[House Hearing, 108 Congress]
[From the U.S. Government Publishing Office]
ASSESSING SEPTEMBER 11TH HEALTH EFFECTS: WHAT SHOULD BE DONE?
=======================================================================
HEARING
before the
SUBCOMMITTEE ON NATIONAL SECURITY,
EMERGING THREATS AND INTERNATIONAL
RELATIONS
of the
COMMITTEE ON
GOVERNMENT REFORM
HOUSE OF REPRESENTATIVES
ONE HUNDRED EIGHTH CONGRESS
FIRST SESSION
__________
OCTOBER 28, 2003
__________
Serial No. 108-124
__________
Printed for the use of the Committee on Government Reform
Available via the World Wide Web: http://www.gpo.gov/congress/house
http://www.house.gov/reform
______
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COMMITTEE ON GOVERNMENT REFORM
TOM DAVIS, Virginia, Chairman
DAN BURTON, Indiana HENRY A. WAXMAN, California
CHRISTOPHER SHAYS, Connecticut 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
MARK E. SOUDER, Indiana CAROLYN B. MALONEY, New York
STEVEN C. LaTOURETTE, Ohio ELIJAH E. CUMMINGS, Maryland
DOUG OSE, California DENNIS J. KUCINICH, Ohio
RON LEWIS, Kentucky DANNY K. DAVIS, Illinois
JO ANN DAVIS, Virginia JOHN F. TIERNEY, Massachusetts
TODD RUSSELL PLATTS, Pennsylvania WM. LACY CLAY, Missouri
CHRIS CANNON, Utah DIANE E. WATSON, California
ADAM H. PUTNAM, Florida STEPHEN F. LYNCH, Massachusetts
EDWARD L. SCHROCK, Virginia CHRIS VAN HOLLEN, Maryland
JOHN J. DUNCAN, Jr., Tennessee LINDA T. SANCHEZ, California
JOHN SULLIVAN, Oklahoma C.A. ``DUTCH'' RUPPERSBERGER,
NATHAN DEAL, Georgia Maryland
CANDICE S. MILLER, Michigan ELEANOR HOLMES NORTON, District of
TIM MURPHY, Pennsylvania Columbia
MICHAEL R. TURNER, Ohio JIM COOPER, Tennessee
JOHN R. CARTER, Texas CHRIS BELL, Texas
WILLIAM J. JANKLOW, South Dakota ------
MARSHA BLACKBURN, Tennessee BERNARD SANDERS, Vermont
(Independent)
Peter Sirh, Staff Director
Melissa Wojciak, Deputy Staff Director
Rob Borden, Parliamentarian
Teresa Austin, Chief Clerk
Philip M. Schiliro, Minority Staff Director
Subcommittee on National Security, Emerging Threats and International
Relations
CHRISTOPHER SHAYS, Connecticut, Chairman
MICHAEL R. TURNER, Ohio
DAN BURTON, Indiana DENNIS J. KUCINICH, Ohio
STEVEN C. LaTOURETTE, Ohio TOM LANTOS, California
RON LEWIS, Kentucky BERNARD SANDERS, Vermont
TODD RUSSELL PLATTS, Pennsylvania STEPHEN F. LYNCH, Massachusetts
ADAM H. PUTNAM, Florida CAROLYN B. MALONEY, New York
EDWARD L. SCHROCK, Virginia LINDA T. SANCHEZ, California
JOHN J. DUNCAN, Jr., Tennessee C.A. ``DUTCH'' RUPPERSBERGER,
TIM MURPHY, Pennsylvania Maryland
WILLIAM J. JANKLOW, South Dakota CHRIS BELL, Texas
JOHN F. TIERNEY, Massachusetts
Ex Officio
TOM DAVIS, Virginia HENRY A. WAXMAN, California
Lawrence J. Halloran, Staff Director and Counsel
Kristine McElroy, Professional Staff Member
Robert A. Briggs, Clerk
David Rapallo, Minority Counsel
C O N T E N T S
----------
Page
Hearing held on October 28, 2003................................. 1
Statement of:
Gilman, Dr. Paul, Assistant Administrator for Research and
Development, Environmental Protection Agency; Diane Porter,
Deputy Director, National Institute for Occupational Safety
and Health [NIOSH], accompanied by Dr. Gregory Wagner,
Director of the Division of Respiratory Disease Studies,
National Institute for Occupational Safety and Health; Pat
Clark, area office director for New York, New York
Occupational Safety and Health Administration, accompanied
by Dr. David Williamson, Ph.D, Agency for Toxic Substances
Disease Registry........................................... 103
Herbert, Dr. Robin, co-director of the World Trade Center
Worker and Volunteer Medical Screening Program, medical co-
director of Mount Sinai; Dr. Stephen Levin, co-director of
the World Trade Center Worker and Volunteer Medical
Screening Program; Commissioner Thomas Frieden, a doctor at
New York Department of Health and Mental Hygiene; Dr.
Michael Weiden, medical officer, New York Fire Department;
Phil McArdle, health and safety officer, Uniformed
Firefighters Association; Jimmy Willis, vice chair for
conductors, assistant to the president, Transportation
Workers Union; John Graham, health and safety instructor,
Carpenters Union; and David Rapp, former worker at the
World Trade Center site.................................... 22
Letters, statements, etc., submitted for the record by:
Clark, Pat, area office director for New York, New York
Occupational Safety and Health Administration, prepared
statement of............................................... 140
Frieden, Commissioner Thomas, a doctor at New York Department
of Health and Mental Hygiene, prepared statement of........ 37
Gilman, Dr. Paul, Assistant Administrator for Research and
Development, Environmental Protection Agency, prepared
statement of............................................... 124
Graham, John, health and safety instructor, Carpenters Union,
prepared statement of...................................... 69
Herbert, Dr. Robin, co-director of the World Trade Center
Worker and Volunteer Medical Screening Program, medical co-
director of Mount Sinai, prepared statement of............. 25
McArdle, Phil, health and safety officer, Uniformed
Firefighters Association, prepared statement of............ 57
Maloney, Hon. Carolyn B., a Representative in Congress from
the State of New York:
Article dated October 28, 2003........................... 7
Prepared statement of.................................... 10
Owens, Hon. Major R., a Representative in Congress from the
State of New York, prepared statement of Ms. Mount......... 100
Porter, Diane, Deputy Director, National Institute for
Occupational Safety and Health [NIOSH], prepared statement
of......................................................... 107
Rapp, David, former worker at the World Trade Center site,
prepared statement of...................................... 74
Shays, Hon. Christopher, a Representative in Congress from
the State of Connecticut, prepared statement of............ 3
Towns, Hon. Edolphus, a Representative in Congress from the
State of New York, article dated August 23, 2002........... 14
Weiden, Dr. Michael, medical officer, New York Fire
Department, prepared statement of.......................... 46
Willis, Jimmy, vice chair for conductors, assistant to the
president, Transportation Workers Union, prepared statement
of......................................................... 64
ASSESSING SEPTEMBER 11TH HEALTH EFFECTS: WHAT SHOULD BE DONE?
----------
TUESDAY, OCTOBER 28, 2003
House of Representatives,
Subcommittee on National Security, Emerging Threats
and International Relations,
Committee on Government Reform,
New York, NY.
The subcommittee met, pursuant to notice, at 10 a.m., in
the Goldwurm Auditorium of the Mount Sinai Medical Center, 1st
Floor, 1425 Madison Avenue, New York, NY, Hon. Christopher
Shays (chairman of the subcommittee) presiding.
Present: Representatives Shays, Turner, and Maloney.
Staff present: Lawrence Halloran, staff director and
counsel; Kristine McElroy, professional staff member; Robert
Briggs, clerk; and David Rapallo, minority counsel.
Mr. Shays. I'd like to welcome our witnesses and our guests
to this congressional hearing. And to say that this is an
important day and we are looking forward to the testimony from
our witnesses.
A quorum being present, the Subcommittee on National
Security, Emerging Threats and International Relations Hearing
entitled, ``Assessing September 11th Health Effects: What
Should be Done?'' is called to order.
Congresswoman Carolyn Maloney invited the National Security
Subcommittee to New York City today because she understands the
threat posed to the health and welfare of all Americans by
terrorism and its lingering aftermath. She has been a
thoughtful, hardworking partner in our bipartisan oversight of
terrorism issues, and we are grateful for the opportunity to be
here.
In place of the fallen towers of the World Trade Center,
these two hard realities cast long shadows over our discussion
today. Many first responders are the second wave of victims in
a terrorist incident. And public health and disability
compensation systems are not fully prepared to acknowledge the
unique wounds inflicted by this all too modern war.
Firefighters, police, emergency medical personnel, transit
workers, construction crews and other first responders came to
Ground Zero knowing there would be risks, but confident they're
equipment, training and community would sustain them. But, as
we will hear today, better equipment and training standards are
needed to match the first responder mission to the new threats
posed by catastrophic terrorism. And the dissident patchwork of
Federal, State and local health support is, in many cases, not
providing the care and comfort they rightfully expect.
After the 1991 war in the Persian Gulf, veterans suffered a
variety of unfamiliar syndromes, faced daunting official
resistance to evidence linking multiple low level toxic
exposures to subsequent chronic ill health. In part, due to the
work by this subcommittee, long term health registries were
improved, an aggressive research agenda pursued and sick
veterans now have the benefit in law of a rebuttable
presumption that wartime exposures cause certain illnesses.
When the front line is not Baghdad but Broadway,
occupational medicine and public health practitioners may have
much to learn from that distant Middle East battlefield. Proper
diagnoses, effective treatment and fair compensation for the
delayed causalities of a toxic attack require vigilance,
patience and a willingness to admit what we do not know and
might never know about toxic synergies and syndromes.
Health surveillance has to be focused and sustained. New
treatment approaches have to be tried now in time to restore
damaged lives. In this effort to heal the wounds of September
11, 2001 and strengthened public health capacity against future
attacks, the Federal Government has a central role to play. The
Center for Disease Control and Prevention [CDC], and its
National Institute of Occupational Health are charged to
develop and implement health protocols against new workplace
dangers like Anthrax and novel particulates from the fiery
destruction of a building.
On our second panel of witnesses today we will hear about
the work and other Federal public health agencies in treating
the walking wounded of September 11th. But before we will hear
from first responders and local officials on the near and long
term health effects of the World Trade Center attack.
We appreciate our Federal witnesses foregoing the usual
protocol of going first so that they could listen and respond
to all the testimony today.
All our witnesses bring impressive expertise and
unquestionable dedication to our discussion. We are grateful
they could join us. We look forward to a constructive dialog on
how to mend the wounds of this and other terrorist attacks.
At this time the Chair would recognize the very gentle, as
they say in terms, and very knowledgeable Mrs. Maloney.
[The prepared statement of Hon. Christopher Shays follows:]
[GRAPHIC] [TIFF OMITTED] T2728.001
[GRAPHIC] [TIFF OMITTED] T2728.002
Mrs. Maloney. First of all, Chairman Shays, I want to thank
you very, very much for coming to my district to hold this
hearing. But I also would like to focus and comment on your
long term commitment to issues of public health, including your
outstanding and aggressive oversight of the response of the
Federal Government to the Gulf war syndrome. In fact, many
people say that the September 11 health concerns are similar to
the Gulf war syndrome and that Washington is not really
reacting to what is a major health crises in an appropriate
way.
The primary question before us today is everything being
done that could be done to help those workers and victims at
September 11. And that is why I asked Chairman Shays to have
this hearing.
And I regretfully expect that we will hear today that the
answer is no. I have read in some testimony that over 1,800 of
the firefighters have had to take early retirement because of
health concerns. I have read the testimony of transit workers
who called the air at Ground Zero ``toxic soup'' filled with
asbestos and pulverized glass and concrete, and that fully half
of their workers are sick.
And fully one-third, I am told by Dr. Levin and others at
Mt Sinai are still experiencing long term related health
problems. And, regrettably, Dr. Levin has told me that 40
percent of the people they have screened so far do not have
health coverage.
There is substantial evidence of high levels of upper
airway and lung problems, respiratory, digestive conditions,
psychological trauma problems. And there are certainly more
injured that are waiting in line to be documented. But there
still seems to be no coordinated response from Washington.
Anyone looking at thousands sickened by one event would
think that it would be treated as a health emergency of the
highest order. But it does not seem that there has been any
sense of urgency from the Federal Government.
I hope that this hearing will help sort all of this out.
And I know that many of the panelists and my colleagues, I
thank them for being here, have a lot of questions.
First, what is being done to actually assist the injured
medically? That is what I would like to hear from the panel.
Is there a coordinated assistance for those that need help;
volunteers, construction workers, residents, first responders
who have injured and have not been able to work since their
time at Ground Zero, many of whom have list their health
insurance because they are no longer able to work?
Do those who were insured know that many can apply? Many of
the injured can apply. And I want to make sure that they know
that they can apply to the Victims Fund. And do they know that
they must apply before the December 31st deadline of this year
for assistance?
What is happening with processing of worker's compensation
claims? I hear reports that is mired in difficulty.
And most importantly, are those injured receiving the
proper care?
Why has there been such reluctance on the part of the
Federal Government to provide sufficient funds for monitoring
and why have the funds been so slow in getting dispersed?
It took over a year to get the leadership in Congress to
support the $90 million for the medical screening of World
Trade Center workers. Federal resources for the monitoring
program, even 8 months after they were appropriated, have still
not been dispersed and apparently will not be dispersed until
May 2004 at the earliest. Why is this happening? This is wrong.
We should figure out to move the system forward.
And I hope that NIOSH will explain why they are proposing
to change the system, and at the very least their changes
should not in anyway disturb the monitoring the program that is
already in place and not have gaps in that monitoring programs.
And are there sufficient funds in place to properly provide
the long term monitoring that is needed? We have never had a
situation in history where pulverized toxic air has been
exposed to people. And we need a long term commitment to
monitor these health risks so that we can possibly plan in the
future for better preventive equipment to protect people at
disaster areas.
And why are the representatives of the workers so directly
impacted by health concerns so unhappy with the work of the
city on the health registry?
And why are there still privacy concerns about the health
registry survey?
Why did the registry not work out a protocol for providing
information and referral for those injured who seek help? I had
my staff call the registry and they didn't refer them to any
other screening or to any health treatment. And why, after 2
years of planning, cannot the city of New York, the great city
of New York do a better job with this health registry?
In light of the revelations about the EPA's public
announcements on the safety of the air after the disaster, the
immense difficulty the New York City House members in a
bipartisan way along with our Senators had in convincing
Washington to support funding, we have to ask why is not
Washington focusing on these issues. And I would like
permission to place in the record an article that was in the
Daily News today that talks about memos from top scientists
that were released to the city about the health crises in the
air and the lack of information and support that got out to the
workers. They were not informed. I request permission to put
this article in the record.
Mr. Shays. Without objection, so ordered.
[The information referred to follows:]
[GRAPHIC] [TIFF OMITTED] T2728.003
[GRAPHIC] [TIFF OMITTED] T2728.004
Mrs. Maloney. I am in the process of developing legislation
which I hope will be a bipartisan effort which will focus on
many of the issues that we are talking about today.
First, the legislation would make sure that everyone who
was injured from their time at Ground Zero, the volunteers, the
bucket brigade, the firefighters, fire officers, iron workers,
construction workers; all of those that do not have health
coverage, that they get health coverage that covers their
health concerns because they risked their lives to save other
people.
And I ask a final question: How in the world are other
first responders going to respond to disasters if they see that
the first responders who rushed to September 11 are not, at the
very minimum, given health care and health screening and health
monitoring for their health concerns because of their selfless
act to rush and save the lives and work to reconstruct our
city?
I would like to place in the record the draft of the
legislation. It also calls for the monitoring to continue for
20 years and for research to look into what this means, this
new type of toxic air that Americans or no one on Earth has
ever experienced before on their long term health needs. And it
tries to facilitate a better coordination and oversight.
Coming here today I saw a bumper sticker that said
``Remember 9/11.'' You see them everywhere. ``Remember 9/11.''
But I hope that today with this focus that Washington will also
remember, the city will remember and we will get the proper
care to the workers. And I hope that this is the beginning of a
new and urgently needed focus on the health impact of September
11.
And I strongly commend the work of the chairman on the Gulf
war syndrome, and for his attention and for being here today.
Thank you.
[The prepared statement of Hon. Carolyn B. Maloney
follows:]
[GRAPHIC] [TIFF OMITTED] T2728.005
[GRAPHIC] [TIFF OMITTED] T2728.006
Mr. Shays. I thank the gentle lady.
And at this time the Chair would recognize the vice
chairman of the subcommittee, Mr. Turner, and thank him for
being here given he has constituent issues in his home State of
Ohio. And I thank you for being here. Thank you.
Mr. Turner. I want to thank our chairman, Chris Shays and
Mrs. Maloney, for having this hearing and for focusing on these
important issues. Mrs. Maloney, thank you for having us in your
district.
Our chairman, Chris Shays, has been a leader in the issues
of looking at terrorism and our preparedness both on the local
and Federal level and our responsiveness to the issue of how do
we prevent terrorist attacks, how do we prepare for them and
how to respond. Even prior to September 11th our chairman had
made certain that this committee looked at ways that
information could be disseminated to communities and throughout
the Federal Government in assisting us in our preparedness for
terrorist attacks.
I am the only Representative who is here who is not from
the larger New York metropolitan area, but I can assure you
that this is a national issue. It is a national issue not only
because September 11th was a national tragedy, but because the
preparedness, the information that we learn from this
experience is important to all of us in our country as we look
to lessons learned and how we can prepare in the future.
Also for my community, Dayton, OH, I served as mayor for
Dayton during September 11, 2001, and even our community sent
EMS, fire and EMS responders as part of the recovery operation
in response to New York's broader request that States
throughout the region send responders here. So I met our
responders as they were returning from New York and spoke with
them about what they saw and how their efforts here impacted
their lives. And I'm very interested then in how the overall
environmental impacts might effect the efforts of really what
was the response from many States in helping New York.
We do have a lot of real important work here to do today.
One is the evaluation of current spending. There have been
millions of dollars that have been spent and millions of
dollars that have been allocated. Have they been allocated to
the appropriate things? And what are the needs that we need to
address?
In looking at the needs, we are obviously going to be
looking at the issue of the full impacts, not just those that
are immediately obviously, but as we further study this and
look to the impacts in this community.
And then also the third would be on the issue of just
lessons learned, and not only for processes but substantive,
technical, scientific information that we have learned.
I am very excited about participating in this and learning
from all of the experts that you have assembled the information
that we need as we look to proceed in the future. Thank you.
Mr. Shays. Thank the gentleman.
At this time the Chair would recognize Mr. Townes, not a
member of the subcommittee, but a member of the full committee.
Mr. Towns. Thank you very much, Mr. Chairman.
Let me begin by thanking you and all my colleagues for
holding this very important hearing. I appreciate that you are
holding the hearing in the city that the most damage occurred,
and that is a fact. The tragedy of September 11 was felt more
by our city than any other place. We encountered the greatest
physical destruction and we lost the most lives. And thousands
of families still mourn the magnitude of this devastation,
which was easily seen by the entire world.
I have been, and remain concerned, about the lack of
attention paid to those who live right outside of Manhattan. As
someone who represents parts of Brooklyn, I am most concerned
about my Brooklyn constituents. The research shows that my
concerns should not be ignored.
According to the Environmental and Occupational Health
Sciences Institute of the University of Medicine and Dentistry
in New Jersey, the intense heat of Ground Zero blew debris,
gases and particles upwards creating a loft effect which may
have caused these pollutants to drop on people living in
Brooklyn.
New York Newsday reported this finding in an article on
September 11th of this year, however this evidence is not new.
On August 23, 2002 Newsday reported that high resolution
photographs shot on September 11 by satellites show clear
images of toxic debris getting blown in a southeasterly
direction from Ground Zero across the Brooklyn Bridge into
several neighborhoods.
I would like to submit this article, Mr. Chairman, for the
record, Newsday of September 11th.
Mr. Shays. Without objection, so ordered.
[The information referred to follows:]
[GRAPHIC] [TIFF OMITTED] T2728.007
[GRAPHIC] [TIFF OMITTED] T2728.008
[GRAPHIC] [TIFF OMITTED] T2728.009
[GRAPHIC] [TIFF OMITTED] T2728.010
Mr. Towns. This was also confirmed by an October 2002
American Prospect article that said ``It is now clear, thanks
to NASA photographs, that the black toxin of World Trade Center
debris blew for more than 30 hours directly from Ground Zero to
the East River, which separates Manhattan from Brooklyn and
Queens.''
Let me point out three Brooklyn hospitals reported
increases in visits related to respiratory ailments.
While I share several concerns with my colleagues about the
health consequences stemming from the WTC disaster, I
especially look forward to hearing from the witnesses on this
issue.
With that, Mr. Chairman, I yield back the balance of my
time.
And again, I thank you for holding this hearing in the
greatest city in the world.
Thank you. I yield back.
Mr. Shays. I think most people agree, it is the greatest
city in the world. It is. And those of us who live near it,
recognize that what happens to New York directly impacts us,
and we care deeply about this greatest city in the world.
Mr. Nadler, we are delighted to have you join us. Mr.
Nadler is not a member of the Government Reform Committee. He
is a very active member, particularly of the Judiciary
Committee. And he is, I think, the Representative who
represents the district, we are talking about directly Ground
Zero. And at this time, Mr. Nadler, you have the floor.
Mr. Nadler. Well, thank you very much, Mr. Chairman.
Let me begin by thanking you for holding this hearing today
regarding the health effects of the September 11th terrorist
attack on those who live or work near Ground Zero, and
particularly for allowing me to participate in this committee,
though I am not a member of the committee.
