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As you read this article, the anniversary of the first catastrophic event to befall the U.S. in this century will have passed, but it will not and cannot be forgotten. Although the attack of Sept. 11, 2001, was horrific, what has happened since then represents bureaucracy at its worse (if not criminal negligence). Nothing like 9/11 has happened before in this country, but that is no excuse for the anguish experienced by those who responded to the tragedy.
Environmental and occupational health problems still plague first responders, volunteers and others who work, go to school and/or live in the lower Manhattan vicinity of the World Trade Center (WTC) site. As reported in the Winter 2004 EnviroMentor (Vol. 4, No. 2), debilitating health problems persist as evidenced by reports and analysis by the General Accounting Office, Environmental Health Perspectives, Morbidity and Mortality Weekly reports, the Sierra Club and my own recollections from an interview with a retired New York firefighter.
More and more reports have emerged of people exhibiting symptoms of severe respiratory distress, painful acid reflux and gastrointestinal conditions, and post-traumatic stress symptoms. Instead of WTC workers/responders and lower Manhattan residents getting better or the numbers of people with symptoms decreasing, the opposite has occurred. In January 2006, the first death directly attributed to the environmental effects of the contamination resulting from WTC response was recorded.
Even when EPA's World Trade Center Expert Technical Review Panel announced that it would test inside lower Manhattan buildings in December 2005, members of its own panel, residents and other critics denounced the plan because it was voluntary and expressed concern about its geographical focus and testing methodology. The excluded neighborhoods had been covered by the dust cloud from the structures' collapse and the effects of the remaining smoldering fires; furthermore, many were along the route of transport of the debris barged or trucked to the Fresh Kills landfill on Staten Island.
The next major structural problem the workers and residents face concerns the cleanup of the 41-story Deutsche Bank Building (aka 130 Liberty St.). This structure was damaged by a 15-story gash from the collapse of the north tower. Nearly 5 years later, EPA found that workers searching for human remains and performing cleanup in the building were working without respirators. Work stopped, and EPA, New York City's environmental agency and the state labor department inspected the site and found that areas of the roof, which had purportedly been cleaned, still contained large amounts of asbestos-laden dust and toxic materials.
In early April 2006, hundreds of bone fragments from 9/11 victims were discovered on the roof of 130 Liberty St., much to the anger of many victims' families. In addition, the building is filled with other poisonous dust, including more asbestos, heavy metals and PCBs. Neighbors and potential demolition and cleanup workers now face another probable source of contamination and possible health effects 5 or more years later.
The reason so many people are concerned about this next demolition project will hopefully become apparent as the article progresses. Many readers may already be aware (although it has not been widely reported) of the extensive and unusual illnesses and deaths linked to the contaminated dust that surrounded lower Manhattan and was inhaled and ingested in the days, weeks and months after the structures collapsed.
On March 15, 2006, the third member of Local 2507 died of an asbestos disease linked to the toxicity of the WTC collapse. Deborah Reeve was a 41-year-old, 17-year veteran paramedic. She was one of hundreds of District Council (DC) 37 (Uniformed EMT and Paramedics) of the American Federation of State, County and Municipal Employees (AFSCME) who worked at ground zero. She breathed in the noxious smoke and poisonous air without protection because in the early weeks, little or no breathing protection was provided. Paper and surgical masks worn quickly clogged with sweat and debris, leaving them useless. It was also difficult to communicate with survivors and other responders through the clogged masks. It has already been established that communication before and after the collapse was a major problem.
During the 8-month recovery period, EMT Reeve was often assigned to work at the morgue at ground zero to help medical examiners identify body parts from the building rubble. By 2003, she was experiencing respiratory problems and a persistent cough (often referred to as the World Trade Center cough), and doctors diagnosed mesothelioma, a cancer that develops after exposure to asbestos.
Despite her deteriorating health, Reeve spent a year fighting New York City for disability benefits. Although her workers' compensation claim was denied, the New York City Employees Retirement System determined that she would be the first city worker to receive a line-of-duty injury disability pension under the new 9/11 disability law. She died before the check arrived.
