos-
laden World--well, to clean up dust--if they saw World Trade
Center dust in their apartments, said that they should clean it
up with a wet mop or a wet rag.
The guidelines just issued say that the dust cloud
contained asbestos and other substances that may be
carcinogenic. Secretary Henshaw, the head of OSHA, and the
Deputy Secretary of Labor of the United States, in a memo on
January--in January 2002 advised that all World Trade Center
dust must be presumed to contain asbestos and triggers all the
legal consequences of such a presumption.
On January 1, 2002, the first day of the Bloomberg
administration, I advised you of this advice on the Department
of Health Web site and told you my opinion that it ought to be
taken down immediately, because it was reckless--it would lead
to reckless danger to life and I thought was illegal because it
is illegal to advise people to remove asbestos-laden material
without being properly licensed and under proper protection.
You disagreed with me. You said it was fine, it would stay
there. Do you still maintain that? Do you still think that was
fine?
Dr. Frieden. The issue is: what are people going to do with
dust in their home or workplace? If they sweep it, or if they
use a routine vacuum cleaner, that is dangerous. That----
Mr. Nadler. Wait a minute. But shouldn't the advice have
been, if you see World Trade Center in your apartment, call a
government agency and we will do something about it, not you do
something about it? In fact, isn't that what was legally
required?
Dr. Frieden. The program established by the EPA--I don't
recall the exact month, it was May or June or July----
Mr. Nadler. That was July 2002, but that was later. That is
right, and that was different.
Dr. Frieden. So what were people to do? The choice was
between not giving guidance that would allow a reduction in
risk, and giving guidance in wet mopping and HEPA vacuuming,
both of which were recommended, are accepted ways of reducing
risk. There are ways----
Mr. Nadler. So you are saying that if there is asbestos-
laden material it is OK to advise people to undergo the danger
of inhaling that material as they move it by cleaning it up
with a wet mop and a wet rag?
Dr. Frieden. No, I am not saying that.
Mr. Nadler. That is OK?
Dr. Frieden. No, I am not saying that. I am saying that a
way to reduce contamination is wet mopping or HEPA vacuuming.
And we also----
Mr. Nadler. Did it say----
Dr. Frieden [continuing]. We also advised New Yorkers to
notify their building owner and/or fire professionals to clean
if the dust was greater than a minimal amount.
Mr. Nadler. But, Dr. Frieden, the law says it is illegal to
move or remove asbestos-laden material unless you are trained
and licensed to do so and wearing proper protective equipment.
And you were advising people who were not trained or licensed
and were not particularly wearing any protective equipment to
remove asbestos-laden material at their risk.
Mr. Shays. Let me just say the gentleman's time is up, so I
would like you to respond, and then we are going to go to Mr.
Weiner. We will have a second round, so we will be able to
cover some territory.
Dr. Frieden. I am a doctor, not a lawyer, but we will----
Mr. Shays. And so let me just say, tread carefully, because
you are--you are not a lawyer.
Dr. Frieden. Yes.
Mr. Shays. And the purpose here is to have us understand.
The purpose is not to try to bag anybody.
Mr. Nadler. That is true. I am really looking at this--this
was done. It is past tense. What I am really looking for is to
say it never should have been necessary, because people should
not be in the position of having to do unsafe things because
government is letting them be victims, because I am looking for
the future on this.
Mr. Shays. And let me just say, all of the witnesses here,
you are--this is a superb panel, and we are going to try to
make sure we, you know, cover the territory with all of you,
and we will have a second round.
But because we do swear our witnesses in, I never want you
to feel rushed, I never want you to feel like you have to say
something without a lot of thought. The purpose is just for us
to understand the truth, and you all--every one of you have
tremendous credibility with us.
At this time, Dr. Weiner--Dr. Weiner, God--[laughter]--what
is happening here? Now, you I might want as a doctor.
[Laughter.]
Mr. Weiner. Thank you very much, Mr. Chairman, and I want
to thank this panel. It is an excellent panel, and I want to
particularly thank Commissioner Scoppetta, Commissioner
Frieden, Dr. Howard, and the talented people who are giving so
much of their time and energy on behalf of the people of this
city and country, and we are grateful for that.
Dr. Howard, let me ask you, has OMB asked you, in
preparation for a supplemental, to put some kind of a number on
the table for what they think might be asked for in an upcoming
appropriation request? Has there been any effort, anyone asked
you to crunch some numbers to come up with some dollars, for
what it would take to solve this problem?
Dr. Howard. No.
Mr. Weiner. Has there been at any time the mandate given
from the Secretary, with whom we met yesterday, to start to do
the process of trying to figure out what a compensation fund
like that contemplated by Congressmember Maloney, or an
expansion of Medicare as contemplated by Congressman Nadler,
has anyone asked you to crunch the numbers on what would be
required for that?
Dr. Howard. No.
Mr. Weiner. And I asked this because, frankly, if you look
at the difference in response--you know, after September 11 we
created the compensation fund, which was largely speaking an
open-ended fund, we did a rather substantial bailout of the
airline industry because it was seen as a Federal
responsibility. The acts of September 11, compensating people,
was seen as a Federal responsibility.
Is it seen by the administration for whom you work that
the--that compensating people for their health care costs,
taking care of them, is, in whole or in large part, a Federal
responsibility by extension of that same thinking?
Dr. Howard. Well, I can only quote Secretary Leavitt, who
you met with yesterday, in terms of his commitment for
compassionate care for all World Trade Center responders, and
his use of the term that, when he referred to the $75 million,
in terms of adding treatment, as a downpayment. I think when
you use the word ``downpayment'' it implies that there will be
future issues.
The third point I wanted to make from the meeting
yesterday, again, he said, ``We all have to work together,''
and I think he was talking about the entire New York
delegation, the Department of Health and Human Services, and
indeed all of the entities that are here today--the Health
Department, the city, etcetera. I think this is a problem that
we all have to work on.
Mr. Weiner. But did he say we all need to work together,
and then you are going to pay the bill? Or we all have to work
together, and then we are going to divide up the bills?
Dr. Howard. Well----
Mr. Weiner. I mean, the concern that I have, to be honest
with you, Dr. Howard, is it seems latent in some of the
comments that you have made, and the Secretary made yesterday,
is this notion that we have to figure out who is going to pay
the bill here, because it could be fairly substantial. And if
we reach that mind-set, we are getting into a morass that could
leave many of the victims of these health problems waiting for
a very long time.
