<DOC>
[109th Congress House Hearings]
[From the U.S. Government Printing Office via GPO Access]
[DOCID: f:28531.wais]
PROGRESS SINCE SEPTEMBER 11TH: PROTECTING PUBLIC HEALTH AND SAFETY
AGAINST TERRORIST ATTACKS
=======================================================================
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
__________
FEBRUARY 28, 2006
__________
Serial No. 109-153
__________
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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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)
------ ------
David Marin, Staff Director
Rob Borden, Parliamentarian
Teresa Austin, 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
Lawrence J. Halloran, Staff Director and Counsel
Kristine Fiorentino, Professional Staff Member
Robert A. Briggs, Clerk
Andrew Su, Minority Professional Staff Member
C O N T E N T S
----------
Page
Hearing held on February 28, 2006................................ 1
Statement of:
Bascetta, Cynthia A., Director, Health Care, Government
Accountability Office; Ronaldo Vega, architect, city of New
York, Department of Design and Construction; Marvin Bethea,
paramedic, New York City; Stephen M. Levin, M.D., co-
director, World Trade Center Worker and Volunteer Medical
Screening Program, medical director, Mount Sinai Center for
Occupational and Environmental Medicine, New York, NY; and
Kerry J. Kelly, M.D. chief medical officer, Bureau of
Health Services, FDNY, and co-director, FDNY-WTC Medical
Program, New York, NY...................................... 11
Bascetta, Cynthia A...................................... 11
Bethea, Marvin........................................... 54
Kelly, Kerry J........................................... 74
Levin, Stephen M......................................... 59
Vega, Ronaldo............................................ 47
de Hernandez, Micki Siegel, Communications Workers of
America, District 1, New York City; Lee Clarke, American
Federation of State County and Municipal Employees,
District Council 37, New York City; John Romanowich, New
York City Department of Design and Construction; Michael
Kenny, Local 375, District Council 37, New York City; and
Charles Kaczorowski, Local 375, District Council 37, New
York City.................................................. 159
Clarke, Lee.............................................. 160
de Hernandez, Micki Siegel............................... 159
Kaczorowski, Charles..................................... 163
Kenny, Michael........................................... 162
Romanowich, John......................................... 161
Howard, John, M.D., M.P.H., Director, National Institute for
Occupational Safety and Health [NIOSH], Centers for Disease
Control and Prevention, U.S. Department of Health and Human
Services................................................... 133
Letters, statements, etc., submitted for the record by:
Bascetta, Cynthia A., Director, Health Care, Government
Accountability Office, prepared statement of............... 14
Bethea, Marvin, paramedic, New York City, prepared statement
of......................................................... 56
Howard, John, M.D., M.P.H., Director, National Institute for
Occupational Safety and Health [NIOSH], Centers for Disease
Control and Prevention, U.S. Department of Health and Human
Services, prepared statement of............................ 136
Kelly, Kerry J., M.D. chief medical officer, Bureau of Health
Services, FDNY, and co-director, FDNY-WTC Medical Program,
New York, NY, prepared statement of........................ 77
Levin, Stephen M., M.D., co-director, World Trade Center
Worker and Volunteer Medical Screening Program, medical
director, Mount Sinai Center for Occupational and
Environmental Medicine, New York, NY, prepared statement of 63
Maloney, Hon. Carolyn B., a Representative in Congress from
the State of New York, information concerning findings and
treatment for high levels of mercury and lead toxicity..... 112
Shays, Hon. Christopher, a Representative in Congress from
the State of Connecticut, prepared statement of............ 3
Vega, Ronaldo, architect, city of New York, Department of
Design and Construction, prepared statement of............. 49
PROGRESS SINCE September 11th: PROTECTING PUBLIC HEALTH AND SAFETY
AGAINST TERRORIST ATTACKS
----------
TUESDAY, FEBRUARY 28, 2006
House of Representatives,
Subcommittee on National Security, Emerging
Threats, and International Relations,
Committee on Government Reform,
Washington, DC.
The subcommittee met, pursuant to notice, at 2:06 p.m., in
room 2154, Rayburn House Office Building, Hon. Chris Shays
(chairman of the subcommittee) presiding.
Present: Representatives Shays, Fossella, Maloney, and Van
Hollen.
Staff present: Lawrence Halloran, staff director and
counsel; Kristine Fiorentino, professional staff member; Robert
A. Briggs, clerk, and Marc LaRoche, intern; Andrew Su, minority
professional staff member; and Jean Gosa, minority assistant
clerk.
Mr. Shays. A quorum being present, the Subcommittee on
National Security, Emerging Threats, and International
Relations hearing entitled ``Progress Since September 11th:
Protecting Public Health and Safety Against Terrorist Attacks''
is called to order.
On September 11, 2001, the World Trade Center site became
the epicenter of seismic events still generating aftershocks
across our entire Nation.
We convene in remembrance of those lost and on behalf of
those still suffering and dying as a result of the toxic
terrors unleashed that day.
The unfinished work of protecting public health in this
dangerous era came into painful focus again last year when
Hurricane Katrina washed away complacent assumptions about
national readiness to deal with large-scale disasters.
So we also come together to commemorate our fellow citizens
who died in the storm and to ask, what more must be done to
care for those who live and work in the past of cataclysmic
devastation.
An 18th century philosopher reached the sad conclusion,
``We learn from history only that we do not learn from history.
We prefer to forget.''
We want to get on with our lives as soon as possible to get
back to where we were before disaster struck.
But many suffering long-term effects from toxic exposures
at Ground Zero cannot forget, nor can they be forgotten.
Recent deaths and diagnosis of debilitating conditions
among September 11th first responders serve as painful
reminders of the enduring duty to acknowledge the wounded, ease
their suffering, and learn the lessons their hard history
teach.
When the subcommittee convened in New York City in 2003, we
heard testimony about a disjointed patchwork of Federal, State,
and local health programs meant to address unique September
11th health impacts.
First responders and Federal employees who answered the
call were falling into bureaucratic crevices between those
special programs and regular health care and workers'
compensation systems ill equipped to diagnose, treat, or
compensate the delayed casualties of the September 11th
attacks.
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 universe
of treating physicians.
Valuable data sets, compiled by competing programs, may
atrophy as the money and vigilance to a September 11th health
research wane.
This unhappy history warns we are not yet prepared to do
essential public health assessments after mass casualty events,
natural or man-made.
More recently, the lack of any baseline measurement
protocols in the wake of Hurricane Katrina suggests the
response to the next disaster may be yet another ruddlerless,
ad hoc scramble.
Last week, the White House Report on Hurricane Katrina
recommended Federal agencies be prepared ``to quickly gather
environmental data and to provide the public and emergency
responders the most accurate information available to determine
whether it is safe to operate in a disaster environment or to
return after evacuation.''
Those charged with implementing that recommendation should
study the history of the September 11th programs as a
cautionary guide to lessons still unlearned and mistakes that
should not be repeated.
We asked our witnesses to discuss how the Federal
investment in the World Trade Center Health Program has been
used, how those efforts can be better coordinated and more
sharply focused.
We asked them to tell us what we have learned for good or
ill about responding to the health effects that sustain toxic
terrorism.
We value their perspectives. We appreciate their expertise,
and we look forward to their testimony.
With that, the Chair now recognizes Mrs. Maloney, who has
been leading the charge in this area, with Mr. Vito Fossella,
who I will also ask at this moment for unanimous consent that
he be allowed to participate, only if he joins us a little
closer. Come on up here, Vito.
[The prepared statement of Hon. Christopher Shays follows:]
[GRAPHIC] [TIFF OMITTED] T8531.001
[GRAPHIC] [TIFF OMITTED] T8531.002
Mrs. Maloney. Well, thank you, Mr. Chairman, and I really
thank you Chairman Shays for holding this hearing. This is the
third of its kind by the subcommittee, and, in fact, this
subcommittee is the only Federal Committee to ever hold
hearings on the health impact of September 11th, which is an
astonishing fact when you consider the enormity of this
problem.
I in particular want to welcome all of the panelists, but
two of my constituents are here--Mr. Ron Vega, Mr. Marvin
Bethea. And I also would like to recognize Ms. Lee Clark,
another constituent from D.C. 37 with Workers' Comp, Micki de
Hernandez from CWA, who has been dedicated to this issue, and
Barbara Coufel from AFSCME. They have all worked selflessly on
this issue.
We are joined today by other workers from Ground Zero. We
could not have everyone as panelists, but their constant
attention, their many visits to Washington, has contributed
greatly to the success that Vito Fossella and the chairman and
myself are so proud to learn on Monday that the administration
has appointed a health czar, a person who will be totally in
charge in coordinating response.
I also must mention that the Mayor's Office is here, who
has been a partner in this effort in securing a health
professional, and also the restoration, which Vito and many
others worked so hard on to restore the $125 million to
Workers' Compensation and to help the injured workers.
We have thousands of people that are sick and Vito has them
coming to his office. I have them to mine, and Chris has his.
Many people from Connecticut as well as across this country
rushed to Ground Zero, and many of them have not been treated.
They have not been monitored, and we hope to change that.
At the last hearing, I asked every witness if they could
name anyone in the Federal Government to whom they could turn
to for help. Was there anyone that they could go to to help
them with their health needs? Everyone called them a hero or a
heroine, but where were they to go when they were sick? And
absolutely no one could give me a name.
Well, today, we finally have a name--Dr. John Howard, the
Director of NIOSH. He is a witness on our second panel. He is a
seasoned health professional, and I know, Dr. Howard, that you
were just given this responsibility yesterday, but along with
Vito and Chris, I look very much forward to working with you,
because we have a great deal of work to do to help the men and
women who are heroes and heroines, such as Mrs. Bascetta who is
here today who was literally buried alive. Many others were
buried alive, dug their way out. They are sick now. They went
back to the mound. They worked to help others, and we need to
be there to help them now.
One of the first things I want to deal with, which I think
is incredibly important, is the medical monitoring programs.
One of our witnesses, Dr. Levin, has been head of the Health
Consortium and has worked on this.
But these programs have documented that thousands of people
are still sick. They are sick from their exposure to a virtual
cocktail of poisonous asbestos, lead, mercury, powdered glass,
pulverized cement, and other carcinogens at Ground Zero, and
that many of these individuals have a lack of access to
sufficient medical care or treatment.
The World Trade Center Monitoring Program alone has found
that roughly half of the 16,000 people they have screened have
a medical condition resulting from September 11th. Some have
called a condition called the ``World Trade Center cough'' that
has emerged from this impact of glass in the lungs.
What is worse is that we are now getting news that several
responders may have died as the result of their service at
Ground Zero years after the attack. And it has been 4\1/2\
years. We are coming up on the fifth anniversary, but since
June of this year, we have mourned the loss of three heroes of
September 11th--EMTs Felix Hernandez, at 31; Timothy Keller, at
41; and NYPD Detective James Cedragu, 34.
These men were all in the prime of their life. Their loved
ones told me they would be alive today but for September 11th.
Tim Keller's son says the night he died he was coughing up
black phlegm, and many tell me they could rub their loved ones
arms and little particles of glass would come out.
The frustrating thing to me is that even with this
information, eligibility for medical monitoring is all over the
map, and it is more dependent on who you are, what hat you
wore, what department you belonged in rather than what you were
exposed to.
And with this appointment of a medical chief in charge, I
would hope that the debate moves to what you were exposed to as
opposed to the various medical monitoring patchwork that has
been created across the region.
If you are a Federal employee, you are eligible now for a
one-time screening from a program that has been shut down more
than it has been operating. The GAO report said that of the
approximately 10,000 Federal employees and we are talking FBI,
CIA, IRS, FEMA, SEC--that were exposed, when they found--they
only monitored or screened 400 of them, and they closed down
the program because they didn't know what to do with them,
because people were sick and there was no treatment program.
I have been told that there will be no followup exams for
the Federal program that is starting up now, and that this
program is a screening program, not a monitoring program.
If you are a former Federal employee, as of today, you are
not eligible for anything. If you are a New York State
employee, you used to be eligible for a one-time screening. But
that program has since shut down.
And our point today is that illnesses are not shutting
down, and we need to have the scientific instructions sent out
to doctors. We have heard stories of people who are coughing
up--and very sick--and they have glass in their lungs, and they
are being treated for asthma. They have World Trade Center
cough.
The CDC has sent protocols to every single doctor in this
country for the SARS cough. Why aren't we sending and
developing protocol for the World Trade Center cough?
That needs to be done.
Now that you are eligible as New York State and Federal
employee to be part of a medical monitoring program, but your
first exam is useless, because the New York State Screening
Program failed to coordinate their exam with the other existing
monitoring programs.
If you were a construction worker, a firefighter, a police
officer, or a volunteer and worked at Ground Zero, you are
eligible to be part of medical monitoring programs that we had
to fight the administration to create.
If you are an area resident and breathed in this debris,
you are not eligible for any federally funded medical screening
or monitoring program.
The same is true for area workers, many of whom were back
on the job the next day, and school children.
The only thing that everyone is eligible for is the World
Trade Center Registry. But let us be clear: Beyond the privacy
concerns that have been raised by a number of local unions, the
Registry has never conducted a single medical examination.
All it has ever done is conduct phone surveys, requiring
individuals to self-report their health status.
I would like to hear from our witnesses any experiences
that they have had with this Registry. Specifically, I would
like to hear from the doctors on whether it has been of any use
to them whatsoever, and it is amazing to me that the Federal
Government has found it necessary to include area residents--
workers, school children, and others--in a health registry, but
are prohibiting the same from existing medical monitoring
programs, even after illnesses and injuries are reported.
As we are working out the coordination of monitoring, we
also must work on providing actual medical treatment to those
who are sick, but lack access to sufficient medical care or
treatment.
It is absolutely wrong, and I would say immoral, to find a
medical condition and then do absolutely nothing about it. We
have made progress in this area and are on the verge of
providing the first Federal funding for treatment. That is
amazing. It has been 4\1/2\ years, and we are just now getting
Federal funding for treatment.
But this only happened after a prolonged battle with the
administration. There is no way that the funds appropriated
will meet all of the unmet needs of the September 11th
responders. The funding that I am talking about is the
restoration, which my colleague, Vito, worked so hard on with
the New York delegation to restore $125 million rescission of
the September 11th funding, and I must mention the workers who
came up repeatedly to meet with the leaders in Congress to make
them aware that this money was needed for their treatment.
Of this $125 million, $75 million will be used for existing
monitoring programs and, for the first time, provide funding
for treatment. This is indeed an important step forward.
We have here today two of the people who were great
advocates in this fight. I would say three. Mrs. Bascetta, Mr.
Vega, and Mr. Bethea.
Without their work, and the work of other September 11th
responders, this funding would have never been returned to New
York.
Now that it has been returned, it is past time for the
Federal Government to come up with a comprehensive plan, not
just on how to spend this money, but develop a plan that looks
to deal with the unmet needs of everyone exposed to the toxins
at Ground Zero.
To this end, I would like to hear from the doctors from the
monitoring programs about the unmet needs of their patients.
Maybe I have this World Trade Center cough, too.
I would be specifically interested in hearing what you
think it will take to finally take care of these men and women.
Too much time has passed. The time to act is now. As the
September 11th responders will tell you, their life very well
depends on it. Thank you.
Mr. Shays. I thank the gentlelady. At this time, Mr. Van
Hollen has said that we could go to our invited member, Mr.
Fossella for a statement.
Mr. Fossella. Well, thank you, Mrs. Maloney, and thank you,
Chairman Shays, for holding this I think is an important
hearing, and, of course, to my colleague, Carol Maloney. She
has been very, very helpful and we are doing what is right for
the people who responded on September 11th.
As been mentioned, too many of the people I represent and
others are living with severe health problems due to September
11th and will continue to do so for years to come. I commend
you, Mr. Chairman, and others for the dedication to this topic.
We know now that when the terrorists flew two airplanes
into the Twin Towers on September 11, 2001, New York's police
officers, firefighters, EMTs, and so many others put their own
lives aside in an heroic attempt to save others. Many did not
return home. In the attacks immediate aftermath, countless
others flocked to Ground Zero to help with recovery efforts.
They spent several days and hours working the pile of wreckage,
holding on to the hope of finding survivors. They worked
tirelessly, driven by the somber reality that Ground Zero
needed to be cleaned up quickly to bring peace for those who
lost loved ones and to help lower Manhattan and America rise
again.
Many first responders and volunteers hoped the pain would
eventually pass, but many continue suffering today. It has been
revealed that tens of thousands of first responders, Federal
employees, and lower Manhattan residents and workers are
suffering from health problems likely caused by exposure to
toxins at or near the World Trade Center site. They inhaled
asbestos, lead, mercury, powdered glass, and other carcinogens
stagnating in the air.
According to a federally funded World Trade Center Medical
Screening Program, approximately half of the 16,000 September
11th responders that they have screened continued to need
physical and or mental health treatment. In many cases, they
need further testing as well.
Our New York City Fire Department I believe we will hear
shortly study reported similar findings: Thousands of other
responders eligible for medical screening are still left in
need.
After a long fight, our Federal Government is now on its
way toward providing a better response to this problem. This
past year has been mentioned. My colleague, Congresswoman
Maloney, and I came together with our other New York colleagues
and successfully reversed the rescission of $125 million for
September 11th first responders and workers.
We were also successful at freeing up this funding to be
used for treatment for the first time ever. Thanks to these
victories, many will continue receiving the treatment they need
to live more normal lives. Those not currently served can also
now live with the hope there is help out there, and America has
not forgotten their sacrifice.
Unfortunately, tragedy has come in the wake of these
successes. We have heard in the past 9 months three of these
responders lost their lives from what are believed to be
sicknesses incurred during the heroic rescue and recovery
efforts. Their names have been mentioned, but bear repeating--
the EMTs Timothy Keller, Felix Hernandez, and Police Detective
James Cedragu, now counted among the victims of September 11th.
Thousands of others are living with persistent health
problems believed to be associated with their September 11th
response. One medic I talked to is no longer able to work due
to severe respiratory illnesses and vision problems doctors
feel all relate to his efforts on September 11th.
Another individual suffers from respiratory problems caused
by severe internal chemical burns from toxins inhaled at Ground
Zero. One of the witnesses today, Mr. Vega, will testify about
high levels of mercury and arsenic in his blood. These toxins
will affect his liver and brain cells. He has also been
diagnosed with restrictive lung diseases and post-traumatic
stress disorder associated with September 11th.
Other common conditions are heart disease, bronchitis, and
emphysema.
Many of our September 11th responders are facing dire
circumstances. Some have tragically passed away. However, today
offers others like him will not suffer a similar fate and those
living with September 11th health problems as they will in the
future.
After requests from Congresswoman Maloney and I, I am very
pleased to, as she has mentioned Health & Human Services
Secretary Michael Leavitt, who we met with earlier today, with
Mayor Blumberg, has been a strong advocate in this cause, has
chosen, as been mentioned, Dr. John Howard as the Federal
Government's September 11th Health Coordinator. Dr. Howard, we
look forward to your efforts in helping those in need.