As the Member of Congress representing Ground Zero, I have
heard from far too many constituents in the last 2 years who
have health problems because of contaminants in World Trade
Center dust that the EPA refuses to clean up or to acknowledge,
despite the fact that OSHA considers the dust to be regulated
asbestos containing material and expert scientists have
measured air pollution levels worse than the Kuwaiti oil fires.
Two years ago in the days following September 11, the EPA
said the air in Manhattan was safe to breath, despite the fact
that they had no scientific evidence to make such a claim when
they made it, and they continued to make it even when they
ample scientific evidence that it was not true.
After hearing from many constituents who told me they were
getting sick and that the EPA refused to help them with
decontaminating their apartments, in January 2002 I asked the
EPA's ombudsman to investigate EPA's inaction. After the EPA's
ombudsman's office conducted two field hearings which elicited
considerable information, the EPA showed its displeasure by
dismantling the ombudsman's office.
In April 2002, I published a white paper on EPA's
malfeasance, and in June testified of that year before the
Senate on the inadequacy of the EPA's indoor cleanup plan,
which they announced a mere 8 months after September 11 in May
2002.
Two months ago the EPA's Inspector General released the
report documenting what many thousands of New Yorkers already
knew; that the EPA had given false assurances to the people of
New York regarding the air we were breathing and that the EPA
had refused, and to this day refuses to take responsibility to
decontaminate indoor spaces such as apartments, offices and
schools despite the fact that they are legally mandated to do
so.
We know that several hazardous substances were present in
the World Trade Center dust and were released into the
environment when the towers collapsed. Clearly, that presented
a hazard for rescue workers on the pile, and one of the
purposes of today's hearing is to investigate the Government
response to the sickness and problems caused by those hazards,
and what I would say is the clearly inadequate Government
response. But those hazardous substances were also present in
World Trade Center dust that was blasted, often with great
force, into surrounding buildings and settled in homes, schools
and work places. Although the EPA declared that the outdoor air
was safe, and this declaration was premature, enough time has
passed that it is probably true that the outdoor air is no
longer a problem today. On the other hand, the problem of
indoor environments and exposure to hazardous World Trade
Center dust that settled inside buildings persists to this day.
And we have every reason to believe that thousands of people
are poisoned day-by-day indoors in work spaces, schools and
homes, and will continue to be so until action is taken to
thoroughly investigate and clean up these spaces.
As OSHA's Secretary John Henshaw wrote on January 31, 2002,
and I see in the packets that were presented here a copy of his
letter was placed, ``In that the materials containing asbestos
were used in the construction of the Twin Towers, the settled
dust from their collapse must be presumed to contain asbestos''
and therefore OSHA Federal regulations apply to the removal of
this material. Nonetheless, the Government told the public is
was safe and advised average citizens to clean up World Trade
Center dust with a wet mop and a wet rag, which was illegal
advice if you assume that has asbestos in it, as well as
recklessly dangerous advice.
In May of last year, the EPA announced a limited indoor
cleanup plan. This plan was a complete sham designed to deflect
criticism of the agency, not to actually address the problem.
And they practically admitted that by saying there is no
problem, this is being done to allay public fears; translation
for PR.
As confirmed in the EPA IG report, the agency's indoor
clean up program was wholly inadequate and did not meet even
the minimum criteria for protecting human health established by
law. And the EPA refused, despite repeated requests, to require
that its contractors in the clean up, require that their
workers wear protective equipment. So we can expect that many
of the workers in the clean up program a few months now will
come down with respiratory ailments.
The Federal Government has never followed its legally
mandated procedures to track the release of hazardous
materials, characterize the site and clean up buildings
contaminated in the terrorist attack. And in this morning's
Juan Gonzalez' article, he quoted this expert at ATSDR as
saying that one of the first things they must do is
characterize the site, which they have never done.
It has not done the proper comprehensive testing to
determine who has been exposed, what they are exposed to and
the full extent of why this contamination has spread. This is
why Senator Clinton placed a hold on Governor Leavitt's
nomination as EPA Administrator, and she should be applauded
for getting this issue back on the national radar screen. But
until the EPA agrees to fully do its job, the issue will not go
away.
This is a very real, serious and continuing health issue
that must be addressed. I refer to many constituents who have
World Trade Center debris in their homes and their work spaces
and who are now sick.
The title of this hearing is ``Assessing September 11th
Health Effects: What Should Be Done?'' It is very obvious what
should be done. All the workers on the piles should have
physical examinations and their health care needs as a result
of this catastrophe for the balance of their lives should be
paid for the Federal Government. The Federal Government should
carry out its mandated responsibility to clean up buildings
contaminated in the terrorist attack. The EPA should adopt and
implement the recommendations in the IG report, and the Federal
Government should assume the responsibility of ensuring the
proper treatment for those sickened by World Trade Center
debris, particularly in cases where exposure was the result of
government negligence and malfeasance.
In conclusion, let me summarize by saying that I regard
there are being three victim populations that should be looked
at separately besides the people who were killed directly by
the terrorist attack.
One is those people who were exposed, who got an acute
exposure by being caught in a toxic cloud. And we should
monitor and help them with their health problems, but no one is
at fault other than the terrorist.
Second are those responders who worked on the pile for 30,
40, 50 days without proper protective equipment, have gotten
sick as a result. And after the first few days it was
inexcusable that not everyone was wearing proper protective
equipment. And, again, we have to examine all these people, we
have to take care of their problems. But somebody should be
held responsible for why proper protective measures were not
taken.
Third and finally, are the thousands of people who are
today living and working in contaminated work spaces,
contaminated schools which have not been inspected and have not
been cleaned up and we can predict that 15 years from now many
of them will come down with mesothelioma or asbestosis or lung
cancer. We can also predict that we can greatly minimize that
problem if we do this proper inspection and clean up now, which
is why this is a current issue. It is not simply a question of
dealing with past damages. We can still eliminate most of the
health problems from those people if the EPA follows the
inspections, properly looks at all the neighborhoods, not just
below Canal Street but wherever that dust cloud went, inspects
and cleans up.
I thank you again, Mr. Chairman, for holding this hearing
and I look forward to hearing the testimony of the witnesses
today.
Mr. Shays. Thank you. I thank the gentleman very much.
I am just going to do a little housekeeping here and ask
unanimous that all members of the subcommittee be permitted to
place an opening statement in the record. And that the record
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.
I ask even further unanimous consent that Representative
Towns, a member of the Government Reform Committee and any
other member of the Government Reform Committee who may show
up, and Representative Jerry Nadler sit with this committee as
a full participant. And without objection, so ordered.
Before recognizing the witnesses, I want to say since this
is the first hearing, this hearing will raise many questions, a
number will not be answered today nor will we even seek to get
some questions answered. We have heard very important
statements from all the participants at this hearing.
Ultimately, it would be the goal of this committee to have
every one of those questions answered and every problem dealt
with.
At this hearing, and I want to say I am going to be pretty
focused on this and pretty strict in adhering to it, at this
hearing we are focused on the workers and first responders'
health conditions, their diagnoses, their treatment, their
compensation. This hearing does not focus on residents, it does
not focus on other workers who may work there. It does not
focus yet on the clean up of facilities there. And we will. We
will focus on those issues and we will make sure that any
Member who has raised his questions, gets answers to those
questions.
At this time, I would recognize our participants. We have
our first panel.
Dr. Robin Herbert, co-director of the World Trade Center
Worker and Volunteer Medical Screening Program, Medical co-
director of Mount Sinai. And she is accompanied by Dr. Stephen
Levin, co-director of the World Trade Center Worker and
Volunteer Medical Screening Program.
So Dr. Herbert will be giving the statement.
We then have Commissioner Thomas Frieden, a doctor at New
York Department of Health and Mental Hygiene. Dr. Michael
Weiden, medical officer, New York Fire Department; Mr. Phil
McArdle, health and safety officer, Uniformed Firefighters
Association; Mr. Jimmy Willis, vice chair for conductors,
assistant to the president, Transportation Workers Union; Mr.
John Graham, health and safety instructor, Carpenters Union,
and; Mr. David Rapp, former worker at the World Trade Center
site.
We don't usually have this many panelists. I have been
liberal when we have a smaller panel of being able to go over
the 5-minutes. I would really respectfully ask that you submit
your statement in 5 minutes. And if you think you need to redo
it a little bit, I can skip over you to give you a little time.
But if you go 5+ minutes, maybe a little longer, but we would
like you stay somewhere within that range.
And so at that time I need to do one more. If you can all
stand up in this cozy area we have, but I do need you to stand.
I do need to swear you in.
[Witnesses sworn.]
Mr. Shays. Note for the record all the witnesses have
responded in the affirmative.
We are going to start with you, Dr. Herbert, and we are
just going to kind of go down the line here. And we will do a
lot of good listening, that is why we are here.
STATEMENTS OF DR. ROBIN HERBERT, CO-DIRECTOR OF THE WORLD TRADE
CENTER WORKER AND VOLUNTEER MEDICAL SCREENING PROGRAM, MEDICAL
CO-DIRECTOR OF MOUNT SINAI; DR. STEPHEN LEVIN, CO-DIRECTOR OF
THE WORLD TRADE CENTER WORKER AND VOLUNTEER MEDICAL SCREENING
PROGRAM; COMMISSIONER THOMAS FRIEDEN, A DOCTOR AT NEW YORK
DEPARTMENT OF HEALTH AND MENTAL HYGIENE; DR. MICHAEL WEIDEN,
MEDICAL OFFICER, NEW YORK FIRE DEPARTMENT; PHIL McARDLE, HEALTH
AND SAFETY OFFICER, UNIFORMED FIREFIGHTERS ASSOCIATION; JIMMY
WILLIS, VICE CHAIR FOR CONDUCTORS, ASSISTANT TO THE PRESIDENT,
TRANSPORTATION WORKERS UNION; JOHN GRAHAM, HEALTH AND SAFETY
INSTRUCTOR, CARPENTERS UNION; AND DAVID RAPP, FORMER WORKER AT
THE WORLD TRADE CENTER SITE
Dr. Herbert. Thank you. Thank you for asking me to testify
today.
The September 11th terrorist attacks on the World Trade
Center resulted in horrific loss of life. Amid the shock and
grief we all experienced immediately after the attacks, some
failed to recognize that the terrorists had also created one of
the worst acute urban environmental disasters ever to occur in
U.S. history.
Soon after the attacks, various New York area health care
providers, including ourselves, began seeing workers and others
with serious health problems due to their World Trade Center
exposures. Many of us participated in the working group
assembled by NIOSH to develop common approaches to the
diagnoses and treatment of World Trade Center related health
problems.
In June 2002, Mt Sinai received $11.8 million in Federal
funding to establish the World Trade Center Worker and
Volunteer Medical Screening Program. This funding enabled us to
design and coordinate a consortium of health care centers in
the New York metropolitan area, and nationally, to provide free
medical screening examinations for World Trade Center
responders who were involved in various rescue and recovery
efforts.
In January 2003, we released some preliminary findings from
analysis of 250 of the first 500 people who had come through
the program. We reported that 78 percent had at least one World
Trade Center related pulmonary symptom while working or
volunteering at the site, and 46 percent were still
experiencing at least one pulmonary symptom in the month before
the screening exam up to 10 months after September 11th.
Eighty-eight percent had at least one World Trade Center
related ear, nose or throat symptom while performing World
Trade Center response work, and 52 percent were still
experiencing at least one ear, nose and throat symptom in the
month before the screening examination.
Finally, 52 percent reported mental health symptoms
requiring further evaluation when they came for screening.
We have now seen over 8,000 men and women in our screening
program and we now know that a substantial number of World
Trade Center responders have developed upper and lower
respiratory problems that are lasting as long as 2 years.
However we do not know what the long term effects of the World
Trade Center exposures will be, and in particular we are
concerned about cancers.
Because of the high prevalence of persistent World Trade
Center related health problems we were seeing, as well as the
worry about what the long term consequences might be, it became
clear that there was a need for both long term medical
monitoring of responders as well as a need for medical
treatment for those who have developed World Trade Center
illnesses. For these reasons we joined with fellow occupational
health experts, labor leaders and concerned Federal legislators
in an intensive year long lobby for Federal resources for long
term medical monitoring.
Last February it was announced that this money had been
appropriated. Although we still await the final award of the
funding, we join with thousands of ill and injured workers and
volunteers in our appreciation of your efforts to secure those
resources. Of the $90 million allocated in the early winter of
2003, $4 million has been provided to allow us to expand the
baseline medical screening program so that 3,000 additional
workers and volunteers will receive free comprehensive medical
screening examines.
Another $25 million is allocated specifically for
examinations of New York City firefighters. And the remaining
funding, approximately $56 million, will be used to establish,
coordinate and conduct a program for long term medical
monitoring of World Trade Center responders. However, these
funds are unfortunately insufficient to provide periodic
medical examinations of World Trade Center responders for the
20 years that we would advocate.
We estimate that the current funding will support a program
to conduct screening examinations of 12,000 responders every
year and a half for 5 years only. However, we would recommend
screening for a minimum of 20 years because the World Trade
Center responders sustained exposures without precedent. These
exposures may cause new, unexpected health consequences,
including possibly cancers, which would be unlikely to show up
for at least 15 years after the time of exposure. This means
that the screening program as currently funded will not last
long enough to ensure that diseases that develop only after
years have passed, can be detected when they're still
treatable.
Equally pressing at this time is the need for treatment.
We're identifying many people who need ongoing treatment for
World Trade Center related physical and mental health problems.
But, unfortunately, there is still not an adequately funded
treatment program. At Mount Sinai we've sought and received
funding from private philanthropic sources to establish a
treatment program for a limited number of World Trade Center
responders. But philanthropy simply cannot provide all the
sources necessary to provide care who need it.
Among the first 350 patients we have seen in our treatment
program, we have found that 75 percent have persistent World
Trade Center related upper respiratory problems; 44 percent
have persistent World Trade Center related lung problems, and;
40 percent have persistent mental health consequences related
to the disaster. But, 40 percent do not have medical insurance
and about one-third are now unemployed. It is, thus, urgent
that funding be made available to provide access to medical and
mental health care for all whose sustained health consequences
from the World Trade Center disaster; workers and volunteers
involved in rescue and recovery, workers from the immediate
area and area residents as well as their children.
In conclusion, funding is vitally needed to: One, to
supplement the current appropriated dollars in order to extend
the duration of the long term medical monitoring program for a
minimum of 20 years; two, to ensure access to treatment for all
World Trade Center related health problems identified in
screening programs; three, to ensure that those who develop
future health problems related to World Trade Center exposures
are able to receive treatment for those conditions, and; four,
to support clinical research to better understand the human
health consequences of the exposures, and most importantly, to
identify treatment modalities for those conditions.
Surely those who responded so selflessly to the disaster
deserve no less.
Thank you.
[The prepared statement of Dr. Herbert follows:]
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Mr. Shays. Thank you very much, Doctor.
Commissioner.
Dr. Frieden. Thank you very much.
Mr. Shays. Is the mic on?
Dr. Frieden. Good morning. Can you hear?
I am Dr. Thomas Frieden, commissioner of the New York City
Department of Health and Mental Hygiene.
I want to thank Chairman Shays of the committee and
especially Congresswoman Maloney for holding these hearings in
New York City.
The immediate effects of September 11 included the deaths
from terrorist attack of nearly 2,800 New Yorkers in addition
to the passengers and crew of the two planes that crashed into
the WTC. Our efforts now are focused on the many people who may
experience long term health problems as a result of September
11.
The WTC Health Registry is a critically important effort to
evaluate the short and long term effects to both physical and
mental health that may result from September 11. A
comprehensive, strictly confidential health survey of the most
highly exposed people, it will identify which groups and
exposures most increase the risk of health problems and which
are most in need of medical intervention. Significant findings
will be shared as soon as they become available and reports
will be posted on the Web every 3 months. We intend to track
the health of persons who enroll for up to 20 years.
The registry is unique. It is the only project that will
allow comparisons across groups and facilitate long term
followup of a large representative group of people with a wide
range of exposures and health histories. It is our best chance
to find out both the spectrum of health effects from September
11 and to identify and target services for the medical needs
arising from September 11. Findings will help participants,
others exposed and the general public and will provide critical
information for medical professionals who evaluate and treat
exposed persons. It is a systematic evaluation that should
allow us to make conclusions about the health effects of
September 11 both for those who participate and for those who
do not participate in the registry.
It is not an attempt to identify and monitor every exposed
person. It is also not a telephone diagnostic program intended
primarily to find people with medical problems and provide
care.
The registry will identify syndromes and conditions
associated with exposure and will put clinical studies into
perspective. We need both the detailed clinical evaluation that
is provided by Mount Sinai and NYU and others, and the
comprehensive approach the registry provides.
The registry is a collaboration between the health
department, ATSDR, FEMA and New York City community and
business organizations. The development of the scientific plan
for the registry has, from its inception, involved the
collaboration of scientists from many academic institutions
both within and outside of New York City.
ATSDR has committed funding for project years 2 through 5
for core functions. However beginning in calendar 2005 we will
need at last $2 million more per year for basic registry
functions for the intended 20 year life of the project.
We are very pleased with the response to the registry in
the first 8 weeks of enrollment. More than 10,000 people have
completed the telephone interview. Another 5,000 have
preregisted, and these numbers continue to increase each day.
We are also reaching tens of thousands of others for whom we
already have contact information.
The registry has a Federal certificate of confidentiality
ensuring protection of individual information from subpoena or
Freedom of Information Act requests.
The registry is the most recent of many activities
conducted by the health department following September 11.
These include: Syndromic surveillance to identify clusters of
illness; inspection of food distribution, mandated washing
stations; emergency department monitoring for injuries; rescue
worker injury and illness monitoring; community needs
assessment of Lower Manhattan; indoor air quality assessment.
And the department also implemented Project Liberty, a FEMA
funded crises counseling and public education program. Project
Liberty has assisted more than 900,000 New Yorkers effected by
September 11 serving a population ethnically diverse and
similar to the city as a whole.
Project Liberty is scheduled to end on December 31st of
this year. We are hopeful for an extension so that the fire and
education department programs can continue.
We thank you for your interest and support. However, much
more needs to be done both to address the needs of those still
suffering from the effects of the attack and to ensure that we
are as prepared as we can be. The city continues to ask the
administration and Congress to provide bioterrorism and
Homeland Security funding based on risk and consequence.
We were the target of two of the four planes hijacked on
September 11. We were the target of four of seven anthrax-laden
envelopes sent in the fall of 2001. And we are the target of
most of the terrorist chatter that mentions a specific
location. But despite having more than half of the Nation's
recent attacks and having more than half of the risk of future
attacks, we receive less than one fortieth of the Federal
dollars for bioterrorism preparedness.
In fact, per capita New York City ranks a shocking 45th out
of the 54 jurisdictions receiving bioterrorism funding.
We have asked the administration and Congress for more than
$900 million for emergency preparedness, $100 million of which
is for the health department. And as I noted before, the WTC
Health Registry, our best chance to know the health effects of
September 11 and most effectively target long term
interventions has a large funding gap in the out years.
Thank you for your interest and continued support.
I will be happy to answer question.
[The prepared statement of Commissioner Frieden follows:]
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Mr. Shays. Dr. Weiden.
Dr. Weiden. Chairman and members, today I've been asked to
talk about the health and welfare of FDNY firefighters and the
EMS rescue workers after September 11. I will focus on what
lessons we have learned and what changes should be made as we
move forward.
On September 11, two 110 story towers and several other
buildings collapsed during rescue and evacuation. With these
collapses, FDNY firefighters and the EMS rescue workers went
from being first responders to victims. Although, first
responders accounted for nearly 12 percent of the dead, our
surviving firefighters and EMS and rescue workers continued to
work uninterrupted both at the WTC site and throughout NYC. We
must never forget that despite the tragedy of that day, FDNY
successfully evacuated over 20,000 civilians and saved
countless lives. The extraordinary heroism of our firefighters
and rescue workers will forever remain a beacon of courage,
commitment and dedication.
WTC dust is pulverized concrete, fibrous glass, silicates,
carbon particulate matter and asbestos. The upper airways were
overwhelmed by this burden and the dust had an extraordinarily
high pH causing deep burns of lung, sinuses and esophagus.
Since inhaling this dust can cause considerable harm, it
was important to find out if masks or respirators were
available and were actually worn by FDNY rescue workers. By
week two, 70 percent of firefighters had the proper respiratory
for this exposure, but only 30 percent were able to wear it
most of the time. Why? Because these masks were uncomfortable
and difficult to communicate to through others.
To improve respiratory protection at future disasters, we
need better planning, improved respiratory design and supply.
Two years after the WTC, we still don't have that. Improved
design and supply will naturally lead to improve compliance.
FDNY Bureau of Health Services understood the need to
provide immediate medical monitoring and treatment. From
October 2001 to February 2002 we provided every FDNY
firefighter and EMS worker with the opportunity for a full
medical. We also partnered with the CDC and NOISH to provide
specialized tests that were not part of our standard medical.
Several months into the World Trade Center rescue and
recovery effort, two Port Authority Police officers were
reported to have high mercury levels. In response, authorities
wanted to close down the site. That would have created enormous
emotional stress to every family member still waiting for a
loved one to be found. At that point FDNY's Bureau of Health
Services had already done urinary mercury levels on over 8,000
people and none were elevated. These findings allowed the site
to remain open, a major untold benefit for families of the
missing.
We have found that 25 percent of the highest exposed FDNY
firefighters have airway hyper reactivity and many have asthma
or reactive airways dysfunction. To date, 280 FDNY firefighters
have qualified for retirement disability pensions due to
permanent lung impairment, and we project that anywhere from
300 to 500 additional firefighters will ultimately be
permanently impaired from respiratory disease.
Respiratory problems are not the only issues FDNY is coping
with. Since September 11 our firefighters and the EMS rescue
workers have been functioning under incredibly high stress
levels. They have lost coworkers, they have lost friends, they
have lost family. They have a different role in life now.
They've been exposed not just to fires, they have been exposed
to a new mission.