Part of the beauty of the compensation fund, with all its
laws, is it provided a certain sense of finality, and frankly a
certain sense of assumption of responsibility by the Federal
Government. When you say we all have to coordinate, we have to
synchronize, we have to get on the same page, does that mean
that the administration doesn't believe that this is something
that should be paid for in whole by the Federal Government, and
that some of these costs they expect to be borne by the city or
State or individuals?
Dr. Howard. No, I don't think that the thinking has
advanced to that direction. I think that is something that I
would be happy to carry back to the Secretary, your issues and
questions with regard to that.
Mr. Weiner. Well, I think it would be something that would
be--you know, that should be clarified, because I think that
what--the next question I am going to ask about the
fingerpointing that has emerged within the last 24 hours, about
who is responsible for some of the shocking mistakes that were
made in those early hours and in the time after.
And I am fearful that what we are setting up for here is a
high stakes game of he said/she said that is being--becoming a
substitute for the important work that Dr. Herbert and Dr.
Reibman and others are doing to try to find help and care for
these people. And that is my concern, and I kind of see it, in
fairness, on the part of city officials as well, people a
little bit concerned about accepting too much responsibility
for fear of what kind of liability that would bring.
If the President of the United States, when he comes here
to visit this weekend, says not we are proud of you, but we are
sorry and we are going to accept responsibility for paying
these bills as soon as we can figure out exactly how to do it,
then I think it opens the door for Carolyn's bill, it opens the
door for Jerry's bill. Once we have that commitment made, then
I think things become a lot easier.
Commissioner Frieden, you are a health expert, one that has
been recognized. I want to read you something, and tell me just
if from your--the documents that you have read and your
experience as a health professional whether you think this is
true.
``If someone said that we, the Federal Government, did
everything we could to protect the people from that
environment, and we did it in the best way that we could, which
was to communicate with those people who had the responsibility
for enforcing, the city was that primary responder.'' Do you
think that, in what you know, that the Federal Government and
the EPA did everything that they could to protect people?
And I want to point out that some of the advice that they
gave in those early days was to wear dust masks, and they urged
first responders and rescue workers to ``change their
clothing.'' Do you believe today, with the benefit of hindsight
after 5 years, the Federal Government did everything they could
to protect people on the pile and in our city during that
period?
Dr. Frieden. This is not as simple a question as can be
answered with a yes or no.
Mr. Weiner. Take your time.
Dr. Frieden. I think the primary issue we are concerned
about is respiratory protection, and the issues are not simple.
I think that reasonable people can disagree on the best course
that could or should have been taken. We know a few things. We
know that if there had been regular wearing of respiratory
protection, the risks would undoubtedly have been lower.
We also know that the respirator that was agreed upon--
half-mask, half-face respirator--is very cumbersome to use. And
20/20 hindsight is easy, but if you remember back to those
first days people were looking for survivors. And to say to
someone in that kind of an emergency operation ``you can't go
there if you are not wearing this mask'' when the mask might
actually make it very difficult to work or communicate, is
difficult. It is a judgment call.
I will correct the record on the enforcement question in
that quotation that you have just read. It is OSHA and PESH
that have enforcement responsibility and authority. The city
Health Department considered and determined that it did not
have the authority to mandate respirator wearing at the site.
Mr. Weiner. But in retrospect, and just as a matter of as
close to fact as we can get, when it was said by the Secretary
of EPA--and this is on September 18--``Given the scope of the
tragedy from last week, I am glad to reassure the people of New
York and Washington, DC, that their air is safe to breathe, and
that their water is safe to drink.'' With the benefit of 5
years of hindsight, that was not true, was it?
Dr. Frieden. And one of the tenets of risk communication is
the issue of safety is always a very complicated one. And I
don't think that was an appropriate way to word the message at
that time.
Mr. Weiner. Commissioner Scoppetta, can you weigh in on
this? Your men were--based on the numbers that you quoted in
your statement, your men and women of your department, almost
every single one of them, was at some time or another down on
the pile or down near Ground Zero.
Based on the information that you know--that you now have
about the condition of the air, the ailments that have emerged
from your members, was it--was that true, that the air was
clean, it was safe to breathe, and the water was safe to drink?
Because part of the defense that Secretary Whitman has made in
this 5-year after-the-fact revision of history was that she was
referring at the time to the pile, which is where your men were
working, or, rather, that she was not referring to the pile,
she was referring to the area around the pile.
But knowing just what you do as a layperson, is it pretty
clear now after the fact that is not--that wasn't true at the
time?
Mr. Scoppetta. Well, as I said in my testimony, within
weeks of the attacks respiratory illnesses were reported, or
symptoms of illnesses. And within 4 weeks we started a
monitoring program because of it, so it did become apparent
that was the case.
Now, we did require, and OSHA and PESH worked with us,
required that our people working on the pile use masks. But
keep in mind they were working 12-hour shifts. It was a
recovery effort. It is extremely difficult to communicate
wearing those masks. So even those who were wearing them
regularly would have to remove them from time to time to engage
in consultation, because it was extremely important that we
recover any remains. And that is why they were on the pile for
9 months.
And so it--to answer your question directly, it seems----
Mr. Weiner. And I just have----
Mr. Scoppetta [continuing]. Clear that the advice we were
getting, those mixed messages, I referred to them as our people
finding illness and at the same time being told that the air is
OK, must have had an impact on our firefighters who were on the
pile.
Mr. Weiner. I see.
Mr. Scoppetta. Thinking they could remove the mask for
longer than they should have.
Mr. Weiner. Well, my time has now expired. I just have one
final--this is something that emerged in the meeting with the
Secretary yesterday. I just want you to clarify--could you
explain to me what type of health coverage a firefighter who
retires--who retires has after they leave service to the fire
department, if they were, God forbid, in a couple of years to
emerge with an ailment? Are they still covered by the health
insurance provided by the city as if they were employed?
Mr. Scoppetta. No. Retirees have to rely on their own
insurance to cover their illnesses, and that--in my testimony--
maybe I didn't get to it, but it is certainly submitted--there
are certainly gaps, insufficiencies we can call them, in
insurance coverage for medication, for in-house health care
across the board, and that is one of the reasons why we so
desperately need funding for treatment as well as monitoring.
Mr. Weiner. Thank you, Mr. Chairman.
Mr. Shays. I have been looking forward to this opportunity
to have a dialog with all of you. I would like to first ask, if
you were not a question but you would have liked to have
answered the question, I would like you to answer the question.
These were good questions of my colleagues, and so I saw some
of you take notes. If you have an observation that you would
like to make--and we are going to go for a second round here.
We are down to the full committee.
I would like you to--I would like you to respond. Anything
that has been brought up in the first testimony or the first
panel or the second, any question that was raised to one of
your colleagues on your panel that you would like to make an
observation or point about? Yes, Commissioner.