I welcome Dr. Howard here again and look forward to working
with all of us and many--I can't bear repeating enough for the
last 4\1/2\ years, there have been many on the ground back in
New York who have dedicated their lives to helping those in
need--many of the not-for-profit, fundraisers, etc., in the
health community, and one person in particular I would like to
acknowledge is Dr. Kelly, most important a Staten Island
resident, who is here today, a Grimes Hill resident and a
graduate of Notre Dame Academy on Grimes Hill. Doctor, thank
you for what you have been doing for these last several years
especially.
With that, Mr. Chairman, I want to thank you and let us
hope that not just the witnesses here, but, as we know, there
are thousands of people who are not here. They need to know one
thing: that September 11th may have been a very bad day and a
tragic one in this country's history, and there are many people
who responded heroically, and they need to know that this
Congress and this country will never forget their sacrifice and
will stand by them. And I think this hearing helps to
underscore that commitment.
Thank you very much.
Mr. Shays. I thank the gentleman. Mr. Van Hollen. Thank you
for your patience.
Mr. Van Hollen. Well, no, thank you, Mr. Chairman. Thank
you for holding a hearing on this very important issue, and I
commend my colleagues from New York, Mrs. Maloney and Mr.
Fossella, for their leadership in this area. And I will be
brief in my remarks.
As you said, Mr. Chairman, in your opening remarks, we have
an obligation as a country to learn from tragedies that strike
us as a Nation. On September 11th, we had a tragedy that struck
all Americans, but, of course, particularly people in New York
City, in the Washington area, and, of course, on the plane that
crashed in Pennsylvania.
And we have had a lot of opportunities as a country to
learn from those disasters and try to determine what we can do
to prevent and respond to other disasters. We saw in the case
of Hurricane Katrina that unfortunately the Federal Government
did not learn its lessons. We were not adequately prepared, and
there is much unfinished business we can do to prevent future
tragedies, whether they are man-made or whether they are from
natural causes, and to respond and be prepared to respond to
those tragedies.
But in the process of learning lessons from the tragedy of
September 11th and lessons from Katrina, it is important that
we not forget the people who were victims in those tragedies
and those who put their lives on the line, and nevertheless
continue to suffer from the long-term health effects of
exposure to toxics and other environmental conditions.
And so I hope as we learn the lessons from those tragedies
to avoid future tragedies and decide how to best respond to
them, we do not forget those heroes who were part of
responding, and that is what today is all about is trying to
find a way to make sure that those people who put their lives
on the line that they have their health care needs addressed.
And I thank you, Mr. Chairman, again my colleagues from New
York for your work in this area.
Mr. Shays. I thank the gentleman. Before I recognize the
witnesses, I ask unanimous consent that all members of the
subcommittee be permitted and those have been given unanimous
consent to participate be permitted to place an opening
statement in the record, and the record will remain open for 3
days for that purpose. Without objection, so ordered.
I ask further unanimous consent that all witnesses be
permitted to include their written statement in the record. And
without objection, so ordered.
Recognizing our panel, we have Ms. Cynthia Bascetta,
Director of Health Care, Government Accountability Office; Mr.
Ronald Vega, architect, city of New York, Department of Design
and Construction; Mr. Marvin Bethea, New York City paramedic;
Dr. Stephen M. Levin, co-director of the World Trade Center
Work and Volunteer Medical Screening Program, medical director
of the Mount Sinai Center for Occupational and Environmental
Medicine; and Dr. Kerry J. Kelly, Fire Department of New York,
chief medical officer, Bureau of Health Services co-director of
the Fire Department of New York WTC Medical Program--Fire
Department of New York? Yes. OK. You get the Fire Department of
New York in there a lot.
Please, if you would stand and raise your right hands.
[Witnesses sworn.]
Mr. Shays. Note for the record our witnesses have responded
in the affirmative, and two others who may provide testimony
will provide that to you, Mr. Transcriber, if they testify. But
they have been sworn in.
You may begin.
STATEMENTS OF CYNTHIA A. BASCETTA, DIRECTOR, HEALTH CARE,
GOVERNMENT ACCOUNTABILITY OFFICE; RONALDO VEGA, ARCHITECT, CITY
OF NEW YORK, DEPARTMENT OF DESIGN AND CONSTRUCTION; MARVIN
BETHEA, PARAMEDIC, NEW YORK CITY; STEPHEN M. LEVIN, M.D., CO-
DIRECTOR, WORLD TRADE CENTER WORKER AND VOLUNTEER MEDICAL
SCREENING PROGRAM, MEDICAL DIRECTOR, MOUNT SINAI CENTER FOR
OCCUPATIONAL AND ENVIRONMENTAL MEDICINE, NEW YORK, NY; AND
KERRY J. KELLY, M.D. CHIEF MEDICAL OFFICER, BUREAU OF HEALTH
SERVICES, FDNY, AND CO-DIRECTOR, FDNY-WTC MEDICAL PROGRAM, NEW
YORK, NY
STATEMENT OF CYNTHIA BASCETTA
Ms. Bascetta. Thank you, Mr. Chairman and members of the
subcommittee.
I am pleased to be here today to update you on the progress
of programs established to monitor adverse health effects in
the aftermath of the World Trade Center attack.
As you know, up to 400,000 people living, working, and
attending school in the vicinity were affected, and thousands
of responders were exposed to many physical and environmental
toxins as they took part in rescue, recovery, and clean up
activities.
The magnitude and unprecedented nature of this event also
caused significant psychological trauma for responders and many
other people.
More than 4 years later, the long-term effects on physical
and mental health are still of great concern.
In my remarks today, I will first discuss the four
federally funded programs that are implemented by State and
local government agencies or private organizations to serve
State and local workers as well as the general population.
Then I will share our findings about the program
established to monitor the health of Federal workers who
responded to the disaster in an official capacity.
For State and local workers, the New York City Fire
Department's program and the Worker and Volunteer Program, have
provided medical examinations to more than 15,000 and 14,000
people, respectively, and are also tracking their health over
time. Both programs are accepting new enrollees for initial
screening, have begun to conduct followup examinations, and
provide referrals for participants who require treatment.
A third program, the New York State Responder Screening
Program, offered one-time examinations to State employees,
including the National Guard.
After screening about 1,700 of the estimated 9,800 stated
responders, this program stopped in November 2003, in part
because the number of responders requesting examinations was
dwindling and no followup was planned.
State responders were allowed to participate in the Worker
and Volunteer Program beginning in February 2004.
The fourth program, the World Trade Center Registry, is
designed for research on long-term health effects through 2023,
and has collected health information through interviews with
over 71,000 responders and others exposed to the hazards caused
by the collapse of the Towers.
Officials from the Registry, as well as the other programs
doing long-term monitoring, expressed concerns that the
duration of Federal funding arrangements may be too short to
identify all health effects that may develop over time.
For Federal workers who are not eligible for other
monitoring programs, a few hundred were screened by Federal
agencies within the Army and the Justice Department. But for
the vast majority, HHS' program lagged behind by about a year,
accomplished little, and was dormant between March 2004 and
December 2005.
Of the estimated 10,000 Federal workers who were sent by
their agencies to respond, only about 500 have received
screening examinations.
HHS officials told us that three operational issues
contributed to their decision to suspend the program. First,
they could not inform all eligible Federal responders because
they didn't have a comprehensive list of their names.
HHS is now spending about $500,000 to develop the list and
to recruit enrollees.
Second, officials reported that clinicians were concerned
about providing screening examinations to the many participants
who need additional testing and followup care, especially for
respiratory and mental health problems.
This issue was resolved in July 2005 by a new interagency
agreement that provided directions for how to handle further
diagnostic tests, treatment, or referral. Five months later,
HHS resumed the program and decided how to resolve its third
issue, dealing with its authority to provide examinations for
former Federal employees.
Mr. Chairman, we believe that Federal, State, and local
government officials who are responsible for planning and
implementing health monitoring in the aftermath of any disaster
could improve their effectiveness by applying the lessons
learned from the World Trade Center experience.
For example, officials emphasized how time is of the
essence in identifying and contacting affected people, because
the passage of time erodes their memories and reduces the
likelihood of collecting accurate information.
Using the Rapid Response Registry could reduce delays in
collecting time-sensitive data.
Another lesson is the value of centrally coordinated
planning, which could improve the underlying data base for
research and eliminate the need for separate and sometimes
incompatible programs for different populations.
Finally, officials stress that it will be time consuming to
identify providers available to treat participants, especially
those without health insurance.
This may be especially important for mental health care
needs, which are often less obvious initially, but which take
on greater significance over time.
This concludes my remarks, and I would be happy to answer
any questions that you or the other subcommittee members might
have.
[The prepared statement of Ms. Bascetta follows:]
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Mr. Shays. Thank you very much. Mr. Vega.
STATEMENT OF RONALDO VEGA
Mr. Vega. Good afternoon, Chairman Shays, and members of
the subcommittee.
I wish to thank you, and especially thank my Congresswoman,
Carolyn Maloney, for inviting me here today.
My name is Ronaldo Vega. I am a registered architect,
employed by the city of New York, Department of Design and
Construction [DDC].
DDC was the city agency tasked by the Mayor to manage the
rescue and recovery effort at Ground Zero. I am also a union
official of AFSCME D.C. 37's local 375, the Civil Service
Technical Guild. Our members have served in the rescue-recovery
at Ground Zero since day one, and continue, even today, at the
Medical Examiner's office.
Along with everyone else who served at Ground Zero, my
story is but one of thousands.
Four and a half years ago, all the world was right.
American families went about their business in blissful
ignorance. By this time on September 11th, the unimaginable
death and destruction had already taken place. Our way of life
changed forever.
The general population became paralyzed by grief and
horror, and yet our response was immediate, overwhelming, and
fearless. We went in blindly, first to save whomever we could,
and then to recover as many remains as there were to be
recovered.
A byproduct of that search was the clean up of the site.
The two operations went hand in hand. They were inseparable.
Human remains and debris had become one. We accomplished both
efforts in 9 months, but we left knowing our job was
unfinished.
You have no idea how sensitive we were about the lives that
were lost that day. We saw Ground Zero as a mass grave where a
senseless massacre took place. We did all we could to bring
them all home, but the fact that we failed weighs heavily on
our minds still today.
Needless to say, every day offered a new traumatic
experience. For many, just 1 minute at Ground Zero scarred them
for life.
How many scars do you suppose we carry, we who worked there
10 hours a day, 7 days a week for 10 months?
Some of these scars reveal themselves when you least expect
them. A few weeks ago, while I was at home, I got up from my
chair and went to the kitchen to get a soda. While I was in
there, my little grandniece, Kayla, decided to play a joke on
me by placing her foot in the opening between the seat cushion
and the back rest of my chair so that by sitting on her foot
she could kick me in the butt.
Well, when I saw that seemingly disembodied foot on the
chair, it triggered a memory. My heart stopped. I held my
breath and shouted, ``oh, no.'' I caught myself before I broke
down in tears.
My daughter, Amanda, noticed my strange behavior and asked,
``what is wrong, dad; are you all right?'' I answered, ``yeah;
yeah, I am all right. It is nothing.''
I hope I never have to tell anyone about the carnage that I
witnessed at Ground Zero. It will remain buried in my memory
until it is time to let it go.
In July 2002, after 300 days of service, I left Ground Zero
for what was the last day of the rescue and recovery effort.
But before we left, we sat around the table at the last
debriefing meeting, and everyone said their goodbyes. When my
turn came around, all I could offer was the song ``Danny Boy.''
I don't know how it sounded, but it really didn't matter. We
all cried together for the first and last time.
We had combed through every inch of that 16-acre site until
there was nothing left. The real last truck left at 10:30 p.m.
with the contents of what was brushed off the windowsills of
1010 Firehouse. It was only then that I turned my attention to
my own physical and mental wellbeing.
For the record, I have no doubt in my mind that my exposure
to poisonous toxins at Ground Zero will eventually kill me. The
rule of medicine that toxins wash out of your body 90 days
after exposure does not apply to an environment that
contaminates you continuously over a 10-month period. And post-
traumatic stress disorder will not go away by itself.
There is an overwhelming need for more mental health
services. The WTC Registry, while well meaning, is not an
accurate gauge of the real effects of working at Ground Zero.
The Mount Sinai Monitoring Program monitors the health, but
funds are needed to provide treatment, too.
Today, after much effort and the help of caring
organizations like the New York Rescue Workers Detox Project
and Serving Those Who Serve, the poisons that resided in my
body seem to have finally washed out. But it is their path
through my body and what damage they may have caused on their
way out that concerns me.
My examination results confirm that 11 months after I began
working on the site, I still had high levels of mercury and
arsenic in my blood. These toxins affect your liver and brain
cells. All the dust and pulverized toxic powder that I inhaled
affected my breathing.
My diminished lung capacity will continue to worsen over
time, and if asthma doesn't get me, then liver disease probably
will.
There have been times since Ground Zero that my breathing
has been so labored, I have felt close to death, close to being
reunited with my first-born son, Justin, who died in 1997 from
an asthma attack.
He died praying for one more breath. Working at Ground Zero
was indeed worth dying for. But when the next attack comes, as
we all know it will, you are going to want us there. You are
going to need us there. Whether we will be healthy enough to
answer the call is up to you. The death toll from Ground Zero
is still being counted. What number will I be?
If you let the best trained, most dedicated responders in
the world die from neglect, then the terrorists truly win.
All that I can ask of you is to give us one more breath.
Thank you.
[The prepared statement of Mr. Vega follows:]
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Mr. Shays. Thank you, Mr. Vega. Mr. Bethea.
STATEMENT OF MARVIN BETHEA
Mr. Bethea. Yes. Chairman Shays and distinguished Members
of Congress, thank you for giving me an opportunity to testify
here today.
My name is Marvin Bethea, and I used to be a New York City
paramedic; and I am disabled due to the results of September
11th. My partner, James Dobson, and myself were assigned to the
Trade Center after the first plane struck.
In the 23 years I was on the job, I have had a gun put to
my head twice. I had been shot at once, and nothing could
compare to what we went through on that day. People ask me what
was it like. Again, I tell people think of going from day to
night in no time, and you are completely blind, and you
couldn't see at all. And at the same token, you had a big
bucket of toxic dirt that was being thrown down your throat.
We were literally blowing out small pieces of concrete out
of our nose on that day.
Five weeks to the day of September 11th, I suffered a
significant stroke, at which I did recover, and went back to
work to only develop asthma, post-traumatic stress disorder, as
well as sinusitis and major depression. January 8, 2004 was the
last day I actually worked.
Why are we here today? We are here today because we have a
major, major health crisis going on. What people failed to
realize is Ron, as well as a lot of other people here, we had
very physical jobs, in which we had to take physicals to get
those jobs, and once we got the jobs, every year we were
required to take a yearly physical, in which we passed those
physicals so we were allowed to continue to work.
So the question now becomes if all these people were
healthy, why now is everybody sick, and the common denominator
is, once again, it is September 11th. And the numbers are just
simply mind boggling.
We were told that the air was safe, which we all know now
is simply not true. Again, it is a disgrace. I would like to
honor Tim Keller, who was a 41-year-old EOT from New York City
EMS, as well as Mike Kendrick, a 53-year-old, who just died 2
weeks ago, who was an iron worker with five children, as well
as Detective James Zadroga, 34. And the list goes on.
We basically have been given a slow death sentence, and we
all got to say who is next? Who is the next person to go? That
is something that is constantly in our mind.
What has the government done or hasn't done? I mean the
government failed. The September 11th Fund was ideal. It was a
great intention. Execution of it was poorly done.
Again, the parameters of this that were set up was simply
totally unfair, and the people got lost in the system.
If something happens until you wait the first 96 hours, it
was OK. But you take a man like John Feal, for instance, a
construction worker, who had half of his left foot amputated
about the 17th day of September 11th. He received nothing from
the September 11th Fund, because it didn't happen within the
first 96 hours; and, yet the man has had 30 different
operations, and he goes back into the hospital this week for a
33rd operation. Again, the government gave him zero when it
came to the September 11th Fund.
I mean how do we do that?
Also for the fact that fire burned for over 3 months, so
all the people who were down there were being exposed on a
continuous basis. So if you were not there within 96 hours, you
got nothing.
If you were there for 3 months, maybe after the fact so you
were still inhaling deadly toxins, but yet nothing was being
done, and you weren't entitled to anything. That is simply not
right.
I have to say thank you to Congresswoman Maloney,
Congressman Fossella, and the other elected officials who did
help us get back that $125 million.
Something needs to be looked into with New York State,
because people are unaware of the fact that workers' comp
situation is so complicated that the workers' comp claims are
being denied five times greater with September 11th, and
something needs to be done about that as well.
I mean these people are already on edge, and they don't
want to go through the New York State harassment with the New
York State workers' comp.
September 11th was the most significant event that happened
in American history today. People often say, where were you
when Kennedy got shot? I remember, because I was 4-years-old. I
remember it like it was yesterday, and now people say well,
what about September 11th. Well, you know, September 11th we
will never forget what happened on that day. And you know, it
gets back to the words of John F. Kennedy, who said, you know,
``my fellow Americans, ask not what your country can do for
you. Ask what you can do for your country.''
And I would be curious what would President Kennedy say
today about the way in which the heroes and the survivors of
September 11th are being treated? It is simply totally un-
American that this is going on.
To the elected officials who made all these promises that
we will never forget you, we will take care of you, I want to
know what has changed now that all of a sudden, we are being
forgotten. Do I need to pull your sound byte and remind you of
what you did say on September 11th? It is an absolute disgrace.
And to the President, Bush, I would say show us some of the
same compassion that I personally showed one of your family
members as a patient in my ambulance.
Thank you.
[The prepared statement of Mr. Bethea follows:]
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Mr. Shays. Thank you, Mr. Bethea. Dr. Levin.
STATEMENT OF DR. STEPHEN M. LEVIN
Dr. Levin. Thank you for letting me testify today.
Mr. Shays. Is your mic on, sir?
Dr. Levin. Is that working? Is that better?
Mr. Shays. I usually find it is the doctors that don't know
how to do it. I am totally teasing--totally teasing. I don't
get it right.
Dr. Levin. Thank you for asking me to testify today. I have
been asked to talk about the unmet health needs in the
aftermath of the September 11th attacks on the World Trade
Center. And I hope that my comments and those of my fellow
panelists can draw attention to the widespread and persistent
health impacts of such disasters.
There are thousands of men and women who are still ill and
suffering as the result of their heroic rescue and recovery
efforts after the World Trade Center was hit. The horrifying
human suffering and loss of life caused by Hurricane Katrina
has again showed the clear need for our Nation to improve its
planning, and implementation of effective public health
responses to man-made and natural disasters.
