Testimony

Statement by
John O. Agwunobi, M.D., M.P.H., M.B.A., 
Assistant Secretary for Health

on
9/11 Health Effects: HHS’s Monitoring and Treatment of Responders 

before
Committee on Oversight and Government
Subcommittee on Government Management, Organization and Procurement
United States House of Representatives

Wednesday, February 28, 2007

Good afternoon, Chairman Towns and distinguished Members of the Subcommittee.  My name is John Agwunobi and I am the Assistant Secretary for Health for the U.S. Department of Health and Human Services (HHS).   Beside me is my colleague within the Department, John Howard, the Director of the National Institute of Occupational Safety and Health at the Centers for Disease Control and Prevention and HHS World Trade Center Program Coordinator.  We thank you for holding this hearing and for the opportunity to testify before the Subcommittee on the federal response to the health impacts of the 9/11 attacks and the federally funded programs that provide monitoring and treatment to responders.

Since the attacks on the World Trade Center towers on September 11, 2001, the Department of Health and Human Services (HHS) has been committed to providing compassionate and appropriate support to responders affected by World Trade Center exposures following the attacks

On September 11, 2001, within moments of the attacks, HHS activated the National Disaster Medical System, placing medical teams nationwide on alert to be deployed to assist local areas in responding to the medical emergencies associated with the attacks.  Within hours, HHS dispatched the first group of emergency medical and mortuary teams, including more than 300 medical and mortuary personnel to the New York City and Washington, D.C. areas to assist local emergency personnel and health providers in caring for victims of the terrorist attacks on the World Trade Center and the Pentagon.  Veterinary disaster teams were also dispatched to New York City to provide care and treatment for rescue dogs.  This was the first time the federally coordinated response system had been activated on a nationwide basis.  HHS also authorized the first emergency use of the National Pharmaceutical Stockpile, delivering substantial supplies to support medical personnel caring for victims of the airplane attack on the World Trade Center.   

Beyond the Department’s initial response to provide supplies and medical responders, it is important to mention the hundreds of millions of dollars that the Department of Health and Human Services spent in the months and years following the attacks has gone to provide health care, both physical and mental, to those who were, and continue to be, affected and in need. 

Within eight days of the attacks, the Federal government and the State of New York jointly created and implemented a Disaster Relief Medicaid waiver.  This 4-month temporary Medicaid authorization included a simplified, one page application, on-the-spot eligibility determination and immediate access to services for low-income New York children and adults in the Medicaid, Child Health Plus and Family Health Plus programs and temporary medical coverage for those affected by the September 11^th attacks.  The Federal government provided the State of New York Medicaid program with $333 million in funds to support the program. 

On September 18, 2001, the 2001 Emergency Supplemental Appropriations Act for Recovery from and Response to Terrorist Attacks on the United States provided the Department with funding, of which:

• $10 million was granted through the Health Resources and Services Administration (HRSA) to 33 Health Centers in New York City and Northern New Jersey to support immediate costs of response as well as longer-term health care services as a result of the attacks;
• $35 million was granted through HRSA to St. Vincent’s Hospital-Manhattan and New York University Downtown Hospital, two nearby hospitals in Manhattan that were dramatically impacted by the attacks, for mobilization of staff to respond to seriously injured patients;
• $22 million was provided through the Substance Abuse and Mental Health Services Administration (SAMHSA) to support mental health treatment for long-term disorders and to expand substance abuse treatment services to address the needs of individuals and families impacted by the attacks; and
• $5 million was provided to the Agency for Toxic Substances and Disease Registry to provide environmental health monitoring.
•  $10.5 million was provided to the National Institute of Environmental Health Sciences (NIEHS) at NIH to support both a research program involving workers and community members who were heavily exposed to WTC dust and to fund the health and safety training provided to workers cleaning up the WTC site and to policemen and firemen who must respond to future accidents/disasters involving toxic substances in New York City.

Beyond the emergency supplemental, additional funding has been appropriated and disbursed to meet the health needs of, and support scientific research related to, victims of the attacks.  This funding includes

• $135 million granted through HRSA under the Hospital Emergency Response program in Fiscal Year (FY) 2002.  This money went to health care entities that suffered financial losses directly attributable to the attacks. 
• $10 million was granted in FY 2002 through SAMHSA to support 5 multi-year grants to the National Child Traumatic Stress Initiative to improve the quality of treatment services to children and adolescents who experienced traumatic events; and
• $4 million was granted in FY 2002 through SAMHSA to mental health organizations to provide services to public safety workers.
• $8 million was appropriated to NEIHS in FY 2003 to continue its research studies on health effects associated with exposure to WTC dust and to develop curricula and train a nation-wide cadre of environmental response workers to respond to future disasters.

In 2003, with $20 million in initial funding provided by FEMA, the Agency for Toxic Substances and Disease Registry (ATSDR) and the New York City Department of Health and Mental Hygiene (NYCDOHMH) jointly developed the World Trade Center Health Registry.  The purpose of the WTC Health Registry is to evaluate potential short and long term physical and mental health effects of exposure to the disaster among responders, building and school occupants, and residents of the affected area.  Over a period of 14 months, more than 71,000 individuals enrolled in the registry.  Since its inception, an additional $10.9 million in Federal funds has been provided to the Health Registry for follow-up surveys and scientific studies of the collected data.

In early 2002, with $12 million in funding from a Department of Defense emergency supplemental, NIOSH developed a baseline medical screening program to address the gap in medical screening of WTC responders.  The NIOSH program was designed to assess the health status of the emergency services and rescue and recovery personnel who were not otherwise covered by established screening programs.  NIOSH contracted with Mt. Sinai School of Medicine in FY 2002 for baseline safety screening of 12,000 responders, rescue and recovery workers.

Also in 2002, $3.7 million was provided to the Office of Public Health and Emergency Preparedness [now, the Office of the Assistant Secretary for Preparedness and Response] to perform baseline medical screenings for Federal responders.  Current Federal workers, who choose to register for tracking, are screened through Federal Occupational Health (FOH) clinics and other clinics that have contracts with FOH throughout the country.  Retired Federal workers and intermittent Federal employees hired during the post-9/11 period to work in Manhattan have access to screening through the NIOSH Medical Monitoring program.   Because these programs are voluntary, the epidemiological data provided has some limitations, but the programs ensure that Federal employees have a safety net to assure their needs are addressed.