Dr. Frieden. I would like to make two points, if I may. The
first, just to amplify on my response earlier in terms of what
the city said and when. On November 1, 2001, Dr. Jessica Layton
testified before the New York City Council Committee on
Environmental Protection, and among other things noted that,
``Persons at greatest risk of health effects include
unprotected workers on the debris pile or very close to the
site, persons with pre-existing conditions, such as asthma,
chronic obstructive pulmonary disease, heart disease, children
who have developing systems and greater exposure due to their
body size, elderly.'' So I think there was recognition and
publicity about that early on from the city's standpoint.
The second point I want to make I think all of us
experienced, sometimes the media coverage being less than as
accurate as we would like it to be, and there were some remarks
of mine several months ago from a television show relating to
Mr. Zadroga that I would like to clarify----
Mr. Shays. Sure.
Dr. Frieden [continuing]. And amplify. I would like to
apologize for any misunderstanding that my remarks made. What I
did say in that interview was that some individuals heavily
exposed are having serious respiratory problems that without
knowing the details of an individual case I cannot comment on
it. But I did not mean to cast doubt on the specific findings,
only to say that I can't comment on them.
I do believe it is useful for us to have transparent,
agreed-upon standards so that if and when there are fatalities
there can be a standard that any organization or institution
can use to assess what the causality might be relating to WTC.
Thank you.
Mr. Shays. Thank you. Any other comments that you would
like to make?
Dr. Howard. Just following the Commissioner's comment and
Representative Maloney's comments earlier on my efforts to put
that into action, a fatalities investigation program, and I am
happy to see that the Commissioner is supportive of that in his
department.
We are working with the New York Department of Health, and
we are working with experts in my agency, with experts at Mt.
Sinai, and we intend to put that in action, so that we can get
a handle on these reports that all of us read in the print and
electronic media of individuals whose deaths are attributed to
World Trade Center exposure. This is extremely important for me
as a project to put into action immediately.
The other issue I wanted to bring up to let everyone know
is in our department, in the Department of Health and Human
Services, we are putting together a Web site on the World Trade
Center. So if you go to HHS.gov, you will see a World Trade
Center logo. And that World Trade Center site will have a one-
stop shopping point of view for all of the issues that we are
all talking about in World Trade Center.
It will have links to every existing resource, including
the physician guidelines that the New York City Department of
Health and Mental Hygiene has put out for physicians across the
country. This is something that I would like to acknowledge
that the committee has supported. It is extremely important,
and we hope to have that live very soon.
Mr. Shays. Thank you. Dr. Herbert, do you have any comments
that you would like to make about any observations of the first
panel? And, Dr. Levin, I am going to ask the same thing of you,
sir.
And let me just say something. They don't need to directly
relate to the work that you do. You think about this all the
time, so you must have opinions outside your own specific
requirements. So what I want is a candid conversation about
what was seen. I am looking for recommendations on how we
proceed.
And I just want to make sure that, like you do, all of you
do, that we see change take place in terms of our being able to
respond to this issue.
Dr. Herbert. I have a couple of thoughts. The first is
completely my own view, and it is that I--you know, I am very
concerned about on the one hand I know there is concern about
fingerpointing between different levels of government. For me
as a physician taking care of World Trade Center responders, it
has been very troubling to see the difficulties our patients
have had receiving medical care and testing.
And I think that the panelists this morning were--it was
heartbreaking to listen to them, and I wish I could say that
they were unusual, but they really represented what all----
Mr. Shays. We didn't bring them because they were unusual,
so----
Dr. Herbert. Exactly.
Mr. Shays [continuing]. So I don't want you to wish that. I
mean, in the sense that I want people to understand that they
had a very universal message.
Dr. Herbert. Exactly. And I just wish that, first of all,
with respect to responders that we could design a system in
which, a) every responder can get regular medical examinations
to look for both physical and mental health for their lifetime.
In terms of treatment, I think it is in the responder's best
interest if we can get away from a system in which responders
have to prove that they were there, have to prove that their
illnesses is World Trade Center related, and all the legal--I
feel like we spend more----
Mr. Shays. Let me just ask--and continue later, go
further--but I think it would be irresponsible if we just
assume that anyone who steps forward and said ``I was there''--
there has to be some way that someone can document it. But, I
mean, yes, not signed, sealed, and delivered. But I would be--I
mean, we saw that with Katrina. I mean, everybody was making
claims, and we just doled out money.
If we do that, there won't be enough money to go around. So
I want to make sure that the people who are, in fact,
responders get it. So you are going to have--to win me over on
that point, you are going to have to give me a little bit of
what you mean, maybe fill in----
Dr. Herbert. OK. I will be a little more precise. I think I
am probably reacting again as a physician to my patients who
were down there for weeks being told--being--you know, men in
their forties and fifties who have worked their whole lives
being brought to tears and worker's compensation courts being
accused of lying about being down there. So I think I may be
reacting to that.
I think the question--the issue is that I think it is worth
at least examining what the possibility of having something
along the lines of a presumption system, so that at least some
conditions would be considered World Trade Center related. You
know----
Mr. Shays. It is a different issue, though. The issue is if
you were there, we presume that whatever illness comes along is
a result of your being there. And there you and I would be
totally----
Dr. Herbert. Right. And I think, I mean, the issue--right,
the issue--I guess Katrina is--you know, most of our patients,
we have not found that the issue of people not--who come to our
treatment program, we have very stringent criteria, exposure-
based eligibility criteria. So I may look at this in a
different way in terms of the exposure, the establishment of
exposure and presence at the World Trade Center site or having
been exposed.
But I think that perhaps what I am trying to say is that
right now so much of the onus remains on the World Trade Center
responder to prove that he or she were down there, and to then,
you know, just sort of try and navigate these very complex
systems of access to health care.
So I think that if there were a way to develop a system
that--where at least there was--where it didn't start out sort
of so heavily tipped against the World Trade responders, which
is the way it feels now.
Mr. Shays. OK. Well, you know, I would like to pursue that
a little bit, but I am so grateful you are making these points,
because these are the points we need to be discussing. And I am
not trying to convince you your point is wrong. I want you to
stay a doctor, and I want you to think like a doctor. I want to
think like a legislator who wants to be helpful, and then let
us see where there is a point where we can do something
sensible. Do you have another point or two?
Dr. Herbert. I just want to acknowledge that Dr. John
Howard has been extraordinarily helpful to all of our World
Trade Center programs, and I think he has been sometimes not as
recognized as he should be, and I want to acknowledge that.
Mr. Shays. Well, you know, Doctor, we are not allowing
applause, but just imagine that the place would be a standing
ovation. We are. Thank you.