A public health response should always include protecting
the health of rescue and recovery workers, as well as saving
the lives and protecting disaster victims.
In the heat of the effort to save the lives of victims, we
have to minimize disability and illness among the rescue and
recovery workers and those who bring such devastated areas back
to life.
Now, nearly 4\1/2\ years after the attacks on the World
Trade Center, the men and women who worked in the rescue and
recovery and clean up efforts are still suffering. Respiratory
illness, psychological distress, and financial worries have
reshaped the lives of many of these responders.
It is important to note that the World Trade Center
responders were provided with important medical programs that I
will talk about in just a moment. The many thousands of
residents of lower Manhattan and the thousands of workers who
returned to the area within days and weeks of September 11th
had no federally funded services available to them to assess
effects on their health. That is a public health need that
remains unmet.
I would like to talk just for a moment about the medical
screening and monitoring programs, and they exist, in large
part, because of the efforts of New York's organized labor
community and the clinical experience accumulated by our Center
for Occupational and environmental medicine and the Medical
Department of the Fire Department of New York City.
Because of their efforts, the Federal Government came to
recognize that evaluating and monitoring the health
consequences of the September 11th attacks was important to the
health of rescue and recovery workers.
It was clear also that we had to learn all we could about
the health consequences of this horrific disaster. In June
2002, Mount Sinai received $11.8 million in Federal funding
from NIOSH to design a medical screening program and to
organize and coordinate a consortium of health care centers in
New York and nationwide to provide free medical screening exams
for responders who were involved in the rescue and recovery
efforts, the removal of debris, the restoration of vital
services, and the clean up of the buildings around Ground Zero,
and those who worked at the Staten Island landfill.
From its inception, in April 2002, to its end, in 2004, the
clinical centers of this program saw nearly 12,000 people. This
was an economically and socially diverse group of individuals.
And of that group, nearly 9,000 were seen by Mount Sinai
physicians.
We published the results of a 10 percent sample of the
people we saw in that program. They have been discussed before.
The real point is that very high rates of upper respiratory
problems like sinusitis, laryngitis, persistent sore throats
were reported when people were down at Ground Zero, but also up
to the month prior to their examination in our screening
program.
Similarly, very high rates of lung symptoms, chest
tightness, wheezing, shortness of breath, cough were reported
among people who were seen in our program--reported about their
experiences when they were down at Ground Zero, but also up to
the month prior to the time that we saw them.
Approximately 40 percent had persistent psychological
distress at the time that we examined them, and what is very
important is that we did objective pulmonary function testing,
not just asked people about their symptoms, but examined them
and did special pulmonary function testing, and the rates of
abnormality were some two to three times what would be expected
in the general population.
Now, it is important to note that these effects were still
occurring on average 8 months after people had left the Ground
Zero site or their World Trade Center efforts. These were not
just brief and transient problems.
What we are seeing in our clinical settings today are very
similar. We are still seeing persistent respiratory problems,
psychological problems, and gastrointestinal problems.
Now, Mount Sinai received Federal funding through NIOSH and
the CDC to serve as a clinical center and as a data and
coordination center for the World Trade Center Medical
Monitoring Program. That is to provide followup examinations
every year and half for 5 years to responders who were seen in
the screening program, and it is also set up to see people for
the first time for first examinations among those responders
who couldn't get into the screening program when it existed.
We began seeing responders in 2004, and we are presently
conducting followup examinations, as well as providing initial
examinations. And we have seen an additional nearly 2,500
people for the first time, and nearly 4,000 for repeat
examinations.
People are still coming for the first time now 4\1/2\ years
after September 11th, because of their concerns about either
persistent current symptoms or because they are worried about
what is going to happen to their health in the long term.
For many coming to our program, fears of future
catastrophic illnesses like cancer, which can take 20 to 30
years to show up, looms large or larger than their current
illnesses, because many responders sustained unprecedented
exposures, of which the long-term consequences are unknown.
This population should be under medical surveillance with
periodic medical examinations, not just telephone interviews,
for another 30 years, not because we want to count how many
illnesses they develop and whether it is unusual, but because
it is important to detect as early as possible diseases like
cancer that develop years after exposure and that are much more
effectively treated if we find them early.
There are new approaches to early detection being developed
every day in research laboratories across the United States and
worldwide. It is important that we use the best tools we have
to protect the health of this remarkable group of men and
women, given what they have done.
We estimate that current funding will permit the World
Trade Center Medical Monitoring Program to conduct examinations
of some 12,000 responders once every year and a half for the
next 5 years only, lasting only through 2009.
Let me speak just for a moment about treatment. One of the
greatest concerns in my responders and those of us who are
trying to provide their care----
Mr. Shays. Doctor, if you could please summarize.
Dr. Levin [continuing]. Is the need for treatment. It is an
excellent thing that we were provided with funding to monitor
and evaluate. It is absolutely key that treatment resources be
made available. We were able to obtain some philanthropic
funding to set up a health effects treatment program. We have
seen some 1,900 responders in that program. They are
persistently ill despite the best care that we are able to
offer them, and the need for care will not end when that
funding runs out in approximately a year and a half.
It is not enough to tell a person who has done what these
responders have done that, yes, you have asthma. Now, go find a
way to get treated.
The data that we have accumulated makes clear that we need
to provide treatment resources for these people. The workers'
compensation system in New York has presented nothing but
insults and frustration for those workers who have attempted to
get access to benefits. A small proportion of claimants have
gotten their cases accepted expeditiously. The majority filed
claims that were fought tooth and nail by workers' comp
insurance companies or self-insured employers, including
unfortunately New York City, with genuine heroes being accused
of lying and malingering, and their testing and treatment
delayed for months and even years.
This is a fragmented health care system in the United
States. It is seen all too clearly in the challenges these
heroes have had to face simply to get treatment for their World
Trade Center related illnesses, and it is important now that we
go ahead and provide mental and medical health care for all who
sustained health consequences as a result of this disaster, and
that means the residents in lower Manhattan, as well as all
those workers who returned prematurely to that dangerous site.
And it seems that we have to do better if there are going
to be disasters in the future in establishing an infrastructure
and a response that truly is public health in its orientation
and in its nature.
We have to provide information to treating physicians,
which didn't happen in the case of the September 11th disaster,
and it is important that we develop programs to provide early
diagnosis and treatment. These heroes deserve no less, and the
people who live in this the wealthiest of nations have reason
to expect that in the face of disaster, their health needs will
be our country's top priority.
[The prepared statement of Dr. Levin follows:]
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Mr. Shays. Thank you, doctor. Dr. Kelly.
STATEMENT OF DR. KERRY J. KELLY
Dr. Kelly. Good afternoon, Chairman Shays, Congresswoman
Maloney, and Congressman Fossella. My name is Dr. Kerry Kelly,
and I am the chief medical officer for the New York City Fire
Department.
I would like to thank you for the opportunity to testify
today. I would also like to thank you for the restoration of
the $125 million in September 11th funds, particularly for the
$75 million that will be available to local agencies providing
health and mental health services and monitoring.
On September 11, 2001, the FDNY responded to the World
Trade Center prepared to save lives. That is what they do every
single day. Fire Department members continued their rescue and
recovery efforts at the World Trade Center site for the weeks
and months that followed. Nearly 14,000 of our personnel from
every rank took part in the rescue, recovery, and clean up
efforts at the World Trade Center site. Our first responders
were the first in and the last out.
During the initial recovery and evacuation and later during
the extended recovery that followed, our first responders were
exposed to the physical hazards of the World Trade Center site.
No less significant is that our members were also exposed
to the emotional trauma. Very soon after September 11th, we
began to see medical symptoms, particularly that of respiratory
complaints. In recognition of those exposers, the FDNY
initiated the World Trade Center Medical Screening Program in
October 2001, just 4 weeks after September 11th.
The Bureau of Health Services partnered with the CDC and
NIOSH to implement medical screening for the exposed FDNY first
responders. More than 10,000 of our responders were evaluated
in the first 6 months following September 11th, and in
collaboration with NIOSH, we started our medical monitoring
followup program.
To date, we have seen over 4,000 of our FDNY exposed first
responders in this second visit evaluation. It is our goal to
continue to evaluate 13,700 first responders over the next
several years, but our goal really has to be to take people
beyond the 2009 cutoff that we currently face.
This extended medical monitoring is critical to the early
detection and treatment of diseases, such as cancer, heart and
lung disease. We know that asbestos-related illness data from
prior occupational exposures show that cancer is detected 15 to
30 years after exposure.
Because HHS had a medical infrastructure in place prior to
September 11th that included annual medical examinations for
all of our first responders, we are able to compare pre-
September 11th data to post-September 11th data. What we have
seen on a significant basis is a drop in pulmonary function
tests. In this healthy, athletic work population, we have seen
a significant decline that correlates well to the members'
initial time of arrival at Ground Zero. This pulmonary function
decline is 11 times greater than the average decline you would
ordinarily see with aging.
In the first 6 months following September 11th, 332 of our
firefighters required extended medical leave for what has been
called the World Trade Center cough.
Now, 4\1/2\ years later, over 25 percent of the FDNY
members are still reporting respiratory symptoms, and 2,000
have received extensive evaluation and treatment for
respiratory disease. Nearly all of these symptoms have been due
to asthma or rads. Unfortunately, symptoms persist, and many of
our first responders still need multiple expensive medications.
More than 540 of our fire department firefighters have
qualified for permanent lung disability, a four to five times
annual increase compared to pre-September 11th.
Our counseling service unit responded to the new needs of
this department after September 11th, expanding from a single
counseling unit in Manhattan to multiple locations in the
communities where our first responders live.
Partnering with multiple resources, we secured critical
funding to provide needed counseling services. More than 12,000
people have sought mental health services through our CSU. Are
those needs still there? The answer is yes.
Before September 11th, we treated about 50 new clients a
month. Currently, our 6 locations now average around 260 new
intakes a month. More than 85 percent of our clients are active
members who remain on full duty while seeking assistance.
The city's Department of Health and Mental Health World
Trade Center Health Registry provides essential tracking of
short and long-term health effects for more than 71,000
enrollees. It is the only resource designed to track and
maintain contact with a diverse group of people most highly
affected by exposure to the events of September 11th.
More than 3,500 of our first responders had to retire
sooner than expected; some with health issues; all with health
concerns. These dedicated first responders would have fallen
off our health track radar were it not for our intensive
followup medical and mental health monitoring program.
Fortunately, with the efforts of the Senators and Members
of Congress, we will receive the additional funding for the
Medical Monitoring Program for another 3\1/2\ years, through
July 2009.
This monitoring program allows us to monitor and identify
early trends of patterns of illness or wellness.
But as I noted earlier, it will not help us follow for the
long term. We need to continue this monitoring program for 20
to 30 years if we are to see the long-term consequences of this
environmental disaster.
The current Medical Monitoring Program also does not
address treatment. That is one of the many reasons why we need
a rapid disbursement of the $125 million Federal World Trade
Center aid to our treatment centers.
We thank you for the reinstatement of the funds, and we
again hope for that quick reimbursement of funding so that we
can provide the needed clinical services.
The FDNY takes great pride in responding to the health and
safety needs of the residents of our city. When the call is
sounded, the FDNY arrives to help, well aware that the threat
of terrorism remains, our first responders provide security for
our homeland every day. But we have concerns about the health
and safety of our rescue workers.
We have an obligation to make sure that no member is left
behind. We lost too many on September 11th. Early diagnosis and
treatment is effective. We can only prevent more loss of life
through sufficient, continued funding to provide long-term
monitoring and treatment. Thank you for the opportunity to
speak to you today.
[The prepared statement of Dr. Kelly follows:]
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Mr. Shays. Thank you all for your testimony. I will give my
time and take his time and allow Mr. Vito Fossella to ask the
first round. And, Vito, we go 10 minutes.
Mr. Fossella. Thank you very much, Mr. Chairman. I will be
very brief. For Dr. Kelly, and then thank the whole panel for
their testimony in coming here today.
Dr. Kelly, CDC is currently working out the distribution of
the funding that we all mentioned has been restored for
treatment. Now, do you have any projections on the long-term
funding needs for the Medical Monitoring and treatment of, in
your case, firefighters?
Dr. Kelly. We would project with additional funding, we
would need about $10 million per year, and again that funding
would ideally take us for the next 3 years, through the year
2009.
That would allow us to do treatment that will supplement
what the American Red Cross has given us. That particular
funding is going to be ending within the 2006-2007 timeframe,
as well as to continue and add to our monitoring program.
Mr. Fossella. Are there any projections beyond 2009?
Dr. Kelly. Again, our minimum would be at least that much,
and we would need to continue that program beyond 2009. It is
very important that we look at the long-term monitoring and
treatment. Two thousand and nine, although it sounds far in the
future, really isn't very far in the timeframe that we are
thinking about if we are going to look at long-term patterns of
illness, given the exposures that we saw in our department.
Mr. Fossella. So we are saying long term. I mean I know you
reference in the testimony upwards of 30 years. Is that to you
long-term or is 20 years long-term in your opinion? How do you
define it?
Dr. Kelly. I think 20 to 30 years would be the timeframe we
would be looking at to see the kinds of outcomes that we have
seen in the past from exposures to something just of asbestos,
there are other exposures at that site that we probably don't
even know all of the different substances and what those long-
term outcomes may be.
Mr. Fossella. OK. For both you and Dr. Levin, funding
aside, are there policies at the Federal level you feel would
be helpful or now a hindrance to assist you in not only, you
know, ongoing and long-term medical monitoring and treatments,
but that can better prepare and help address the needs of
firefighters and first responders for a, God forbid, future
attack?
Dr. Kelly. I think we were very fortunate that we had a
pre-existing medical office, and we were there on the ground
ready to start our work. We were able to recognize patterns of
illness, because we have a centralized medical office. I think
we worked very well collaborating with fellow medical
institutions, such as Mount Sinai, and we have also worked with
CDC and NIOSH so that we could develop programs that brought
thought and balance into these programs. I think we play a
critical role because of the cohort size we see. We see over
10,000 to 15,000 members. Mount Sinai sees about the same
amount of people. The larger the groups that you can evaluate
and see, the better you are able to see patterns of illness,
and you can really appreciate the development of treatments and
understand how to take care of people.
Dr. Levin. If I can just add to what Dr. Kelly has said. It
was clear in the wake of the September 11th disaster that there
was not a coordinated response at any governmental level to the
health concerns. It was rapidly clear to those of us who
practice occupational medicine that the likelihood of
respiratory problems and psychological distress was very high,
given what we saw on television people being dragged off the
pile choking, you know, for breath and at no point did any
level of government issue an advisory to the treating medical
community on how to understand the exposures, how to understand
the illnesses that might develop from those exposures, how to
evaluate such individuals, and how to treat them. We do that
for many other illnesses. It is a normal public health
response. It didn't happen here. And in any disaster situation,
it is the most important thing that physicians and other
practitioners who are going to see such individuals have some
idea of how to understand what they are going to be evaluating
and treating.
We don't train our physicians in this country in
occupational and environmental medicine, so the best
intentioned of physicians treated many of our patients with
antibiotic after antibiotic for things that were not
infections, but rather chemical burns.
In the situation following September 11th, there never was
assembled a panel of people with expertise in public health, in
understanding environmental exposures and their consequences,
to make an assessment of what were the exposures and what were
the consequences. There was a considerable amount of political
and economic influence on policy shaping. It seems to us that a
public health response requires that experts in understanding
the health effects of such exposures have to be isolated from
those influences for at least a period of time so an accurate
assessment can be developed and appropriate attempts to control
the illnesses among responders and other victims can be
developed.
The issue of a failure to develop treatment resources and
the slowness of developing a screening program and monitoring
program for other than the fire department, it was a wonderful
thing that they had an infrastructure in place. There was no
such infrastructure in place for the other responders other
than New York State's Occupational Health Clinic Network
Centers, which we are one of. And it was a good thing that we
were there.
Nevertheless, the failure to develop a treatment response,
we are still seeing the consequences of because treatment
delayed for many meant a greater severity and longer
persistence of their illness.
Mr. Fossella. Is there a time period in which there should
be this treatment response or this group to sit down, as you
say, a panel of experts to assess the nature of the problem and
then to issue the advisories accordingly?
Dr. Levin. Three weeks before the disaster and that means
now we should be thinking about what sort of panels are
appropriate to pull together for this purpose. But certainly
after a disaster, within a day, it is possible to gather people
with relevant expertise to assess the situation and develop
proposals as to how to mount a public health response.
We are an advanced technological society. We are capable of
doing this sort of thing, and it requires the political will to
make sure that it happens, because technically it is possible
to do it.
Mr. Fossella. Finally, doctor, and it is more of I guess
procedural--I know there was many--and we have received some
calls from some former New York City Police Department officers
who are now retired and living in other States. My
understanding is Mount Sinai contracts with the clinics outside
of New York, so September 11th responders living in those areas
have a place to go for exams. Can you elaborate on that, and if
there are those officers who are not near one of these clinics,
are there plans in the works to identify clinics that are
better prepared to handle that population?
Dr. Levin. Under the auspices of our screening program,
from 2002 through 2004, we saw nearly 700 responders from
around the country outside of the New York Metropolitan Area,
who had come to New York and done their significant rescue and
recovery efforts and then returned home.
We were able to work with an association of occupational
medicine clinics that exists throughout the United States
during that time to provide screening examinations. No
treatment resources were available for that group as well.
In the monitoring program, we are now in the process of
setting up exactly that sort of network around the country to
provide a second round of examinations and ongoing examinations
to those responders from around the country.
Again, the issue of treatment resources for them will be a
problem. There are some responders from areas of the country
where there is no local expertise in occupational or
environmental medicine. There isn't an occupational medicine
center nearby.
We will work with local physicians, providing them with
basic training materials on how to do the assessments that we
do here in our programs in the New York Metropolitan Area, and
how to make appropriate referrals with guidance sheets as to
how to understand these illnesses and how to manage them and
treat them so that local physicians, even if they don't have
expertise in occupational medicine and unfortunately too many
don't, will at least have the guidance of our experience that
we have accumulated over the last 4\1/2\ years.
Mr. Fossella. So it is up to, say, in this case, an
individual to see if there is a local physician willing to
assume that responsibility and willingness to learn from you
how to handle----
Dr. Levin. We will try to identify such physicians in any
geographical area where responders are. If they are unable to
travel to get to a clinical center with real expertise, we will
try to identify local practitioners, physicians with whom we
can work to provide these examinations.
Mr. Fossella. Thank you very much. Thank you.
Mr. Shays. I thank the gentleman. Mrs. Maloney, you have
the floor.
Mrs. Maloney. Thank you. First of all, I would like to
thank all of the witnesses today for their excellent testimony,
especially our two September 11th responders, Ron Vega, who is
a constituent of mine, and Marvin Bethea, who is a founding
member of the Unsung Heroes Helping Heroes, a group that I am
always proud to stand with in our fight for September 11th
issues. And they are representative of thousands more workers,
and they have led efforts to bring their concerns to Congress.