At the time of Reeve's and others' deaths, the city treated such incidents as accidents instead of illnesses. Those who did not get sick within the first 2 years after Sept. 15, 2001, were simply out of luck. All rescuers received credit for the first 96 hours following the catastrophe.
The other two members of Local 2507 were EMTs Felix Hernandez and Tim Keller. Fernandez had answered the original call, but he also returned to ground zero to work on the recovery effort. He was exposed to the asbestos and died of lung disease on Oct. 23, 2005, at the age of 31.
Keller was among the first responders to arrive and actually witnessed the collapse of both towers. He also worked around the clock in recovery efforts. Keller died from a respiratory illness on June 23, 2005, at age 41.
A study released in May 2006 found that New York Fire Department (FDNY) rescuers and workers (they were the only ones considered in this particular study) who inhaled the toxic air at ground zero had lost the equivalent of 12 years of lung function during the first year after 9/11. Montefiore Medical Center-Einstein College and the FDNY analyzed 12,079 fire and EMT workers. The study's co-author, Gisela Banauch, a professor at Montefiore/Einstein College in the Bronx, noted that these statistics reflected a significant loss. She added that this study and others provide a causal connection between WTC exposure and short- to intermediate-term respiratory disease-tying such loss of lung function to sickness and death.
The 12-year loss is only an average. Thousands of firefighters, such as Tim Keller, who were present at the actual collapse suffered the greatest loss of respiratory capacity. Another study co-author of the study, David Prezant, FDNY's chief medical officer and a professor at Einstein College, has noted that the closer to the time of the collapse that a responder was at ground zero, the more severe the symptoms and loss of pulmonary function. He added that this did not necessarily mean an irreversible loss. Early diagnosis and treatment would help.
The study identified more than 400 chemicals in the toxic WTC air. Significant for many of the lawsuits that have followed is that the report said adequate respiratory protection was not immediately available and that only 22% of the responders who first arrived onsite wore masks of any kind. Even among responders who arrived later, the figure never topped 50%. The study also maintains that the respiratory equipment first used had no appreciable effect.
John Miscanic was on an engine from Company 276 going over the Brooklyn Bridge when the south tower collapsed. He suffers from severe asthma and airway hyperactivity. His lung capacity diminished by more than 20%, and he is one of 600 FDNY workers who have qualified for respiratory disability since 9/11. His medical report concludes that his respiratory disability is permanent and related to his 9/11-WTC exposures. He is age 40 and although he was a fitness buff before 9/11, he now coughs up brown mucus every morning and wheezes every night. Air fresheners make him choke and perfume burns his insides.
Investigations into the health risks and effects on workers in recovery and cleanup operations have begun to provide clues to the various debilitating and fatal diseases that are so prevalent. Signs now clearly indicate that the dust, smoke and ash that were breathed in at ground zero have scarred responders' lungs and reduced their capacity to breathe.
One of the most significant scarring diseases is sarcoidosis. This disease increased to five times the expected rate among firefighters between Sept. 11, 2001, and Sept. 11, 2003. Medical personnel who see workers who were at ground zero in the first 48 hours after the towers collapsed expect that monitoring will exhibit many more cases of lung-scarring diseases among this group. In addition, as many suspected, new evidence suggests that workers who arrived later or worked on the areas around the disaster site may also be susceptible to these same lung ailments.
Dr. Stephen Levin, a director of the World Trade Center Worker and Volunteer Medical Screening Program, has noted that thousands of people were at the site with unprotected exposures, and many have and will develop severe asthma. Some will also develop lung-scarring diseases that lead to disability or death. One clue that has helped researchers is the statistically unexpected high respiratory disease among the young responders. The respiratory conditions that researchers see are much more serious than the WTC cough. These diseases usually take at least a few years to develop and sometimes get progressively worse.