Any other points before I go to Dr. Levin?
Dr. Herbert. No, thank you very much.
Mr. Shays. OK. Dr. Levin.
Dr. Levin. Well, I just want to make a couple of points,
and I think everyone knows that in the immediate hours, and
even few days, after September 11--the September 11 attacks it
was a chaotic environment. Everyone understands that is so, and
when there is conditions of chaos it is hard to impose
organization.
But it is also clear that the September 11th experience
should be teaching us the lesson that we have to be better
prepared in advance. For example, the point about registering
everyone who was there--the boundaries were very porous down at
Ground Zero for the first several days, and gradually there
evolved checkpoints and ways to identify who was coming in and
who was going out.
If we can't in advance of the next either a natural
disaster or manmade disaster find ways to identify who was
there and have teams of people prepared to do that as people
come into such environments, and leave such settings, then we
are going to make the same mistakes that we made this last time
and that we made in Katrina. And Katrina was even harder I
think than dealing with what happened in Lower Manhattan.
We will find ourselves in the position of not knowing who
was exposed, dealing with the very question that you just
raised and that is: how do we know if someone was there? We had
that terrible story told to us this morning of someone who had
several photographs of himself down on the pile and was asked,
``Well, this could have been digitally altered.''
To be--I have many patients who have been challenged in the
worker's compensation process, in the pension process, with
exactly that kind of question. They have a picture book full of
photos of themselves, sometimes with elected officials with
arms around them identifying them as heroes, and yet it wasn't
sufficient for the worker's comp process as an identification
of the fact that they were there.
Mr. Shays. Well, let me just be clear, since I responded so
clearly about this issue, there has to be common sense.
Dr. Levin. Right.
Mr. Shays. And that is really I think as a physician trying
to take care of patients and get care for them, to have common
sense prevail we think would be really important. And let me
just extend that a little bit.
You know, in public health there is this notion of the
precautionary principle, and it says that if there is reason to
believe that there is hazard, but you don't know yet whether it
is so, you behave as if it is so until you know better. That is
a sort of a rephrasing of the general principle.
And I think that approach really wasn't taken following the
September 11 attack. I don't think that at each government
level we behaved in a way that indicated concern that, in fact,
there were hazards there or might be hazards there. Putting
aside Ms. Whitman's open statement to the contrary, there was
in general a failure to recognize the necessity of protecting
people and monitoring them closely.
I am going to make an observation to you, that intuitively
those statements defy logic. But they also defied logic to the
press then, and everybody was given a mask.
Dr. Levin. I am not sure which statement to----
Mr. Shays. I am going to say to you, to have said--for
anyone to say that this was a safe environment, it defies
logic. And everyone knows that. You can't have what we had and
have people believe for a second--and all I am saying to you is
that the press is really on to this issue now. I am not looking
to pick a fight with the press, but I am willing to say to you,
everybody was focused on a lot of other issues.
Dr. Levin. Yes, I understand that. And in a way that large
population of responders fell through a very large crack, and
we are dealing with the consequences of that now. And I can
tell you, just to follow what you just suggested, there was
hardly a physician with experience in occupational or
environmental medicine who saw people being dragged off of the
pile, really choking for breath, for whom the issue of
potential asthma occurrence, sinusitis occurrence, didn't
arise.
It was an environment so clearly one that had hazards for
respiratory illness, never mind psychological----
Mr. Shays. We had a--I have a constituent who runs a
national rental business, and they provided, without rent, a
lot of this equipment. They said the equipment literally shut
down every few moments, because it was getting clogged up as it
was sucking in air to feed the gasoline in the engine.
Dr. Levin. Under those circumstances, which were obvious to
all--not just to physicians but anybody who was there, people
who watch television, to find ourselves as physicians working
so hard to persuade worker's compensation officials, pension
boards, etcetera, of the reality of this illness--of these
illnesses that developed, even to the current day because so
many of our patients still have unresolved claims, are still
fighting to get benefits that really just help pay the
mortgage, that we are not dealing with a common sense approach
never mind a scientific approach, but, rather, we are dealing
with, unfortunately, politics and economics that really don't
have a place in the public health concerns that I think we are
really talking about here.
Mr. Shays. Thank you for your observation. Any other
observations?
Dr. Frieden. Since you have asked, you know, what are the
issues to deal with, Chairman Shays, I just--one of the points
made this morning I think shouldn't be lost, and that is that
in addition to the special and significant problems being faced
by people who were there at September 11th and the months that
followed, what we are seeing is that overlaid on a health care
system that has problems, gaps in care, lack of access, co-
payments that can be very significant, even for people with
insurance.
Some of the chronic conditions may be hundreds of dollars a
month for medications and specialty service needs. So I think
as we think about what to do, I think that is a point worth not
losing.
Mr. Shays. We were--I was basically blown away yesterday to
learn that while you are in the fire department you are getting
Medicare, and if you are, you know, on disability and you are
out because you are ill, you are not getting that health care.
You are paying for it yourself. That just blows me away. Blows
me away.
An observation, Commissioner, or Dr. Reibman?
Mr. Scoppetta. Well, of course, that is one of the points
we make in the testimony about the need for assistance in these
particular circumstances. September 11th was an unprecedented
event. The response was unprecedented, and it turns out perhaps
the illnesses that were contracted after that, at least in this
particular event--instance our retirees ought to get some help.
Mr. Shays. We are going to talk about that. Dr. Reibman.
Dr. Reibman. I would just like to say that I think what we
have been hearing about mostly, and appropriately so, are the
issues of the responders. But the responders, maybe they can
show a picture, can have some evidence that they were exposed.
For many of the residents, it will be much more difficult to
have attribution and disease. And this is a major issue that we
have been dealing with and will be dealing with, attribution
that the disease is due to World Trade Center dust exposure.
Mr. Shays. See, what we did when we had these hearings, we
had 15, give or take, hearings on Gulf war illnesses. Not being
a physician, it was fascinating to go through this process. But
there was unbelievable resistance on the part of the Department
of Defense and VA to acknowledge that people were sick, and we
used to have the generals and the doctors testify first, and
then people who were sick, and hold lots of different ways, and
parents of young kids in a sense who had lost their lives
testifying, and the first panel left so we reversed that.
But it took even the intervention, frankly, of Ross Perot
who started to fund research for what happens when you are
exposed to toxic material when you are under stress. And when
you are under stress, there is a whole different way your body
responds. And there were some breakthrough efforts, but it took
10-plus years.