In our FDNY WTC medical monitoring program, 48 percent of
our rescue workers reported difficulty sleeping; 36 percent
reported unusual irritability; 34 percent reported difficulty
concentrating, and; 33 percent reported anxiety. These are
major problems for people who did not have problems pre-WTC.
Eighty percent of our firefighters and EMS rescue workers,
independent of their age or their extent of WTC exposure
indicate that they are concerned about their health, and 20
percent are worried about that their future may be cut short.
Since September 11 our counseling unit has rapidly expanded
to provide educational group and individual sessions using
funding from Project Liberty, the IAFF and FDNY and local
unions and private philanthropists. Project Liberty dollars
supplemented by these other sources has allowed us to provide
individual counseling sessions to over 5,700 FDNY rescue
workers and families. These individual counseling sessions are
in addition to the many group therapy, firehouse briefings,
department wide interventions that we've done since that time.
To serve their needs and to allow FDNY to continue to serve
the needs of New York, it is essential that Project Liberty be
continued past its 2004 end date.
In conclusion, we cannot prevent the exposures that have
already occurred to these men, but through the long term
medical monitoring and counseling programs that I've described
today, we can all work to restore the health of those who did
survive. That is why the Federal funding provided for long term
medical monitoring of WTC rescue workers is critically
important. We are glad that the recent agreement has been made
that should help with the release of these funds. We need to
continue our commitment to each FDNY firefighter and EMS rescue
worker, a covenant that states when you come out of the flames,
we will be there for you.
[The prepared statement of Dr. Weiden follows:]
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Mr. Shays. Thank you, Dr. Weiden. I know that you had to
skip over parts of your testimony. The whole testimony will be
a part of the record. And I appreciate your assisting us. And I
know others of you did that as well.
Mr. McArdle.
Mr. McArdle. Good morning, everyone.
I am Philip McArdle, health and safety officer for the
Uniformed Firefighters Association. I would like to thank this
committee for inviting me to present this information to you on
behalf of the 8,500 firefighters serving the city of New York.
It has been over 2 years since the September 11 attacks and
almost 1 year since the UFA lobbying before the U.S. Congress
for September 11 medical monitoring money. Many of the long
term health issues that I will discuss here today have been
reported many times to committees, in congressional hearings
and to the Department of Homeland Security. Unfortunately, even
after the countless task forces, testimonies, circumstances
have not changed for the members of the Uniformed Firefighters
Associations. In fact, in the opinion of the executive board
and our membership, the situation has gotten worse.
In the days following September 11, many firefighters were
not given the proper respiratory protection devices, even
though complaints about this issue had been made for years. The
department did not have still does not have a respiratory
protection program as required by Federal regulations for air
purifying respirators for well over 10 years. This is clearly a
violation of the Code of Federal Regulations 29 CFR 1910.134,
which states the standards for respiratory equipment
supervision and use. The results of improper respiratory
protection are clearly stated in a study conducted by Mount
Sinai more than a year ago, with support of the National
Institute for Occupational Safety and Health that found that 78
percent participating first responders reported at least one
WTC related pulmonary symptom. The same study reported that 52
percent of the September 11 workers are suffering from some
form of post-traumatic stress syndrome. It was within 1 year
that these numbers have increased. Unfortunately, we cannot
provide you with any specific data about the amount of increase
in the health problems because the funds that were allocated
for the long term medical care of our members have yet to be
distributed to the FDNY Bureau of Health Services. We are still
waiting for that money, and it has not come.
The hold up in the distribution of funds coupled with the
reality that no money has been allocated for treatment of WTC
victims' related illnesses has resulted in the health needs of
our membership being neglected because of partisan politics and
bureaucratic red tape.
As of October 2003, the FDNY has retired approximately
1,800 firefighters due to WTC related illnesses. And I'm just
going to break from my testimony for 1 second to make another
point. As late as last night I was told by the department that
there are still some 600 members of our department who are
still waiting to be processed out of the organization.
Both the union and the fire department agree that this
unprecedented retirement rate will continue as more
firefighters are examined and diagnosed with September 11
related illnesses. All 1,800 of these firefighters were healthy
before September 11, and would have most likely worked for the
fire department for an average of 20 years or longer, which had
been the trend prior to September 11. Instead, we have members
who in some cases are as young as 30 years old, who will be
disabled for the rest of their lives.
As retirement decreases, it will cost more for long term
health care than ever before. Prescription drugs is our biggest
concern. The New York City Firefigher WTC medical monitoring
treatment that will be run by FDNY Bureau of Health Services
with joint sponsorship of the UFA, UFOA and the EMS/Paramedic
Unions has found that in the first month four firefighters
required life support, mechanical ventilation, for chest
surgery for severe respiratory stress following WTC exposure
during the collapse. Ninety-five percent of the firefighters
complained of new-onset respiratory symptoms, mostly cough,
during the first week. In the first 6 months following the
collapse, 343 FDNY firefighters required more than 1 month of
medical leave for new onset respiratory illnesses such as
asthma. And nearly 2 years later, over 1,800 FDNY firefighters
have or in the process of receiving permanent disability for
new onset of post-WTC asthma and respiratory injuries.
Random volunteer testing of the highest exposed of FDNY
firefighters present during the first day of collapse has found
that 25 percent have new onset, post-WTC airway hyper
reactivity/asthma on objective medical testing--
methacholinechallenge testing. This has persisted on serial
testings. Firefighters who were not present during the collapse
but were there during intense rescue and recovery efforts over
the next 48 hours, nearly 7 percent have new onset post-WTC and
persistent airway hyper reactivity.
This is not a New York City issue. This is a national issue
because the U.S. Government is handling the situation. It is,
and will be looked at as a template for what could happen in
the future. Long term health problems, increased disability
claims and the rise in the cost of prescription drugs needed to
treat these problems will financially impact everyone, not just
the people in New York City.
We strongly believe that the $25 million that was
appropriated specifically for firefighter/EMS long term health
care monitoring needs to be distributed to the FDNY Bureau of
Health Services as soon as possible. This program is already in
operation and is carefully monitored by an expert advisory
panel that includes many notable experts in this and related
fields. This program is in danger of ending without funding
that has already been appropriate but not yet provided.
Furthermore, our initial findings clearly indicate that
additional services will be needed. We strongly urge that every
dollar go for its original intention: The medical care of our
rescue workers. $25 million should immediately be transferred
to this program.
These dedicated firefighters and the EMS workers rightfully
deserve long term health care and monitoring funding
immediately. They deserve to be treated with the dignity and
dedication that they rightfully earned when they risked their
lives and health while participating in the largest rescue and
recovery effort in his-
tory.
Thank you very much for your time.
It would be my pleasure to answer any questions you have
regarding this issue.
[The prepared statement of Mr. McArdle follows:]
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Mr. Shays. Thank you very much.
Mr. Willis.
Mr. Willis. Good morning.
Mr. Shays. Good morning.
Mr. Willis. I would like to thank the Chair and the members
of the committee for the opportunity to speak on these vital
issues.
My name is Jimmy Willis. I'm here on behalf of President
Roger Toussaint and members of the Transport Workers Union,
Local 100, the subway and bus workers of the MTA New York City
Transit, and most particularly on behalf of our 4,000 members
who worked ``on the pile'' at Ground Zero.
On the morning of September 11, 2001, as the Twin Towers
burned, there were two evacuations in progress. One, of course,
of the towers was due to the heroic efforts of fire, police and
emergency response teams. The other evaluation took place in
the subways and buses in, around and under the Trade Center and
was accomplished by Transit workers.
Due to the fact that the disaster occurred during rush
hours, there were dozens of crowded buss in the area and
approximately 200,000 passengers in the subway trains in the
area. All of these passengers were safely evacuated without
injury by Transit workers. Hundreds of evacuations began
simultaneously in the transit network around Ground Zero. Two
of those evacuations are indicative of what transpired.
In the minutes before the first collapse, train operator
Hector Ramirez had instructions to bypass the World Trade
Center by subway control. As his train entered the station,
Ramirez saw hundreds of panicked screaming passengers. Despite
orders, he stopped his train. Ramirez and his conductor then
evaluated everyone from the platform and took the train out of
the station. That was the last train through before the towers
collapsed.
One block from the Trade Center bus operator Franklin
Chandler stood by with his bus in case he was needed. After the
towers collapsed, Chandler did not leave his post. HE searched
through the debris for injured survivors, placed them on his
bus until it was full, and drove them all to area hospitals.
New York City Transit must be ready to rebuild and repair
the largest subway system in the world. Thousands of Local 100
members are hard hats: welders, track workers, payload
operators, carpenters, ironworkers, etc. At approximately 11
a.m. on September 11th all of Transit's heavy equipment was
mobilized to the Brooklyn waterfront and loaded on barges.
Thousands of transit workers then sailed with the equipment to
Manhattan and began the torturous process of digging through
the pile.
The U.S. Department of Transportation has recently released
a report which states that: The MTA played a critical role in
the rescue effort at Ground Zero and in helping restore parts
of the city's infrastructure including communications, and; at
one point MTA employees comprised 60 percent of the rescue
force at Ground Zero.
Unfortunately, this level of response has come at a
terrible price. It is well documented that rescue workers were
exposed to asbestos, mercury, lead, pulverized glass and
concrete, a virtual toxic soup. Transit workers toiled for
weeks at Ground Zero without respirators. Unfortunately, New
York Transit, New York City Department of Health and New York
State deferred site air quality and safety to the EPA. Of the
4,000 transit workers who responded to Ground Zero, as many as
half of us are now seriously ill. Thousands of other rescue
workers are also ill. Most of us should not have been allowed
to work at the site without appropriate personal protection.
The investigation into the EPA Inspector General's report, as
well as the EPA's role with regards to Ground Zero air quality
must be thoroughly and completely investigated.
Local 100 members who were at Ground Zero are now suffering
from respiratory disease, gastrointestinal disorders and
depression. The same afflictions our brothers and sisters from
the fire department, police department, emergency service and
building trades are facing. I can attest to this. I worked with
our welders at the site. As a result of my time spent at Ground
Zero, I've been diagnosed with gastrointestinal disorders and
lifelong respiratory disease. I am only one of many.
We at Transit work for a State agency that is self insured
for workers compensation and has, as a result, controverted
every single case, comp case, arising out of Ground Zero. Among
those cases is bus operator, the Reverend Franklin Chandler,
who I previously mentioned, and who saved so many lives on
September 11th. When he filed for injuries arising out of his
heroic work that day, he was termed a liar, malingerer and
fraud by Transit. He and his family went 8 months without a
check until a compensation judge ruled in favor. It is
outrageous that men and women who risked their lives for their
country and on behalf of others should be so callously treated.
Local 100 President Roger Toussaint insisted the New York
City Transit partner with us in a counseling program aimed at
alleviating some of the trauma associated with Ground Zero
among transit workers. I coordinated that program on the
local's behalf. After helping only 150 of the 4,000 members at
Ground Zero, New York City Transit pulled out of the program
once they became aware of its workers comp implications.
The issue of medical treatment and compensation arising out
of work at Ground Zero and the cost associated with it, should
rightfully be borne at the Federal level. Appropriations for
this must come through Congress and be signed by the President.
Many Local 100 members have been seen by the staff at Mount
Sinai World Trade Center Clinic. This program provides for
initial and followup screenings, and the programs is federally
funded. The medical and support staff at the Mount Sinai World
Trade Center Clinic have been wonderful. My members continually
praise the care they receive there. Any thought to reducing
this primary source of care to make more available to satellite
clinics is ill advised. Rather, an increase in funding is
called for. However, an increase in funding for screenings is
not nearly enough. The members of my local are utilizing their
own medical benefits to cover the costs of actual care. In 2
years when we begin contract negotiations with the MTA, they
will point to the burdensome charges carried by our health
plan. Costs associated with Ground Zero work. The reality is
that New York City Transit will seek to renegotiate down our
health benefits due directly to so many members utilizing care
because of Ground Zero related illness.
Those of us who responded to Ground Zero are in crises. The
response to that crises on a State and Federal level has been
sorely lacking. Federal funds need to be allocated immediately
to cover the cost of health care for those who sacrificed at
Ground Zero. Additionally, the MTA, a New York State agency,
needs to realize that those of us who responded to Ground Zero
must have immediate access to our workers compensation benefits
without needless controversy.
Finally, congressional leaders applauded the rescuers at
Ground Zero. On September 13, 2001, President Bush appeared at
Ground Zero and thanked us for being there when this country
needed us. We ask the same thing, Mr. President. Those of us
who were there when our country needed us are now in peril.
Will you and Congress help us now that we are in need.
Thank you.
[The prepared statement of Mr. Willis follows:]
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[GRAPHIC] [TIFF OMITTED] T2728.041
[GRAPHIC] [TIFF OMITTED] T2728.042
Mr. Shays. Thank you, Mr. Willis.
Mr. Graham. Thank you. We're all set.
Mr. Graham. Hello. My name is John Graham. I am a health &
safety instructor and officer of the New york District Council
of Carpenters. In addition, I am an emergency medical
technician. I participated in the initial response, rescue,
recovery and clean up operation at the World Trade Center site,
beginning the morning of September 11th and ending May 30,
2002.
On the morning of September 11th, I reported to the World
Trade Center on behalf of the carpenter's union as a safety
officer to assist and aid my fellow carpenters who were working
at the World Trade Center who might be in need of my assistance
due to the initial plane crash. Upon reaching the scene I was
utilized by emergency personnel as an EMT. Stationed at the
base of the North Tower I witnessed the more horrific events
that I have ever seen in my life, the events that continue to
haunt me to this day. I continued to perform my duties despite
the appalling scene unfolding before me until I was momentarily
incapacitated by the collapse of the World Trade Center.
With the collapse of the Twin Towers, I and those around me
present on that day and those who came to the scene in the days
and weeks that followed became victims of the worse chemical
exposure events in the history of the United States.
On the day I was, I was engulfed in a toxic cloud composed
of but not limited to pulverized asbestos, lead, mercury,
cadmium, PCBs and benzene which are known to be highly
corrosive to human lungs. This cloud that contaminated much of
lower Manhattan and Brooklyn, unbeknownst to the innocent
people living and working in the neighborhoods surrounding the
World Trade Center site. My exposure to this toxic soup of
carcinogenics continued through the 262 days I worked at the
World Trade Center site.
Almost immediately I began to feel the ill effects of the
exposure. In the moments after the cloud of the collapse of the
World Trade Center began to clear, I and those around me lucky
enough to be alive, began to choke, gag and vomit from the
forced inhalation of the toxic cloud. I had to rinse my face
and eyes to try to find relief from the severe burning
sensation I was feeling on my skin and my eyes.
Within 2 weeks of my initial exposure, I began to develop
severe respiratory symptoms requiring medical attention.
Knowing Dr. Stephen Levin of Mount Sinai Occupational and
Medical Center, and his expertise in these medical chemical
exposures on a job site, I turned to him for his medical
expertise.
Since October 2001 I have been receiving treatment from Dr.
Levin and his staff at Mount Sinai for my respiratory and other
exposures resulting from the chemical exposure at the World
Trade Center site. I have been diagnosed with and continue to
suffer from RADS, reactive airway disease, a chronic form of
asthma resulting from the chemical exposure at the World Trade
Center site. My rescue inhaler is my constant companion,
despite the staff at Mount Sinai doing their best to help me
with my medical problems as possible at this time.
In addition to my medical problems, I have been and
continue to suffer from chronic post-traumatic stress disorder,
for which I have been receiving treatment since October 2001.
Prior to September 11th, I was a healthy, hard working
father, son and husband. Today, I am a chronically ill man who
is anxious about my ability to support my family. I am no
longer able to work as a carpenter. My chronic asthmatic
condition makes it difficult for me to carry out my duties as a
safety officer, father, son and husband. I often have to stop
my activities to use my inhaler and catch my breath. It breaks
my heart not to be able to run and play with my two daughters,
as I once was able.
I'm not alone in my ill effects that I am suffering from
the chemical exposure on September 11 and the days after. I am
one of thousands. Despite the best treatment available, we
continue to experience severe symptoms. And more research is
needed to understand the diseases we suffer from and the
treatments that will effectively bring relief.
I am not naive enough to think that anyone can cure us from
our chemical exposure we have experienced, but some relief
would be nice.
On September 11th, 2,811 people were killed. My greatest
fear is that the number of fatalities from the World Trade
Center attack will continue to rise as time goes on and those
of us exposed to this toxic soup begin to die off from the long
term effects of this deadly chemical exposure.
It is only with the support of Martin Daly, my boss, and
the National Institute of Environmental Health Sciences and the
doctors and staff at Mount Sinai that I am able to continue and
function at this time.
Thank you.
[The prepared statement of Mr. Graham follows:]
[GRAPHIC] [TIFF OMITTED] T2728.043
[GRAPHIC] [TIFF OMITTED] T2728.044
[GRAPHIC] [TIFF OMITTED] T2728.045
Mr. Shays. Thank you, Mr. Graham.
Mr. Rapp.
Mr. Rapp. Good morning, committee, members of Mount Sinai,
ladies and gentlemen. My name is David Rapp. I'm a construction
worker with the Local 1456 Dock Builders District Council of
Carpenters.
I was at Ground Zero for near 5 months including 3 days of
the first week of the terrorist attack. I hope my testimony is
going to make everyone aware of what we experienced at Ground
Zero and what I and others are going through now.
I viewed, smelled, handled things that you could not
imagine. Although I worked 12 hours a day, 7 days a week, I
looked forward back for another shift. I started experiencing
health problems like dizziness, shortness of breath and skin
rash while I was still working down there. Although we
accomplished what we set out to do, which was keeping the
slurry wall from collapsing as the debris was removed, our job
was installing tie-backs while being exposed to who knows what.
My job was completed in March 2002 at Ground Zero. I went
to my next job at Kennedy Airport driving piles for American
Airlines where my ability and stamina had diminished. I was
laid off the first week of April and have not worked since.
I am a 42 year dock builder that normally could do as much
as a 22 year old, and more. I could carry a 150 pound tank of
oxygen or astatine a half a block through a rough job site. But
now I cannot even take out my household garbage.
I am also an auto mechanic with 5 certifications. After a
long day of dock building I could still come home and install a
200 pound transmission on my back off my chest. Now I cannot
even change a flat tire.
There is a lot of fear in my life now. I have had several
emergency visits, several short stays in the hospital. I rely
on oxygen at night to sleep and I still wake up sometimes
gasping for air trying to stay calm. Sometimes I feel like I'm
underwater.
I have had a sore throat for 15 months now. When I cough I
can feel the outlines of my lungs. I sleep on a recliner,
straight up. I cannot go out in the humidity or breath cold
air. I need to keep my house at a 65 degree temperature where
my wife sleeps with a quilt. I am on steroids, which have
caused weight gain. I have put on 50 pounds since I stopped
working in April 2002, which probably does not help my
condition but the steroids do help.
I am on 12 other different medications, plus 3 types of
inhalers. And I carry an oxygen tank wherever I go for
assistance to breath. I cannot tell you how hard it is living
like this. My fear of not being able to get my next breath is
unbearable.
I am going to two different doctors at this time. One is a
Dr. Leo Parnes and the other is Mount Sinai Health for Heros.
Mount Sinai has been great to me. They have been helping me
since November 2002. They helped me get immediate benefits from
workers compensation. Most importantly with the medications
that I rely on to breath. All of their staff have been
compassionate and express real concern for my future. They
always make sure I have enough medication.
I would like to end this with I have a beautiful wife of 27
years and two sons in their 20's that fear for my future, as
well.
Thank you very much.
[The prepared statement of Mr. Rapp follows:]
[GRAPHIC] [TIFF OMITTED] T2728.046
Mr. Shays. Thank you, Mr. Rapp for your testimony. Thank
you for being here today. We really appreciate it.
I am going to call on Mr. Owens, who has joined us. He is a
very active member of the full committee. And then it's my
intention to recognize for questions Mrs. Maloney, then Mr.
Turner, then Mr. Towns, then Mr. Owens, then Mr. Nadler and
then myself.
The usual procedure in Congress is that we have 5 minutes
of questions. This subcommittee prefers 10 because you can have
better followup. We are going to just set the clock at 7
minutes, Bob.
And at this time, though, Mr. Owens, this is not your
question time. But if you would like to make a statement, we
welcome that.
Mr. Owens. Thank you, Mr. Chairman.
Let me begin by thanking you as chairman and my colleague
Carolyn Maloney for putting forth the effort to make this
hearing possible.
On April 28th of this year in response to a request by the
Central Labor Council under Brian McLaughlin and the New York
Committee on Occupational Safety and Health headed by Joel
Shufro, we held an unofficial hearing, Caroyln Maloney and I
here in New York on that worker Memorial Day, April 28th. And
that was several months before the EPA Inspector General issued
his report.
I see at least three of the people who testified at that
hearing. I want to thank them for their past testimony and for
their testimony here today.
We are making a headway at a very slow pace, but I think
that we are bringing the attention to the fact that what
happened on September 11 highlights something unfortunate about
our government. It says that certain governmental agencies have
no respect for residents and citizens and workers. They may
even have contempt for them. We have a Government that proposes
now to bring justice to Iraq. After liberating them, they're
going to provide justice and just government. But here the
justice does not include taking care of the workers who are
suffering now, in this country, as a result of being victimized
by an act of war. It was an act of war. And many of our
colleagues in Congress seem to think that New York is asking
for something special when it asks for this kind of help. But
it was an act of war. They were not targeting the World Trade
Center because it was in New York State or New York City. They
targeted the World Trade Center because it was a target of the
United States that was the target of the terrorists.
One of the ways that we must move at the State and city
level, along with the congressional delegation and the two
Senators from New York, is to keep insisting that the World
Trade Center tragedy was a result of an act against the United
States of America. The people of New York State and New York
City should not be asked to suffer unduly or to bear the cost
of righting all the things that have gone wrong as a result of
September 11th. It was an act of war.