They have been here many times, and I thank them for their
work.
I would like to ask Ron Vega. It is my understanding that
you are a participant in both the World Trade Center Monitoring
Program and the World Trade Center Health Registry.
Can you tell me about your experiences with each, and were
they helpful to you?
Mr. Vega. Thank you for your help. I have to say that the
Registry, which I participated in, as I have said, probably a
month after I left the site in 2002, I have to be apologetic.
It had so little significance to me that I forgot that I even
participated in it.
I remember that we were forced by our agencies and nagged
and nagged and nagged to make that call, and then, when we made
the call, we were very frustrated by the questions that were
being asked of us. It was actually kind of consultant service
that was hired. These people really had no idea what we had
been through. The presentation of the questions were very
insulting in many ways. The questions that we were being asked
were like don't you know what we have been through? Why are you
asking us that?
So I have to say it reminded me of when I was a young
teenager and I got a survey about somebody doing a sex survey
and how active I was in my teens sexually. I have to say I lied
a lot on that survey.
And I had the same reaction on this survey. I didn't really
know how to answer it, because I knew that the questions did
not allow the proper answer that I wanted to give.
So I do appreciate the attempt that was made, but I didn't
really appreciate the questionnaire or the people that were
asking. I was pretty frustrated when I got off that phone. I
think I needed therapy when I got off the phone, and there was
nothing there. So that is why when the WTC Mount Sinai Program
started, at least it was something that said look you go into a
hospital. You are going to a hospital environment. You are
going to go see nurses, doctors. People are going to look at
your health. They are going to give you an examination. Even
that in a sense is frustrating, because you feel like OK, you
are going to watch me die, and you are going to watch me die
over 20 years. And you are going to confirm that I died out of
something I got at Ground Zero. But maybe that will help other
people.
See you keep talking about long-term monitoring. I don't
think I have 10 more years. I am pretty sure I don't. I don't
think Marvin thinks he has it, either. Not that we are going to
see 10 more years. We are going to make these good 10 years,
and no doubt if the country calls upon us again, we will go.
But I am pretty sure I don't have it. So just monitor us until
it makes a difference.
Mrs. Maloney. Have you received treatment from the
Monitoring Program?
Mr. Vega. No. No, I have not.
Mrs. Maloney. Have you received treatment for your
condition anywhere?
Mr. Vega. Here is the problem: the problem is if we are
working city workers, we can't take the time off to prove we
are disabled. I am an architect. So what if I can't walk up 5
flights of stairs anymore. Take the elevator. You can still do
some design, can't you?
But the problem is I can't. I can't even function half as
much as I did before. When you can't breathe, when you think
you don't have much life left, guess what? It affects the way
you work mentally also.
So we are at a high level of mental--I mean I always
thought that I was a pretty good architect.
Mr. Shays. Could the gentlelady yield for a second?
Mrs. Maloney. I yield to the chairman.
Mr. Van Hollen. Yes.
Mr. Shays. You know, this is very sensitive, but I find
myself reacting to what you are saying in one way impress that
you have an attitude, but feeling like you need to think
differently. And I really believe that do you do things like
exercise? Do you do things to compensate or--I mean maybe this
isn't part of the hearing, but it strikes me that when we talk
about mental health issues, this is as much a mental health as
a physical issue for you. And I am thinking that the system is
broken down more than I even thought, if you are allowed to
think that without at least being confronted.
So I want to confront you with it as----
Mr. Vega. No, you are right on target. You are right on
target. They are interchangeable. They are intermixed.
Mr. Shays. Do you have kids?
Mr. Vega. Yes, I do.
Mr. Shays. How old are they?
Mr. Vega. My oldest now is 25.
Mr. Shays. Right.
Mr. Vega. No. 2 is 20, and No. 3 will turn 18 this Friday,
God help me.
Mr. Shays. OK.
Mr. Vega. So----
Mr. Shays. You need a 5-year-old that makes you want to
live for more than 10 years.
Mr. Vega. No, I have a grandniece, who makes me want to
live, and she makes me want to live every minute that I live.
Mr. Shays. Right.
Mr. Vega. When you know what it is like to be without air,
and you get that feeling constantly, when you have to walk all
around your life with one of these--it goes to a nebulizer----
Mr. Shays. Has the medical community told you have 10 years
to live?
Mr. Vega. No. No, no, no.
Mr. Shays. Yes.
Mr. Vega. You know, as I said in my testimony----
Mr. Shays. You know what I would--we don't have the 10-
minute rule with the----
Mr. Vega. Oh, OK.
Mr. Shays [continuing]. Gentlelady from New York and I when
there is just two of us left. So I will give her back the
floor.
Mr. Vega. OK.
Mr. Shays. I just needed to tell you that I couldn't lead
this hearing and hear you say what you are saying without
wondering a bit about whether that is to your advantage to feel
that way. And I wish there was some doctors that could comment
about it.
Mr. Vega. I appreciate what you are saying. I really do.
Mr. Shays. Where is Dr. Fleming when we need him?
Mr. Vega. I hope I am wrong, believe me. I hope I am wrong,
too.
Mr. Shays. I mean, Dr. Levin, maybe you could just respond
in general about the attitude that says you are--I mean should
we make an assumption that people can't be helped, that they
can't find healings? I mean tell me. Help me out. Dr. Kelly.
Dr. Kelly. When we did questionnaires right after September
11th, we asked people about health concerns. Even those who
didn't have an active problem truly believed their lives would
be shortened by their exposures. The feeling that you had when
all of that dust and debris were falling down on you was that
this can't be good for my health. And for the people who
continued to have respiratory symptoms, particularly in a group
who was in good health before that, this was a group who was
very athletic, very physical. They sought our department work,
because they liked that hands on. They had no problem running
up and down buildings with equipment on.
When you suddenly can't do what you could do before, life,
as you know it, changes.
Mr. Shays. Right.
Dr. Kelly. You know he brings up the point that someone
says you can take an elevator, but that is not what you planned
on doing with your life, so people have a changed image of
their own health, their wellbeing, and what their future holds.
Mr. Shays. I guess I am reminded of Congressman Dingel, who
told a whole group of us his father was a rather crusty guy,
and the doctor told him he only had 5 more years to live, and
he said, the hell with that. He said, I am going to piss on
your grave. And that is Congressman Dingel's father, and he
lived many, many years, and I am just responding to that.
Dr. Levin. Well, let me comment on this because our
clinical experience tells us that many of our patients who have
been given the best of care we know how to give are improving
but very few are feeling the way they did before September
11th.
Mr. Shays. But that is a different issue. Yes.
Dr. Levin. And the issue of whether, in fact, people's
lives will be shortened by this experience is not something
that we can answer with any certainty----
Mr. Shays. True.
Dr. Levin [continuing]. At this point. And unfortunately,
the recent deaths in New York have provoked lots of words among
World Trade Center responders as well as community residents
and everyone who came back to work in lower Manhattan.
Mr. Shays. I just don't like the idea that we are going to
pay money to monitor their death. I want to monitor their life,
and I want to find ways to help them live.
Dr. Levin. I think the last point that you made is the most
important point.
We are interested in learning what we can about the
consequences of this disaster. We are much more interested in
trying to intervene so that people's health can be protected,
improved, and that unnecessary death can be prevented. That is
the purpose of the monitoring program, not to gather
statistics.
Dr. Kelly. And the other thing is that this is health and
mental health, and we know that those two go together, and that
your mindset affects how you feel physically.
Mr. Shays. Right.
Dr. Kelly. And attention to the mental health aspect is
critical in this monitoring program. We know that the full
effect from a mental health perspective is not always felt, a
week or two after the event. It is felt later. And addressing
that issue is a critical part of what this program is all
about.
Mr. Shays. Well, the bottom line is, Mr. Vega, I like you a
lot. I want you to live a long life.
Mr. Vega. I just hope that you understand I am about the
most positive person on Earth.
Mr. Shays. I know.
Mr. Vega. So when I say that, it carries a little more
weight.
Mr. Shays. Well, you are a beautiful man, and----
Mr. Vega. Thank you so much.
Mr. Shays [continuing]. Mr. Bethea.
Mrs. Maloney. OK. Thank you, Mr. Chairman. I would like to
ask Marvin Bethea if he would share with us his chart on the
medicines that tells a huge story in itself. And I would also
like you to share some of your experiences and specifically do
you believe or think it is the responsibility of the Federal
Government to fully monitor and treat the sick and injured
September 11th responders?
Mr. Bethea. Absolutely. Again, I would like to draw and say
now being sick changes your life. I mean I was very athletic,
and I took great pride in the fact that at 38, I could hit the
boys' ball to the second baseman, and still beat the ball to
first. I mean that is how fast I was. They had to go up two
flights of stairs of huffing and puffing. I played tennis. I
rode bicycles. I was very athletic. But again, being a
paramedic, we had to climb up and down stairs. You carry a
patient, so with September 11th we went. We served. We did what
we had to do on that day, not realizing that this is going to
be a slow death sentence. And as much as you try to think
positive, you do think about death. And I mean I am very
grateful for the Mount Sinai program, and my psychiatrist, Dr.
Laurie Malkoff, because without her, I don't know if I would be
here today. The tests might mean I will never be the same. I am
very, very emotional. You know being on all this medicine, it
is very hard.
For instance, before September 11th, I was taking two
medicines for colitis. And now, because of September 11th, here
is all the medicine I have to take.
Mrs. Maloney. How are you treated? Are you a part of the
Monitoring Program, on the Registry?
Mr. Bethea. Right. I was very--I am sorry.
Mrs. Maloney. What are your experiences with the Monitoring
Program and the Registry?
Mr. Bethea. The Monitoring Program at Mount Sinai has been
absolutely wonderful. I was very fortunate that I got into the
program early enough not only to get monitoring, but I also get
the treatment. And so I was one of the lucky guys--myself as
well as my partner. But there is, you know, like a 3-month
waiting list to get treatment. So again, is it is nice that the
government can tell you OK, you can go here. You will get
monitoring. We will do some screening. But as far as your
asthma, post-traumatic stress disorder or any other problem you
have, well, you are on your own, and come back in another 5
months, and we will tell you whether or not you still have
these problems, but yet, we are still not going to give you
treatment, because of the thing is diagnosing, recognizing what
you do have and then on top of it is then making sure the
person gets the treatment. And unfortunately, too many people
are not getting the treatment, and the Federal Government needs
to have--I mean we see this also go down with Katrina--a
Federal health care insurance where that if anyone responds to
a man-made or a natural disaster that and you respond in an
official capacity, and, God forbid, you get injured or hurt,
that you will have Federal health care coverage as well as
receive some type of financial compensation, because now they
tell everybody about COBRA. Oh, go out and get COBRA.
Well, COBRA is nice, but if you aren't working and have no
money, COBRA costs money, so you don't have health care. All of
this is a real wakeup call for me, because I have always had
health care insurance. And all of a sudden, when I stopped
working and I lost my benefits, it was like, oh, my God, I am
one of those 43 million plus people who don't have health care.
And that was a real wakeup call.
Fortunately now, since I do receive Social Security, I now
have my health care back through my union, but for a while
there, I did not have health care, and you don't realize how
important it is until you don't have it. And, you know, we all
went out to do our jobs that day. I mean you look at a lot of
these young people who were so affected by September 11th that
they turned around and they joined the military. They got into
the Armed Forces, because everybody felt they had to do
something to support this country, and that is what we did.
And it is a shame now again and I get back to President
Kennedy. I always admired President Kennedy that, you know,
what would President Kennedy say to what the U.S. Government is
doing today about the treatment of heroes and survivors. It is
totally un-American, and we are a better Nation than that, and
we can do better than that. It doesn't make any difference
whether you are a Democrat, Republican, or an Independent or
whether you are a Catholic, Jewish, Protestant, Muslim. You
know, we are a better country. I mean you cut me. I bleed red.
You bleed red. And it is just a shame that we have somehow lost
sight of all this. I was very touched and moved by especially
New York City, as well as the country right after September
11th how we all became one. And it wasn't this or that. We were
all united together, and unfortunately, as the years have
passed now, we started to lose that, and we are quickly
forgetting what brought us all together again.
And some people say it is almost as if we need another
attack to wake us up again, and we don't want that to happen,
but, you know, we could do a lot better than that, because why
should any rescue people respond to anything knowing that, God
forbid, I get hurt or I get sick that I won't be able to take
care of myself or my family. I mean these people--I know guys
that are losing their families, losing their homes, because
there is no money, and every time they go and try to get help,
it is like, well, you don't qualify for this. You didn't fill
out the paperwork soon enough. And I know, yes, we are a better
country than that. We truly are, and we need to take care of
the people, because you can pay me now or you can pay me later.
And we need to pay the people and do it now, so we don't wind
up paying a big price down the road.
Mrs. Maloney. Well, I think you raised a lot of important
points and that we need to, God forbid, we have another
September 11th, but we have to learn from this experience for
future disasters and future emergencies.
I want to compliment Dr. Kelly on your testimony. The fire
department really is the symbol of the strength and resilience
of New York. You lost so many people. They performed so
bravely, and I know I join Congressman Fossella in supporting
his line of questioning on what it is you need to continue your
work and just ask that request be placed in writing to our
committee so we can continue to work with you and the
administration on meeting your needs.
I would like to pose the same question to Dr. Levin that
Congressman Fossella posed to Dr. Kelly, which is, what do you
feel you need to complete your work in terms of resource and
length of time, and I--what do you feel that you as a
consortium need to continue to complete the work of helping the
September 11th responders?
Dr. Levin. About a year or a year and a half ago, we were
asked to come up with an estimate of what would be needed to
follow this group of responders out over the next 20 years, not
just for screening evaluations and monitoring examinations, but
for treatment as well.
Dr. Prezant, Dr. Kelly's colleague, and I sat down and
quickly made an assessment of well, what were our current
levels of funding, what were we not able to do with that
funding, and what would be needed.
And over the next 20 years, we made an estimate of about
$315 million to $320 million to provide monitoring as well as
treatment resources over this next 20-year period. If this
population----
Mrs. Maloney. And that is with the fire department and
Mount Sinai or just the Mount Sinai consortium?
Dr. Levin. At that time, it was the two programs combined.
Mrs. Maloney. The two programs together.
Dr. Levin. We have learned some now that we didn't know
when we made that first estimate of what it really costs to
provide especially mental health services, how commonly these
mental health problems are experienced by our responder
populations, and how severe they are.
And I think that initial estimate was probably something of
an underestimate, but it is a reasonable approximation.
The problem is that following people for only 20 years
means that some people will go ahead and develop cancers as a
consequence of their exposures at Ground Zero or at that Staten
Island landfill, who will not develop those diseases within 20
years time. We know the experience of occupational groups and
how long it takes for them to get their cancers after
exposures.
So a period of at least 30 years is warranted, which means
that some additional money would be needed to follow them for
another 10 years.
Mrs. Maloney. Thank you, and I join Fossella in hoping you
will get that to us in writing.
And GAO, you haven't had a question yet, so I thank you for
your testimony and the many research papers that have done on
the September 11th response and what is needed.
And I would like to ask isn't it likely that the variation
in the current array of monitoring programs--I believe you
mentioned four in your testimony--will lead to many situations
in which people will have the same exposure, but may not have
their needs met because they will have unequal access to exams,
unequal followup and unequal treatment.
Ms. Bascetta. Yes, that is certainly the case. I think that
Dr. Levin characterized our health care system as fragmented
and that, in combination, with a rather haphazard approach to
monitoring as the situation evolved over the last several
years, you know, creates, as we have stated, some people who
get only a one-time exam; others who get an examination with
followup. Those examinations are not necessarily consistent
across the programs, and they are certainly not needs-based.
They are not based on the exposure that the individual
experienced. They are based on what program the person is
eligible for, so that certainly creates inequities across the
programs if you are looking from a needs-based perspective.
We would also about the differences in referral patterns
and how consistently those might be occurring. So you are
correct in your characterization.
Mrs. Maloney. So it what hat you wore, not what dirty air
you breathed in?
Ms. Bascetta. That is right.
Mrs. Maloney. In terms of what you are confronted with
treatment. It should be the same. If you breathe the same dirty
air, got the same exposure, you should get the same treatment,
is that basically what you are saying?
Ms. Bascetta. From a medical perspective, that is what you
would need.
Mrs. Maloney. Thank you. My time is up, but I have one last
question. I would like to ask Dr. Kelly and Dr. Levin, I would
like to ask you about the World Trade Center Registry, and has
this Registry ever provided you with any information that you
have found valuable in conducting your medical monitoring
programs?
Dr. Levin. Well, I will take a first crack at that. They
did release interim reports based on their telephone surveys,
and what it did was confirm what we were seeing among our
responder populations--fairly high rates of respiratory
symptoms being reported and some psychological distress, as
well as gastrointestinal problems.
I can't say that anything has been learned that is new that
we didn't already know from our examination programs. And it is
probably too early for a registry of that sort to be able to
identify problems since many of the diseases that presumably
the registry was set up to identify aren't going to appear for
another 20, 25 years.
The real problem that I have with the Registry, and this is
something of a technical matter, is whether it has the
statistical power, enough people in its enrollment, to be able
to detect increases in some of the diseases that we are
concerned may result from these exposures. The epidemiological
method that it uses and this is by their own calculations
indicates that they may not have numbers sufficient to be able
to answer important questions like are lung cancers going to be
increased in this population.
So registries are valuable and important if they have the
technical capacity to answer the questions they are set up to
answer. I am not confident that this registry can do that, and
that is a real concern. We have not learned anything new from
them thus far.
Mrs. Maloney. To followup, in reading your papers and
others, the ``World Trade Center cough'' is usually described
as a respiratory problem, a breathing problem. Many of the
people who come to me have rashes and breathing problems.
You mentioned gastrointestinal problems, and is this
something that is new coming out years later, but in the first
research I wasn't gastrointestinal. And is that as prevalent as
the cough pattern? When you have the cough, do you have the
related gastro--I think the point that you made on having
medical protocol like we have for SARS is very, very important
so that we know what to look at, and I have many people call me
on their concerns, and this is the first time I have heard
gastrointestinal. Is that as prevalent as the breathing?
Dr. Levin. We reported on it early, in September 2004, and
we began seeing it as soon as we began seeing patients that
people were experiencing acid reflux problems, very severe
heartburn, chest discomfort with acid secretions backing up
into their throats. People had never had this problem before
September 11th.
Then we talked to our colleagues at the fire department,
and they were seeing this very frequently among the firefighter
responders. And it is quite clear that in our treatment
program, not the monitoring program, a very high proportion of
our patients have this reflux problem. That is what we mean by
the gastrointestinal problem, and it complicates asthma and
sinusitis. Those people who have acid reflux, who also have
sinusitis and asthma, we find very much more difficult to
manage medically because the reflux itself makes those other
conditions much worse.