What I am struck with is this, and then I am going to go to
Mrs. Maloney for her second round--I have taken my second round
right after my first, that is a privilege the chairman has--but
what I am struck with is there is not a chance in hell that you
would have been able to stop a first responder from going
there. And if you said to them, ``You are going to cut your
life by 10 years by going in there,'' they are saying, ``My
buddies are down there. I am going to get them. I am going to
help them.'' You couldn't stop them.
But where I have my big problem is after the first week.
Now, but I also have a big problem for the guys and the women
who the first week were doing that who aren't getting help,
because it is like we should be on our knees in gratitude and
then we should be saying, ``What can we do to help you? And by
the way, what can we help your young child, that 4-year old
child who is growing up now without a dad, what can we do to
help her?''
So that is kind of where I am reacting. When I get my third
round, I am going to want someone to describe the whole
universe to me. I mean, we have firefighters, police, emergency
medical personnel, transit workers, construction crew, and
volunteers in general.
I want to have a sense of what the whole--now that is just
the responders, and then, I am going to make an assumption that
I want corrected or not, that the challenge we have for the
residents is that the ones who are probably most affected, who
had a pocket of a cloud, who--so, in other words, that it won't
be evenly dispersed, it will be someone in some apartment
building nearby, and then someone further away, and they would
have been exposed to something really deadly, but everyone in
between might not have.
In other words, I just think intuitively that as these
clouds disperse, and they weren't there indefinitely, as they
were right above Ground Zero where there was just a heated
furnace for months and months and months. So I will want to
have someone kind of walk me through that.
Mrs. Maloney, thank you for your patience.
Mrs. Maloney. Thank you so much, Mr. Chairman. I would like
to ask Commissioner Frieden, earlier we heard some--a very
moving statement from the father of James Zadroga, where he
testified that a medical expert in New Jersey directly linked
his son's death to his work at Ground Zero, the fact the lung
weighed three times more than a normal lung, was totally black,
and was laden with debris. Does the city of New York recognize
these medical findings? In other words, did James Zadroga die
from his work at Ground Zero? Yes or no.
Dr. Frieden. I cannot comment because I have not seen the
details of his situation. But what it highlights is what both I
and Dr. Howard mentioned earlier, I think it is critically
important that we agree on and have everyone have input so
people can agree upon a set of standards that can be used to
assess fatalities related to see whether the weight of evidence
suggests that they are related.
From the media reports, it certainly sounds consistent with
illness from WTC, but without knowing the details of what
examinations were done and what the prior history is, I can't
responsibly make that determination.
Mrs. Maloney. The New York Daily News has documented the
death of at least seven responders, including James Zadroga.
Many people come to my office saying their loved ones died as a
direct result. So the Daily News has documented seven, and we
have probably a list of about 30 in my office. How many deaths
has the city's Health Department documented? You say you didn't
look at this material. Shouldn't you have looked at it and
given some support to James Zadroga's father?
Dr. Frieden. His death was in New Jersey, so it was not
within our jurisdiction. In terms of deaths within the
jurisdiction here, if the cases are cases that are referred to
the medical examiner or taken by the medical examiner, then
they get a full assessment.
Otherwise, it is a determination of whether the family
agrees to an autopsy, and I really commend families that do
that, because it can be difficult. But that is what allows us
to increase our awareness and knowledge of what is happening,
so we can all try to get closure in individual cases as well as
more generally.
Mrs. Maloney. Well, the city's Health Department has
documented at least 20 deaths as a direct result of this
summer's heatwave. And how can the city a month later know that
certain deaths occurred because of the heatwave, but they are
not able to document any deaths related to the September 11th
toxic fumes that happened 5 years ago?
Dr. Frieden. We will indeed be tracking the deaths and
illnesses and cancers associated with the more than 71,000
people who registered for the WTC health registry. This will
provide us with as close as we can get to a population-based
summary.
I would also point out that the process for death
certification includes specifically whether it was from heat
exposure. So the death certificate comes in with it written on
the death certificate, heat exposure. That does not occur for
situations like the WTC, so it is not as simple as it might
seem.
Mrs. Maloney. Well, you testified there should be
guidelines, there should be transparency. It is 5 years later.
People are dying, and we now know scientifically what we have
known in our hearts that it is related to September 11th. When
will the city have the particular transparent documents that we
can get some numbers and some sense from this?
Dr. Frieden. In terms of the specific fatality
investigation, Dr. Howard and NIOSH are taking the lead on
that. And what we intend is for there to be a document that
everyone can comment on, so people can agree at the outset
these are the standards that need to be applied but by whatever
institution needs to do the investigation.
Mrs. Maloney. Well, that is another thing thrown on your
plate, Dr. Howard. You testified earlier and came back and
clarified one of my questions. Earlier you said that November
1, 2001, in testimony before the New York City Council, the
then Health Director did testify that there were illnesses
related to September 11th toxic fumes.
And where were the clinical guidelines for these illnesses
and conditions? The city has known that people were sick since
November 1, 2001, according to your testimony but waited until
last week to issue and mail out guidelines to the doctors.
Dr. Frieden. Just to clarify, I did not say that the city
said people were sick. What I quoted was testimony that
highlighted populations for which there was the greatest risk
of health effects, including unprotected workers and others
with pre-existing conditions. I would also----
Mrs. Maloney. Thank you for that clarification, but my
question is: why did it take 5 years to mail out guidelines on
physical sickness? The Federal Government got guidelines out on
SARS, the bird flu, and every other flu you can imagine within
a very short period of time. And you testified earlier that you
had mailed out guidelines for mental health.
I would say people dying of respiratory sicknesses, people
should be notified. And I really want to put on the record a
study and ask that this study be put in the record. It was done
by the fire department or done by the World Trade Center
consortium. I am going to get this study. This study showed
that 30 to 40 percent of the people that were being reviewed I
believe in the World Trade Center consortium were misdiagnosed
and mistreated.
They were having lung disease and treated for asthma, and
that this was causing many, many problems. So my question to
you, and I feel very strongly about it, because what you see in
this panel is what members--prior panel is what Members of
Congress see in their offices every week, sick people coming in
saying they were misdiagnosed. Why in the world could the city
of New York, the greatest city on earth, I really believe that,
why in the world could not the city of New York get out the
medical guidelines until 1 week ago?
Dr. Frieden. I would like to point out a few things. First,
the conditions that those guidelines go over are actually very
common conditions seen in medical practice--cough, sinusitis,
the reflux disease. These are not conditions with which doctors
are unfamiliar, or these are--to say that more clearly, doctors
are familiar with these conditions.
We did not know until relatively recently the extent to
which symptoms have been persisting--mental--not mental health,
but physical health symptoms have been persisting. In fact,
really our first sense of that was in November 2004 when we
looked for the first time at our own data from the registry and
saw such a high rate of respiratory conditions.