Homeland Security becomes a farce if we are going to treat
the people who are on the front lines of Homeland Security with
contempt. And this situation shows that they are being treated
with contempt.
We would like to see workers and all those who support
workers begin to scream louder and in a more continuous fashion
to get this injustice corrected.
In the war against terrorism, workers are going to be
warriors whether they like it or not. They are warriors.
Workers must be recognized and rewarded as heros. Certainly
workers should receive the best medical care possible.
And I ask unanimous consent to enter a more expanded
statement into the record with documentation.
Mr. Shays. Thank you.
Without objection, so ordered. It will be done.
This hearing is not, again, going to answer every question
that is raised. I am going to ask for the support of this
committee to make sure that we do not waste the opportunity
with the witnesses we have to look at the call of the hearing;
and the call is what is known about the short and long term
health effects of the September 11th attack on those who worked
at Ground Zero and live there today, and how effective are the
steps taken by the Federal and local government to investigate
health effects and provide treatment for those injured.
We are interested in knowing.
To start with at this hearing, next hearing we will expand
it, but we want to know what is the health condition of those
who were working on Ground Zero. What type of diagnoses,
treatment, compensation, and we do not want to waste the
opportunity to learn the answers to these questions.
I realize some Members are going to ask some questions that
we may not have answers for. I felt very strongly that Members
should have an opportunity in their opening statements to
address an issue much wider than this hearing; put it on the
record, challenge the committee to deal with this issue during
the course of our hearings. And I think that is the challenge
that we need to accept.
At this time, Mrs. Maloney, I recognize you for 7 minutes.
Mrs. Maloney. Thank you, Mr. Chairman.
And I thank all the panelists and I thank especially my
colleagues for their ongoing support of efforts to help the
victims, the rescue workers and everyone with September 11.
And you have raised many, many issues that we need to
address. I find it startling that we did not have the proper
equipment to protect people and that we still do not have the
proper equipment to protect people in the event of a disaster.
But I have two questions that I would like to ask the
entire panel. And first of all, I would like to ask you to
raise your hand if you think the Federal Government can do more
than it is doing to help the workers, rescue workers and others
because of the effects of September 11? Raise your hand if you
think we should be doing more?
Mr. Shays. For the transcriber, all our witnesses including
Dr. Levin has responded in the affirmative.
Mrs. Maloney. And then I would like each of you very
briefly, because you could use up all of my 7 minutes and I do
not want it all used up, could you tell me very briefly what it
is you feel the Federal Government should be doing? And we are
going to start with Dr. Herbert and go right down to Mr. Rapp.
What more could we be doing to be helpful? Very briefly.
Mr. Shays. Very briefly because I know time is short.
Dr. Levin. The issue has been addressed by several of the
panel members.
No. 1, there is a terrible need for treatment resources. I
think the witnesses here, the workers who are effected, made
quite clear that the resources available now really are a
patchwork of a broken workers compensation system and
philanthropic funding, as well as people's private insurance or
out-of-pocket. And this is no way, from a public health
perspective, for the Federal Government to address what is
clearly a public health need.
For people to have to jump through the hoops of a workers
compensation system that sets up barriers to their getting
through that system and getting actual treatment, benefits, and
wage replacement is an outrage, given what these people have
done.
No. 2, we need adequate funding for followup evaluations of
this population. Those who have been screened already have
exhibited high rates of respiratory problems, high rates of
psychological distress. We need to follow them in the short
run. Out of the $90 million, $60 million now can be used for
the followup of this group of responders. That is enough to
cover, perhaps, 5 or 6 years of examinations. It will require a
great deal more funding to follow them for the minimum of 20
years they should be followed, not only because we will learn
something important scientifically about what the consequences
of exposure might be, but because people who may develop these
longer range illnesses need to have these illnesses identified
when they are treatable; that means the earliest detection
possible.
I do not have time to say much more. I will say only that
we need also a more comprehensive coordinated response in
general, should there be an event like this in the future, so
that we are not playing catch up and doing our first screening
examinations 10 months after an event.
Dr. Frieden. I'll be brief. Three areas where we urge the
Federal Government to do more.
First, to fully fund the WTC Health Registry in the out
years. There is a funding gap of $2 million each year for 20
years.
Second, as all of the panel has noted, resources for
referral and medical care for those effected by September 11
are needed. They are not sufficient as they currently exist.
This is a national tragedy that happened, the expenses are
being borne by the city, by the workers, and by the individuals
who are effected. The Federal Government should step up to the
plate and provide those referral and treatment resources.
And third, in terms of future efforts, to prioritize New
York City. Please do not play politics with preparedness. We
know that most of the risk is to New York City. We have many
needs for preparedness that are not yet met. We need increased
resources to meet those needs.
Dr. Weiden. So I implore you to break the bureaucratic log
jam that is preventing money that has already been allocated
from setting up ongoing health monitoring. I am one of the two
pulmonologists working for the fire department. I routinely say
goodby to people after they have gotten their disability
retirements. And I say wait for a letter from us stating when
and where you should show up for your long term monitoring.
There is no such letter being sent out. There is no place to
bring these people back. And the longer the gap between our
ability to monitor them and care for them, and some place that
they can centrally be cared for, the more people will fall in
between that gap.
Mrs. Maloney. Mr. McArdle.
Mr. McArdle. I just have four items. And basically I
believe that the Government should provide long time monitoring
care for our members. They also need to provide long term
treatment for our members, not just monitoring. But treatment.
And also long term care for our members.
Because the fourth item that I just want to mention is that
the Government has a responsibility to show the rest of the
Nation that if they follow a good template for taking care of
the people in New York, they can take care of the rest of the
country the same way. If they do not establish a good template
for taking care of people here, there is going to be no
confidence in Government in the future of taking care of these
catastrophic events.
Mrs. Maloney. Mr. Willis.
Mr. Willis. Thank you.
Federal appropriations for long term treatment and care is
a must. And frankly, with respect to Ground Zero, the State
comp process should be taken out of it. It should really be a
Federal function.
And, Congresswoman Maloney, I could not agree with you
more; if these issues are not taken care of now, if we have
another disaster, we are going to be hurting finding people to
respond.
Mrs. Maloney. Mr. Graham.
Mr. Graham. My issue is I think that sooner or later I will
be disabled and the health coverage for myself is an issue, and
for my family. I am a sole provider for my family on health
coverage. And if I do go out on disability, besides for the
one-third less salary I will be bringing home, I will not have
any health benefits for my two daughters who are 9 and 5.
Mr. Rapp. I, too, like Mr. Graham am sole supporter. And I
believe that we should be covered for our future. And instead
of sending billions of dollars over to other countries and
stuff like that, we should be taking care of that as a
priority.
Mrs. Maloney. Thank you.
Well, would you be surprised, Mr. Rapp and Mr. Graham, who
have been working and receiving workmans comp, that the State
of New York got $175 million to help pay for workers
compensation. But you seem to be having trouble getting this
money, Mr. Willis, even though the money was appropriated by
the Federal Government, the $175 million? I guess he is telling
me my time is up, but if you could----
Mr. Shays. No, go ahead and answer the question.
Mrs. Maloney. If you could. In other words, we sent the
$175 million and you are saying you are having trouble getting
it out of workmans compensation and we should just abolish the
program and go straight to the Feds. But if you could explain?
They are turning down people like yourselves that have risked
your lives to save others? Could you elaborate a little bit,
because this has to be addressed. We have to get the money to
the people who sacrificed their lives.
And I have to say, Mr. Graham and Mr. Rapp, if you do go
out on disability and you lose not only your income, to lose
your health insurance is just awful. At the very least, the
Federal Government should provide the health protection for
those of you who risk your lives. I thank all of you on behalf
of my constituents in my city for your brave efforts.
But could you respond to that, in fact we sent the money,
so what is the problem? They're not processing or----
Mr. Willis. OK. With regards to transit workers, we work
for a State agency. New York City Transit is self insured for
workers compensation. As such, it is a budgetary process for
them. Every dollar they spend on comp is a dollar out of their
budget. They are holding a meeting today telling the people of
the city of New York how broke they are.
It is outrageous that every comp case for a State agency
has been controverted.
We have people who were down at Ground Zero who have been
fired because they were Section 71 by the State.
Mr. Nadler. What is Section 71?
Mr. Willis. OK. Section 71 if you have more than 12 months
off out of work on a comp case or on an injury or an illness,
the State can seek to terminate you, and they have.
In one case I know of a welder who was at Ground Zero, is
one of our transit workers. And some of you may remember in the
first days as horns went off went they thought there would be a
building collapse, this guy was knocked down. He had a knee
replacement, was not able to get back to work. He has been
fired. He is not alone. OK.
This is a State agency.
Mrs. Maloney. Well, we will followup on that.
My time is up. I thank the chairman.
Mr. Shays. Mr. Rapp, Mr. Graham, what about responders?
Mr. Graham. I will just speak on my own behalf. My workmans
comp case has been controverted. So that is my--I know what
that means, but it means they are not paying.
Mr. Shays. For the record, what does it mean?
Mr. Graham. It means that they are arguing my case. That
they are not actually----
Mr. Shays. They are protesting.
Mr. Graham. They are protesting.
Mr. Shays. They're protesting. OK. Fair enough.
Let us go on. How much time did we use on this question,
totally how much did we use. What does the clock say? OK.
Mr. Turner, you have the floor.
Mr. Turner. Thank you.
I want to thank all the members of the panel for the spirit
of which they are approaching this. I appreciate Mr. Owens'
statement that this is an act of war against our country and
that the individuals who have impacted in this have been
impacted by a national catastrophe and an act of war.
And, Mrs. Maloney's statement that this is an issue that
has bipartisan support. Because certainly the Nation's response
to this was on a nonpartisan basis. So certainly our analysis
of how we go forward is also bipartisan and nonpartisan.
When Mrs. Maloney asked the question of how many people on
the panel think that the Federal Government could do more, I
wish you had allowed us to raise our hands, too. Because I
would have joined you, Mrs. Maloney, in saying that the Federal
Government can absolutely do more.
Mrs. Maloney. Thank you, Mr. Turner.
Mr. Turner. The question that we have, obviously, before us
is do more of what? And so it is not a neglect of the Federal
Government that there is not an action of our list of things
that we could do. This is the process that we go through, the
deliberative process of making certain that we do the things
that are best and that those get implemented.
I really appreciated the information on what are the things
that we need to do and the gap of treatment and making certain
that individuals that do not have access to treatment, receive
the information of followup and the coordinating of response.
I think we all want to make certain that the heroes of
September 11 get the attention and response that they need, but
our concern is that the bureaucracies of September 11 also get
the oversight that they need.
In looking at the issue of the amount of long term health
monitoring and the information and the testimony that has been
provided to us, some of the money has been released, some of
the money has not yet been released. But we have already on the
Federal Government allocated and some spent, $122 million for
assessment and for registry and for screening. That is not a
small amount. And the request that we get today is that amount
be extended in 20 year programs and then looking at what that
amount will be.
My questions are twofold. One, as I acknowledged in my
comments, you know mine was a community that responded to the
call from New York City to send EMS and firefighters as part of
the recovery effort that is here. So my first question is to
what extent does the fire registry program, the New York City
Department of Health and Mental Hygiene and Mount Sinai's
efforts go beyond just the individuals that currently are in
the area, but those that were impacted that came in?
And second, I would really like some discussion
specifically between Mr. Freiden and Dr. Herbert and Mr.
McArdle concerning the coordination of these programs. Because
you know when you get to $122 million and you are just
beginning to scratch the surface and you are each talking about
20 year programs and the annual amounts to maintain them, to
what extent are your processes being coordinated?
Let me start with Dr. Herbert?
Dr. Herbert. Well, actually because Dr. Levin and I are co-
directors, we agreed that I would give testimony and he would
respond to questions, if that is OK.
Dr. Levin. She left the tough job to me.
Well, No. 1, we have worked very well with the fire
department's medical group and have compared notes and findings
and approaches to the monitoring and evaluation of our
respective groups, really from the beginning. And what was so
striking to us early on was how similar the findings among the
firefighters were to what we were seeing among the other rescue
and recovery workers.
In going forward, are very likely to be able to work out
common screening protocols so that we may even at some point be
able to share data in a common data base. And this will be
important, I think, to understand better what the clinical
consequences were and what are the best approaches to
treatment.
So far as the other question, the national scope of our
program, were mandated by NIOSH, when we received a contract to
establish a consortium of institutions to provide these
screening examinations, to cover all of those people nationwide
who had come to New York and then returned to their home cities
to do rescue and recovery work here at Ground Zero. And we are
doing this through the coordination of the Association of
Occupational and Environmental Clinics, a network of public
health oriented clinics throughout the country. They are going
to have provided, by the end of this program, some 1,000
examinations at cities located geographically pretty well-
distributed across the country.
And, in fact, in Ohio I just spoke with the director of the
program at University of Cincinnati who is seeing some of the
people in Ohio.
It is not enough. There are people, we are afraid, who will
not be covered. For example, the Federal employees who were
paid with Federal dollars to do their rescue and recovery work
are not covered by our program. State employees are not either.
Unfortunately, unlike the State employees here in New York,
there is still no program for Federal employees who came to
Ground Zero. There is no screening program, no monitoring
program going forward. I think, again, if we're talking about
public health across the States, this is clearly another public
health mistake.
Mr. Shays. Let me just say, I want to give 10 minutes to
each Member. We are going to end up using it anyway. So add
three.
Dr. Frieden. In terms of the extent of the registry, anyone
who meets the eligibility criteria can enroll. We have already
had enrollees from dozens of States, including several dozen
individuals from Ohio. And so it is available for any who were
in the groups that were most exposed to enroll.
In addition, the results of the registry will be relevant
not only for those who participated and not only for those who
meet the criteria for enrollment, but also for others who had
lesser levels of exposure. It will allow us to generalize. It
is the only evaluation that can put into context the clinical
findings and give us the overall picture.
In terms of coordination, I think there's excellent
coordination. We are on the advisory committee of the Sinai
group, they are on our advisory committee. We coordinate
frequently. We consult each other when issues arise. And we are
looking at different pieces of the puzzles, which will give us
the most comprehensive overview of the impact, the groups at
highest risks, the conditions that are most problematic, and/or
what the treatments that are most effective for those who have
been impacted the most.
Mr. Turner. Mr. McArdle.
Mr. McArdle. I think that the points that I want to make is
that we do have some coordination, but not complete
coordination. I believe that we communicate regularly with the
people at Mount Sinai. We communication, our labor union
communicates with our medical office. And I believe that in the
end what will actually happen is that the data that is
collected by the New York City Fire Department will be the very
best data available on what happened. And this is the reason
why.
Our people from the day they start employment in the New
York City Fire Department get a medical annually because of
hazardous materials regulations. And because of that, we have
data knowing what everybody's medical condition was pre-
September 11. And this is why it is so important not to hold
back on the money from the FDNY.
Our money was sole sourced. And we believe that what is
happening in this battle for the rest of the money, you are
neglecting a very important portion of the information that is
going to of value to the entire Nation down the road. It is
imperative that our fire department get the $25 million right
away. And there is a lot of government haggling about the
money. And we absolutely need that to stop.
Mr. Turner. Dr. Weiden, the issue on coordination?
Dr. Weiden. I think that because of the organization of our
occupational health facility, we will be leading indicators.
And we are dedicated both to collecting the information,
disseminating the information in an academic channel. We have
now published, I think, four articles which I think were the
first. I think that we will continue to find things, publish
them, get them out there and be a light for everybody else.
So I would urge that you support us as a separate entity
and then we will then disseminate the information.
Mr. Turner. Mr. Willis on the issue of coordination from
the registries and--no answer?
Mr. Graham. I think we need more research and more
coordination from all departments to find out what medications
might work, what treatments might work. If someone comes up
with more ideas of treatment that might relieve some of the
problems that we all are experiencing, if that should come down
and people could join together and find out. We need research.
We need somebody to find out.
Right now my medication just keeps me at this point. I am
not tremendously getting better, I am not getting tremendously
worse. I need to find something that would cure, relief,
something.
Thank you.
Mr. Turner. Thank you, Mr. Chairman.
Mr. Shays. Thank you.
At this time the Chair would recognize Mr. Towns.
Mr. Towns. Thank you very much, Mr. Chairman.
Let me begin by first commending on the outstanding work
that you are doing here at Mount Sinai. I notice that was one
thing that everybody sort of agreed on at the table, and I
would also like to associate myself with those remarks.
Let me ask, and Dr. Herbert, you have indicated that the
questions should go to Dr. Levin, right?
Dr. Herbert. That is right.
Mr. Towns. OK. Dr. Levin, as the medical director of Mount
Sinai, said the earlier WTC related illnesses are detected and
treated, the more likely the treatment will prevent long term
illness and disability. Given this, it makes sense to me to
expand the list of people who should be included in screenings
to make sure that every one adversely affected is checked.
Maybe you pay a little more up front to detect problems, but
you save money and people's lives in the long run. Do you agree
with the logic?
Dr. Levin. Yes, I certainly do. And I think that has been
our approach from the very start.
We saw people being taken off that pile within the first
couple of days, gasping for breath, choking, and could predict
at that time that there would be a great deal of potential
longer-term effects with respiratory problems--upper
respiratory problems and lower respiratory problems.
But in our clinical center, our Center for Occupational and
Environmental Medicine, before our screening program began we
were seeing community residents. We were seeing people who had
returned to office space down in lower Manhattan for whom this
screening program is not intended. Those people suffered
respiratory illnesses as well. Do I think the Federal
Government should have developed a program to evaluate those
people who came back to work in the area, who came back to
occupy residential space, the school children who came to
school so early? Yes, I do. I think from a public health
perspective that would have been the correct thing to do. I
still think it is worth doing.
Mr. Towns. Right.
Dr. Freiden, how do you feel about that?
Dr. Frieden. Certainly early detection and effective
treatment of conditions related to WTC is something that can
minimize future impact.
Mr. Towns. Right. Well, let me say this: On August 26, 2002
following the Newsday article ``Winds of 9/11: No Scrutiny For
Brooklyn For Attacks, Toxic Smoke Drifted.'' I wrote to you
expressing my concerns about leaving Brooklyn residents who may
have been exposed to WTC toxins out of the World Trade
registry. Given the additional research performed which shows
that the intense heat of Ground Zero blew the pollutants
upwards creating a loft effect causing these pollutants to blow
toward Brooklyn and dropped on my constituents, do you think
that it might be worth reconsidering now whether Brooklyn
residents should be eligible for the registry?
Dr. Frieden. Let me clarify several things.
First, the services available for evaluation, medical
evaluation and treatment are not related to participation or to
eligibility for participation in the registry.
So whether or not someone is eligible to participate in the
registry and whether or not they do actually participate in the
registry has no bearing on the services available to them. The
same services will be or will not be available to them in
either case.
As it is, there are in our estimate close to 400,000 people
who would be eligible for participation in the registry. Given
that, our focus is on those most heavily exposed so that we
have the best possible chance of documenting what the health
impacts were and the extent of those impacts.
There is no harm to opening the registry up for more people
who would want to participate, however it is not currently
funded for a broader group of individuals who are not among
those who are among the most intensely exposed. If resources
were available, we would not in any way be opposed to allowing
people from Brooklyn or, for example, from between Canal and
Chambers which is also not in the eligibility now of the
registry to participate. They're undoubtedly exposed. We are
not saying that they are not exposed. What we are saying is
that given the extent of the exposure, the heaviest exposed
groups are those that are currently eligible for enrollment. If
resources were to allow, we would have no objection to having
additional people eligible enroll.
Mr. Towns. And when you say additional resources, what are
you really talking about?
Dr. Frieden. It costs, to be frank about it, about $100 per
person who enrolls in the registry. We are currently funded to
allow the enrollment of as many as people as are eligible from
within that most heavily exposed group. This, from a scientific
perspective, we do feel will allow us to make conclusions about
all of the groups, not just those who are most heavily exposed,
not just people who are participating, but also others
including those from Brooklyn.
And I would also comment that many people from Brooklyn do
fall within an exposure category and are eligible for
participation. We already have thousands, I think more than
1,000 of Brooklyn residents who are part of the registry, as we
also have thousands of people who are from the unions who are
part of the registry. We have had a very good response, and we
continue to encourage people to participate so that we have the
best possible chance of documenting and evaluating the
population-based long term health impacts.
Mr. Towns. I think the reason I'm raising this question, as
you know, the Newsday article indicated that from the photo you
actually could see this cloud up in the sky and it was dropping
over Brooklyn.
So it seems to me we should have a great interest in trying
to find out more about that, being we are trying to get as much
knowledge as we possibly can. And it has been indicated by
Mount Sinai that early detection makes a lot of sense. So it
seem to me that we would want to devote some of our resources
and energy into trying to make certain that we find out this
information as soon as we possibly can in order to prevent long
term disability and all kinds of other things that might occur
if we do not do this.
Dr. Frieden. Based on the best data available, atmospheric
data, analyses of the plume, analyses of exposure, we feel that
the current exposure groups for the registry do represent those
individuals most heavily exposed to and most at risk for
potential health effects of September 11.
Mr. Towns. Right. Well, you know I just want to make
certain that we do not leave Brooklyn out.
Let me just sort of move on to coordination point.
Running down the table, can you think of anything that
needs to be done that might assist in the coordination? Because
I think that coordination is very, very important because we
are not talking unlimited resources.
Yes?
Dr. Levin. Well, I will comment on that. Yes, I think the
coordination should have been in place from the very start of
this terrible event, and going forward, should there be another
disaster, whether it is a terrorist attack or some other
natural disaster, we need certain things in place. And that
includes, for example, an independent, already identified panel
of experts, environmental health experts, who could be convened
rapidly to assess the hazards and the likely health
consequences and clinical effects of these exposures.