Medical experts consider the granulomatous pulmonary diseases, typified by swirling marks left on the lungs by foreign matter such as dust, to be most worrisome. These include pulmonary fibrosis and sarcoidosis. In the latter case, any exposure to dust causes the body's immune system to attack itself.
In January 2006, New York Police Detective James Zadroga died. An Ocean County, NJ, coroner's report directly linked the death of the 34-year-old Zadroga to granulomatous pneumonitis-fatal respiratory failure caused by WTC dust. The autopsy found swirls throughout his lungs.
His death was the first to be officially linked by an autopsy report to inhalation of ground zero dust. Unofficially, DC 37 attributed the deaths of three emergency technicians/paramedics discussed earlier, and the Uniformed Firefighters Association attributed the deaths of two firefighters and a battalion chief to similar granulomatous lung diseases and respiratory ailments.
The use of respirators may have helped, but even when effective ones were used, they only lasted 20 minutes. When digging for or recovering bodies in tons of toxic rubble, 20 minutes goes by quickly, and communication was very difficult. Also, even though only a small portion of the 40,000 responders onsite have been diagnosed with lung diseases, the deaths of these responders and debilitating effects of the poisonous dust have left others with breathing problems and questions about whether they are next.
Dr. Levin, a professor at Mount Sinai School of Medicine, notes that more than 60% of the firefighters and EMS personnel who have been examined have developed respiratory conditions such as sinusitis. Continued monitoring suggests that more serious lung problems could follow, and he plans to complete a new epidemiological study soon.
Unfortunately, the Police Pension Board decided that police officer James J. Godbee Jr., who worked at the disaster site for more than 850 hours and developed sarcoidosis, did not die from working at "The Pit" or "The Pile" as it was also called. The Board said that sarcoidosis was "not known to be related to employment in the police force" and denied Godbee's widow a line-of-duty death benefit. There is hope that the board's decision will be overturned on appeal since it would be difficult for government to treat two people with similar positions differently.
Although the death of Detective Zagroda was the first to be directly attributed to the WTC toxic mess, the fight of Deputy Mayor Rudy Washington (under former mayor Rudy Guiliani) put the spotlight on the diseases and poisonous effects of ground zero and its cleanup. He was the official who directed other officials to test the air after the attacks. He somehow made his way back to City Hall to take the first call from New York Governor George Pataki and ordered the bridges and tunnels into Manhattan closed.
Washington, 52, filed a medical claim for respiratory illnesses attributed to the disaster site pollution. He had been caught in the cloud of dust and debris after the north tower fell, but he continued to worked for weeks. He filed his claim about 1 year ago due to his rising medical costs. It was approved on March 11, 2006. However, he learned soon after that the city planned to appeal the award.
Washington had become sick shortly after working at ground zero. He was hospitalized and finally diagnosed with asthma, which he had not had before Sept. 11. Like many other victims of the toxic fumes, he takes several medications and has been to his doctor and the emergency rooms several times in the last 5 years. He had also joined the Mount Sinai Hospital screening program. On May 17, Mayor Michael Bloomberg finally told city lawyers to drop their appeal of Washington's workers'compensation claim.
Stricken workers who filed for claims, pensions or other benefits from the city have been thwarted at every turn-at precisely the time the city should be doing all it can to help them. Besides firefighters, EMTs and police, other city employees, such as sanitation workers, helped clear the site and transport toxic materials to barges and to Fresh Kills. In addition, barge workers at Fresh Kills and garage workers and mechanics who cleaned and maintained the vehicles, klieg lights, cranes, etc., were covered with poisonous dust.
Dr. Robin Herbert, the new director of the World Trade Center Health Effects Treatment Program at Mount Sinai Medical Center, notes that the workers' compensation program was one of the most common nonmedical complaints from her patients. She also notes that patients who have physical and mental health problems from the disaster have had their psychological distress worsened by the difficulties they have experienced with the workers' compensation system.