Mr. Shays. Why is that?
Dr. Levin. We don't have a full understanding, but clearly
the acid, when it backs up to the throat, some of it is
inhaled, and that acid is a very strong irritant to the
respiratory tract, whether we are talking about sinuses or
whether we are talking about the airways in the lungs. And we
know that acid mist can provoke asthma and cause it and make it
much worse.
Maybe Dr. Kelly has some new understanding of how the acid
reflux makes conditions worse, but certainly we observe that
those patients who have this problem, especially if it is
uncontrolled, find that their asthma and their sinusitis is
much more difficult to take care of.
Dr. Kelly. I don't begin to have the answers, but we have
seen that same increase in GI-type symptoms. It can even be a
reason for a cough. It can certainly affect some of the voice
changes that people have, because as that acid refluxes back,
it can affect the vocal chords, so that a lot of the upper
symptoms can be influenced and the cough with the GI symptoms.
But, you know, getting back to the Registry, I think the
Registry serves a different purpose than the monitoring
program. It is not a substitute for a monitoring program, and I
think the problem always is if there is X amount of money, none
of us should be in a position where we are competing with the
Registry for money. They are separate programs. They serve
separate needs.
But to look at the overall pattern of the people who were
there and to see trends it serves a purpose in that regard. And
I think it also serves as a unified presence so that people who
are looking to do research and looking to develop programs
about other aspects. You know, we just talked about a
fragmented medical program. There are specific groups of people
that may have been at the September 11th situation whose
conditions or problems are similar to hurricane victims in
Florida, and if there is someone in that medical community who
is studying the effects on a group of school-aged children, you
have the ability through the Registry to look at a comparison
in that group.
Therefore, people who are outside of that mainstream that
we are looking at might be able to be looked at through the
Registry.
So it does serve a purpose. It is not the same as a
monitoring program. We can't look at it to provide the same
sets of information, but it is another tool to help us look at
long-term patterns.
Mrs. Maloney. As a followup to you and Dr. Levin, all of
these individuals, all individuals are eligible to be part of
the Registry, but area residents and school children are not
allowed to be part of the Federal monitoring program. Does that
make sense to you? Do you believe access to medical monitoring
should be based on who you are or what you were exposed to? And
I open it up to Dr. Kelly and Dr. Levin for any comments.
Who you are or what you are exposed to, because you have
all these programs, and they are limited. This is for this
group of people. This is for that group of people. At the very
least, the Registry is open to everyone, and again I just ask
do you believe access to medical monitoring and treatment
should be based on who you are or what you were exposed to?
Dr. Levin. Well, I think it is clear that the exposures
should be the key aspect of this, and I say that on the basis
of real clinical experience. We have in our Center for
Occupational and Environmental Medicine many patients who were
not eligible for the monitoring program or the screening
program, because they weren't responders. They were people who
were required to come back to their employment in lower
Manhattan sometimes within a week of September 11th, in part
because the EPA said that air quality was safe, the employer
said you have to come back to work or you don't have a job. I
have patients who never had asthma before, who came back to
office space within a week of September 11th that was 4 or 5
blocks southeast of Ground Zero. Each day they would go from
subway to their offices, walking through that cloud of dust and
smoke and developed asthma, developed sinusitis, the same
conditions that the responders developed.
There is no access to a program for such individuals, and
the same can be said of some of the community residents, who
returned to their homes, their apartments; found themselves
exposed; found their children developing asthma for the first
time. Some of them had adequate insurance. Many did not. Many
found it difficult to get health care. And it seems to me a
public health response that is comprehensive, especially in a
country that can afford to do this sort of thing, would entail
making sure that all the affected people had an opportunity to
be evaluated and taken care of.
Mrs. Maloney. Any comment, Dr. Kelly?
Dr. Kelly. Well, our particular group has always taken care
of our fire department, so that has been our avenue of concern,
and I suppose our exposure has placed us in the forefront of
this event, because we again were the first there and the last
to leave.
So looking at our health patterns, I think helps other
people see what their exposures were, because there were none
in my mind greater than ours.
And certainly the mental health, we have seen the trickle
down effect not only to our first responders, but their
families, so that it is clear that these effects were felt
across the board, not just by the people there, but the people
in that surrounding area.
Mrs. Maloney. Thank you for your testimony.
Mr. Shays. Thank you. Mr. Bethea and Mr. Vega, when you
were working at Ground Zero, were you paid employees or were
you volunteers?
Mr. Vega. I worked for the city of New York, but I
volunteered for that detail.
Mr. Shays. So they were asking for volunteers, but you were
being paid as a city employee.
Mr. Vega. In lieu of going to our regular city job----
Mr. Shays. Exactly.
Mr. Vega [continuing]. That became our city job. Yes.
Mr. Shays. Mr. Bethea.
Mr. Bethea. I am a 911 paramedic, and in New York City half
of the EMS system is run by the city fire department providing
hospitals like Saint Vincent's----
Mr. Shays. Well, let me ask you how long were you at the
site?
Mr. Bethea. I was there that day. I got buried by both
towers that day, and then I went back on the 14th, the day the
President came, and dug all day.
Mr. Shays. So you were only the----
Mr. Bethea. Two days.
Mr. Shays. Just 2 days.
Mr. Bethea. Two days. I got buried the first day, and then
on the 14th. And you can hear this----
Mr. Shays. And you, Mr. Vega, were there for 10----
Mr. Vega. Ten months.
Mr. Shays [continuing]. Yes 10 months. It is interesting
for me to kind of sort how some people can be there for, you
know, 10 months and be healthy and others 10 months and not,
and then someone 2 days and not be healthy with just 2 days----
Mr. Vega. If you had seen that site, you would understand.
That site gave up plumes of toxic fumes from unpredictable
spots. If you wound up being in that wind stream, you inhaled
about 10 months worth. Or if you worked there 10 months and you
were able to avoid the blue-greenish smoke as it came out of
the hole, you were OK.
Mr. Shays. Would you. Yes?
Mr. Bethea. Again, it is just like, you know, in medicine,
we have different routes at which you give medicine. And like
take it--and given intravenously, that is the quickest way to
get medicine. But if I take the medicine and rub a cream on you
and it is absorbed through the skin, it will take an effect,
but it takes longer. So you have to understand on that first
day, when those towers came down, we got a massive dose of all
the toxins that was in the air, because you got to remember, I
mean I was literally white from head to toe----
Mr. Shays. OK. So----
Mr. Bethea [continuing]. And I was literally blowing out
pieces of concrete out of my nose that day, so I inhaled a
major--it was like--the best way to describe it was a big
bucket of toxic dirt that I swallowed, and so that is why a lot
of us who were there that first day got sick, because we were
there when the towers came down.
Mr. Shays. Well, which was leading into my first question I
looked to my left. I looked to my right. I see this
unbelievable picture of just, you know, 90 plus stories two
times, plus another building, all in total debris next to the
Statue of Liberty. There is something incredibly poetic or
striking about that. But I have empathy for government
officials that allowed you to be there the first day because
you were hoping to save lives that day. But once it began that
we were looking for body parts, I am just wrestling with how it
is that we allowed this to happen. That is what I wrestle with
and others. As eager as you are to get in there, you know we
should have held you back. I am talking to Mr. Vega. We should
have held you back.
Mr. Vega. I thought that same thing many times. After the
first 2 weeks, there should have been a stop, hold, let us
rethink this. I understand what it was like to go in there
looking for bodies and try to save people. A lot of the
engineering feats we did on that site were to save people. But
after 2 or 3 weeks, pretty much all hope was lost, and there
should have been a step back. Let us look at this.
Mr. Shays. But then I am struck by that fact that in 10
months, you all did what some people said was going to take 2
years. And you got that out of the downtown Manhattan and out
of the center, so, in a sense, lots of lives were saved,
because we could have just let that thing smolder for years,
and it would have just been spewing out all the caustic things
it did.
Ms. Bascetta, as Director of Health Care, tell me your
background, your expertise?
Ms. Bascetta. My expertise is in public health. And before
I worked in this area, I spent about 8 years looking at
veterans' health care and disability compensation.
Mr. Shays. So I guess as you are doing this study, I am
curious if you said, my God, how is it that we allowed this to
happen? I mean I am in the outside looking in. I am not a
medical professional, but I know we would never have allowed in
downtown Manhattan to have a landfill, a burning landfill. I
mean so and we wouldn't, because it would be highly dangerous.
So this thing is highly dangerous, and it was highly
dangerous for nearly 10 months. But what I am wrestling with is
why we didn't tell people they had to go in in suits and total
protective gear, and if you couldn't work in that condition for
8 hours, maybe you worked for 2, and we just kept bringing new
people in, and you had 2 hours on, 2 hours off, and so on.
Tell me if you had any of these emotions when you were
doing this study? Or in thinking about it now?
Ms. Bascetta. Well, I used to work for the Occupational
Safety and Health Administration.
Mr. Shays. Pardon me?
Ms. Bascetta. I worked for the Occupational Safety and
Health Administration, and so as a person with that background
when I was watching as a citizen, I was very concerned about
the exposures of people who would be engaged in recovery
operations. But I have to say I mean I think everyone was
overcome by the emotion of the time. It was unprecedented. You
know there are lots of problems fitting personal protective
equipment, particularly on a scene like that. It would have
absolutely slowed things way down, perhaps appropriately.
You know I think we need to step back for a moment and ask
why our preparedness overall is a problem, and I think that
part of it is that we don't think before an event about what we
need to do and what we need to be concerned about. We didn't
think, you know, from the first day about what we needed to do
to prevent the people who were going to go in and do the
recovery operations. We didn't think about----
Mr. Shays. But there wasn't even one person?
Ms. Bascetta. Well, we didn't think systematically. I mean
we had----
Mr. Shays. Yes. I guess what I would be interested is I
would love to have a hearing with that person who said, you
know, I was saying this and no one was listening. Then I would
like to know why no one was listening. It had to have been
somebody who said this is about the craziest thing in the
world.
Ms. Bascetta. Yeah.
Mr. Shays. And, you know, the Congress included. Me
included.
Ms. Bascetta. Well, I am asking.
Mr. Shays. All of us. I mean I think about it now, and I
just--well----
Ms. Bascetta. Well, I am asking myself now whether we are
repeating something in a different situation in New Orleans,
where we have workers engaged in recovery operations there who,
you know, under the National Response Plan, OSHA has an
obligation to assure that they are provided with equipment to
make that job as safe as possible, and EPA has done some amount
of monitoring. I hear anecdotally that, you know, there are
disputes about the EPA measurements.
I mean it seems to me that several years from now, we could
be in a similar situation were we have some other kind of
Katrina-related health effects, and we haven't proactively
dealt with that either.
Mr. Shays. Help me, Dr. Levin, Dr. Kelly, wrestle with the
issue of Mr. Vega and this is a hearing from the people at the
front here, sir. You can speak to any Member afterwards. We
would be happy to talk with you. Thank you.
Let me ask you is there anyone in this audience that was
involved in the clean up site, if you would raise your hand, is
anybody here?
[Show of hands.]
Mr. Shays. OK. We may invite one or two of you to come up
afterwards, so we will see about that. All right?
What is the point of monitoring for monitoring's sake? Let
me ask you this, Mr. Vega: what kind of health care are you
getting right now?
Mr. Vega. Whatever my city health insurance can offer me.
It is almost like a catch 22. You can't claim you were hurt at
Ground Zero, otherwise you got to go to workers' comp, and
otherwise you have to take time off from work. I can't afford
any of those.
So now, you wind up going to your regular doctor who has no
training in this kind of toxic exposure. When I give him my
test results and show the high mercury and the high arsenic, he
had no idea what to do. There was not any doctor in his whole
service, provider service, that could deal with this. I just
had to sit back and get a bunch of these. And this is what I am
on--albutyrol and nebulizers.
Mr. Shays. But that may not be helping you.
Mr. Vega. This is all I have. This is all I have. I hear
now----
Mr. Shays. I mean I don't want to continue a program that
is going to continue with what you are doing. I want you to get
help.
Mr. Vega. Well, that is what we are asking you to do, to
continue a program and offer some treatment component with the
Mount Sinai situation. That would be the best thing.
I mean I am a city worker recovering from Ground Zero
contamination, but I am using my regular city services. It is
crazy. There should be some kind of like medical consortium
saying let us attack what happened at Ground Zero. Let us put
all these people together and find out how to help them, like
we just came out of some toxic disaster, and you want to make
sure we don't contaminate anybody else. There should have been
some way to say look, let us take care of these people, not
because they are nice people, but because you are probably
going to need them tomorrow.
I mean we really feel like we have been abandoned here. We
were sent back to our city jobs. Go back and design your
libraries and your churches and your firehouses and go back to
your life as normal. It was us being proactive that said, no,
we need debriefing. We need mental health services. We need you
to put everybody that came back. I mean 1 day coming back from
that site, you just can't go back to your regular job. You
can't think of anything. You are frozen. Really, your mind is
still not opened up yet. So we had to be proactive. We had to
beg people to send therapists and counselors to our office
sites so that when 60 guys came back, they sat at a lunch
period, and everybody got kind of debriefed a little bit, and
were reached out to. And there are still members of my--in my
agency that have not had one ounce of therapy. And they are
hurting, and I can see it in their faces, and they are just
trying to go on blindly day by day. They look like they are
lost souls. I can't reach them yet. But maybe if we start
talking about the fact that it is really out there, and we
really reach out to Mount Sinai and say Mount Sinai instead of
you asking me how many body parts did I see in the 10 months I
was there, 10 seconds after that send me to a therapist; that
will work.
I tell you sometimes I go through those questionnaires, and
I need more therapy than when I went in. It is amazing. It is
amazing. It is sort of like anecdotally, well, you know, the
first 10 days how many body parts did you see. OK. About the
next 10 days. It was like that. Those are the questions that
are in these programs, and I help as much as I can. I answer
everything honestly, but don't ask, well, you know, can you
have me talk to somebody now. He said, well, we will make an
appointment for you. We have a whole set of services here we
can provide for you, but you know you need the help right then
and there when you open up those wounds.
These are the kinds of things that we are dealing with. And
we are going about our business. We are doing our city work. I
mean when the wall collapsed on the Henry Hudson Parkway, we
were there. OK. The blackout in New York, we were there.
We are still jumping to the call. We are still answering
the call. We are just maybe taking a step longer to get there.
Dr. Levin. I think what Mr. Vega is talking about points to
some of the very real problems of setting up a monitoring
program without a treatment program aspect to it, because we
found ourselves in the situation until we got some
philanthropic funding of identifying people who really needed
care desperately and having no resources available to provide
that care. And the point that he makes about the workers' comp
system, and it is not just taking off from work. It is also
then finding the New York City Law Department, because the New
York City is a self-insured entity, fighting these cases tooth
and nail, and every city worker who has gone through this
workers' compensation process knows just how difficult it is
made for them and how insulting a process it is and people talk
to each other. And so what Mr. Vega does is what so many
workers have done and said, I am not going into that system,
even though it is set up presumably to take care of people for
that purpose, because it is too difficult. It is too insulting,
and the end process is too far away for me to get care.
For claims that are filed in workers' comp for World Trade
Center-related illness, we have seen people wait 2\1/2\ and 3
years before their claims are resolved. During that period of
time, who's providing the medications? Who is providing the
support for additional testing that is necessary? The workers'
comp carriers, the insurance companies, and in this case the
city of New York was not, so people were left to their own
devices. We did get some philanthropic funding. That made it
possible for us to take care of some of the people that we
identified through our screening program who needed care.
Marvin is an example of that.
Those funds we had to go hat in hand to those philanthropic
organizations and say please we have people who are sick. Can
you give us funding so that we can take care of them, because
there was nothing systematic set up to make sure that they were
cared for.
It is good to hear that $125 million is now restored to New
York. But frankly, even though the efforts were successful and
we are deeply grateful that it is happening, it is a backdoor
way of taking care of what should have been a governmental
response to a public health problem that was caused by an
attack on this country that these people responded to. There
has never been up to this time a systematic and comprehensive
approach to how to take care of people like Mr. Vega, who
desperately need care, and some of his concerns about what his
life is going to be like might be helped by such care, but, in
fact, no programs have been funded by the Federal Government or
any other level of government to make sure that people are
taken care of.
Mrs. Maloney. I thank the chairman for yielding, and
request permission to place in the record the ``Findings and
Treatment for High Levels of Mercury and Lead Toxicity.'' This
is a paper put forth by Dr. KOKi and Claire Haaga Altman, who
is president of the project Olive Relief, and I request to
place it in the record.
Mr. Shays. Without objection.
[The information referred to follows:]
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Mrs. Maloney. Many people wanted to testify today. We did
not have room for the panel, but I would like to ask a question
to Drs. Levin and Kelly about my constituent, Mr. Vega.
He just mentioned he has high levels of mercury and lead.
What is the treatment, if any, to remove these terrible items
from his body? What is the treatment to remove mercury and lead
from our firefighters and our Mr. Vegas and our Marvin Betheas?
Dr. Kelly. One of the issues is that you have to test the
correct way. If you do blood testing for mercury, you may get a
false elevation. You need to check urinary mercury, again
because we had been doing this beforehand with our HAZMAT
units, we had known this fact so that when we set up our
medical monitoring, we set up our program so that we did test
that way, and we worked with NIOSH and CDC to send off for many
of the unusual heavy metal and toxins that might be seen at the
site so that in our overall numbers, we had very, very few
people that had high mercury, because we did that the correct
way.
At one point, there was a problem because they had been
done incorrectly and there was a concern raised about mercury
at the site, but then when the retesting was done correctly
using urine mercury, it was realized that was sort of a false
positive. So that we did not run into that type of a heavy
metal problem with our particular group.
Mrs. Maloney. But if you did, Mr. Vega has tested high in
mercury and lead and others have, and assuming that they have
been tested----
Mr. Shays. Just lead. Just take lead.
Mrs. Maloney. Take lead.
Mr. Shays. How do you get it out?
Mrs. Maloney. How do you get it out of their bodies? How do
you treat them if they have these particles in them?
Dr. Levin. There is a standard treatment for lead
poisoning, and it involves what are known as chelating agents.
We have a long history in occupational medicine of taking care
of individuals who have lead toxicity, ranging from iron
workers to people who are exposed to lead in paint, in battery
manufacturing. So we have very well standardized approaches for
testing for lead poisoning, as Dr. Kelly mentions, as well as
the treatment of it, and there used to be an intravenous
treatment with what is known as EDTA. Now we can use an oral
agent, known as Succimer, or DMSA. These are compounds that
bind to the metals and enable them to be cleared in the urine
by the kidneys. That is true of mercury as well. There are
particular treatment agents that can remove inorganic mercury,
not the kind of mercury that is present in fish, but the kind
that comes from exposure in industrial circumstances or other
environmental circumstances. When these levels are genuinely
elevated in the body, we do have treatments that can be
effective.