When I say ``independent,'' I mean independent of political
and economic considerations. Not that they will not come into
play at some point, but in the deliberations of that expert
panel, they should not be influenced by politics and by money
considerations as they consider the issues of health
consequences and the decisions made to protect people's health.
In such an event you need a rapid comprehensive
registration of everybody who is down there. And as much as it
was the wild west, surely we could have done better in trying
to capture who was down at that site. And that may occur in the
future, the necessity to try to register people quickly.
You need the rapid distribution of respirators. You need
the rapid training of people to wear respirators. A number of
people here have talked about that issue; how late it was in
getting adequate respiratory protection to people who really
needed it.
You need the rapid establishment of health evaluation and
treatment capability, including a fast-track mechanism of
funding from the Federal Government to institutions that can
provide this kind of an evaluation, so that we will not be in
the position again of waiting 8, 10 months, a year before
people get their first evaluation after they have been ill now
for at least that period time.
Yes, we need coordination. The coordination has to be
immediately in response to the event, and then all those
institutions and agencies that are involved in trying to
provide a public health response have to be working together
under some coordinating unit.
Mr. Towns. Right.
Any other comments on coordination? Because I think that is
very, very important.
Yes, Mr. Willis.
Mr. Willis. Actually, Congressman Towns, at that time at
that day I lived in Brooklyn. On the morning of September 12th
my wife and daughter woke up to think that there was a fire in
the house. What they were smelling was a cloud coming down from
Ground Zero. At that time we lived by the foot of the Verrazano
Bridge, which is down in Bay Ridge--10 miles away. And they
thought there was a fire in our house.
And in terms of coordination, I think that Federal agencies
simply need to recognize that there is an issue here and they
have to wake up and give help now.
Mr. Towns. Thank you.
Doctor.
Dr. Weiden. So, I am an academic. And on the academic model
one of the ways of assuring coordination and transparency is a
series of annual meetings with all of the stakeholders
participating where the current results are presented in
public. And I think that would go very far to ensuring the
various constituencies here that everything that can be done is
being done; that the money is well spent and disseminate the
information beyond the specialized centers to the board
constituencies with regard to care.
Mr. Towns. Right. And, Mr. Chairman, I have enough for Mr.
McArdle's answer?
Mr. Shays. Yes.
Mr. Towns. Yes, sir?
Mr. McArdle. Just a few issues. As far as coordination
goes, I think that one of the important things is to make sure
that when we have these types of events, that there is
compliance with Federal safety regulations. Clearly, they were
not followed on September 11. I know a lot of the rules went
out the window. But labor organizations, who are a good part of
the early operations, were basically ignored. And some of their
concerns about their members' health was ignored. And now we
are paying the consequences for that right now.
And I think the strict safety discipline at these events in
the future is also very important and going to prevent long
term exposure issues and long term medical problems.
Dr. Frieden. I would just like to say very briefly that at
the city health department, we have a total commitment to
openness and transparency. We are clear about what we know,
what we do not know, what studies we have done, what they have
found.
I think at the general level, Federal, State, local there
are many very controversial issues, particularly environmental
issues are controversial.
In regard to environmental issues, there is a great deal of
suspicion, there is a great lack of knowledge. And it would
serve the public best if there were a combination of complete
openness and, as was called for before, a kind of independent,
impeccable respected, scientifically-valid group to look at
what we know already, what we do not know already and determine
what more we might need to know. Because there have actually
been an enormous number of studies done, some of them done
superbly by groups here at this panel, some of them by others.
There is, in fact, an enormous amount of environmental data
available.
And so I think it is important that we have the mechanism
to look at that openly, transparently, hearing from everyone
and being clear about what we know, what we do not, and what
more we need to know.
Mr. Towns. All right. Thank you, Mr. Chairman.
Mr. Shays. Thank you.
Mr. Owens, Major Owens, you have the floor.
Mr. Owens. Let me begin with one narrow question to
followup on my colleague Mr. Towns' question. We are both
concerned about the fact that residents of Cobble Hill,
Brooklyn Heights and Park Slope who, incidentally, lost a
number of lives in the World Trade Center think they have been
abandoned, deserted in terms of concerns about the pollution
impact there.
In your determination of the areas that you would focus on,
were there any criteria other than budgetary ones that
determined how broad, how wide your scope would be, how big
your area would be?
Dr. Frieden. Let me reiterate that there is no less
attention to those who were exposed in any area. The World
Trade Center Health Registry does not enable people to get more
health services, nor does it restrict health services from any
other groups. It is an attempt to systematically document
health impacts, so that we can generalize about the people who
were exposed and identify what syndromes are associated with
exposure to WTC.
Many residents from Brooklyn have already enrolled. We hope
that many more enroll.
In determining which were the most heavily exposed groups,
we did not look at budgetary issues at all. We looked at what
the exposures were, and the exposures related to residents,
they related to presence, they related obviously to rescue and
recovery operations both in WTC and at the Fresh Kills landfill
where there was exposure directly to the potentially toxic
materials that were involved in the WTC. Residents in lower
Manhattan are all included.
Mr. Owens. What's the geographical, you know, if they are
in proximity to the site? Nobody went out and took any
measurements in Brooklyn----
Dr. Frieden. No. Actually extensive--right.
Mr. Owens [continuing]. To find out much debris had dropped
there.
Dr. Frieden. Extensive analysis of the plume was done. And
in no way are we saying there was not exposure in Brooklyn.
However, all of the evidence that we have reviewed does
indicate that the exposure, that the plume, fell most heavily
in lower Manhattan.
Mr. Owens. Thank you.
I see that a representative of the National Institute for
Occupational Safety and Health was scheduled at one point to
testify here.
Mr. Shays. Panel two.
Mr. Owens. Panel two. Well, I will save this for panel two
then.
Well, I will ask you. Anyone of you, what kind of role have
you seen OSHA play in this drama from beginning to end? Would
you like to make any significant comments as to the role of
OSHA? Yes?
Mr. Graham. OSHA was there very early on. They were there
to help myself and many other workers there. It was a touch job
they were put into. There is no real regulations that state
what do you do when a 110-story building collapses, how do you
handle it.
Extremely enforceful. They mandated that anyone on the job
site not complying was removed. My administration complied to
that.
A lot of due diligence on OSHA's part. They were there 24
hours a day, 7 days a week to do the best job they could.
Mr. Owens. What has been your experience at Mount Sinai
with OSHA? Any significant?
Dr. Levin. Well, we have many colleagues and friends who
were on the ground, so to speak, working with OSHA trying to
determine levels of exposure, trying to ensure respiratory
protection.
There was clear arena of debate, and that is that OSHA was
not in enforcement mode. They were in a consultative mode.
There was a partnership between the contractors and the unions
to enforce safety regulations on the job. And if you look at
the actual accident rates and the fact that not one fatality
occurred on that site, clearly the accident rates were half of
what would have been expected on a comparable demolition or
constructionsite with that many person hours worked.
Nevertheless, the fact that OSHA was not in enforcement
mode did mean that some of those workers out there on the pile
were not wearing adequate respiratory protection and there was
not full enforcement requiring that they do so. And there was a
price that was paid in the health consequences for people who
were there.
I do not fault those hard-working OSHA people that we have
worked with for so long for their efforts, because they tried
very hard to do the right thing. The policy question of whether
that was the right way to go, I think is a remaining subject
for debate and discussion.
Mr. Owens. Are you getting cooperation from them now that
is compensatory to what they had to do then?
Dr. Levin. In our screening program we have worked most
closely with NIOSH, the National Institute for Occupational
Safety and Health, which is sort of the research arm under the
CDC. And we have worked very well with our colleagues at NIOSH.
Our only complaint is we would like to see this funding coming
through for long term medical monitoring fast enough so that we
will not be stuck in a situation where there is a gap between
the current screening program and the future longer term
monitoring. But in the development of the medical protocol, in
how to think about these issues, we have worked very well with
NIOSH and found the experience with them to be very helpful.
Mr. Owens. My final question is a little broader. The
Federal Government is to be congratulated, the administration
and both parties, for the steps it took to deal with the
casualties, the victims at the World Trade Center, the way the
insurance and the compensation has been handled I think is
outstanding. You know, I voted for it so I take some credit.
But it was unprecedented.
Is it not possible to deal with workers on the site and
their problems in the same kind of way? Under one umbrella make
some decisions about who is to be compensated for what and what
kind of care, who it is entitled to and for how long, and what
kind of damages people are due compensation for? Is that
undoable?
We are dealing with a finite number of people. I am not
talking about residents. I am talking about workers who were
there on the site, most of them who can prove they were onsite.
Is it not possible to look at some kind of bigger more
comprehensive program which would deal with all these problems
and not have to nickel and dime it and then beg your way
through philanthropy and agency generosity here and there?
Dr. Levin. Well, if you are asking us at Mount Sinai that
question?
Mr. Owens. I am asking everybody who might want to comment,
yes.
Dr. Levin. Well, we certainly feel it ought to be possible.
Because the actual experience of people who responded down
there, whether they were workers or volunteers, has been
absolutely awful.
I mean, you heard from people today what it is like trying
to get through this broken workers compensation system. The
system was broken not just after September 11. It was broken
before. It is quite stark now that you have people who did so
much down there to help others who----
Mr. Owens. Yes. But there was no system for the insurance,
the payment of people who lost their relatives there. We
created a system afterwards.
Dr. Levin. Yes, you are right.
Mr. Owens. And that is what I am talking about. Can we not
create a system which then would become a model for the future
in terms of situations like this instead of trying to put
together with rubber bands and gum?
Dr. Levin. I certainly think that such a system could be
developed. I think the experience that we at Mount Sinai, and
others, who have provided care to such workers and volunteers
could help develop such a system. And it would be rational and
it would put in place a mechanism for getting people treatment,
for their studies that they absolutely need, without their
having to go through the nightmare of trying to get some
workers comp insurance company to say yes to this after a year
and a half has passed and still nothing has been done. Yes, we
could develop a system.
Mr. Owens. Thank you for putting that on the record.
Thank you, Mr. Chairman.
Mr. Shays. Thank you, Mr. Owens.
Mr. Nadler.
Mr. Nadler. Thank you, Mr. Chairman.
First, just to followup on the workers comp for a moment.
Commissioner Freiden, you have heard here that the MTA, which
is a State agency, has controverted and disputed every workers
comp case arising out of the World Trade Center catastrophe.
Has the city administration done anything to speak to the
Governor the State or the MTA about this disgraceful practice?
Dr. Frieden. I am not familiar with that, but we could
certainly find out about it and get information back.
Mr. Nadler. I mean, in other words all these employees of
government agencies, every single case the MTA says, the
government says you may be a hero in September 11 but you are a
malingerer, you are a liar, you are a phony false claimer.
Every single case. I find that disgraceful. I find it
disgraceful for the State government. I find it, frankly,
disgraceful that the city government has not done anything
about it. No. 1.
No. 2, Mr. McArdle, Mr. Willis, Mr. Graham, Mr. Rapp, when
you were working on the pile were you wearing respirators?
Mr. McArdle. I was, yes.
Mr. Nadler. The entire time?
Mr. McArdle. Yes.
Mr. Nadler. And you still have all these health effects?
Mr. McArdle. I am not one of the people who is impacted by
it.
Mr. Nadler. OK. Mr. Willis?
Mr. Willis. No, I had a paper mask.
Mr. Nadler. I'm sorry?
Mr. Willis. I had a paper mask.
Mr. Nadler. Not a respirator?
Mr. Willis. No.
Mr. Nadler. Were you offered a respirator?
Mr. Willis. I'm sorry?
Mr. Nadler. Were you offered a respirator?
Mr. Willis. No. None were available.
Mr. Nadler. None were available? Did you ask for one?
Mr. Willis. No.
Mr. Nadler. But you were made aware that none was
available?
Mr. Willis. Yes. There was no one around me at that time in
the first, you know, in the first few days that I saw where we
were working who had them.
Mr. Nadler. And then was just the first few days.
Mr. Willis. Right.
Mr. Nadler. What about after the first few days?
Mr. Willis. After that, you know, some of our people in
transit who were respirator qualified----
Mr. Nadler. Were respirator qualified?
Mr. Willis. Right. You have to be qualified for a fit?
Mr. Nadler. You mean physically qualified?
Mr. Willis. Right. Yes. Yes. For instance, with a beard,
you are not.
Mr. Nadler. And if you were not qualified, they did not
tell you to shave off your beard, they said go work there
without the respirator?
Mr. Willis. That question did not even come up. We were
ordered there, and a lot of us actually volunteered. I, for
instance, volunteered.
Mr. Nadler. But respirators were or were not available
after the first few days?
Mr. Willis. No. No, no, no, no. They were not--first of all
transit does not even have that quantity of respirators to
cover the thousands of hard hats that they had there.
Mr. Nadler. So people in transit worked for weeks on the
pile without respirators and no one made any attempts to get
them respirators.
Mr. Willis. I mean, we had bus operators. For instance, the
firemen for the most part were brought down to the site from
Canal Street by our bus operators back and forth. I am aware of
bus operators who will never work again because they had no
respirators.
Mr. Nadler. OK.
Mr. Graham.
Mr. Graham. During the initial collapse I did not have a
respirator. Following that my trips down there were, I did have
a respirator and I did do--personally give my membership a
tremendous amount of--we spent a tremendous amount of money, my
membership, on respirators and fit testing.
Mr. Nadler. The union bought the respirators?
Mr. Graham. Yes, they did.
Mr. Nadler. Not the State or city government, or the
Federal Government?
Mr. Graham. I am trying to give you the exact date. The
12th or 13th, those days are a little blurry to me, sir, but
that week my particular union bought thousands of dollars in
respirators.
Mr. Nadler. In respirators.
Mr. Graham. And we bought fit testing and we brought it to
the site. And we got our membership and we started fit testing
our membership.
Mr. Nadler. And you saw the necessity of doing that right
away?
Mr. Graham. Yes. I felt it.
Mr. Nadler. OK.
Mr. Graham. In my chest.
Mr. Nadler. Mr. Rapp.
Mr. Rapp. Yes. Me also. I had a respirator from November to
March when I was working.
Mr. Nadler. From November? What about September to
November?
Mr. Rapp. No. I wasn't there. I volunteered. I did not have
the respirator.
Mr. Nadler. So you used the respirator the entire time?
Mr. Rapp. Well, it was hard to communicate with your other
workers----
Mr. Nadler. So you used it part of the time?
Mr. Rapp. Yes.
Mr. Nadler. Part of the time?
Mr. Graham. Mr. Nadler.
Mr. Nadler. Yes.
Mr. Graham. Just one other thing. I would love for the
congressional hearing to try to work, even sitting at a desk,
for a 12 hour day with this respirator on.
Mr. Nadler. With a respirator on? I understand.
Mr. Graham. Not walking up and down and not digging in a
pit, but just sitting for 12 hours, even 2 hours. Just try it
and see what it is like.
Mr. Nadler. Yes.
Now, Mr. McArdle, in your testimony you say that many
firefighters were not given the proper respiratory protection
devices even though complaints about this issue have been made
for years, the department did not and still does not have a
respiratory protection program as required by Federal
regulations for air purifying respirators for well over 10
years. This is in violation of CFR 1910.134. To your knowledge
they still do not have those respirators?
Mr. McArdle. Yes. And I would just like to make a
clarification also, Mr. Nadler. When you asked the question
about respiratory protection, I had respiratory protection when
I initially got down there, which was self contained breathing
apparatus, not a full faced APR. Once the air supply ran out,
that was it.
When I say that the department did not have respiratory
protection, they did not have full faced air purifying
respirators----
Mr. Nadler. They did not have the adequate proper
protection?
Mr. McArdle. Right.
Mr. Nadler. Mr. Weiden, does the department not have the
proper protection that is required by law or does it? And if it
does not, what are you doing to change that?
Dr. Weiden. I do not know what the law is. I am a clinic
physical taking care----
Mr. Nadler. OK. I'm sorry, do no answer that. I thought you
were more higher up in the department or differently, laterally
in the department.
Dr. Frieden. He is higher up.
Mr. Nadler. That is why I said laterally. That is why I
said laterally in the department.
Dr. Weiden. But let me answer it to the extent that I can.
Mr. Nadler. Yes.
Dr. Weiden. The police department has issued terrorism
bags, which include a respirator to all of its membership.
There is no such equivalent, currently sanctioned equipment
that either goes with the member or on any of the apparatus----
Mr. Nadler. For the fire department.
Dr. Weiden. For the fire department. The only respirator
that is currently being used is the full face self contained
breathing apparatus.
Mr. Nadler. So in other words, it is fair to say that it
differs by department and for volunteers and people from other
departments, a lot of people did not have respirators and some
did.
Let me ask the following question: Dr. Freiden, you state
in your testimony and you spoke about it in response to earlier
questions, that you concentrate in the registry and where
people were most heavily exposed, that is to say below Canal
Street. What scientific data do you have that Canal Street is
the boundary for heavy exposure; that there is any difference
between one block south of Canal Street or one block north of
Canal Street, or for that matter in Brooklyn or on the other
side of the Hudson River, New Jersey? Is there any scientific
basis for the boundary for--well, in fact what you did was
simply copy the boundary that the EPA made for their so called
clean up program. Is there any scientific basis for this
boundary?
Dr. Frieden. Well, first of all, I would like to clarify
that it is not solely geographic. There are different groups
that are eligible----
Mr. Nadler. No, no. But residents----
Dr. Frieden. Individuals who are eligible to participate
include those who worked in rescue or recovery, those who went
to school or taught in schools--in lower Manhattan. Those who
lived or worked there.
Mr. Nadler. All right. People who lived or worked there.
Just please answer the question, I have more questions.
Part of this is geographically limited. What is the
scientific basis for the geographic limit?
Dr. Frieden. There is a question if a decreasing level of
exposure. At----
Mr. Nadler. Well, my question is how do you know given the
fact that you haven't done--nobody has done what the IG
recommended, namely concentric circle testing going out in
concentric circles from the World Trade Center, how do you know
that in fact there is a decreasing exposure as you get further
away and how do you know where it is appropriate to place a
boundary? What is the scientific basis for that?
Dr. Frieden. We are making the best judgments, given the
available data, of what the highest level of exposure is. We
are not saying that those who are a block away from that are
not exposed. We are saying that there is a gradient of exposure
based on the best available data.
Mr. Nadler. Could you furnish us that data? Because
everything that I know says that there is wholly inadequate
data. Every testimony that we have had at other hearings says
that there's wholly inadequate.
Well, let me ask Dr. Levin. Do you believe there is
adequate data to sustain what the Commissioner just said?
Dr. Levin. Well now, we have been advocating all along,
really since early city council hearings, that this approach of
going from Ground Zero in radians in all directions, assessing
levels of surface contamination in interior surfaces, ought to
have been done. It is a straight-forward approach, and still
could be done. Because not all clean up has occurred.
Mr. Nadler. And that is the IG's recommendation?
Dr. Levin. That would be the way to characterize the extent
and perimeter of the contamination that occurred.
Mr. Nadler. But do you believe that the Commissioner is
accurate in effect saying that a boundary line at Canal Street,
or any particular street over there, is scientifically based on
where the most heavy exposure is?
Dr. Levin. I do not think----
Mr. Nadler. And not just Canal Street, but----
Dr. Levin. I do not think he said that. I think he said
``on the basis of the best available data.'' He, I think, did
not speak to the question of whether the available data are
truly adequate. I do not think they are adequate to make that
determination. I think the characterization by this sort of
approach we just were talking about really ought to be done,
and then he can answer the question.
Mr. Nadler. So it is not scientifically valid to do that
unless we have data that we do not yet have.
Dr. Levin. Generally we like to proceed from data.
Mr. Nadler. OK. Thank you.
Mr. Shays. Thank you. I am going to take the questions now
and just read a part of the briefing paper that we had, and
this was replete with this kind of information.
Various sizes of particular matter floated in the air and
blanketed New York City streets. Fires burned under the debris
until the middle of December 2001. A mixture of plastic, metals
and other chemicals and products burned or decomposed into very
fine particles. The content of the plume varied centimeter by
centimeter. Some researchers found one molecule that had never
been there before. According to Paul Lioy of the Environmental
Occupational Health Science Institute of the University of
Medicine in New Jersey ``Initial exposures were basically a
blackout, people will, cumulatively, never see in a lifetime.
The problem we have now is we do not know the long term
lifetime health consequences. We just do not know.''
Do any of you disagree with that basic description?
Let me say to both you. Commissioner, thank you for
staying. I know you feel a little anxiety because the Council
has asked you to be there, too. We got you first. And thank you
for staying.
And Dr. Levin, I think your health registry is hugely
important. And your screening is hugely important. I just want
to go on the record. I am troubled, however, that of the
200,000 potential people, that only approximately 12,900 have
been enrolled and only 6,000 have completed the 30 minute
telephone survey. And I am puzzled by this.
We have allocated $10 to $20 million for that. I cannot in
a lifetime think of how we would spend so much money for that.
And I need you to explain it, and that is why I am happy you
stayed.
Dr. Frieden. Thank you very much. And thank you for your
support of the registry. The registry began enrollment only 8
weeks ago. And so the money was allocated. It was up to the
ATSDR, the Agency for Toxic Substance and Disease Registry, to
select a contractor. They went through the contracting process.
That took a relatively long time.
Mr. Shays. So you have not spent $10 million yet?
Dr. Frieden. Oh, no. No, no.
Mr. Shays. OK. It is allocated for it?
Dr. Frieden. That is correct. That is correct.
Mr. Shays. OK.
Dr. Frieden. And as of today, we have more than 10,000
people who have already completed. And so it is really rapidly
expanding. It is not that the money is already spent. The
registry just began enrollment 8 weeks ago.
Mr. Shays. If we care about the people who are impacted,
the 200,000 who may be, one of the most important things that
could come from this hearing is having people be aware of it.