One of those frustrated is William Dahl, a 42-year-old paramedic who had worked for FDNY for 21 years. He was allowed to retire on disability in April 2006 but has been fighting for long-term healthcare coverage. Dahl was an emergency responder near the disaster site and had filed a pre-emptive compensation claim, but he did not develop symptoms until a year later.
His current conditions include sinusitis, tracheitis, gastroesophageal reflux disease and synovial sarcoma, a rare cancer; and he coughs constantly. However, shortly after he was awarded his three-quarters disability pension in April, the city's law department informed him that it would challenge his claim for healthcare benefits under the workers' compensation system. He cannot understand how one arm of the city-the pension system-can allow his pension based on WTC-related disabilities, while the city's law department can challenge how sick he is.
The state-run workers' compensation system is intended to provide workers who are injured or disabled on the job with medical assistance and fixed weekly payments. As one professor noted, the system is not designed well for diseases that have a long latency period. Because so many new claims have been filed since the deadline of September 2003, the state legislature has been urged to pass new laws extending the deadline for late-filing workers-those for whom the onset or worsening of their respiratory, digestive or psychiatric conditions did not occur until years later and others for whom such physical and mental illnesses have yet to become apparent. It is reported that 290 city workers missed the 2003 deadline.
As the number of workers whose illnesses worsened or who experienced a latent onset of conditions attributed to the toxic effects of working at ground zero increased, two legislators introduced a bill that would create the presumption that certain illnesses resulted from 9/11 and waive the burden of having to prove that assertion of causality. It would also waive the 2-year deadline to give workers up to 6 months to file their claims from the time they notice their symptoms. Plus, it would allow for workers to get a new hearing if their claims had been rejected.
The Blame Game
In May 2006, British Broadcasting Corporation (BBC) aired a program called "Fallout," which explored the physical and mental damage to 9/11 responders, plus office workers and residents of the area near the disaster. A main theme of the program centered on the fact that all of the abovementioned people believed the government, both federal and local, when they said it was safe. The show included a sound byte from Sept. 16, 2001, when former EPA Administrator Christine Whitman reported that the EPA had not seen any air monitoring readings which indicated a health hazard.
The program also interviewed Mount Sinai's Dr. Levin, who reiterated that he is convinced of a link between the air in lower Manhattan and the nearly 15,000 cases of respiratory illness known to exist in that exposed population.
Dr. John Howard, head of NIOSH, was also interviewed. Howard was appointed by the Bush administration to coordinate federal initiatives for the various ground zero health programs. Howard noted that he did not know the basis for the EPA's determination that the air in lower Manhattan was safe to breathe.
Although many community and political groups in New York City, especially those in or representing parts of Manhattan and Staten Island, have long been critical of the EPA, the BBC program renewed the furor and criticism as to what the former EPA administrator and/or her staff said/did not say, meant or did not mean.
The 71,000 people who signed onto the WTC health registry 2 years ago will be resurveyed through a comprehensive medical assessment. The goal is to gather up-to-date information on how medical conditions among those registered have changed. The surveys will be both in English and Spanish and can be taken online. In addition, medical surveys of the original 71,000 will be taken every 2 years for the next two decades.
Dr. Howard noted that survey results could be used to support requests for additional federal monies from the federal government for treatment and monitoring. He said he expects the results by the end of 2006. He also noted that the registry could be used as a scientific platform from which programmatic decisions can be made. He added that some participants reporting a high prevalence or worsening of symptoms might be called in for a medical exam.
One issue not known is how much money and personnel will be needed for such a continuing monitoring program, but will likely be more than the $125 million originally allocated by the federal government (which had been dropped to $50 million by the Bush administration, but later restored after much clamor by the New York congressional delegations and others).
David Newman, an industrial hygienist with the New York Committee on Occupational Safety and Health (NYCOSH), noted the need for an adequate characterization of the nature and scope of the contamination, without which it is difficult to quantify the kinds of problems people will face. The worse case is that an entire group of people may still become seriously ill.