The question that I have, and I don't know about Mr. Vega's
individual case, and maybe we will have an opportunity to talk
after here.
Mrs. Maloney. Let us ask him right now. Mr. Vega, have you
gotten any of those treatments?
Mr. Vega. As I have stated, once I went to my primary care
giver through the city agencies. They had no professional
provider to deal with this issue.
Mrs. Maloney. You have gotten no treatment for your high
levels of lead.
Mr. Vega. No, we did everything we could. We went to the
Indian herbal treatments--Ayurveda, 2000-year-old treatments.
We have taken herbs. We have been taking--we have been going
to--I am just----
Mrs. Maloney. But you never had the treatments that Dr.
Levin just described?
Mr. Vega. No. No medical treatment. Any person who wanted
to help us, try to get us healthy any way they can, we tried.
And some of them are not as present as others, and we have
tried everything we can, because there is nothing else out
there. We are that desperate.
So we have been proactive. We have been proactive medically
and proactive with mental health issues, but we were told
pretty much there was nothing else out there, even at Mount
Sinai. We just had monitoring, and no treatment, so what else
could we do?
Dr. Levin. I make an open offer. All right. That you and
your colleagues might bring the medical records to us. Let us
have an opportunity to take a look. See if we are in agreement
with whether the right testing has been done. If, in fact, we
find elevations of metals among any of your colleagues, we
would be pleased to offer the best that we know how to offer in
the way of treatment, if, in fact, there are problems along
these lines.
Mr. Shays. Yes, I mean with all due respect, I mean
monitoring is OK, but I would rather you put your resources
here.
Well, let me do this: I just want to make sure the
professional staff covers one or two issues that we need to
just put on the record for our report.
Ms. Fiorentino. Ms. Bascetta, your testimony talked about
the lessons learned in the aftermath of 9//11, including the
need to quickly identify and contact people, the value of a
coordinated approach, the importance of monitoring both
physical and mental health and the need to plan for providing
referrals for treatment. In the work that you have done and the
work you are currently doing on Hurricane Katrina, have you
seen any steps the government has taken to apply the health
monitoring lessons learned from September 11th? And then
second, do you feel that health monitoring programs are being
included in disaster planning?
Ms. Bascetta. Unfortunately, I have to say that we are not
aware of any of these lessons learned being applied in New
Orleans or in the other Gulf Coast States.
With regard--your second question again? I am sorry.
Ms. Fiorentino. Are health monitoring programs being
included in disaster planning as far as you know?
Ms. Bascetta. Again, you know, we are engaged in a review
now of the NRP and other preparedness plans, and we are not
aware of a proactive approach to health monitoring.
We are aware that under the NRP, OSHA has an obligation to
protect first responders. We are aware that, EPA has a role in
measuring the levels of toxic exposures that first responders
may experience, but we don't see any mindset to set up--to have
a plan in advance for who will be accountable for establishing
and following through with medical monitoring if it is needed.
Dr. Kelly. When we sent firefighters to Katrina, we had
volunteers that went in cycles of every 2 weeks. We ensured
that before they went, everyone had the protective vaccinations
that they needed, including tetanus, Hep-A, and our members are
already protected against Hep-B; therefore, we didn't let
anyone go unless we had proven record that they had received
their shots and that it had taken. We made sure that they
brought their PPE with them, and when they returned, we made
sure they all had a followup medical evaluation. We have marked
their charts to recognize that they had that Katrina exposure,
and we will continue to monitor them when they come for their
annual exam with that set of information. So as an agency, we
are able to do that based on our prior exposure at September
11th and as a proactive effort as they went out to Katrina.
Ms. Fiorentino. Thank you very much.
Mr. Shays. Is there anything that any of you would like to
put on the record before we get to our next panel? Any last
comment?
Yes, Mr. Bethea?
Mr. Bethea. You really need to look at the workers' comp.
It is totally out of control. Case in point: my hospital
statements since--in 2002, every year you have EMS physicals in
May. The hospital gave myself and the five others who were down
at Ground Zero, we all received plaques as well as we got a
citation from the New York City Council.
The event was on television. It was in the hospital
newsletter. They made a whole big to do about it.
Last year, at a workers' comp hearing, the lawyers
representing the hospitals got up in court and said to the
judge, Your Honor, nothing for nothing. How do we know Mr.
Bethea was actually down there? And if he was down there, what
was he doing down there?
Now, they inquired to me in the hospital. It was already
acknowledged that I was there. They gave me an award, but yet
they were allowed to go into court and argue or raised this
issue on whether or not I was down there. We all know it was a
lie.
Mr. Shays. Mr. Bethea, that is not a racist issue. I mean
that was----
Mr. Vega. Raised this issue.
Mr. Bethea. Raised. Raised. Raised. Raised. Raised.
Mr. Shays. Raise the issue. Oh I am sorry.
Mr. Bethea. I am sorry. I said raised the issue. Oh, I am
sorry.
Mr. Shays. Yes.
Mr. Bethea. Oh, I am sorry. So I got the sinusitis. I am
all stuffed up now. I apologize.
Mr. Shays. I apologize. I heard you incorrectly.
Mr. Bethea. Yes, it was a raised issue, and now, it is
totally nonsense. I mean you have a right to defend your
client, but to make a blatant lie like this, as Dr. Levin has
said, you know, they harass you so much and humiliate you,
people don't want to go through that. And so this $125 million,
if the workers' comp system was better that money would have
never gotten taken away from us, because we would have had
access to it. You can't penalize us for money that we don't
have access to. I can't get money if you never give me a chance
to get that money. So what they should do is seriously look
into the workers' comp system and what is going on with it,
because it is an absolute disgrace. And people just don't want
to be humiliated anymore, and they are constantly denying
claims. Well, that was just one example. There are hundreds of
stories, of horror stories, and that needs to be addressed. And
I got to commend you for taking the time to listen to us about
what we have to say and what is really going on with September
11th, and they should use this as a model to not to make the
same mistakes down in Katrina, but unfortunately, they will.
Mr. Shays. Thank you. Thank you for your comment and thank
you for being here. Anyone else?
Ms. Bascetta. I would just like to add that I think that
Dr. Kelly's comment is illustrative of the facts that we do
have very different organizations that respond very
differently, and if we can learn from those who are better
positioned and who do take a proactive stance, and include some
of those principles in planning and our various government
levels--Federal, State, and local--we will all be better off.
Mr. Shays. OK. I wanted to close this, but I am going to
ask you to react to what I am going to say.
And I am going to leave a lot out. But, first, I am going
to ask this question: Was this the responsibility of the State
health department, the local health department, the local
environmental protection folks, the State, or the Federal
health and environmental to have basically taken control of the
site and looked out to protect the workers? Which level of
government should have been the one taking charge? Dr. Levin.
Dr. Levin. I think the primary responsibility is with the
Federal Government because it has the greatest resources
available to it to develop a comprehensive public health
response. I don't mean by that the State agencies, the public
health agencies at the State level and city levels shouldn't be
integrated into such a response. But the Federal Government has
the greatest capacity to do monitoring and to set up the kind
of programs that do early detection of health problems that
might result from such disasters.
The lack of that kind of overall coordination had real
consequences for what happened at this site and during the
ensuing really year and a half up to the present time. And it
seems to me that the Federal Government is the site where the
resources are greatest and the best opportunity exists for
setting up a comprehensive plan.
Mr. Shays. Anybody disagree with that? OK. Let me ask you
this, though: Isn't it true that any one of the three could
have shut the site down and said you can't go in here until you
have proper protection of the workers?
Dr. Levin. I don't know what the legalities of that may be
as to where that power really resides within the law. I know
certainly the Federal Government could have declared this a
site that was hazardous waste site, for example.
Mr. Shays. Well, the State could have as well. Ms.
Bascetta? You don't know?
Ms. Bascetta. I don't know. I mean I think when it was the
first battle in a war, and for those of us who were there, that
was our feeling, that this was a war. And it was a war zone
that held the remains of people that were beloved by all of
those who had suffered losses. And when there are any attempts
to even close down the site for a night, there was a protest by
our members because they felt an obligation to be there to
remove those who were missing, and those who had died.
There was active fire at the scene until mid-December.
Mr. Shays. OK. If health care folks who had the expertise
had an obligation as well. They had an obligation, and I want
to know where they were? You know. They had an obligation on
the local, State, and Federal level. They had the expertise.
They were down there, and it is pretty amazing to me.
In a perfect world, react to this--I guess what I am trying
to--we are going to try to come out with recommendations as a
subcommittee, and I am just wanting to understand. It seems to
me you have the event. You were going to have a few days of
just rescuing the workers. You are just going to do
everything--of rescuing people that possibly someone might be
alive, even though I think there was a feeling, you know, that
was very unlikely, but you just keep at it until you are pretty
convinced that there is no one alive.
But at that point, it seems to me there should have been
the Federal Government, the State government, and local
government, the health people should have basically shut the
site down. They should have then made a determination who could
work in there and on what conditions. And I can see that there
are tradeoffs between the health of the workers and the health
of the entire city in terms of it being a condition that you
needed to clean up as quickly as possible. So you were going to
have some tradeoffs. But I am struck by the fact that in terms
of some kind of model, someone takes control, someone tells the
workers in going, someone decides what kind of equipment, how
long they should be there; maybe they should only be there for
a few weeks, and then you bring in another group.
I mean it strikes me that is the kind of process that
should take place, and I don't have any conviction that is
happening.
So what I am going to probably do for this hearing is we
are going to bring in the folks that can explain what you do in
an emergency and what we should do. And maybe since then, there
are people who put their heads together and figured this out,
and we just don't know about it. So. Thank you all very much,
and we will get to next here.
I said that I would maybe consider having a third panel. So
this panel is adjourned. Thank you very much.
Raise the hands of the people who would like to address
this subcommittee? You have one, two people. OK. We will have
you both address the subcommittee after the third and fourth.
No more than five, but we will allow a third panel. We will
swear you in. We will sign you up, but not right now. We will
go to our second panel. And that is Dr. John Howard, Director,
National Institute of Occupational Health, Centers for Disease
Control and Prevention, Department of Health and Human
Services. You can stay standing, Dr. Howard.
Do you have anybody else, Dr. Howard, that might be
responding to questions with you?
Dr. Howard. No.
[Witness sworn.]
Mr. Shays. Thank you very much for your response, which was
in the affirmative. And, Dr. Howard, we welcome your testimony.
I am going to ask that you go down and sign up in the back.
I am going to ask our staff to go to that table over there and
anyone who wants to address this subcommittee can go over
there, and we will fill out your names and address and so on.
Actually, Bob, I am going to have you do that. Right over
there. So this gentleman here, if anyone wants to address the
subcommittee on the third panel that we will--do know that you
will be sworn in and anything you say before the subcommittee
will have to be the truth.
Dr. Howard, what would you like to tell us?
STATEMENT OF JOHN HOWARD, M.D., M.P.H., DIRECTOR, NATIONAL
INSTITUTE FOR OCCUPATIONAL SAFETY AND HEALTH [NIOSH], CENTERS
FOR DISEASE CONTROL AND PREVENTION, U.S. DEPARTMENT OF HEALTH
AND HUMAN SERVICES
Dr. Howard. Good afternoon, Mr. Chairman, and members of
the subcommittee.
My name is John Howard. I am the Director of the National
Institute for Occupational Safety and Health, part of the
Centers for Disease Control and Prevention within the
Department of Health and Human Services.
I am pleased to report on the screening and medical
monitoring of World Trade Center responders, development of a
new treatment program for responders, and to give you a brief
report on the World Trade Center Health Registry.
In 2002, as you know, Congress provided funding through
FEMA for baseline health monitoring of responders. CDC
partnered with the New York City Fire Department, the New York
State Department of Health, and the Mount Sinai School of
Medicine to conduct baseline medical screenings.
The symptoms identified in these screenings, such as the
``World Trade Center cough,'' as we have heard about, prompted
the development of a medical monitoring program to assess long-
term health effects.
This program consists of a consortium of clinical centers,
together with data and coordination centers, to provide
standardized clinical and mental health screening, patient
management data, and clinical referral services.
One center is operated by the New York City Fire Department
for firefighter responders, and the others are operated by
Mount Sinai for responders within and outside the New York
Metropolitan Area.
All these responders receive the same examination utilizing
a standardized protocol.
Since 2002, the Monitoring Program has served more than
30,000 responders, and as of February 2006, the Fire Department
and Mount Sinai both have conducted nearly 19,000 screenings,
approximately 75 percent of them being initial examinations and
25 percent being followup.
The clinical data is analyzed regularly, and in September
2004, the program published data showing that the majority of
screen responders reported experiencing upper and lower
respiratory symptoms, along with musculoskeletal and
gastrointestinal symptoms.
These clinical findings, I stress, that are the same
clinical findings we saw in the early program are being seen in
2005 and 2006, and highlight the need for a long-term medical
monitoring and treatment program.
In March 2003, FEMA and HHS completed an interagency
agreement allocating $3.7 million to have the Federal
Occupational Health Service conduct baseline medical screening
for Federal responders. The program began in June 2003, but by
January 2004, as has been reported, FOH halted the screening
process, because they too identified the need for more robust
mental health screening protocols, the need for other
diagnostic tests, and the need to have a referral mechanism for
health concerns identified during the screening.
In addition, it also became necessary to identify the
administrative authority to provide services to former Federal
employees, including retirees and those were Federalized for
the time of the World Trade Center experience.
The agreement was modified in July 2005 to address these
mental health diagnostic testing and referral concerns and the
screening resumed in December 2005.
However, since the FOH mission precludes them from
conducting screening for former Federal workers, a decision was
made to contract with NIOSH World Trade Center program to
provide a single baseline screening for former Federal workers.
To date, of the $3.7 million allocated for this program,
$2.2 million has been obligated to Federal Occupational Health
for the purpose of screening current Federal employees and for
outreach and registration management. The remainder of this
fund will be allocated to the NIOSH program for the purpose of
screening former Federal employees.
Since restarting the program for Federal workers, 135
Federal agencies have been contacted, and approximately 1,700
individual Federal responders have been identified out of an
estimated population we believe of around 5,000.
Of those responders identified, 423 current, 40 former, and
12 retired Federal employees have registered for screening and
of these registered responders, 166 have been screened; 250 are
awaiting screening.
To ensure the continued screening and treatment of World
Trade Center responders, Congress recently appropriated $75
million to CDC for treatment; $50 million was appropriated for
the Uninsured Employers Fund. A portion of these funds will be
used to establish a World Trade Center Responder Treatment
Program to support existing monitoring programs and to fund
program needs identified by the World Trade Center responder
community such as the New York City Police Foundation Project
Cope, as well as the police organization providing peer
assistance.
Also appropriated funds will be directed to support the
World Trade Center Health Registry, which began baseline data
collection September 5, 2003, and finished 71,437 interviews on
November 20, 2004.
Registrants will be interviewed periodically through the
use of a comprehensive and confidential physical and mental
health survey. The first followup interviews are scheduled to
begin next month, and will last approximately 6 months.
Information about the Registry's finding is posted quarterly on
their site at www.wtcregistry.org.
Thank you very much, Mr. Chairman. I would be happy to
answer any questions.
[The prepared statement of Dr. Howard follows:]
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Mr. Shays. Thank you. Mrs. Maloney.
Mrs. Maloney. Thank you very much, Dr. Howard, for your
testimony today. A great number of us have waited a long time
to have one particular person in the Federal Government to
direct our questions about September 11th health emergency, and
we are thrilled with your designation, and I join my
colleagues, Mr. Fossella and Mr. Shays, in congratulating you
on your new job.
But I do have a series of questions, and first of all, do I
have your word that we will finally have a coordinated Federal
response to the September 11th health emergency, including a
plan from your office on how to fully monitor and treat
everyone affected and sick?
Dr. Howard. I am certainly going to try to bring
consistency across, as you have said and several others today,
for all exposed workers. That is my first priority, based on
their exposure, not based on the particular system that they
happen to be receiving there--either screening, monitoring, or
in the future treatment care from.
Mrs. Maloney. And when can we expect to see your
recommendations and plan of how you are going to run this new
outreach in response to injured workers and responders?
Dr. Howard. Well, I hope very soon. In fact, I have already
contacted the acting director of the Federal Occupational
Health Service. She and I will be meeting to look at that
issue, which has, I know, as GAO reported and as you and the
committee have pointed out, is an issue that we need to
address.
Mrs. Maloney. And in your testimony, your testimony reports
that the majority of World Trade Center responders
participating in the World Trade Center Medical Monitoring
Program have experienced health problems that have continued
until today. And you go on to say that these trends highlight
the need for a long-term health monitoring program. And how
many years are you talking about for a health monitoring
program?
Dr. Howard. I think I would agree with Drs. Kelly and
Levin. Our experience as occupational physicians teach us that
many conditions--dust diseases of the lung, which were referred
to already this afternoon, like asbestos exposure--have
significantly long latent periods.
So I think even though we have been doing incremental
budgeting for these types of programs, and we are very happy to
be able to be in a position now to administer a treatment
program that will get at that issue and also continue our
monitoring program, I think we have to look seriously at our
vision for the future in terms of looking at that kind of
timeline.
Mrs. Maloney. Could you give me a specific number of years.
We are funded for 5 years. Do you think this monitoring should
be 20 years or, as Dr. Kelly and Levin said, it should be 30
years?
How many years are you talking about?
Dr. Howard. Well, I certainly agree from the medical
standpoint that these long latent diseases require us to think
in that kind of timeframe. At the present time, I think we have
to look at all of our findings, both from our monitoring
program, as well as from our registry program, and titrate, if
you will, those needs based on time as we go through the next 4
to 5 years.
I think we are at the point of producing significant data.
Our clinical data management centers have that job. And I hope
within the next 12 to 24 months that we see good statistically
valid studies on these issues so that we are able to plan for
these long-term periods of time that you and others have talked
about--the 10, 20, and 30-year timeframes.
Mrs. Maloney. I am glad you are thinking about 10, 20, 30-
year timeframes.
Mr. Shays. Would the gentlelady yield 1 second?
Mrs. Maloney. Yes. But may I ask one question real quick to
followup? What I think is very interesting is that the
statistics that are coming from the World Trade Center
Consortium, the fire fighters and fire fighters and officers
research, and others, they are consistently the same: half the
people they are looking at are sick. For some reason, half are
immune to the problems, in all of these studies, if you look at
them, half of the people that they looked at are sick.
And in a sense, I don't think we need to reinvent the data
that you talk about, because that is what they have been
releasing, and I monitor this very carefully. This is the third
hearing that we have had. Consistently, they are showing half
the people are sick, and I yield to my colleague, the chairman.
Mr. Shays. I just want to be clear as to what is the point
of monitoring someone for 20 or 30 years? What is the point?
Tell me the point.
Dr. Howard. Well, I would say the simplest point is that
some conditions take time to show themselves clinically.