We need people to register, we need these interviews to take
place, we need this data.
Tell us, Dr. Herbert, your screening is basically the
workers who are working in this facility primarily, correct?
Dr. Levin. It includes--the people who are eligible--
include those rescue and recovery workers and volunteers other
than New York City firefighters, State employees and Federal
employees. It also includes people who restored essential
services: the telephone services, the electrical services,
water services, etc. It also includes those people involved in
cleaning up the buildings immediately adjacent to Ground Zero.
And it includes those workers out at the Staten Island landfill
who did what they did in the effort.
So they are the groups that were included.
Mr. Shays. And it is screening, it is diagnoses, it is you
are providing medical assistance as well?
Dr. Levin. No. No funds are available for medical
treatment. What we do is identify people who, on the basis of
their history, their physical examination findings, their
laboratory findings, have illness which we feel are related to
World Trade Center exposures, and we have a case management
function built into this to make sure that they get plugged
into care. That is the role of the screening program.
Identify those who are ill and make sure, whether it is on
physical grounds or psychological grounds, and make sure that
they get put into care. We do not have the resources to provide
the care, other than some moneys from philanthropic sources
that enable us to see a small number for a relatively short
period of time. And that program, which we are grateful is
funded, now has a 3 month waiting list to get in.
Mr. Shays. During our Gulf war hearings, of which we had
more than I can even remember the number, we had a pilot who
had ALS. He could hardly move any part of his body. He could
only whisper. His wife and sometimes his father had to tell us
what he said.
The last question we asked him was knowing what you know,
would you still have done what you did. And I think you know
the answer; he said he would do it again. He would do it again.
I suspect that all four of you were less concerned about
your health and more concerned about meeting a very drastic
human need.
Mr. McArdle, you wisely used a respirator. If you had not,
do you think you would be feeling some of the health effects of
our other three witnesses?
Mr. McArdle. Yes, absolutely I would be feeling some of the
same effects. I was fortunate enough to have one with me when
the event occurred.
Mr. Shays. Thank you.
How many days did you work in Ground Zero?
Mr. McArdle. Approximately 10. I got there right after
the--I pulled up on the scene right as the first building
collapsed.
Mr. Shays. Mr. Willis.
Mr. Willis. Would I go back? I had--like I said, I
volunteered to be there, but I had a special reason. I lost two
family members under there. So, yes, of course I would.
Mr. Shays. You lost two family members?
Mr. Willis. Yes, I did.
Mr. Shays. Let me ask you this, how many days were you at
the site?
Mr. Willis. Weeks.
Mr. Shays. Weeks.
Mr. Graham.
Mr. Graham. Would I go back?
Mr. Shays. I do not need to ask you that question.
Mr. Graham. OK.
Mr. Shays. I am really asking you how many days in the
site?
Mr. Graham. I was there at least 3 days a week throughout
the whole project.
Mr. Shays. Right.
Mr. Rapp.
Mr. Rapp. I was there through--for 5 months.
Mr. Shays. Five months.
Mr. Rapp. Five whole months.
Mr. Shays. Well, thank you for what you gentlemen have
done.
Now, there is no question on the part of any panelists that
people need to be properly diagnosed, they need to be properly
treated and they need to be properly cared for. Some of that
may be a Federal responsibility, some of it may be a State
responsibility, some of it may be a local responsibility. In
any instance, however, it needs to be a process that is
seamless and does not make you sick just going through the
process. And nothing should delay that process from happening.
I would like to know as it relates to the long term health
effects exposures, what is the best treatment for those
suffering from respiratory problems? What is the best
treatment? What do we know?
Dr. Levin. Well, there is a standard of care for irritant-
induced asthma and sinusitis. It usually involves inhaled
steroids, either nasal steroids or the kind of steroids that
asthmatics use. And, of course, Mr. Graham here talked about
his rescue pump. These are broncho-dilators, things that open
the airways when they are shutdown. And there are a number of
other anti-inflammatory medications that are taken either by
inhalation or by mouth that can be effective.
When sinuses become acutely infected, one is on
antibiotics; even a person who has asthma who develops a
bronchitis, winds up on antibiotics. But the basic standard of
care for these conditions is well established.
Mr. Shays. Dr. Freiden, if you need to go, why do you not
leave. Thank you.
I'm sorry.
Dr. Levin. There is a well established standard of care
which involves the use of these anti-inflammatory medications.
Mr. Shays. Is it expensive?
Dr. Levin. Is it expensive? Yes.
Mr. Shays. Yes.
Dr. Levin. Unfortunately, these inhalers are quite
expensive.
Mr. Shays. No, but the whole process of dealing with
someone with this type of ailment?
Dr. Levin. The evaluation expenses?
Mr. Shays. The evaluations, the treatment?
Dr. Levin. And the treatment is expensive.
Mr. Shays. Describe to me what expensive means?
Dr. Levin. Well, each one of these inhalers runs between
$60 to $80 for a single unit. A person who has active asthma,
you know, will go through several of these in the course of a
month.
Mr. Shays. Dr. Herbert, you can answer the questions, too.
Dr. Herbert. Actually, some of the inhalers are even more.
I mean----
Mr. Shays. But I am asking about the whole treatment.
Forget just this little element of it. I want to know are we
talking thousands of dollars a month, are we talking thousands
of dollars a year? The total treatment, the total care. I want
to grasp something about the magnitude of the cost.
Yes, Dr. Weiden.
Dr. Weiden. So they are involved in screening, I am
involvement in treatment.
Mr. Shays. OK.
Dr. Herbert. We also do treatment----
Dr. Weiden. So that their agenda is not treatment of all
people who come to them.
Mr. Shays. Yes, sir.
Dr. Weiden. My agenda is treatment of all people who come
to them. And I can just tell you that on average I will treat
these patients for well over a year. I will see them at least
once a month frequently, two or three times a month. I will
order testing that will come up to maybe $2,000 to $5,000 for
any individual case. And I would guess that the respiratory
component will cost between $200 and $400 a month. And in
addition with regard to prevention, one of the surprising
things that we found is that these patients also have severe
heartburn. And that treating the heartburn, which is also quite
expensive, then markedly improves the respiratory symptoms that
respiratory patients have. So I think there is an advantage to
having all of this done in one place with physicians who see a
high volume of these patients, and it allows us to be more
efficient.
Mr. Shays. Let me ask you, is there anything that any of
you want to want to record?
First, may I just ask, is there any Member that just has a
question that needs to be put on the record, any Member here?
If not, anything that any of you would like to put on the
record before we go to panel two?
Yes, sir?
Dr. Weiden. One of the things that has been obliquely
mentioned but is not really been the focus of the testimony is
post-traumatic stress disorder. I am not an expert in this, but
it is my assessment that a large proportion of the patients who
I treat for respiratory illness have post-traumatic stress
disorder. And I believe that as many permanent disabilities
will occur on this basis as on a respiratory basis, and it has
already occurred within the fire department that the number of
suicides related to the World Trade Center has far exceeded any
other cause of mortality after the initial collapse.
Mr. Shays. Anyone else like to put anything on the record?
Yes?
Dr. Herbert. We, in fact, have treated hundreds of
responders. And one of the concerns I have is that in addition
to treating the respiratory conditions and the mental health
conditions, our patients are a group who have tremendous
psycho-social needs because many of them are disabled. They
need social services as well as physician care. And I would
hope that would be thought about in any plans for treatment.
Mr. Shays. Yes?
Mr. Nadler. Dr. Levin, one question. On a long term basis
based on what you have seen of respiratory ailments and all the
other things that you've seen, would you expect to see a high
incident in all these people of long latency diseases that come
out 15 years from now, cancers and so forth?
Dr. Levin. We do not know, but there are certain groups
among the people that we have screened that we worry about a
great deal. That includes the people who were cleaning those
buildings day in and day out, disturbing settled dust without
respiratory protection, without training. And there were some
people who were on that pile, right where the plumes of smoke
were coming out containing high concentrations of carcinogenic
agents, without respiratory protection who may, in fact, may be
at significantly increased risk for cancer.
Mr. Nadler. You are talking about the people who were
cleaning buildings afterwards?
Dr. Levin. Cleaning buildings after the collapse of those
towers, who were provided with no respiratory protection, no
training, who did this disturbance of settled dust day in and
day out and in enclosed spaces and really may have sustained
enough exposure----
Mr. Nadler. Are you talking about the people who were
cleaning in the EPA clean up, or you are not referring to that?
Dr. Levin. Not necessarily that specific group. I do not
know their levels of protection.
Mr. Nadler. OK.
Dr. Levin. I know that building after building, office
buildings and residential buildings, were cleaned by largely
immigrant workers who were provided----
Mr. Nadler. Through private contractors.
Dr. Levin. Through private contractors.
Mr. Nadler. That is inside and out?
Dr. Levin. Inside and out, and the issue for them may in
fact be one of concern about cancer down the road.
Mr. Nadler. And OSHA, nobody enforced standards or
protection on these workers?
Dr. Levin. Not to my knowledge.
Mr. Nadler. Thank you.
Mr. Shays. Thank you.
Any other closing comments from anybody? Yes, Mr. Graham?
Mr. Graham. With your statement before about OSHA, OSHA did
lose their office and they did mobilize quite quickly with no
office, no communications and no equipment. So, I just wanted
to put that in.
Mr. Shays. Thank you.
I think, Mrs. Maloney has a comment.
Mrs. Maloney. A brief question to Mr. Rapp, Mr. Graham and
Mr. Willis, all of whom are suffering from health problems
related to September 11. I would like to know possibly in
writing, since our time may be running out, who is paying your
medical bills? How are you managing financially? Did you apply
to the Victims Fund, the special fund that is managed by Mr.
Feinberg? Did they respond to your concerns? And what is the
current status of your workmans compensation plan? Are you
having trouble or has that been resolved?
Mr. Shays. Let us do this; we will supply you a letter with
those questions. You will make sure our committee has that. And
if you could respond to it, it would be very helpful.
Do you have a general response in terms of that question
that you would like to respond to before we go?
Mr. Graham. Well, generally my union's paying. Thank God I
am still working.
Mr. Shays. You say your union is paying?
Mr. Graham. My union benefits, my coverage through the
union is paying for that. And----
Mrs. Maloney. But if you terminate because of health
reasons, there will be no health coverage?
Mr. Graham. Right. I have to work so many hours to earn my
benefit hours. So if I do not work, there is no benefit. And I
have applied for victim's compensation. And my workmans comp
has been denied, whatever.
Mr. Shays. OK. Denied.
Mrs. Maloney. Denied? Unbelievable.
Mr. Shays. Contested?
Mr. Graham. Contested at least.
Mr. Shays. OK. Well, we got our work cut out for us, do we
not?
Thank you all very much. You have been a wonderful panel. I
appreciate your patience.
Mr. Owens. One of the members of the audience, you know her
written testimony, she could not testify.
Mr. Shays. Yes. If we could have the name of the individual
and their address and we will submit it into the record. And we
will note for the record who that is.
Mr. Owens. Ms. Heidi Mount.
Mr. Shays. Without objection, that will be submitted into
the record.
[The prepared statment of Ms. Mount follows:]
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Mr. Shays. We are going to call our next panel. Our next
and our final panel, we appreciate their cooperation.
Our next panel is: Mr. Paul Gilman, Assistant Administrator
for Research and Development, Environmental Protection Agency;
Ms. Diane Porter, Deputy Director, National Institute for
Occupational Safety and Health [NIOSH] accompanied by Dr.
Gregory Wagner, Director of the Division of Respiratory Disease
Studies, National Institute for Occupational Safety and Health.
And our third witness is Ms. Pat Clark, area office director
for New York, New York Occupational Safety and Health
Administration also accompanied by David Williamson with Ms.
Porter is Dr. David Williamson, Ph.D, Agency for Toxic
Substances Disease Registry.
If our witnesses will stand up, please, and we will swear
you in.
[Witnesses sworn.]
Mr. Shays. And I thank others for standing in case we
needed to go on your expertise. That is very thoughtful.
I am going to say again thank you for being the second
panel. Thank you for listening to the first panel.
We know what our task is, and we are going to get to it. We
are going to start first with Ms. Porter. We will go to Dr.
Gilman and then we will go to Ms. Clark. And that will be the
order of it.
Ms. Porter, thank you.
STATEMENTS OF DR. PAUL GILMAN, ASSISTANT ADMINISTRATOR FOR
RESEARCH AND DEVELOPMENT, ENVIRONMENTAL PROTECTION AGENCY;
DIANE PORTER, DEPUTY DIRECTOR, NATIONAL INSTITUTE FOR
OCCUPATIONAL SAFETY AND HEALTH [NIOSH], ACCOMPANIED BY DR.
GREGORY WAGNER, DIRECTOR OF THE DIVISION OF RESPIRATORY DISEASE
STUDIES, NATIONAL INSTITUTE FOR OCCUPATIONAL SAFETY AND HEALTH;
PAT CLARK, AREA OFFICE DIRECTOR FOR NEW YORK, NEW YORK
OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION, ACCOMPANIED BY
DR. DAVID WILLIAMSON, PH.D, AGENCY FOR TOXIC SUBSTANCES DISEASE
REGISTRY
Ms. Porter. Good afternoon, Mr. Chairman, Representative
Maloney and members of the committee. My name is Diane Porter
and I am the Deputy Director for National Institute for
Occupational Safety and Health, a part of the Centers for
Disease Control within the Department of Health and Human
Services.
Accompanying me here today are Dr. Gregory Wagner, a
physician and the Director of the NIOSH's Division of
Respiratory Disease Studies and Dr. David Williamson, the
Director of the Division of Health Studies with CDC's agency
for Toxic Substances and Disease Registry.
Thank you for this opportunity to appear today to provide
testimony on behalf of CDC and ATSDR regarding our ongoing
efforts to address the health impacts of the World Trade Center
disaster on the rescue, recovery and response workers and on
the nearby community members who were so directly effected by
the events that day.
As you know, CDC provided extensive emergency assistance to
workers and residents near Ground Zero in the immediate
aftermath of the September 11th attacks. My testimony here
today will focus on our subsequent activities to address the
health effects of that disaster on the emergency and front line
workers who came to help, and to evaluate the physical and
mental health impacts on the wider community of people living,
working and going to school in the vicinity of the World Trade
Center site.
In the interest of time, I will summarize these activities
today, but a more detailed description of our efforts is in the
written statement submitted to the subcommittee.
In the weeks following September 11th, NIOSH was in close
contact with the medical staff of the fire department of New
York and with other community based occupational health
providers who began reporting health problems they were finding
in workers and volunteers who had been at the site. An informal
network of occupational medicine specialists was established
with NIOSH's assistance.
Mr. Shays. Let me just interrupt you a second and say if
this panel, given it's three, goes over its 5 minutes, you know
that is acceptable. We want you to put on the record what you
need to put on. So do not feel you have to rush.
Ms. Porter. Thanks.
This informal group, lead by Mount Sinai's School of
Medicine Center for Occupational and Environmental Medicine
discussed their findings and began to better define the type
and severity of health problems they had seen. And this
activity laid the ground work for the creation of a
comprehensive medical screening program for these workers.
In November and December 2001, NIOSH was contacted by
several labor unions and employers representing workers
employed in buildings near the World Trade Center site asking
us to look into their health. In response, NIOSH performed a
series of health hazard evaluations that showed elevated rates
of upper and lower respiratory and gastrointestinal system
symptoms as well as symptoms of depression and post-traumatic
stress disorder in the World Trade Center area workers compared
to similar workers elsewhere. These symptoms were still present
2 to 6 months after September 11th.
In January 2002, with funds from FEMA, CDC provided $4.8
million to the New York City Fire Department and $2.4 million
go the New York State Department of Health to conduct baseline
medical evaluations for New York City firefighters and State
employees who responded at the World Trade Center site. Shortly
thereafter, also in 2002, Congress gave $12 million to CDC for
baseline medical screening of the other emergency service and
recuse and recovery personnel who responded to the events of
September 11th.
CDC awarded the contract to Mount Sinai Center for
Occupational Environmental Medicine to establish this program
within weeks of receiving the funds. Mount Sinai, in
consultation with CDC and other occupational health experts,
developed a comprehensive screening program which beginning in
July 2002 provided response workers with a baseline medical
assessment and assistance with referrals for followup care. A
consortium of occupational health clinics was created to
provide these services to response workers and volunteers
throughout the New York City area and in the rest of the
country.
As of October 2003, the consortium has screened over 7,000
workers.
In 2003 also, Congress directed that FEMA provide $90 to
CDC for long term medical monitoring of the World Trade Center
rescue and recovery workers and volunteers including $25
million that was designated to the use for current and retired
New York City firefighters.
In anticipation of receiving these funds, CDC held a public
meeting in New York City in May 2003 to gather input regarding
the content and structure of a long term screening program.
There was broad consensus among leading participants that the
program should include: Multiple clinical sites; that the
existing short term screening program was very satisfactory and
therefore current providers should continue to provide
services; that quality control across the centers is important,
and; that the content of the program should remain flexibility
to accommodate evolving needs and treatment.
There was also agreement that the baseline screening
program should be extended beyond the 9,000 workers who were
currently funded.
Based on this input, CDC supplemented the existing contract
with Mount Sinai within 6 working days of receiving the funds
with $4 million to cover baseline screening examines to
approximately 3,000 additional workers. These examinations will
be conducted through March 2004.
The $25 million designated for long term followup for the
New York City Fire Department will be provided to FDNY to
conduct a program in coordination with CDC.
Just as the baseline screening program is completed in
March 2004, the remaining dollars will be provided to clinical
centers to implement the long term medical screening program
that will provide workers with a choice of providers. The
program will also include a centralized coordination center to
assure quality control and allow for periodic review of
screening.
In addition to our activities to address the health needs
of rescue response and recovery workers, HHS agencies in
collaboration with others are working to identify the health
effects of the World Trade Center disaster on the people who
were living, working or going to school in the vicinity of
Ground Zero. Details on these studies are outlined in my
written testimony.
Finally, the subcommittee has expressed specific interest
in the World Trade Center Health Registry which was launched on
September 5, 2003 with an extensive outreach campaign. In
collaboration with the New York City Department of Health and
Mental Hygiene and with startup funds provided by FEMA, ATSDR
has established a registry to identify and track over the long
term the health of tens of thousands of workers and community
members who were mostly directly exposed to smoke, dust and
debris from the World Trade Center site. To date, more than
10,000 people have been interviewed. It is estimated that the
registry will included 100,000 to 200,000 individuals including
rescue and recovery workers, office workers, residents and
school children making it the largest registry of its kind.
The registry will provide a complete picture of the health
effects resulting from the events of September 11th. It also
will serve as a resource for future research studies into the
health consequences of September 11th and a tool for
disseminating important health information to the public and to
health care providers so that people can make informed
decisions about their health care.
In addition, people interviewed also will be provided with
referrals to health care providers for health problems they may
be currently experiencing.
The registry will be maintained over time by the city
Department of Health and Mental Hygiene.
In summary, CDC and ATSDR are committed to assessing the
health effects resulting from the September 11, 2001 attacks on
the World Trade Center and identifying the physical and mental
health needs of effected workers, residents and community
members.
Thank you for your attention.
I'm please to answer any questions.
[The prepared statement of Ms. Porter follows:]
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Mr. Shays. Thank you, Ms. Porter.
Dr. Gilman.
Dr. Gilman. Can I show my slides from the podium?
Mr. Shays. Yes, fine. And as we pick you up in the mic,
that is fine.
Dr. Gilman. OK.
Mr. Shays. And we will see it on this TV screen here, I
guess.
Dr. Gilman. Mr. Chairman, first, if I could just go over
the elements of EPA's response to the events of September 11th.
EPA in its emergency response capability activated its
emergency response team within minutes of the attack and sent
on senior coordinators to begin collecting bulk dust and air
samples, both at the site of the World Trade Center and
subsequently on the 11th to areas of New Jersey and Brooklyn as
well.
In the days following September 11th we began to establish
a fixed air monitoring system which ultimately consisted of 20
different monitoring stations in addition to the network of
monitoring stations that are in place for activity such as
monitoring for particulate matter under the Clean Air Act.
EPA's principle mission immediately following the collapse
was to address the safe collection and disposal of large
amounts and quantities of dust and debris. And along with other
Federal agencies, my colleagues here today, supplying
respirators and protective gear to workers and truck operators
for Ground Zero.
EPA had subsequently been asked by the city to initiate its
residential clean up program, which began in May of last year.
And we continue to perform laboratory health effects research
on dust and other contaminates from the World Trade Center in
our effort to try and better understand the health consequences
of that day.
In that regard, let me speak to you about our draft
exposure and human health evaluation which was released in
December of last year. It is currently undergoing peer review
and response to that peer review. And let me start by saying a
few things that--I will start by saying what the report does
address and then what it does not address.
The draft report does focus on outside air. It focuses on
the general public.
It highlights six particular contaminates that we believe
were most important to assess. It also tries to look at what
the human exposures to the contaminates were. As you know, a
contaminate may have a health effect, but just what kind of
health effect it has depends on how much an individual is
exposed to of that. So we are trying to assess how much
individuals were actually exposed to these contaminates.
We discussed the potential health impact of those
contaminates and utilized the data that was available at that
time.
The draft report does not address indoor air except
incidentally. It doesn't address first responders at Ground
Zero. It doesn't assess residential or occupational exposures.
And it doesn't predict human health effects, nor does it
purport to examine all the different contaminates that were
found at the site at the time.
Now, let me generally give you the findings of the report,
then we can talk a little bit of the specifics of the
contaminates in question.
First of all, people exposed to extremely high levels of
outdoor pollutants on September 11th at the time of the
collapse in the vicinity of the World Trade Center are at risk
for both acute and potentially long term or chronic respiratory
and other types of health impacts.