Dr. Levin adds that some people are only now being seen for the first time, nearly 4 years later. He also said that some of those have had persistent symptoms yet have not been screened or received care. Some have said they were in denial having seen or knowing fellow workers who were chronically ill or had died. Others have said they were concerned that if their employers knew they were ill, their jobs could be affected or they would lose their insurance.
Union officials have said it has been difficult to get members to register or to get a checkup because members fear they will be told they can no longer work. Many responders who are in the trades and other workers eligible for overtime can make more than $80,000 a year, whereas New York workers' compensation only pays about $400 a week. A staff person for one union said she had no doubt that people with symptoms are not being checked because they have mortgages and families, and cannot afford to stop working.
Politicians outside of New York have been lobbied for more federal funding and an established protocol for tracking and treating the health problems of those exposed to the contamination at and around the WTC site. In March, CDC said it would distribute about $75 million of the $125 million. This would be the first federal money to be spent directly on medical treatment for 9/11 health effects. Dr. Howard has added that in his opinion there is a national responsibility to help. He noted that those people who helped at the site did so without regard to their own safety. He feels they deserve to be treated like heroes.
Thomas Van Essen, New York City Fire Commissioner on Sept. 11, 2001, has noted that baselines existed for all firefighters based on their annual medical exams, but he notes that this was not always the case for construction workers, crane operators, iron workers and volunteers who either worked at the site or came to help.
As noted, the worst effects are being found in emergency workers who were at the disaster site when the towers fell. One firefighter at the scene when they collapsed reported that he had his mask with him but did not have it on. When he reached to put it on, it was filled with so much debris that when he took a breath he inhaled only dust and nearly vomited. Perhaps he would have been better had he had vomited-he was pulled off active duty last year after the most recent and most serious of his asthma attacks. He will probably not work again. To compound the situation, when this firefighter saw that policemen and EMS workers did not have any masks, he shared his with several of them.
Jonathan Bennett, NYCOSH public affairs director, notes that as someone who has worn a respirator, it is not the easiest of tasks, especially with no training. He has done it for an 8-hour workshift with training, but many of these responders were working up to 14 hours. Another important factor that many have noted is that in the early hours and days of rescue attempts, it was extremely important for rescue workers to communicate with each other. Workers trained to use respirators use hand and other signals, but those were usually not possible for workers with no training. Also, as all could see during the TV coverage, complete silence was often mandated so those trapped in the debris could be heard.
Although doctors have said repeatedly that it could still be years before ill effects are felt by these responders, workers have said they have no regrets and would do it again. Their problem is not so much what they did- often without being asked or thinking of themselves-their problem is that they have been left to navigate through a system in order to get the help (or sometimes ask the right agency for help) they need in a bureaucracy that many call very disorganized and much too restrictive. An occupational illness as defined by New York is only an infirmity common to an employee's line of work (e.g., lung cancer for firefighters), but the policy is ambiguous for EMTs or other nonuniformed workers.These are the types of situations that are leading to more litigation and to proposed legislation to help these workers and those to come.
In June 2006, a broad medical survey was initiated of the 71,000 people who have been affected by the 9/11 attacks. This survey may be the best hope of identifying and treating these ailments. In addition, this survey will include firefighters, police, lower Manhattan residents and office workers, and will be of great use in seeking federal funding and forming a federal policy for other catastrophic events. These 71,000 are those who signed up for the initial survey between 2003 and 2004. This new survey is the first of several follow-up questionnaires that are proposed for the 20-year life of the federally funded program.
This has been an overview of what has been happening to these brave and far too often sick responders to this national catastrophe and what they have endured over the past 5 years. Part 2 of this article will, however, appear in the next issue. We wish it were truly the "rest of the story," but that is not possible because this story may not be over for years to come.
Sources for this article include NYCOSH; Newsweek; Village Voice; Time; New York Times; New York Daily News; Newsday; New York Post; Chief- Leader; Downtown Express.