Mr. Shays. Then what?
Dr. Howard. In terms of the condition or?
Mr. Shays. So we have this great graph of how people got
sick 20 years later from some disease, I want to know what is
the point.
Dr. Howard. I would approach it from the population that
was originally exposed, which we know to number some 30,000 to
40,000 people, whatever category they are in, whether they are
responders or residents.
Mr. Shays. You need to say it differently. I already know
the answer to how I would answer the question. I am interested
to know how you will answer the question. What is the point of
monitoring someone for 20 or 30 years.
Dr. Howard. I think in terms of a registry, where you are
monitoring a large population, one answer is to get at the
prevalence of a particular condition in that population. So
population monitoring I think I would contrast with individual
monitoring. The registry is doing population monitoring. The
screening and monitoring program----
Mr. Shays. What is the point of monitoring someone?
Dr. Howard. To look for conditions and also the knowledge
that we accumulate day by day, month by month, in terms of
those aspects that Dr. Levin talked about of prevention so that
we could detect at the earliest possible stage, the existence
of a condition and intervene as early as possible----
Mr. Shays. Yes.
Dr. Howard [continuing]. To prevent the condition from
worsening or manifesting itself and harming the individual.
Mr. Shays. Right. Well that is, to me, the bottom line, the
key in the whole reason why we would do this. And what I leave
this hearing is feeling like we have done a lot of monitoring
haphazardly, but not a lot of intervention, and certainly not
very helpful intervention.
Do you view it as your job to be in charge of the
monitoring and in charge of making sure that there is
intervention?
Dr. Howard. I think the real value that we are approaching
right now, with $75 million, able to develop treatment programs
I think is really crucial to that question. And I think we are
at a very important time in the development of these programs.
Mr. Shays. So is the answer yes?
Dr. Howard. Yes.
Mr. Shays. Thank you.
Mrs. Maloney. Thank you, Mr. Chairman, and, Dr. Howard, I
was pleased with your statement that you believe that medical
monitoring should be based on exposure and should include
residents, school children, whoever breathed the debris, not on
what hat you were wearing, whether you were the police or the
fire, but whether you breathed the items or not. Is that clear?
Do you think it should?
Dr. Howard. Well, it may not be absolutely what I meant.
What I meant to do is to suggest in terms of the most exposed
population, which were responders at Ground Zero, many of whom
spent months and months at Ground Zero, the most exposed
population I think from 2002 to the present we have developed
screening programs, monitoring programs, and now treatment
programs for that population. The Registry was set up in order
to look at that population. The greatest majority of those
71,000 interviews have been done in residents of the lower
Manhattan area and other areas of New York City--school
children, office employees who work there, but were not
residents, or responders. So the information that we are going
to get from the Registry I think would go to that latter issue
that you just raised with regard to the need for screening and
or monitoring for residential exposure, if you will, in lower
Manhattan. So I just wanted to make that clearer.
Mrs. Maloney. Well, personally, I think everyone should be
included, but going back to your statement and pleasure with
the $75 million, and we are thrilled. That was a long effort by
the workers, the unions, and Members of Congress to get that
funding in the budget, and we are thrilled that it is now going
to provide some treatment. But do you believe that it will
provide for all of the unmet needs of individuals who are still
sick from September 11th? We heard from two of them today. And
will you make recommendations within your budget for adequate
funding? Up until this hearing, the initiative has come from
Congress to ask the administration, and we are grateful for
your appointment today. We are grateful for the $90 million
that has been allocated for the Consortium monitoring. We are
grateful for the money for the fire monitoring and treatment.
We are grateful for all this, but what many of us would like to
see is your department requesting the money and the proper
funding for the treatment and the long-term monitoring. I
believe Drs. Kelly and Levin testified $305 million.
My question is, how are we going to fund this? Will you be
requesting it in the administration budget? Will you be pushing
for this funding from your side of the aisle? We are pushing
with you. Let me tell you.
Dr. Howard. I think in answer to your first question is no.
Based on what I have heard, what I have seen the last few years
participating in the NIOSH program at the World Trade Center
and Mount Sinai and with the Fire Department of New York City,
no. There appears to be quite a number of unmet needs.
In regard to your second part of the question relative to
budget recommendations, you know I won't hesitate based on my
job of looking at where coordination is best, where unmet needs
need to be met within the budget structure that I operate on in
the executive branch, I would not hesitate to make those needs
known.
I would add just parenthetically that I think it is
important to build on some of the ad hoc budgetary work that
Dr. Levin referred to. I think it is important for us to do a
more formalistic evaluation so that we are able to succeed
within a budget process in the executive branch. And I hope to
be able to do that, and my job now is to pull those people
together and do a more formalistic look at that question.
Mrs. Maloney. There was some questions about Katrina, and I
would like to ask in a general way if there were another
September 11th, if we were to have another September 11th,
would you recommend the patchwork of medical monitoring that we
currently have or would you recommend a coordinated response
that monitors and treats all who are affected?
Dr. Howard. I would say no, I wouldn't recommend it. We are
all sort of prisoners of our various systems that we operate
on. I think the challenge that we have--and throughout CDC and
HHS this is one that we are actively working on and that we
actively believe in--we need coordination across partnerships,
multiple levels of government, and with non-governmental
organizations. So I would say that, no. This wouldn't be the
route that I would take if we had to do this again.
Mrs. Maloney. And a very important point that was raised by
Drs. Kelly and Levin and others was the need for protocol and
treatment to be developed, really learning from all the many
different programs that were out there, trying to treat and
trying to help, and do you see your department coming forward
with a SARS-type of advisory that would go to the medical
community on what to look for and how to treat those that have
the World Trade Center cough?
Dr. Howard. I say yes. And I was very impressed by the fact
that we haven't done that yet. We need better communications in
the medical community, and I hope to be able to work with Mount
Sinai at the Fire Department, the FOH, to look at the
protocols, to make that information known to any physician who
may encounter a responder in his or her practice. That is
critical communications information.
Mrs. Maloney. And basically how long, not trying to tie you
to any date, because I believe in your sincerity, how long do
you think it will take to develop this protocol and get it out
to the medical community? And I might add it is not just New
York and Connecticut and New Jersey. We had people from
California, divisions from Wisconsin. My office gets calls from
all across the country of people who are sick. Now, I can refer
them to your office. So this protocol is needed really not just
for our region, but for the whole country, because many, many
people rushed to respond and volunteered.
Dr. Howard. Well, my answer to your question is much sooner
than it has been done. I think we have an excellent protocol
available at Mount Sinai. We are very proud at NIOSH that Mount
Sinai is our partner in this.
We need to get that information that has been developed
over the last 4 years with excellent medical input, both from
Mount Sinai as well as the New York City Fire Department, Dr.
Kelly, Dr. Prezant, and others. We need to get that information
out so that we are able to empower physicians who may see these
responders, whether they be, as you say, in California,
Wisconsin, or New York.
Mrs. Maloney. As one who represents Mount Sinai, if you
will allow me to be personal for a moment, I am very proud of
their record in environmental health care. They pioneered in
this years before anyone thought about environmental causes
causing severe health problems, and they are still building on
the environmental disaster that impacted so many of our
residents and my neighbors and friends.
I have great respect for all workers, and I am very
disturbed at how the Federal employees were treated in the
monitoring. They began the monitoring. They estimated 10,000
were involved. They stopped after 400. I hear you are going to
activate the response here, but as I understand your testimony,
you report that Federal employees who worked alongside the
heroes and heroines, the responders, and they also the FBI, the
CIA, FEMA, all these Federal workers, they breathed in the same
toxic air, and as I understand it, they are only eligible for a
one-time screening; is that correct at this point?
Dr. Howard. That is correct. But we hope to use the
treatment program to allow them to enter. It is my intention
that they would enter the treatment program so that they would
be eligible for followup monitoring as well as treatment within
that program so that gap is not created.
Mrs. Maloney. Well, I am very, very glad to hear that they
will be eligible for treatment and long-term monitoring. All of
these people should be eligible. Those that rushed down there
to help others, if they are volunteers, Red Cross, Federal,
State, city should be helped in my opinion.
Now, the one part of your testimony that does not--I would
like you to elaborate on is the Health Registry. You testify
that the Registry has conducted more than 70,000 interviews,
and this includes area workers, residents, and school children.
And this group of exposed individuals, according to your
testimony, are having similar health problems as the September
11th responders. But this group of people are barred from any
of the federally funded medical monitoring and treatment
programs; is that correct?
Dr. Howard. It is largely true. I believe out of the 70,000
registrants, about 30,000 are in the responder category, if you
will, so that they would be eligible for screening and
monitoring. But that would leave about 40,000 in the category
of residents of lower Manhattan that did not respond, nor were
sent to the site.
Mrs. Maloney. OK. Last, because my colleague and great
leader on this, Mr. Fossella, has a series of questions, but
can you explain to me why these individuals should be left out?
They were exposed to toxins. Our government said it was safe.
These are people who would lose their job if they didn't return
to work. The SEC offices are there. The FEMA offices are there.
These are Federal workers that had to return to their jobs and
others. Why should they be left out of the monitoring and
treatment?
Dr. Howard. I can say that I don't see that reason either
other than if you go back to the origin of how these programs
were structured in 2002 we as an occupational safety and health
agency, with statutory responsibility for workers receiving
money from FEMA, we had limitations ourselves on monitoring, on
screening programs, so it is unsatisfactory. I realize that,
but I hope that as we work on the issue of the Registry, and
they are just beginning their second interview schedule, I am
hoping we can use the data from the registry, based on their
subgrouping of school children and residents and others, I am
hoping that we will get that positive information that we need
out of the Registry to build on that need that you have
identified.
Mrs. Maloney. Thank you so much for your testimony, and as
one who was there on September 12th, I was in meetings with the
State and city government where the estimates of the dead were
25,000, 30,000. It was a time of great crisis and because of
heroic actions by many, we lost 3,000. But those early days we
had no feel for how many people had perished, and it was truly
a trying experience for all of us.
So I thank you for all of your help, and I yield back.
Dr. Howard. Thank you.
Mr. Shays. I thank the gentlelady, and this time the Chair
would recognize Mr. Fossella.
Mr. Fossella. Thank you, Mr. Chairman. Dr. Howard, thank
you for being here and thank you for your assignment of your
duties you are about to assume in addition to what you have
done already. I appreciate it.
And just an overall observation, and it bears again to be
underscored. September 11th was, in a way, an act of war in
this country. Seventy-one thousand people, as you say, have
gone through the Registry, which is when you think about it in
perspective, it is about the size of if not larger than many
cities in this country. And, you know I guess by the way of
example, Pearl Harbor, 65 or so years ago, if somebody is a
survivor of Pearl Harbor, they are treated with reverence and I
think every ounce of the Federal Government is there to help an
individual who survived Pearl Harbor 60 plus years later.
And you know and you have been listening to the testimony
of the doctors here before you that we are looking at another
20, 30, if not more years ahead of us. Many of the people who
responded were in their 20's and 30's, so they weren't people
in their 50's or 60's or 70's. They were in their 20's or 30's.
The three individuals who died from apparently exposure to
September 11th were very young.
And it just strikes us as I hope what you take back because
any responsibility borne by the Federal Government, any
obligations that we believe--at least I believe--we should have
to those who responded is going to far outlive us in your
professional capacity and my professional capacity.
So the sooner we get our arms around the entire situation,
the sooner we work--as I think you have just said, you want to
work with the Mount Sinais, the fire department, the non-
governmental agencies, organizations--the better, because this
is an obligation that is going to have to exist for decades to
come.
And it is not going to be fair to those individuals to have
a--I believe a--in the words that I guess of my colleague, Mrs.
Maloney, a legislative undertaking every year to be lobbying
for funding.
It should be coming from I believe almost it was part of
the executive budget within HHS to step forward and say this is
going to be our obligation with respect to these individuals.
And it is going to be an obligation that is going to be, you
know, for a time to come.
And I say that just as a general observation because I sure
would--hopefully for the next several weeks and several months,
as you continue to put your arms around this issue, which is a
heavy undertaking, and I just hope you keep that in mind.
With respect to some of the things that I have heard
regarding NIOSH's partnering with--NIOSH I should say
partnering with the Red Cross to establish in a new outpatient
treatment program that will serve as an extension of the
existing WTC Medical Monitoring Program, this is a nice effort.
I was just curious was--does this mean that NIOSH's point on
directing some of the $75 million recently secured to the Red
Cross or is this a separate?
Dr. Howard. No.
Mr. Fossella. No?
Dr. Howard. I think it is a misstatement in our testimony.
What we meant to say was we are meeting with the Red Cross----
Mr. Fossella. OK.
Dr. Howard [continuing]. Trying to look at their program
and see what they have learned from running a treatment
program, the lessons they have learned and how they may be
applied to our structuring of a treatment program. But our
money, the $75 million to the extent for the treatment program
would go directly to--through our extramural grant program to
the New York Fire Department as well as Mount Sinai.
Mr. Fossella. Well, that is good. That is what I was hoping
to hear.
In discussing that money, I think in the testimony you also
say you increased costs ``resulting from the recent expansion
of the protocol to include a comprehensive mental health
assessment, and the increase in outreach efforts necessary to
inform participants of the services provided by the program may
make it necessary to use a portion of these funds to supplement
the World Trade Center Medical Monitoring Program. The funds,
initially appropriated for this program in 2003, are available
through 2009.''
Out of curiosity, what portion of the newly appropriated
funding do you think should be used for such initiatives?
Dr. Howard. Our understanding right now that would probably
be 10 percent or less. It is a small amount of funding. It is
largely, as we point out in the testimony, for cost increases
associated with a robust mental health screening. We have
encouraged some debt on that side of the program. But it would
be a small portion of the $75 million. The bulk of the $75
million would go to treatment.
Mr. Fossella. OK. And finally, we are seeing as a Nation
involved in the last several years, especially in responding
and being prepared for disasters of different forms, natural or
obviously in this case September 11th, do you see, as I asked
before the doctors anything legislatively that Congress needs
to be doing that would allow you to better do your job, either
now or prospectively?
Dr. Howard. Well, I believe that throughout the last couple
years, the Congress and the Department of Health and Human
Services, through our office of Public Health and Emergency
Preparedness, the Centers for Disease Control, etc., have
worked hard on this issue to look at the needs as we prepare
for pandemic flu, for instance.
I think with regard to this program, it is important that
we look, as I said, to Representative Maloney--it is important
that we in the program, working with our partners, develop the
justification for others to act on, both within my department
as well as the appropriators in Congress.
So hopefully, my job will be to make sure that we have that
justification done so that we can tell our department, through
our processes and the appropriators, here is what we need to
make this program work better.
Mr. Fossella. OK. Well, that sort of concludes it, and let
me just again thank you, Dr. Howard. I know you are very well
respected, as I mentioned earlier. We have met with Secretary
Levitt before--very well respected both inside and outside of
government. You know, but the injuries, the illnesses are
staggering. Dr. Kelly talked about four to five times the
personnel who have had to leave the fire department due to
permanent lung disability. A number of pulmonary problems.
12,000 individuals who have to seek mental health already. So
these are staggering numbers. You have a tough task ahead of
you, and I just hope that you keep us in mind to the degree
that we can help, and help those who truly need it.
So thank you very much.
Dr. Howard. Thank you.
Mr. Shays. Dr. Howard, we are going to complete. I want to
have professional staff, Kristina Fiorentino, just ask you a
question so we can have it for the record.
Ms. Fiorentino. Dr. Howard, what steps have been taken to
ensure health monitoring programs are included in disaster
planning?
Dr. Howard. Disaster planning in the Department of Health
and Human Services?
Ms. Fiorentino. Right.
Dr. Howard. Yes. I would say that we work constantly on
this issue, and we have talked this afternoon about the Katrina
response. Our department, the agency I work for, the Centers
for Disease Control and Prevention, was very much involved. We
at NIOSH were involved and actually are doing a health hazard
evaluation study on New York--on New Orleans Police Department
individuals.
So we are actively and I know this is an issue for this
committee as well as for many others, we are actively looking
at the lessons that we have learned from New York to apply them
to Katrina, the lessons we are learning from Katrina to apply
them to the future. So I would say that we are always trying to
sharpen our tools for any other future disaster planning.
Ms. Fiorentino. And is there a recommended protocol for
health monitoring after a terrorist event? Are we just doing a
wait and see approach and then tailoring it after an event
happens?
Dr. Howard. Well, I hope not. I think that is really where
we have to look at the lessons that we have learned in New
York, because I think that is really for disaster planning in
terms of health monitoring for these large events that is a
very important issue.
We at NIOSH commissioned 3 reports that RAND Corp. did for
us, and I would be happy to provide the committee copies of
those three reports that really get at much of the detail of
this issue.
So certainly, we at NIOSH, we at CDC, we at HHS think this
is an extremely important issue, so we hope to be able to--and
it is difficult because the exposures differ depending on the
disaster. The exposures are a little different in New York than
they were in New Orleans, so one has to be able to modulate
this.
But we certainly hope to be able to have a health
monitoring outcome, if you will, so that we can quickly adapt
to whatever situation is out there.
As you may know, I will just tell the subcommittee about
the development of the Agency for Toxic Substances Disease
Registry's Rapid Response Registry Survey Form, which is
designed to be used quickly in these types of events. So we are
constantly trying to fill our tool bag with these sorts of
things.
Ms. Fiorentino. Thank you very much.
Mr. Shays. Dr. Howard, just quickly. Should it be you and
your office that ultimately takes control of a site like this?
Which, first, should it be Federal, State, and local within the
Federal? Who would be the one to basically stop workers from
going in there?
It strikes me that it would be you that would have that
responsibility?
Dr. Howard. Well, I actually think probably not. These
sites are quite complex. This site was owned by the Port
Authority. It was in the city of New York, in the State of New
York. Under the Occupational Safety and Health Act, New York
has a program for public sector workers, but the Federal
Occupational Safety and Health Administration is responsible
for other workers, so it is a complex matrix, and I would defer
to the Occupational Safety and Health Administration on the
issue with regard to who has jurisdiction over the workers.
Mr. Shays. Yes. It just strikes me, though, that if you are
going to design a protocol, we had better know who is in
charge.
Dr. Howard. Yes. For the health monitoring issues, there is
no doubt about that.
Mr. Shays. No doubt about what?
Dr. Howard. There is no doubt that our department, Health
and Human Services, CDC, and NIOSH that is the job that we do
to make sure that the health of the workers in terms of the
screening programs, the monitoring programs. OSHA does not do
that. They do the immediate protection of the employees.
Mr. Shays. Well, then did you all drop the ball in not
taking charge of this early on?
Dr. Howard. Well, we don't have that jurisdiction. We are a
research agency at NIOSH. OSHA is the enforcement agency for
Occupational Safety and Health.
Mr. Shays. Right. So I am sorry--that OSHA should have
taken charge. I said it incorrectly, so you answered----
Dr. Howard. I am sorry.