But as Dr. Reibman appropriately pointed out, we didn't
assess for persistence at that time. Additional information was
provided, case reports were coming out, we began the process in
2005, and we sought to achieve consensus. Maybe it is better to
get something out that not everyone agrees with, but we felt
what is important is to get something out that not only will we
be able to say we got it out, but people will say, ``We agree
with this, we are behind it, and we are going to do it, we are
going to follow these guidelines.''
All of that said, would I wish that they had gotten out
sooner? Absolutely. I would also wish that we would have had
more scientific published evidence sooner that would help us
make those determinations and make those recommendations.
Mrs. Maloney. I would say everybody with any common sense
knew that there was a medical connection. And I ask you then,
how were you able to get out mental health guidelines but you
were not able to get out medical guidelines? Is mental health
guidelines easier to get a consensus on? What was the
difference between the two that you could get out mental health
clinical guidelines, and you were going to get back to me at
what time and year you got them out.
And also, by the way, after September 11th everybody sort
of did what they could, and my office adopted--they adopted
mental health, and we worked with the mental health community
and got grief counselors out to every business organization
that had lost people on September 11th. So we interact with
that community because we worked with them as a special
project, and I thank my office for their help today, and really
for every day working on September 11th. It is a top priority
of my office.
But mental health doctors did not tell me that they got
guidelines, so I would like to know in writing who got these
guidelines? How far were they mailed? Was it to 100 people or
every mental health doctor in New York? Because I know many
that we--the offices said they never got them. So I would like
to know where it was sent, when it was sent out, and why can
you get out mental health guidelines--that is important, I
congratulate you--but you could not get out physical health
guidelines?
Dr. Frieden. Just to reiterate, we knew from the first
moments of the attack, based on other experience, that mental
health effects would be long lasting and severe, and we began
to produce guidelines to address those.
Mrs. Maloney. Did you not know that those that were
breathing that debris that was so----
Dr. Frieden. No, we did not.
Mrs. Maloney [continuing]. Thick you could chew it, that
you would not have physical problems?
Dr. Frieden. No, I can say I did not. We certainly knew
there were short-term health effects. What the long-term health
effects were we--I could not predict. Others may have predicted
them accurately, but I certainly could not have.
Mrs. Maloney. Well, did the city of New York have a role in
developing the clinical guidelines for mental health and for
physical health? Did the lawyer's department have a role in
developing these guidelines?
Dr. Frieden. We have shared early drafts with a wide
variety of individuals including the Law Department, but every
technical, clinical, scientific decision on the guidelines is
made solely by the Health Department in conjunction with our
partners in that document, including Mt. Sinai, the fire
department, and others.
Mrs. Maloney. Beyond reviewing the draft clinical
guidelines, what role has the city's lawyers had when it comes
to your public statements about September 11th health and the
toxins at Ground Zero?
Dr. Frieden. As you know, for all public officials there is
a review process, and so our comments are reviewed by the
General Counsel, the Health Department, as well as by the Law
Department. They make suggestions. We determine whether or not
to take those suggestions.
Mrs. Maloney. Did the lawyers review your testimony before
us today? Have you received any advice from the city's lawyers
in preparation for your appearance today?
Dr. Frieden. Yes.
Mrs. Maloney. OK. I would like to ask Dr. Howard--can I----
Mr. Shays. I want to--it has been 10 minutes here now, and
ask you, Commissioner, about what I want to understand is I
want some--maybe I can have you, Dr. Herbert first, or Dr.
Howard, have me--I am trying to make sure that we get
information to be able to write a report hopefully by this
year. And the information I am asking is relating to not
whether someone should have acted sooner or not, that is not
going to help my committee get this done, and I need to make
sure before we leave we get this done.
I need to understand the varying degrees of coverage that
all of these so-called--I want to take the universe--here is
what I am wrestling with. I want to take the universe, and I
want to know who got the best coverage and who got the worst
coverage.
And it strikes me--and, Commissioner, I am going to start
with you, it strikes me that almost every firefighter was a
potential volunteer at Ground Zero, but that you all should
have been able to determine pretty well how many of the
firefighters were. Can you tell me who they--your universe that
you think, of your total number, how many you think were there?
Commissioner.
Mr. Scoppetta. Me?
Mr. Shays. Yes. I am talking firefighters now.
Mr. Scoppetta. Yes. Virtually every member of the fire
department served some time at Ground Zero.
Mr. Shays. It was almost a badge.
Mr. Scoppetta. Yes, it is more than 11,000 firefighters,
and more than 300,000 EMTs and paramedics worked at the site
during----
Mr. Shays. We can make an assumption almost everybody did.
Mr. Scoppetta. Yes.
Mr. Shays. OK. Now, I make an assumption that you had
monitored all of them, as your testimony--in other words, this
is a group of folks who got monitored early on, and while they
are part of the department are getting health care. The bottom
line is, though, that they are--some may not show any signs of
not being well right--of being sick. But that they may be sick
when they are no longer employed by the department, is that
correct?
Mr. Scoppetta. That is correct.
Mr. Shays. But at least--the good news is this, that with
our firefighters they were monitored, and anyone who had health
problems were getting attention, their health needs met, is
that correct?
Mr. Scoppetta. Yes. And we are monitoring retirees now as
well.
Mr. Shays. And is that being paid for by the department?
Mr. Scoppetta. That was paid for--the Federal funds are----
Mr. Shays. So that is the Federal dollars.
Mr. Scoppetta. Yes.
Mr. Shays. And by the way, if I expose some ignorance here,
feel free to jump right in and clarify. You know, I need to
know. So these are the Federal dollars, what enables you to
continue this process for those who no longer are active.
Mr. Scoppetta. Yes.
Mr. Shays. Dr. Herbert, Dr. Levin, Dr. Howard,
Commissioner, whomever, Dr. Reibman, tell me who comes closest
to matching the firefighters in terms of getting good
monitoring and good health care at least while they are active?
Who would that be?
Dr. Herbert. I would say monitoring and health care are two
different issues.
Mr. Shays. Absolutely.
Dr. Herbert. OK. To be eligible for our program----
Mr. Shays. No, I just--let me just--I have given you the
folks that I think are involved here--fire, police, emergency
medical personnel, transit workers, construction crew, and then
obviously volunteers in general--was there any other--do I rank
the firemen, firefighters, up at the highest level? I am just
trying to--I want to know where people fit in here. Are the
construction folks, the guys who are getting screwed the most,
are they getting help? Help me out here, guys.
Dr. Herbert. You have in the world of other responders, the
people who did----
Mr. Shays. Tell me who gets the next best after the
firefighters. Maybe nobody.