We found that the information available on September 11th
and in the days following did not really allow us to well
characterize this particular period of exposure and the
potential health effects. Except for exposures on September
11th and possibly during the next few days, we did find that
the people in the surrounding community were unlikely to have
been exposed to contaminates in a way that would result in
either short term or long term adverse health effects.
Now, the status of the report is, that is currently draft.
It is going through revisions and we hope to have it finalized
in the spring of 2004.
The contaminates we looked at included particulate matter,
asbestos, dioxins and PCBs, metals and volatile organic
compounds.
For the particulate matter, in the several days after the
attack monitors were showing high levels of particulate matter
that did exceed the EPA's 24 hour air quality index, but by
mid-October those levels had receded to ones historically seen
in the city.
For asbestos, there were reactively few outside air
measurements of asbestos that exceeded EPS or OSHA standards.
And I should comment that for all of these substances we
are hampered to some degree by the fact that we had not in the
past expected to have to look at short term exposures. So the
benchmarks we are utilizing in doing this analysis are borrowed
from the occupational agencies and other circumstances. EPA has
traditionally focused on longer term chronic exposures.
So for asbestos, the air measurements taken. There were a
few exceedences of EPA and OSHA standards. High levels of
asbestos were found in dust in two apartments sampled on the
18th and in the grab samples that were done in the area of the
World Trade Center.
The report also does discuss the ATSDR study that was done
on apartments beginning in the November timeframe.
Dioxins and PCBs, there were high measurements in the first
month after September 11th, in particular in and around the
World Trade Center Ground Zero site. Exposures by inhalation of
dioxins in particular were not at a level that should cause
either acute concerns or long term concerns. The major path for
dioxins of concern is really through ingestion, through food
exposures.
For metals, there were some exceedences of EPA benchmarks
for lead in the first month, but the way the lead standard is
set is it is for exceedences that extend over a 90 day period,
and we did not see anything like that for the lead at the site
or in the areas surrounding the site.
And last, for volatile organic compounds, we did see
elevations principally of benzene over the month following the
Trade Center, but none of those exceeding benchmark standards.
Now let me speak for a moment to our efforts at trying to
reconstruct the exposures that people have seen. What I have
here on this screen is actually a graphic of reconstruction of
the plume for the first days following the collapse of the
World Trade Center. It is animated, and as you can see through
time the wind direction did shift.
This is the standard sort of a tool we have available to us
today. It is based on meteorological information that comes to
us from sites like LaGuardia Airport or Kennedy Airport. And
currently the Department of Energy and NOAA are engaged in
putting place systems in a number of cities around the country
that are much fine scaled, if you will. Where the
meteorological information that is collected is much better
represented for the areas in question.
EPA is currently engaged in collaborating with them, and
what we are actually trying to do is apply some tools we had
begun to develop in midtown New York. We are trying to better
understand how people living in a urban setting are exposed to
normal pollutants.
What we have done with what is a computer model, a
numerical model, is now transfer that work to the lower end of
Manhattan and try and computationally understand how the
particles and emissions flowed in the area in and around the
World Trade Center. And so this is a visualization now of that
kind of modeling.
The field that is moving through shows you the different
directions and volicities of the wind, the different points
along the southward movement at the World Trade Center.
And we are using this model along with an actual physical
scale model that was done for lower Manhattan at our research
facility in Research Triangle Park to work back and forth
between the physical model, a wind tunnel model of lower
Manhattan, and that computational model that I described. And
this is a scene of gases, simulated gases being released at the
World Trade Center site.
The result of moving back and forth between this kind of
physical model and computational model is that we can begin to
recreate exposures at the time of the collapse and in the few
days following that we cannot do from actual measurements. So
what you see here is a recreation of concentrations of no
particular pollutant. We have yet to go back and plug in to
these models actual omissions data. But what this represents
is, and let me explain the different so called ``isolines,''
lines of common concentration.
The yellow circle in and around the World Trade Center site
represents the highest concentration. The green line with the
No. 10 on it would represent a 10-fold reduction in the
concentration of a contaminate. And the blue line, a 100-fold
in the contaminate. Also marked on this map is the area that
represented the exclusion zone in the initial phases of the
disaster. We have also done this now for one other wind
direction, and we are continuing to expand that.
Our hope is using a model like that and also, again, a
computational approach to understanding what happened
immediately as the World Trade Center collapsed, we will be
able to recreate the exposure levels that people were exposed
to.
What I have here is a computer generated model. This is not
an animation. This is actually a calculation done of the
collapse of one of the buildings at the World Trade Center. And
it is through this type of modeling that we hope to be able to
combine the physical model that I showed you, the numerical
model and begin to better estimate the exposures that people
present at the time of the collapse and first responders were
subjected to.
Let me now summarize for you some of the things that the
EPA has done since the World Trade Center in an effort to
improve our response capability. We have updated and revised
our national approach to response. We have expanded our
training and incident response. We have built a more
sophisticated and larger emergency operation center. We have
established both at headquarters and in the regions a support
corps. Actually back up folks for our trained professional in
emergency response.
We have also purchased special communications and
monitoring equipment that would overcome some of the
difficulties we had in establishing a monitoring network in the
case of the World Trade Center. We have established another
emergency response team, national emergency response team in
the west. And we have created a Homeland Security Research
Center to develop the kinds of technologies and first responder
computer tools that I have been trying to show you here today.
Those rapid risk assessment tools, we believe, can help
with preplanning for first responders.
We have also developed a scientific response team that will
be available to both first responders and EPA decisionmakers
for future events.
We have also been trying to improve those models, as I
showed you, on air transport.
And also, we have upgraded our laboratory capacity to serve
as a backup to the Department of Defense when it comes to
biologicals and other agents.
And I will stop there, Mr. Chairman.
[The prepared statement of Dr. Gilman follows:]
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Mr. Shays. Well, Dr. Gilman, you have given us a lot to
think about and you will generate a number of questions by your
presentation. Thank you.
Ms. Clark.
Ms. Clark. Mr. Chairman, members of the panel. Thank you
for this opportunity to discuss OSHA's role in protecting
workers after the tragic events of the World Trade Center on
September 11th.
I am the Regional Administrator for Region 2, OSHA, which
covers New York, New Jersey, Puerto Rico and the Virgin
Islands.
OSHA's mission is to ensure safe and healthful working
conditions for employees in this Nation. Within hours of the
attack, OSHA joined with other Federal, State and local
agencies, as well as safety and health professionals from
contractors and trade unions onsite, to help protect workers
involved in recovery, demolition and clean up operations.
Working under perilous conditions, OSHA began coordinated
efforts to protect the health and safety of workers.
In line with the Federal Response and National Contingency
Plans, OSHA determined it could be most effective by providing
assistance and consultation. It was apparent the site was not a
typical construction or demolition project. Workers needed
immediate protection from hazards, the scope and severity of
which were unpredictable.
OSHA's primary responsibilities were to conduct personal
air monitoring to characterize exposure, distribute and fit
respirators along with other personal protective equipment, and
conduct safety monitoring. OSHA committed nearly 1100 staff,
sometimes as many as 75 a day. Our employees remained on the
site for 10 months providing a 24-hour presence, 7 days a week.
Our staff spent more than 120,000 hours onsite. We conducted
over 24,000 analyses of individual samples to quantify worker
exposure. We collected more than 6,500 air and bulk samples for
asbestos, lead, other heavy metals, silica, other inorganic and
organic compounds totaling 81 different analytes.
Personal sampling was conducted around the clock each day
and coordinated with safety and health professionals onsite.
OSHA's sampling efforts included breathing zone samples of
workers on and near the pile. The tasks included search and
recovery, heavy equipment operation, steel cutting and burning,
manual debris removal and concrete drilling and cutting.
OSHA's breathing zone samples showed exposures that were
well below the agency's permissible exposure levels for the
majority of chemicals and substances analyzed.
To ensure that workers were fully informed about the
potential risks, we employed several means to disseminate the
information. We distributed sampling summaries to trade unions,
site contractors and agencies during daily safety and health
meetings. Personal sampling results, including an OSHA contact
number were mailed directly to worker. Those whose sample
results exceeded the PEL were encouraged to seek medical
consultation. We also posted these results on our Web site
within 8 hours.
OSHA consistently recommended workers on the site wear
appropriate respirators. The respirators were selected jointly
with all the site safety and health professionals. We agreed on
a high level of protection. A half mask, negative pressure
respirator with high efficiency particulate/organic/vapor/and
acid gas cartridges. This was communicated through orders and
notices posted throughout the sites. And you will see a number
of exhibits labeled No. 1 through No. 8, as well as the poster
in the front showing this.
OSHA continued to conduct extensive risk assessment to
verify the selected respirators remained appropriate. When
sample results for jack hammering and concrete drilling
operations indicated a higher level of protection was needed, a
full face piece respirator was required for those operations.
Shortly after the attack, OSHA became the lead agency for
respirator distribution, fitting and training. At the peel of
the operation, basically the first 3 weeks, we gave out 4,000
respirators a day. We distributed more than 131,000 during the
10 month recovery period.
Mr. Shays. Could you repeat that number again? How many?
Ms. Clark. 131,000 in the 10 months.
Distribution to workers did pose challenges. OSHA initially
deployed staff by foot with bags of respirators. We followed
this up by mobile teams on all terrain vehicles, as you will
see in exhibit 9.
We also established a distribution point at the Queens
Marina, which was the fire department of New York's staging
point. We opened multiple equipment distribution locations
throughout the 16 acres site. You will see two of those in
exhibits 10 and 11.
OSHA conducted over 7,500 quantitative fit-tests for
negative pressure respirators, including nearly 3,000 for FDNY
personnel specifically. You can refer to exhibit 12 for that.
Fit-testing included instruction on storage, maintenance, the
proper use and the limitations of respirators. 45,000 pieces of
other protective equipment were given out as well, such as hard
hats, glasses and gloves.
We are also proud that despite this highly dangerous rescue
and recovery mission there was not one fatality. More than 3.7
million work hours were expended during the clean up operations
with only 57 non-life threatening injuries. This is really
remarkable given the nature and the complexity of the site.
The key to success was working in partnership. A joint
labor management safety and health committee was established to
identify hazards and recommend corrective actions. And
unusually high level of safety and health oversight, training
and direct involvement of workers resulted.
Union stewards met weekly with us and with the other
agencies and their employees. They distributed safety bulletins
directly to their workers and they held tool box talks. OSHA
and the Center to Protect Workers Rights of the AFL-CIO
collaborated to provide mandatory safety and health training
for all the workers on the project.
We learned a great deal at the WTC site, lessons that can
help the agency and the Nation improve emergency preparedness.
Employers must regularly review and practice evaluations. Also
essential to establish channels of communication prior to an
emergency.
Nationwide, OSHA's reaching out to the entire emergency
response community and coordinating this with the Department of
Homeland Security. One of the goals in this is to ensure that
first responders wear properly fitted and maintained
respirators at work sites that may have toxic releases.
The agency is also working in partnership with the CPWR to
provide skilled support personnel with the training to ensure
that America has a work force that is prepared to safely
respond to national emergencies.
Mr. Chairman, in addition to my concern for workers at the
WTC site, I have personal interest in the short and long term
effects of exposures because my staff and I spent so much time
there, 10 months. Our Manhattan area office was destroyed when
the North Tower of the WTC collapsed on our building. During
evaluation our employees were exposed to all of the same
potential contaminates in the atmosphere as others who were in
lower Manhattan that day. I can say with confidence and pride
that OSHA's staff did everything humanly possible to protect
the workers during their recovery efforts.
Thank you.
[The prepared statement of Ms. Clark follows:]
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Mr. Shays. Thank you.
Before recognizing Mrs. Maloney, I want to say that this
has been very important testimony, and there will be some tough
questions to follow, but I wish some of this information had
come out sooner. And I will say to you, Ms. Clark, I think our
previous panel, some of the witnesses to make sure that your
work of your agency was recognized. Because you were in the
thick of it.
And I am also going to say that in the first day or two we
probably needed the respirators more than later. But I know the
mentality of everyone there; they just wanted to do whatever
was necessary to get the job done. And I hope we do not forget
what motivated people in those first few days. It was not about
their own safety, it was just see if we can find anyone who is
still alive. And we know that.
And I am also going to say that we are all Americans here.
We love our country and we love the people who serve it, and we
love the people who were involved in this effort. And we are
just going to look backward and go forward.
And so, with that, I am going to first recognize Mrs.
Maloney. I am going to then go to Mr. Turner, then to Mr. Owens
and then to Mr. Nadler. We might have a second round if it is
deemed necessary or partly that.
And so, Mrs. Maloney, you have the floor for 10 minutes. I
am not going to let you ask a question and in the 10th minute
that takes them 5 minutes to then respond to. I am going to
keep you to the 10.
Mrs. Maloney. OK. Thank you, Mr. Chairman. And I thank all
of the panelists for your testimony and your hard work.
If you were here earlier, I asked a question of the first
panel. I asked them if they thought the Federal Government was
doing all that they should or could do to respond to September
11. And everyone raised their hand saying that they did not
believe that enough had been done, and then they said what they
thought should be done.
I would like to ask you the same question and to respond
with what you think Congress should be doing or the Government
should be doing to respond to the disaster of September 11. And
be very short and go right down the line, starting with Ms.
Porter and going straight down, or Dr. Williamson.
Ms. Porter. I think related to the health issues of workers
that it is critically important that the screening program,
which is underway, be continued and be funded for the long
term.
I think that in addition funds for treatment would be
appropriate, as would funds for research studies that could be
done.
Last, I think that having listened to the first panel, it
is really important that we sort out the workers compensation
issue.
Mrs. Maloney. Yes.
Dr. Wagner.
Dr. Wagner. In our particular arena, I think the efforts at
getting our emergency response teams prepositioned, trained and
properly equipped are underway. We need to complete that.
We continue to support research both in the short run for
better understanding of what took place in terms of human
health at the World Trade Center, and more broadly for other
potential terrorist attacks for the future.
Mrs. Maloney. OK. Ms. Clark.
Ms. Clark. I think it's essential that we not lose focus
about what happened here and that we not forget and do not
plan. Planning is absolutely essential. Emergency preparedness
is all about using the things that we learned here; what went
right, what went wrong and try to work on these.
I think working with the respirator community on having
respirators that are more likely going to be worn by workers is
very important.
Working with the responders to make sure that they are
comfortable with respiratory protection. Prior to September 11
they really were only accustomed to the self-contained
breathing apparatus, the scuba-like tanks. They did not know
what negative pressure respirators were, and that was a
problem.
And we are working very hard with those groups.
Coordination, collaboration and let us not forget that we
have to keep working on this issue. I think that is absolutely
essential. We can all do more in that regard.
Mrs. Maloney. Ms. Porter, if you heard the first panel, I
would like to place into the record a series of questions
really on the funding. The funding for the monitoring was a
bipartisan effort, along with Senator Clinton and Senator
Schumer and others. And Mr. Shays and Mr. Turner all supported
it. Yet what we heard from the first panel is they are not
getting the money. The fire department says they're not getting
the $25 million to continue their monitoring and treatment, and
Mount Sinai does not know if there will be a disruption in
their screening program. They have people on the waiting list
trying to get in to be screened.
And I am sure you heard the comments that they felt the
central registry, both in Mount Sinai and the city, was more
effective in compiling the data for future research. I
understand you have plans to market it out to different areas
around the city, or whatever. And this might be problematic.
And my overall question is why can't they get the funding?
We voted on this months ago. This was a bipartisan effort. It
was signed into law. And they are still telling us they do not
have the money.
Ms. Porter. Right. The funds were transferred to us from
FEMA on June 17th. And 6 days subsequent to that, we provided
funding to the Mount Sinai Clinic to extend the baseline
screening work, which was what was deemed appropriate after the
May 2nd meeting that we had, which we had, by the way----
Mrs. Maloney. But the continued funding, the $25 million
and the continued $90 million.
Ms. Porter. Right. And then on 10 days, subsequent to
receiving the funds, we provided--we signed a contract with the
New York City Fire Department. And, unfortunately, we have in
working together with the fire department, learned that we want
to encourage firefighters to participate in the program, ensure
the quality of the data as well as the consistency of the data
with the other screening programs so that it's utility over
time is there. And, unfortunately, we determined that the
contract mechanism was not the appropriate mechanism to use,
even though it got the money out there quickly, it meant that
the Government had to have the data. In other words, the data
was transferred to us. The fire department was concerned about
that issue related to confidentiality.
Mrs. Maloney. Well, I would like to work with you in a
future meeting on how we can get these funds released and out
of Washington.
Ms. Porter. Right. Right.
Mrs. Maloney. And into where they were designated.
Dr. Gilman, as I mentioned, that there was an article today
in the Daily News where they talk about a memo that came out
directly after September 11 saying that it was a health crises,
it was detrimental to the health of people, that they should
not return to the area, should not be in the area. And I do not
know if you have read the article, but it is a scientific----
Dr. Gilman. Juan Gonzalez' column.
Mrs. Maloney. Juan Gonzalez' column, but a scientific
expose, basically saying that there was not a response.
Just in walking outside for a moment, several people came
up to me, including one reporter, who said they were at Ground
Zero. The catastrophe happened on Tuesday, but it was not until
Saturday before any monitoring notice was put up saying that
the air could be problematic. That there was no monitoring
notices put up until Saturday.
You said in your testimony that you responded immediately,
yet they are telling me nothing was put out publicly to them
until Saturday. And according to Juan Gonzalez' article, the
scientific analysis that was done was not responded to.
Because he is going to cut me off I know, I just want to
say that at this map that you showed of the plume going out and
where it was the most problematic, I quite frankly was
surprised to see that the area that we the most infected really
was in Brooklyn in the plume that went out from the study.
So I would like to know if you have any data, Ms. Porter or
others, on the emergency rooms that responded on September 11,
particularly from Brooklyn hospitals after September 11?
According to that plume, there should have been more medical
problems in Brooklyn, and I have been told through hearsay from
medical doctors that there were huge increases in admission for
adult asthma and general respiratory problems after September
11. In Brooklyn, as much as 23 percent. I do not know if there
is any historical data on that. But if you could get back in
writing to me on it, if we do not have the time.
But, Dr. Gilman, what they are telling me out there
including reporters, they are saying I was down at Ground Zero.
There was nothing put up telling us that there was a health
problem from EPA until Saturday, clearly many days after the
disaster?
Dr. Gilman. Well, let me start by saying your
interpretation of the graphics is incorrect. The first two
photos appended to the testimony actually show the greatest
concentration in the immediate vicinity of the World Trade
Center, not Brooklyn in fact.
Mrs. Maloney. But this one, the impact after days. Is that
not Brooklyn. This graph, this plume study.
Dr. Gilman. The plume study, yes.
Mrs. Maloney. That is Brooklyn.
Dr. Gilman. And that is not the dust plume, but that would
be the plume from fires and the different concentrations are
color coded there with the greatest concentration being in
close in the red area. And there is no question that in the
first hours and probably all the way through to the second day,
there were debris from the World Trade Center found in
Brooklyn, as the representative from the New York Department of
Health was saying. The question was where were the
concentrations the greatest, where was the greatest concern for
exposures to people.
As far as information available to the folks at Ground
Zero, the EPA and other Federal agencies were getting together
within 24 hours of the event and trying to sort out----
Mrs. Maloney. But they are saying no notices were put up.
We have an example of a notice here for safety.
Dr. Gilman. Well, I do know----
Mrs. Maloney. But nothing was put from EPA saying that this
is a dangerous zone, watch out for your health. That there was
no air monitoring reports to the public until Saturday. That is
what they are telling me.
Dr. Gilman. Well, two different things.
Mrs. Maloney. OK.
Dr. Gilman. The public at large and the people located at
Ground Zero and at the site of the collapse, the World Trade
Center, EPA professionals as well as other agencies were
telling people at the site that it was a dangerous place in
terms of what was being breathed. And so the advice throughout
was, as offered by OSHA and others, was to use respirators.
The question of what was being said to the public, you
know, I cannot speak to the availability of flyers or not. But
I can speak to the fact that there were oral communications
with the city, with the workers on the part of, I think, all of
our agencies about the danger at Ground Zero.
Mrs. Maloney. My time is up. Thank you.
Mr. Shays. And we will be able to ask a few more questions
here, so it is not your last chance here.
We are going to go to Mr. Turner.
Mr. Turner. As the Nation watched the tragedy of the World
Trade Center collapsing, I do not think that there is an
individual who witnessed that, either on television or here in
this community, who did not intuitively understand that there
were health impacts and that there were health concerns as a
result of those towers collapsing. It does not take an EPA
report or an OSHA report for all of us around the country
immediately to have understood the health struggles of those
who were both responding and who were fleeing the tragedy. We
saw them all on television, we read them in our newspapers. And
scientific analysis was not really needed for us to initially
understand that the people who were responding were doing so as
true heros and in peril of their own safety.
Dr. Gilman, I have some questions concerning the EPA's
jurisdiction. There have been some questions concerning the
EPA's actions during this time period. And I am assuming that
there is a regional air pollution control agency in this area
other than just the Federal EPA or other air control agencies
or monitoring agencies present in the New York area, are there
not?
Dr. Gilman. The way the Clean Air Act is it really is a
partnership.
Mr. Shays. I am going to ask you use one mic and we will
just have one mic directly in front of you.
Dr. Gilman. It really is a partnership under the Clean Air
Act with State government and the Federal Government. And so,
for example, some of the monitors I mentioned that were used
that were already in place for purposes of the Clean Air Act
are ones that are not operated by the Federal Government.
Mr. Turner. So this information was readily available to
the State agencies and perhaps even the local agencies, not
just merely handled or controlled under EPA?
Dr. Gilman. Yes. And we did create a Web site quickly. It
was actually up and functioning by about, I believe it was
September 26th to provide general access to the public for the
information as well.