Mr. Shays. No. You don't need to apologize. I need to
apologize to you. Not you, but should it have been OSHA that
should have been----
Dr. Howard. I would defer that answer to the Occupational
Safety and Health Administration.
Mr. Shays. In other words, don't put you in the spot of
having to answer the question?
Dr. Howard. I have a big enough job as it is.
Mr. Shays. OK. Fair enough. I won't make your job more
difficult.
All right. Thank you, Dr. Howard. Is there anything you
want to put on the record before we get to a third panel that
we will be having of people I have never met before and have no
idea what they are going to say?
Dr. Howard. No, sir. Thank you.
Mr. Shays. You might want to stay and listen. Thank you.
We are going to call our third panel. We have done this
once before in my 19 years, and this may be the last time I
ever do it. We have Ms. Micki Siegel de Hernandez,
Communications Workers of America; Sister Ms. Lee Clarke,
American Federation of State County and Municipal Employees,
District Council 37; Mr. John Ramanowich, who is New York City
Department of Design and Construction; Mr. Michael Kenny, Local
375, District Council 37; and Mr. Charles Kaczorowski.
Now, let me explain the rules. We never have people here
who aren't sworn in, so you will be sworn in. Being sworn in
means if you have not told the truth, you could be prosecuted.
If you are saying something to which you just made a mistake,
that is one issue. But if you knowingly say something false,
then you are breaking your oath. And let me say that I will
give each of you 2 minutes to make any comment you would like
to make, and so I am going to ask you to stand up, and I will
swear you each in.
[Witnesses sworn.]
Mr. Shays. Note for the record our witnesses have responded
in the affirmative. It is frankly nice to have you all here. I
am going to in the order I called you--Ms. Micki Siegel de
Hernandez.
Thank you. You can go first. There is a button on there
that you hit.
Ms. de Hernandez. Got it.
Mr. Shays. Maybe describe who you are and why you want to
testify before you start.
Ms. de Hernandez. Sure. My name is Micki Siegel de
Hernandez, and I run the Health and Safety Program for the
Communications Workers of America in New York in District 1. I
also sit on the Executive Committee for the Medical Monitoring
Program and was also the labor liaison on the EPA Expert
Technical Review Panel.
Mr. Shays. OK.
STATEMENTS OF MICKI SIEGEL DE HERNANDEZ, COMMUNICATIONS WORKERS
OF AMERICA, DISTRICT 1, NEW YORK CITY; LEE CLARKE, AMERICAN
FEDERATION OF STATE COUNTY AND MUNICIPAL EMPLOYEES, DISTRICT
COUNCIL 37, NEW YORK CITY; JOHN ROMANOWICH, NEW YORK CITY
DEPARTMENT OF DESIGN AND CONSTRUCTION; MICHAEL KENNY, LOCAL
375, DISTRICT COUNCIL 37, NEW YORK CITY; AND CHARLES
KACZOROWSKI, LOCAL 375, DISTRICT COUNCIL 37, NEW YORK CITY
STATEMENT OF MICKI SIEGEL DE HERNANDEZ
Ms. de Hernandez. I have been struck by so many things
while the hearing was going on, and I was particularly struck
by your question, Congressman Shays, as you looked at the
picture with amazement on your face and asked the question of
Ron Vega how could nobody have stopped what was going on. How
come people weren't protected?
We are still asking that question. And there are still
huge--there aren't gaps in the response. There aren't gaps in
what has happened. There are huge chasms that still remain, and
until we fix those problems, at the response of September 11th
the rebuilding after September 11th, there will be no lessons
learned. We will continue to make the same mistakes.
There were a couple of comments made about OSHA and whose
responsibility this was. We do believe that it was the primary
responsibility of the Federal Government, the National Response
Plan. There were parts of that Response Plan, many parts, that
were not followed, but what has happened onsite and since
September 11th is I think what you just saw: There were
different agencies pointing different fingers at each other
every time we talked to them.
OSHA was onsite, and they decided that they would not be
onsite and do compliance with the standards that they had. They
were going to be there just to help----
Mr. Shays. Is it possible they did that because it was such
a dirty site that they were afraid that they wouldn't be
allowed to allow anything to happen; is that?
Ms. de Hernandez. I can't speak for what their reasons
were.
Mr. Shays. OK.
Ms. de Hernandez. But they are now deciding. They are
talking about doing that at every future response.
Mr. Shays. Right. OK.
Ms. de Hernandez. But part of the problem with OSHA taking
control over all these situations that there are gaps in the
laws that exist. There aren't laws to cover a situation like
September 11th that would protect workers, that would protect
the community----
Mr. Shays. OK. Let me do this.
Ms. de Hernandez. Sure.
Mr. Shays. Your contribution is outstanding. Speak to
Kristine afterwards and walk through some of what you think
needs to happen. We might be able to come back to you, but let
me stick with the 2-minute rule for now, and I gather you are
Ms. Lee Clarke.
STATEMENT OF LEE CLARKE
Ms. Clarke. Yes. Thank you, Congressman. Thank you for
letting us address you.
I too was struck by your question, and the answer that you
did not get. Let me say I am from District Council 37 of the
American Federation of State, County, and Municipal Employees.
We represent 120,000 New York City government workers in
New York City. We had thousands of our members down there from
day one to the day Ground Zero was no longer a rescue or
recovery area.
Micki talked about OSHA not enforcing the law. It was not
only OSHA. In New York State, we have the Public Employee
Occupational Safety and Health Bureau that abdicated their
responsibility to Federal OSHA, and it was a domino effect.
Everybody threw their hands up, and nobody protected the
workers.
Early on and about a week after the Trade Center fell, we
sat down as union representatives with the city of New York to
talk to them about documenting the presence of our members down
there, providing medical monitoring for them, providing medical
treatment for them. Dr. Steve Levin from Mount Sinai
accompanied me to those meetings, and to this day we still do
not have treatment for city workers.
I have a tremendous amount of respect for Dr. Kelly and the
fire department, and Dr. Prezant. They are running a fabulous
program; so is Mount Sinai and the other clinics.
However, the city workers that go to the Mount Sinai
program have to go on their own time. When the Fire Department
workers go on work time, that is important to point out.
As Ron Vega said to you, point blank, I don't have any more
time to take from work. This is costing me a lot of money out
of my pocket. We have thousands of city workers who are not
getting treated.
This is an important point to raise: why? When we talk
about the $75 million and how it is being divvied up or who is
holding their hand out for some of that money, I am concerned
about the Registry also standing in that line.
I don't want to see--the Registry serves some purpose, and
not a good scientific purpose in my mind.
But I don't want to see money go to the Registry and not
going to treatment of these workers who are sitting here today.
And these are my members from the Department of Design and
Construction.
Mr. Shays. Thank you.
Ms. Clarke. Who could give you first hand information of
their problems with the system.
Mr. Shays. Well, let me go to Mr. John Romanowich.
STATEMENT OF JOHN ROMANOWICH
Mr. Romanowich. Well, good afternoon.
Mr. Shays. So you are the guy that started this. You rose
your hand in a hearing? It has never been done before.
Mr. Romanowich. I have been held accountable for a lot of
things.
I think I do have the answer. I can't address the medical
questions that the other experts have addressed, but I can
answer the question that you posed to Mr. Vega. How was he and
all of us allowed to dive into that mess? And the answer is
that the business of America is business, and that was not just
the New York financial center. That was the financial center of
the world. Because of all of our efforts, the police to secure
the site, the fire department to put out the fires, the
sanitation, the transportation, DDC to organize all of the
other people, business was restored to lower Manhattan and to
the rest of the world.
Mr. Shays. Right.
Mr. Romanowich. The stock market reopened within 10 days.
Telephone service initially was knocked out on all of lower
Manhattan. That was restored block by block, bit by bit. A lot
of people don't realize that the Federal Reserve Bank is only 3
blocks from that site, just across Broadway and down the hill
is the New York Branch of the Federal Reserve Bank.
Something like $200 billion of gold bullion was safely and
orderly removed from the vaults below the World Trade Center. A
lot of people don't even know that, but for 24 hours armored
trucks had a steady stream of gold bullion leaving that place.
They were able to leave because we got the streets cleared.
They were able to leave because the police department held back
with the National Guard--held back the onlookers. It was all
organized by DDC. We orchestrated everything there. The police
department has credit coming. The fire department certainly has
credit coming. The sanitation, the transportation people,
everybody.
There was urgency in that the entire site was in danger of
flooding by the New York Bay, which was just a couple of
hundred feet to the west--the Hudson River and all of the
Atlantic Ocean.
That site, if it had flooded, would have flooded the entire
subway system of New York and probably you would still be
pumping it out today, not just pumping out New Orleans, but
pumping out the entire subway of New York.
We stopped the bleeding. We restored the breath. We cleaned
the wound. We pulled the edges together. Day by day, that site
grew smaller. Streets were opened and put back into service.
The whole thing was shrunk down, shrunk down. Life continued.
Life restarted and continued around it, until eventually you
have a nice clean wound that anyone could look at.
Mr. Shays. So the question is could we have done that and
protected the workers at the same time?
Mr. Romanowich. No.
Mr. Shays. No?
Mr. Romanowich. No, because the time someone had developed
the proper training, got all the protocols in order, the subway
system may have been flooded. There was a real hustle in the
initial days to stop that site from----
Mr. Shays. OK. I am going to buy into the first week, the
second week, the third week, the fourth week. There was a
point, and what you said makes me very proud of what took
place, because it is pretty extraordinary, and it is wonderful
to have you put on the record these urgencies. But there was a
point, and at the very least, every worker should have been,
you know, someone should have looked in their face, held their
head and said, you may become sick doing this. Do you volunteer
to do this? So there are things we could have done. Let me get
to the next person.
Mr. Romanowich. Yes. As individuals, we were aware of the
dangers. But just like the people who walked into Chernobyl to
secure that atomic energy disaster, they sacrificed their lives
for their country, we threw ourselves on the fire.
Mr. Shays. Right. You know, I think you did in one sense.
But there was a point where they left Chernobyl the way it was,
and didn't ask people to go in after everybody was dead and the
emergency. For 10 months, this happened.
Mr. Romanowich. As the urgency lessened there, the training
increased.
Mr. Shays. Yes.
Mr. Romanowich. There was a definite relationship.
Mr. Shays. Let me hear from somebody--I think what you have
made is on the record, and it is important to be on the record.
Let me get to the next. And the next person is Mr. Mickey
Kennedy--Michael Kennedy.
STATEMENT OF MICHAEL KENNY
Mr. Kenny. Thank you. I am Mike Kenny.
Mr. Shays. I am going to have you start over again. Hold
it.
Mr. Kenny. OK. Hello. I am Mike Kenny, and thank you for
having me down here.
Mr. Shays. Nice to have you here, sir.
Mr. Kenny. And it is an unexpected surprise, but a good
one.
I am Local 375, Civil Service Technical Field, health and
safety officer, but I also spent 7 months at the site.
Actually, it was 6 weeks before I was tested for PPE, because
that is how crazy it was down there, to find the time to get.
So until after 6 weeks went by, I really didn't have the right
PPE, because I was taking whatever I could find when I went
down there. And then I was tested, fitted, and I knew which one
to take.
After 7 months being at the site, I was injured. I broke my
collar bone, and I left the site. And to go to through the
workers' comp system and to try to get treatment with an injury
from the site and to be contested from the city at the same
time was very derogatory, because once you filled out the
paperwork saying you were hurt at the site, and you go to the
doctor, the doctor wouldn't take you until you got a workers'
comp number from the city. And I was out of work for 40 weeks.
Mr. Shays. Wow.
Mr. Kenny. And when I went back to work, I was so
depressed, I couldn't even walk up a flight of steps at that
time.
There was nothing there. Mental health was through Project
Liberty. I was able to find mental health. I went through the
mental health division, and then after that Red Cross gave me a
grant to go to more mental help. And I am still going to mental
help from what happened down at the site to me.
But even after going through the workers' comp, 3 years
before my case was finally--we went right to the day of trial
when the city backed up and said OK you were injured at the
city, they gave me back--out of 200 days I was out, they gave
me back 80 days. That is all they gave me back, and they said
thank you, you know.
I am in the treatment program right now at Mount Sinai. I
have major health concerns that I am actively going to. But I
have missed deadlines to reapply for mental health workers'
comp, because there is only a 2-year window. I never thought I
would still be in the situation I am in now. I have many
members come to me, and they don't want to take on the fight
with the city, because of the way you are handled. If you--you
try to go to work every day, and then you try to go--I go to
counseling. I give up one Saturday every 2 weeks with family to
go into the city for counseling.
Mr. Shays. Thank you. Thank you for your testimony. Mr.
Kaczorowski.
STATEMENT OF CHARLIE KACZOROWSKI
Mr. Kaczorowski. My name is Charlie Kaczorowski. I am
District 37, Local 375. I was there the morning of September
11th, and I was there for the next 10 months as the site
supervisor to the midnight to 8 a.m. shift.
Mostly I am going to speak about my concerns for my fellow
co-workers, Ron and Mike and John and Marvin back there.
Thirty-seven years ago, I spent a tour in Vietnam. I was
exposed to Agent Orange. In 1980, I had a liver two and half
times the size and inflamed and enlarged. The doctors figured
this came from Agent Orange.
Like Ron Vega said earlier, it depends where you stood on
the site, where the wind was blowing. It was night in December,
I spent 3 hours with two battalion chiefs, where we were trying
to watch the firemen go down to the boys to look for body parts
or victims, where the iron workers were cutting down the sticks
of the Trade Center facade. When the sticks fell, it caused a
ripple effect across the site, and the chiefs were concerned
about losing more men. So in order to be in contact with the
chiefs and 10/10 and the iron workers, I had my mask off for
that long time, and during those 3 hours, the clouds were
coming up out of the ground from the fumes, and it ripples. And
3 months later on, I had the ``World Trade Center cough.''
Today, I now have--my wife says I don't sneeze like I did
before September 11th. It is loud and it is unbelievable. I
have rashes now on my arms. I have a loss of breathing. I get
tired quickly, and my concerns are of my fellow co-workers
about what they are going through right now for what I
experienced 37 years ago.
Mr. Shays. Thank you very much. Let me just turn to Mrs.
Maloney for any comment or questions you might want to ask.
Mrs. Maloney. Well, first, I would like to thank the
chairman really for holding the only three Federal hearings on
the health needs of the Federal workers and for inviting the
workers and union leaders to come to the table. I think that is
an extraordinary expression of concern. It is the only time I
have ever seen that happen since I have been in Congress, to
bring up a group of people.
Charlie, what is Local 375? What was your job down at the
site?
Mr. Kaczorowski. I was a site supervisor.
Mrs. Maloney. You were a site supervisor for what? For what
agency?
Mr. Kaczorowski. DDC.
Mrs. Maloney. DDC.
Mr. Kaczorowski. I am construction project manager.
Mrs. Maloney. Construction project. I want to say that your
testimony and John's and Michael Kenny's I think that there are
so many stories of unsung heroes and heroines, and the one that
you shared of coming down there and securing the site, of
stopping the flooding, of getting the treasure of the United
States removed, there are so many people who did extraordinary
things with the police and the fire, but not everybody knows
the story of what the construction workers did and the iron
workers and all of you. And I think that one thing I would like
to propose with my colleague, Christopher Shays, and we have
had a lot of successes together legislatively. We passed the
intelligence reform bill, which I think is probably the most
important bill that has come before this Congress since I have
been elected to office. It will hopefully make all of us safer
with the sharing of intelligence.
I would like to propose that we put forward a piece of
legislation, not just on rotating workers, which we are going
to have to do when we talk to Micki and to Lee about that
aspect of the holes in the whole OSHA deal.
But I would like to propose that we fund an oral history
now that we have people still alive that is part of the Library
of Congress that shares the incredible stories of the men and
women that were at Ground Zero. And what has struck me so much
from Mr. Vega's testimony and John's and Michael's and
Charlie's is that you know that you were making yourself when
you went down there. I knew I was making myself sick when I was
down there. Yet, you felt like this was a responsibility to
protect our government, protect our people, and to really
respond and help people.
And what I found the most astonishing really and made the
biggest impression on me--and I hear September 11th stories all
the time, and your stories today, to me, were very moving--is
that what is the most irritating to you is the way that the
government response has treated you. How dare they say to you
you were not down on the site. How dare they say to me you were
not there trying to keep the subways from being flooded. How
dare they say to you that you weren't there when the Towers
fell, when the iron workers brought back the skeletons down and
the fumes came up. How dare they question your integrity that
you were there when you selflessly went down there.
And what I hear is such an outrage and disappointment
really from workers that the Federal Government did not--and
the State and the city--did not respect their work and respect
their valiant actions really for the whole country. That seems
to be more disturbing to people than anything else. I talked to
one guy, he said he found the flag. He has a picture of
himself--the flag that went all over the country and all over
the United States and Europe and Iraq, and they questioned that
he was on the site.
We have people who have testified they have lost their
limbs, and they question they were on the site.
And so I hope that with this new appointment, which I
consider a real milestone--I am absolutely thrilled with this
appointment--that we have someone who can listen to their
voices, hear their concern, and respond hopefully to it.
But, as always, the response of the people who lived
through it--the union representatives, the workers, the police,
the fire, the volunteers, the residents--I think we should have
an oral history that we begin now before we lose more of the
people that were involved with it that hopefully we learn from
their experiences. And I say to you and me, Chris, how dare we
not have a policy that workers are rotated in and off after the
first crisis week or two. I mean that should have been a given
that we should want to get people in and out and into fresh air
for their health care.
I wanted to thank Charlie for your service to our Nation in
Vietnam.
Mr. Kaczorowski. Thank you.
Mrs. Maloney. I feel that the Vietnamese war heroes were
not treated with the proper respect by our country, and I
really vow to you and hopefully with the help of Chris and Vito
Fossella that we make sure that our heroes of September 11th
are treated with the respect that they deserve starting with
absolute adequate, unquestioned health care. You were there for
us. We need to be there for you. End of story.
Mr. Kaczorowski. Thank you.
Mrs. Maloney. And I say it has to be a city and State and
Federal responsibility. I am surprised at the city's response
that I am hearing from you today. Thank you.
Mr. Kaczorowski. Thank you.
Mr. Shays. Thank you all.
Mr. Kaczorowski. Thank you.
Ms. de Hernandez. Thank you.
Mr. Shays. Thank you all very much and just for the record,
we are having these hearings at the request of Mrs. Maloney.
She is the one who asked the committee to have these hearings,
and so I thank the gentlelady for making sure that we focus on
this issue, and we will continue. Thank you very much. I
appreciate all of your testimony.
Ms. de Hernandez. Thank you, Mr. Chairman. Thank you,
Congresswoman Maloney.
[Whereupon, at 5:18 p.m., the subcommittee was adjourned.]
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