Dr. Howard. Let me try this.
Mr. Shays. And you can take monitoring, and then you can
take----
Dr. Howard. Yes. If you are a responder or a volunteer, if
you were rescue, recovery, cleanup, restoration, essential
services, OK, if you were in that category, which we commonly
call responder or volunteer, then there is--there was medical
screening for you. Dr. Herbert's group reported on her findings
recently.
Mr. Shays. For those who volunteered to be----
Dr. Howard. Exactly. Responder or volunteers.
Mr. Shays. Yes.
Dr. Howard. Then, they got monitoring----
Mr. Shays. Let me just--I am sorry, but I am really trying
to nail this down. When you work for the police department or
you work for the fire department, you are part of a club. If
you work for a union, you are part of a union. You know, you
talk to your colleagues. I want you to separate the volunteers
who came just--and just came every day that weren't part of any
organization. I want to be able to categorize, so I need a
little bit more definition to what you are telling me.
Dr. Howard. And your categorization criteria is, which of
those groups that we are going to name has the most
availability of medical support, monitoring of treatment.
Mr. Shays. Right. And while you are telling me that
everyone who was a potential responder has the right to
monitoring, there is a difference between having the right and
actually taking advantage of the right.
Dr. Howard. OK. If you look at that, just that question,
and you use the estimate that Mrs. Maloney used that we
commonly use of 40,000 as the denominator, in the combined
programs that the Federal Government has funded for screening
and monitoring we have screened and monitored about 30,000, so
that is about 75 percent.
We still--and we always take every opportunity--I thank the
print and electronic media for giving us the opportunity to say
if you were a responder in that 40,000 group, and you haven't
had an examination, please come in and get an examination. So
out of that 40,000, we have screened 30,000.
Mr. Shays. OK. So, and as Mrs. Maloney points out, and
others point out, and you all have pointed out, being screened,
being monitored, and getting health coverage are two different
issues.
Now, let us just talk about health coverage. Do you want to
talk, Dr. Levin, about----
Dr. Levin. Because health care delivery is such a patchwork
system----
Mr. Shays. I am going to ask you to give the mics back to--
we basically have three mics. You are going to share the mic
with Commissioner Scoppetta, so that way you only have to go to
two, OK?
Dr. Levin. What we are dealing with is a patchwork health
care delivery system and our patients, the responders. Putting
aside community residents, and putting aside office----
Mr. Shays. Well, putting aside community residents, because
that is an important issue, but I just want to first get the
responders, the responder community.
Dr. Levin. You have a special group of cleanup workers who
were the undocumented workers, often hired from the street
corner to work each day, often struggling to get paid at the
end of the day, offered no protection, and who are very worried
themselves about entering any kind of system because of their
concerns about being identified as undocumented workers.
That is a group that we have been seeing in our center. I
know Dr. Reibman has been seeing a number there, but they are
not easy to reach because of their fears of----
Mr. Shays. Seen for what? To get health benefits or----
Dr. Levin. To be evaluated and then treated for----
Mr. Shays. Oh, to be treated. OK.
Dr. Levin. Yes. We know that there are many, many hundreds,
probably thousands, who have never been seen in our programs
because of their concerns about being identified as
undocumented workers. That is just one aspect of it.
We have in our population of responders a number of people
who are pure volunteers. In other words, they were not employed
down there. They never received a paycheck. They came to do
volunteer work. It turns out that after some struggle the
worker's compensation system in New York did set up a program
to cover the health care costs of volunteers.
Those people had an easier path to getting health care
benefits through the worker's compensation system than people
who in fact were employed down there and filed worker's
compensation claims.
Mr. Shays. I mean, this is the stuff we need to hear.
Dr. Levin. I thought that this was the kind of issue that
you were concerned with. The volunteer program had no insurance
company opposing the cases. Employed workers had either
insurance companies or self-employed--I mean, self-insured
employers like the city, New York City, or the Transit
Authority, or Conn Ed. These are self-insured worker's comp
programs, and I can tell you that the track record of our
patients in getting through the system, if they were employed
down there, was really nightmarish.
Mr. Shays. OK. Nightmarish as it was, once they got it,
will they get it when they retire?
Dr. Levin. So long as they have persistent medical problems
that derive from their exposures at Ground Zero or in World
Trade Center response work, their medical care is supposed to
carry through for the rest of their lives unless--and if you
want this level of detail I think maybe it is useful to you.
Unless they take a lump-sum settlement, which they are
vigorously encouraged to do within the system, at which time if
they take a lump-sum settlement they waive all their rights to
further payment for medical care or wage replacement or
anything else.
Now, many of our patients who face financial difficulties
paying the rent, dealing with, you know, the kids' tuition----
Mr. Shays. What kind of settlement are we talking about?
Dr. Levin. Something in the order of $50, $60, $70,000.
Mr. Shays. So it could just be a whisper compared to what
they need.
Dr. Levin. Yes, but what it does is it enables them to get
out of debt temporarily.
Mr. Shays. I understand that. I am not----
Dr. Levin. But, yes, you are right, it is barely enough to
cover a couple year's expenses, and then they are left on their
own. And as was pointed out before, you are talking about
medications alone that can cost several hundred dollars a month
just to keep symptoms under control.
So you have people in the worker's compensation system who
were delayed in getting care, delayed in getting testing, and
ultimately may not be covered for the duration of their
illnesses, because they have taken lump sum.
I want to talk about construction workers, because that is
a large group of people who are down there.
Mr. Shays. Is that the largest group, do you think?
Dr. Levin. In our population, law enforcement and
construction workers were almost comparable in terms of----
Mr. Shays. Do you put law enforcement--firefighters as law
enforcement?
Dr. Levin. No, because the firefighters were not seen as
part of our program.
Mr. Shays. OK. I got you.
Dr. Levin. So construction workers are in the paradoxical
situation that if they are ill enough not to be able to put in
enough hours on the job----
Mr. Shays. Let me just stop you. We are not going to go too
much longer. Do we have a time problem here? I am sure you do.
OK. How much more time do you have? You both have time problems
here.
Let us do this. I am going to just have--we are going to
go--if my colleague wants another 5 minutes, we will go with
that and end with that. Does that meet your needs?
Just finish your question.
Dr. Levin. I will finish this, because it--you have the
paradoxical situation for construction workers that they have
to put in a ceratin number of hours on the job in order to
retain their health benefits and the benefits for their
families. At the very time that they are ill from the World
Trade Center experiences, and they can't work because often
their jobs are dusty jobs that provoke their symptoms, they
find themselves losing their health care insurance.
Mr. Shays. Let me just interrupt. Your questions will not
involve either Commissioner? OK. Gentlemen, thank you very
much. Thank you.
Mrs. Maloney. I just want to thank the fire department for
their extraordinarily leadership. They have come to Washington
10, 20 times to lobby for more funds. We are deeply grateful.
Mr. Shays. And I also want to thank our Commissioner for
being here. Thank you. You have been at our other hearings, and
you have been very forthcoming and we appreciate it.
Dr. Levin. Well, just to continue briefly, you have people
who are falling through what you could consider natural cracks
in a patchwork system, but you also have people who are facing
the vigorous opposition of their claims by both insurance
companies and self-insured employers. That has been the most
common of experiences.
Mr. Shays. Do the construction workers get covered by their
own fund, their own health care? That is what I am not clear
about. Does it depend construction to construction?
Dr. Levin. Overwhelmingly, the way construction workers get
health care is through joint employer/union administered
benefit funds. And it is part of I think the way construction
trades are set up.
Mr. Shays. I will have my staff followup on this.
Dr. Levin. But they lose their health care benefits, find
their cases being fought in the worker's compensation process.
And essentially, if it weren't for the treatment resources that
we have been able to garner at Mt. Sinai, and our partners from
Red Cross, etcetera, these people would do without health care
because there would be no resources available to them.
So even though construction workers seem on the surface of
it to have excellent plans, under ordinary circumstances in the
particular situation of the World Trade Center related
illnesses, they find themselves in desperate circumstances
because there is no source that you can identify if it is not
from philanthropic sources, and now the prospect of Federal
funding.
Mr. Shays. Dr. Reibman, do you want to respond to any of
this? OK. Mrs. Maloney.
Mrs. Maloney. First of all, I would like to thank my staff
that has worked every single day on these issues since
September 12, particularly my chief of staff in Washington,
Vince Chevette, my district chief of staff, Minnie Elias, and
Edward Mills, who has worked with me to draft and implement
several legislative proposals and the continual letters that we
send out practically every day on this.
I just would like to ask Dr. Howard, we learn in the Bible
that Moses traveled in the desert for 40 years, because he did
not have a plan. And what has struck me is how every single
question keeps being bounced back in your court, and every time
I pick up a paper I read that you have not even one single
staff member assigned to your--help you on this.
So a lot has been thrown on you, Dr. Howard, and my
question is: when are we going to have in writing, submitted to
Congress, the plan?
Mr. Shays. And I am just going to say, in my religious
belief they wandered in the desert for 40 years because the
children of Israel weren't ready to cross the Promised Land.
[Laughter.]
Mrs. Maloney. But in any event, my constituents can't wait
40 years. They want the plan now, and they have bounced in your
court the fatality report and the criteria. To me, if someone's
lungs are black and they are throwing up black phlegm when they
are dying, and their family talks about how they spit out nails
and black phlegm, I would say it is related to September 11th.
But in any event, we need a fatality report that builds on
the science that came out of the Mt. Sinai-World Trade Center
consortium science, but we need that also in writing, so it can
be implemented.
So my question to you--and I think your question back to
us, is to call Ross Perot and get you some more resources to
help get this research done. But I see a tragic ending here. I
know--we can all be idealistic, but I know if you do not have a
plan, if you do not have cost estimates that are scientifically
based, even with all the plans in the world that are
scientifically documented, it is had to get it in the budget.
So we don't have a prayer as a New York delegation combined
with Connecticut and New Jersey in getting a budget line for
health care unless we get the plan, unless we get the
documentation and the health estimates, which is a huge job. So
my question to you is: we can't wait 40 years. When are you
going to give us our plan in writing? And thank you very much.
Mr. Shays. Is there any comment that any member of the
panel--I thought it was a statement that----
Mrs. Maloney. No, it was a very sincere question.
Mr. Shays. OK. Well, then----
Mrs. Maloney. He gave us a definite deadline. I hope he can
make it, but God bless him he gave us a deadline of October 1st
for distributing the first money. And if we don't get a
deadline, and if we don't get a commitment in some framework,
we are going to be waiting for 40 years. So in all sincerity,
it is a sincere question.
Mr. Shays. Could you respond?
Dr. Howard. In terms of the treatment money, yesterday
after our meeting with the Secretary we sent out to the
grantees, some who were sitting very close to me, an e-mail
solicitation of 15 items that we need from them to immediately
begin this process, so we can get their applications in writing
and we can begin the review process, so we can meet that
October date.
So that is the important thing. With regard to the World
Trade Center fatality investigations program, we have----
Mrs. Maloney. May we have a copy of those items?
Dr. Howard. Sure. I will send you the e-mail. They will be
receiving even more detail----
Mr. Shays. Send the full committee the e-mail as well.
Dr. Howard. They will be receiving an e-mail on Monday,
which even contains more detailed requirements. So that is
moving forward. We hope that we can meet that date. I have
every indication we can.
With regard to the World Trade Center fatality
investigations program, which we talked about, the Commissioner
mentioned, we have a draft which will be coming out for
external review next week. I would like to thank the Mt. Sinai
Medical Center, Dr. Landergen, and others who have worked on
that as well.
Mrs. Maloney. May we see----
Dr. Howard. Of course you can. It will be out for external
review. And the Health Department. This is a combined effort,
and I would like to thank all of the partners for that.
Mr. Shays. Thank you. Let me just ask you, Dr. Howard, one
last question that Vito Fossella wanted to ask. He said----
Mrs. Maloney. But, sir, you didn't answer the full plan. We
can't wait 40 years. Can you give us a general----
Dr. Howard. You know, as I have mentioned, I am hoping that
the Secretary's task force that does give policy guidance will
be able to assist me in that regard.
Mr. Shays. Dr. Howard, this is from Vito Fossella. He said,
``Dr. Howard, at our meeting yesterday Secretary Leavitt
announced the formation of a new task force dedicated to the
long-term health needs of September 11th first responders. In
your role as September 11th coordinator, you have already been
extremely effective, and we want to make sure you remain an
integral part of this effort. Can you explain how your role
will or will not change in the context of this new task force?
Dr. Howard. As I explained before, my role--eyes and ears--
as a program coordinator here on the ground in New York City,
will be to liaison with this high-level policy guidance task
force that will give the Secretary his policy guidance.
Mr. Shays. And you will be a part of that task force?
Dr. Howard. Yes, sir.
Mr. Shays. Fine.
Mrs. Maloney. Thank you.
Mr. Shays. Thanks all very much. We appreciate your
testimony. We want to thank you.
This hearing is adjourned.
[Whereupon, the subcommittee was adjourned.]