Mr. Turner. In your testimony and the slides you gave us,
you mentioned the nationwide air monitors that were already
were in place that were staked, that you were coordinating with
the EPA. Then you go on to say that the EPA established 20
World Trade Center air sampling stations. Now, I am assuming
that information was not solely in the control of the EPA when
these stations would report. Who else would have had the
information that was coming from these stations?
Dr. Gilman. Well, there was a task force put together of
State, city and Federal agencies that were all trying to share
that information. A data base was created. I do not know the
exact date at which it was up and running for sharing among the
different agencies. But, as I say, the publicly available site
was up by September 26th. Maybe Kat Callahan of Region 2's
office can----
Mr. Turner. My basic point, though, in asking about who had
access to this information is that there has been some
perception that somehow the EPA or others might have controlled
the spin of the dissemination of this information. And it is my
belief that this information would have been much more widely
available to State, local agencies so that it would not have
been able to be controlled by the EPA or others in its
dissemination or spin, if you will.
Dr. Gilman. Why do we not have Kathy Callahan, who was in
charge of this effort for our Region 2 office----
Mr. Shays. You got your own mic.
Mr. Turner. And I hope my time will be extended while we do
all this.
Mr. Shays. No, we do not need mics. We are all set.
Everybody has a mic. I am losing control.
I would like you to tell me your name, your title and then
answer the question.
Ms. Callahan. I am Kathleen Callahan. I am from EPA's
Region 2 office. And I am the Assistant Administrator for
Response and Recovery in New York City operations.
Mr. Turner. Yes.
Ms. Callahan.
And to answer the question of who had access to what
information. On September 12th we established, and it began the
afternoon of the 11th, but we began our first of many, many
conference calls with agency representatives from the Federal
Government, from State government, from city government.
Initially, actually, from the private sector as well because
they were taking samples. And we exchanged sample results among
that group and consulted on what to do next and what the
implications of those samples were.
In addition to that, everyday the emergency operations
committee that was established uptown, which had
representatives from a broad base of Federal agencies, State
agencies, city agencies had morning meetings at which, you
know, data results were provided. Evening meetings to see if
there was anything new to add. And downtown there was a daily
meeting at which sample response results were provided and
health and safety issues were also--everyday.
Mr. Turner. So the analysis of this information, the
dissemination of it, the reporting of it to the community was
not solely controlled by one point or one agency?
Ms. Callahan. Absolutely not.
Mr. Turner. Mr. Gilman, in looking at the information that
you had--Dr. Gilman, excuse me. If you look at the information
that you have concerning EPA's indoor air monitoring and
cleaning program, one of the misconceptions that I heard during
panel one was that the EPA had a mandated responsibility to
clean up all of the buildings and the apartments that were
around the World Trade Center. And when I read your testimony
it talks about a request that you received from New York City
and your response, and a voluntary program where you went to
individuals that were in the area and provided some services.
And there may be some criticism or question as to the
effectiveness of your program. But I just want to touch on the
point of whether or not you were legally mandated to clean up
the results of the World Trade Center collapse?
Dr. Gilman. I will defer to Kathy in a moment, but I will
say that under an emergency response and under the emergency
response plan, different responsibilities get divided up among
the different agencies. In the case of the indoor air, the
initial responsibility went to the city of New York.
Subsequently, the city asked the EPA to become more involved
and ultimately to take over the testing and clean up program
that was begun in May 2002.
Kathy, do you want to add?
Ms. Callahan. That is absolutely accurate. And I think that
in addition to that, the underpinning of our sort of
statutorial authorizations is important. The Stafford Act is
what defines sort of the agency's funding and statutory
opportunities to respond to a federally declared disaster. And
so EPA was operating under the Stafford Act.
In addition, EPA operates under the SuperFund law and the
national contingency plan regulations that support that law in
supporting its role within the Federal Response Plan and in
support of the Stafford Act.
Mr. Turner. Could you expand your answer related to
testing, but specifically with the area of clean up. I mean, it
is the same. Your testimony was that both testing and clean up
concerning the program was not something that EPA was mandated
to do internally in individual dwelling spaces. Is that
correct?
Ms. Callahan. The National Contingency Plan and the
SuperFund law, which is part of what we are responding under,
authorizes EPA to undertake certain actions. But there are a
lot of criteria that are applied in exercising the judgment so
that we determine when we proceed on that authorization. And in
a federally declared disaster, we do that in the context of a
Federal Response Plan and the Stafford Act as well. And so it
is not, per se, a directive to conduct certain activities. It
is an authorization to conduct them given the agency's
evaluation of the appropriateness in the response.
Mr. Turner. Ms. Porter, when you talked about the different
baseline medical screening and the data bases that were being
created, we have a split that is happening between the New York
Fire Department's baseline screening, what Mount Sinai is doing
for those individuals who responded to the site, worked on the
site but were not necessarily members of the fire department,
and then we also have what the health department is doing with
individuals that live in the area.
What is your assessment of the coordination of those
programs and what advice might you have in that area?
Ms. Porter. I think currently there is a steering group
where, as you heard them testify, all Mount Sinai sits on the
fire department's steering council as does the fire department
sit on Mount Sinai's group. And so there is coordination.
Could there be better coordination? Always. And I think
that as we construct the longer term program, we will actually
mandate in the announcement a steering group that will be
constituted and funded through that mechanism.
Mr. Turner. Thank you.
Thank you, Mr. Chairman.
Mr. Shays. I thank the gentleman.
At this time the Chair would recognize Major Owens.
Mr. Owens. Thank you, Mr. Chairman.
I would like to begin by getting some clarification from
Mr. Clark, since they distributed the largest number of
respirators. Can you clarify the terminology? There were some
workers who said they never had anything for the first few
weeks but paper masks. Is that a respirator, a kind of
respirator? You mentioned half mask, full mask; there are two
categories. Are there other categories? Do people mistakenly
call it something else, the respirator?
Ms. Clark. I can talk about what we provided. And we did
this under the auspices of the New York City Department of
Health.
We offered that we would take over the respirator
distribution and fit checking and fit-testing eventually
process for them. And we did so. Prior to that the New York
State Department of Labor, Public Employee Safety and Health
Program as early as the 12th were involved with handing out
respirators.
I mentioned that as a group all the safety and health
professionals on the site got together very early on, after the
first couple of days, and determined that because the site was
so unpredictable and we were not able to determine exactly what
the exposures to the workers might be, we would go to a high
level of protection. And that was the half faced piece negative
pressure respirator with the three types of cartridges. The
high level particulate filter that would be appropriate for
things like asbestos or silica or other particulates. An
organic vapor that would be for things that might be coming out
of the fires, the plumes and acid gases that also might be in
that context.
Those are the three major categories of----
Mr. Owens. So this is one mask you are talking about with
three different internal components that can be adjusted?
Ms. Clark. Three large--it has a very large canister. In
fact, in your exhibits, and I think it is exhibit 7 or 8, you
will see two of my compliance officers who were onsite wearing
the respirator with that cartridge on with the triple
cartridges.
That is what we felt was appropriate, and we continued to
do so until we found some of the higher levels in particular
operations. And then we said not just a half faced respirator,
but one that is full faced for people who were doing jack
hammering or some of the core drilling operations you need a
higher level of protection that is afforded by that kind of
respirator.
Those were the kinds of respirators that were provided us
through the city of New York. They got contributions from all
over the country, our Assistant Secretary called equipment
manufacturers of respirators early that first week asking for
donations. Those were all provided. The city bought a lot of
respirators.
In addition, contractors and unions also brought
respirators to the site. Very early on, though, the site safety
and health mandated, as you can see by the signs and in some of
the exhibit, that type of respiratory protection, that high
level. And that is what we were involved with using.
Mr. Owens. Are you familiar with the mask that Members of
Congress have been given. All our offices have a certain supply
of masks. I think they are called gas masks. Maybe that is a
popular term. Are they same as respirators? Are you familiar
with the model that are distributed to Members of Congress.
Ms. Clark. A mask, some people do use the term gas mask to
refer to a type of respirator. I am not familiar specifically
with the ones that you may have in your offices. No, I am not.
I am happy to work with you if you would like to have a
separate consultation on that.
Mr. Owens. Before I go any further, I just want to
congratulate OSHA for the magnificent job they did. You were as
much a victim in many cases. Your whole agency wiped out, as
other people were. Your heroism is to be--certainly you are to
be congratulated for that. But I hope your experience can be
used for the future.
And one of the items that you anticipated where I was
going, is there a problem with a supply of respirators in the
country, manufacturers? Is there a problem the technology of
respirators when they are so clumsy that people do not want to
wear them? They do not feel that they can work in them and wear
them. Are we on top of a respirator crises or was there a
respirator crises?
The city certainly did not have enough. You said they had
to get them from various sources. The Federal Government did
not have any, otherwise you would not have to turn to the city.
I mean, you had no procedure for a large number of masks that
you could reach and pull into the situation right away.
Ms. Clark. There actually was a large number, a cache of
respiratory protection in the city itself. We did lose our own
office, our Manhattan area office. So all of our people were
without. I am very fortunate that my regional office is a mile
and a half north of the city. We did have some respirators
there. We also have----
Mr. Owens. You have respirators stored in your office?
Ms. Clark. Yes. Yes. And we had enough for the Federal
community. We also certainly consider your concern about
lessons learned issues on respirators. This is clearly one of
the major issues that has come up. And we're working on that in
a number of ways.
Under the Department of Homeland Security we are working
with them to establish caches of equipment around the country
including respiratory and protective equipment.
Goggles, the dust on the site was also very intense. And
that was appropriate to have eye protection as well.
And so these caches will have that kind of equipment and
they will be located throughout the country.
We are also working with the equipment manufacturers, the
respirators especially, to determine what their turnaround time
is to put more respirators out if we need them and where can we
get them, and how can we get them to the site. If the issue is
in lower Manhattan, how can we get them there very quickly?
The National Guard and all of the other groups that were
very helpful in our supply route was very essential of that.
But that is part of our preparedness that I talked about before
this. So essential.
Mr. Owens. It is recognized that we need a system for
dealing with supplies of respirators.
Ms. Clark. Absolutely.
Mr. Owens. And that system is in process at this point?
Ms. Clark. Yes.
Mr. Owens. Being developed?
Ms. Clark. Yes.
Mr. Owens. One other question. At least one person
mentioned, they used the phrase ``that OSHA was not in
enforcement mode.'' What is the significance of that? You have
mentioned partnership model and my committee, which is
responsible for work force protection, I am constantly being
assailed by the majority party about the need for partnership
models. I generally agree that it is a good approach. But did
that have anything to do with limiting the liability of anybody
in terms of the city or the State, and does that have any
impact on the callous way in which people who did get ill and
have been effected are being treated? Did that remove any
obligations?
Ms. Clark. Absolutely not. As I did try to explain before,
we were working within the guidelines of the Federal Response
Plan and the National Contingency Plan, which provide for us to
do consultation and assistance in some kind of catastrophic
event such as this.
We quickly determined that this was not a typical
constructionsite, it was not any kind of normal situation where
enforcement would work. The enforcement process is a very legal
process that can take months to years to occur. That was not
what was needed.
What was needed was to have safety and health
professionals, OSHA onsite, the eyes and on that site finding
hazards, getting them corrected immediately. That is why I had
so many people there for 24 hours a day, 7 days a week for 10
months working with all of these other safety and health
professionals.
And as someone has already mentioned, it did work. We did
not lose another life on that site during that time. And I
think that certainly the issue of having people there, their
presence. We had workers tell us, ``You know, these respirators
are tough but when I see one of your people, I remember to put
it back on. I might take it off to talk to someone or I might
not put it on after the break, but your guy reminded me.'' I
mean had people there telling me that.
Mr. Owens. Yes, it is miraculous that no lives were really
lost there. And the whole atmosphere, obviously, was conducive
to getting the job done with minimum risk.
Just the last question is can anybody whose brought into
court by some of the sick workers who are looking for relief
use your whole harmless approach as an argument, find that your
whole harmless approach is being used as an argument against
their being able to get compensation for their disability?
Ms. Clark. By not using our enforcement tool, that only
meant that we did not issue citations to the contractors. Those
were the people who would have received any kind of citation.
That is the only issue. And there would have been----
Mr. Owens. The contractor cannot say in court that you gave
them carte blanche to operate a certain way, therefore they
cannot be liable?
Ms. Clark. No. They certainly cannot. Because under the
partnership agreement that you mentioned earlier, we had a very
strong commitment that this type of respirator protection was
part of that partnership agreement. Every contractor on the
site, the four major contractors on the site signed it. The
union signed it. The city agencies that were directing it. The
FDNY and the Department of Design and Construction. We all
signed that. We were all committed to this very comprehensive
safety and health program that went far beyond what our
regulations would require as far as the respiratory protection,
the safety measures, the training. No, I think they actually
were under a higher level of requirement, actually.
Mr. Owens. And you do not cover the Transit Authority and
the city and State?
Ms. Clark. That is correct. We hold that the private sector
and Federal employees, we--in New York State the New York State
Department of Labor Public Safety Employee and Health Program
covers the State and municipal workers.
Mr. Owens. Thank you.
Mr. Shays. We will be able to come back.
Mr. Owens. Thank you, Mr. Chairman. I am sorry I went over.
Mr. Shays. No, these are excellent questions. I am learning
a lot from both the questions and from, obviously, our
witnesses.
In the 9 years I have chaired this committee, the only
person I never swore in was Senator Byrd, because I chickened
out. I do want to make sure, I think Ms. Callahan, you were
sworn and you stood up behind. Yes, so we will just note for
the record you are sworn in as well. I did not want to add you
to my list. You would have been in high company there.
At this time the Chair recognizes the gentleman whose
district is, obviously, directly impacted though so many were.
Mr. Nadler. Thank you, Mr. Chairman.
Mr. Turner asked a number of questions or made some
statements a few minutes ago which I think go to the heart of
some of the questions here. And he said that the EPA does not
have a mandate to clean up these buildings. Dr. Gilman, Ms.
Callahan said the same, or answered the questions to that
extent. And Ms. Callahan referred to the Stafford Act.
Now, my impression, and let me very careful on this. It is
not my impression. My knowledge. Is that under Presidential
Decision Directive No. 62 signed by President Clinton in 1998,
the EPA is mandated to clean up any building contaminated in a
terrorist attack. Administrator Whitman testified to this
effect before the Senate in November 2001. Acting Administrator
Herinko testified in a recent deposition under oath that PDD 62
applies to the World Trade Center case and to the clean up of
building interiors. Under President Bush's National Strategy
for Homeland Security issued in July 2002, after the World
Trade Center, admittedly, the EPA is ``responsible for
decontamination of buildings and effected neighborhoods''
following a major incident.
Would you like to withdraw what you said a few minutes ago
and reconfirm it under oath?
Ms. Callahan. What I said was the exercise of our authority
under the Stafford Act and under the National Contingency Plan,
and I believe it is consistent with the Presidential Decision
Directives, was a decision process. And we made those decisions
as to what was appropriate and we feel we made them reasonably.
Mr. Nadler. Well, let me ask you this question then. Is it
or is it not the duty of EPA under Presidential Decision
Directive 62, and I would say also under the CIRCLA law, but
more importantly under PDD 62, to see to it perhaps by
delegating to the city or to somebody else, but making sure it
gets done one way or the other, it is your responsibility to
see it that indoors as well as outdoors is cleaned up from
hazardous waste discharges as a result of a terrorist attack?
Yes or no?
Dr. Gilman. Kathy is not the attorney for the agency.
Mr. Nadler. So you are the attorney?
Dr. Gilman. And I am not an attorney, either.
Mr. Nadler. We have been pursuing this question for almost
2 years now.
Dr. Gilman. Yes. And I am not an attorney for the agency,
either. And you may be a trained attorney. And I am happy to
try and get some response to your question. I am not qualified
to answer it. I am not sure that Kathy is either.
Mr. Nadler. Well, let me say, both of you sat here and said
essentially it was the city's job, they did it--or they did not
do it, but it was the city's responsibility and they asked you
for help. At other times people from EPA have testified that
the city asked you not to help. And we have been maintaining
for 2 years that it is EPA's responsibility to do it or to
delegate it to someone, but make sure it gets done under their
supervision. And essentially you have been saying that is not
your responsibility.
We have been saying, and again Acting Administrator Herinko
testified in his deposition a few months ago that it was. The
agency should be able to say it is or it is not your
responsibility.
Dr. Gilman. But, Congressman, at the time I did say, we
have taken on that responsibility.
Mr. Nadler. No, you have not. Well, I want to know is or is
it not your responsibility to do it? And whether you have taken
it or not is a separate question. I would say you have not, and
I will not get into that now.
If you do not want to answer under oath, etc., without
getting a lawyer, fine. But I would ask that you supply an
answer to that question afterwards.
Dr. Gilman. Sure. Be happy to.
Mr. Nadler. Thank you.
Mr. Shays. I would like to say, that these are very fair
questions, but under no circumstance do I think that our
witnesses are doing anything but just trying to provide very
honest and very candid responses. But I also want to say to the
gentleman that I know this has been a gigantic and legitimate
concern and answers have not been forthcoming. And it is
important those answers happen.
We did not ask the legal side of EPA to be here to even
deal with that issue, frankly.
Mr. Nadler. I raised it because Mr. Turner did.
Mr. Shays. Right.
Mr. Nadler. Let him supply the authority.
Mr. Shays. Right. And then there will be, and also I just
assure the gentleman, he will be given more time. I did
interrupt.
Mr. Nadler. Thank you.
Let me also just make one comment and then go into some
questions.
Mr. Turner said that, and quite logically, that it was
common sense if you smelled the thing and went there that
people knew that there was something wrong with the air. The
problem is that starting 2 days after the disaster in the
person of Ms. Whitman and others, the EPA started assuring
everybody do not worry, the air is safe to breath. There have
been reasons for that those assurances were done. I will not
get into the IG report, but there were a lot of assurances and
at the very least mixed messages.
Now, let me ask you, Dr. Gilman, in the clean up that the
EPA began in May 2002, despite demands from my office, the
workers who were cleaning up asbestos laden material when the
testing revealed asbestos, did not wear any protective
equipment. Why?
Dr. Gilman. I am not personally familiar with that clean up
program.
Mr. Nadler. Ms. Callahan.
Ms. Callahan. Based upon the data that was collected in the
clean up of the immediate surroundings of the World Trade
Center, OSHA provided us with a negative exposure assessment
that permitted workers not to wear personal protective
equipment in the clean ups that were being conducted under----
Mr. Nadler. But you did testing. And if you had--go ahead.
Ms. Callahan. Under Scope A, which was where there was very
minimal dust in the apartment.
In the Scope B clean ups that we characterized where there
might be substantial dust still there, they would indeed comply
with wearing personal protective equipment.
So we worked in conjunction with OSHA on that issue.
Mr. Nadler. Well, let me say first that Secretary Henshaw's
letter says that wherever there is any dust you must wear--
where there is any asbestos you must wear protective equipment,
No. 1.
No. 2, I would hope that OSHA can supply us with a copy of
that letter saying they do not have to wear protective in Scope
A clean ups. And then I would like to square it with Secretary
Henshaw's prior letter of January 2002.
And third, it is my information from talking to dozens of
people, constituents, we never observed a worker ever wearing
protective equipment in a Scope A or a Scope B clean up. So I
do not know what evidence you can produce at this point that
they did.
Also, would you define ``minimal dust'' for this purpose?
Ms. Callahan. A light coating of dust, minimal dust.
Mr. Nadler. A light coating. With a 1-percent asbestos in
it, perhaps?
Ms. Callahan. We did not test for asbestos content.
Mr. Nadler. So was it one----
Ms. Callahan. We made an--excuse me, if I could finish,
Congressman, I think it is important to your point.
Mr. Nadler. OK.
Ms. Callahan. We made an assumption that all the dust had
the potential for asbestos from early on. And so, you know, we
felt we were being consistent. And the negative exposure
assessment was based on the personal monitoring of workers that
worked in heavily, heavily contaminated areas. And I think that
is why OSHA felt that they could give that assurance and permit
us to proceed.
Mr. Nadler. So a light coating of dust which might have 2
or 4 or 5 percent, for all you know, asbestos in it, it is safe
to have people remove it with no asbestos, and legal for that
matter, with no protective equipment?
Ms. Clark. Congressman, if I might join the discussion?
Mr. Nadler. Yes, please.
Mr. Shays. Hold it a second. These mics do not turn on
until a person starts to speak, and then they pick up.
I want no comments from the audience, please.
Ms. Clark. As part of the EPA clean up of the residences,
we were involved in doing 156 safety and health inspections of
those clean up operations to look at what was happening with
the workers that were involved. Some of those involved Scope A,
as I understood it, no visible dust or Scope B where there was
some visible dust as well as any cleaning of the heating and
air conditioning systems.
And as Ms. Callahan indicated, during Scope A they were not
wearing the protective equipment, the respirators, but they
were during Scope B and with the HVAC.
All of our sample results for those 156 clean ups did not
show any over exposures for asbestos.
Mr. Nadler. OK.
Ms. Clark. In fact, as far as air, the majority of them
were nondetected.
Mr. Nadler. I have another question. And the yellow light
is on. Thank you.
I have two more questions. One should be very quick. It is
Ms. Porter. You said that we should do a lot more screening.
What about medical care for people who the screening tells us
need medical care, do you think the Federal Government should
get into this in a big way on this?
Ms. Porter. I think that as you heard, Mount Sinai
testified 40 percent of the workers are uninsured that have
gone through their screening program. And in those instances
there is a need for some bridge funding to enable people----
Mr. Nadler. Bridge funding?
Ms. Porter. Some funding to enable people----
Mr. Nadler. Some sort of funding? Thank you.
Ms. Clark, if I read your testimony, in fact your testimony
was that there was low levels of contaminates or safe levels.
You read that testimony here. ``OSHA's breathing zone examples
of exposure is well below the agency's permissible exposure
levels for the majority of chemicals and substances analyzed.''
By the way, that is interesting. Does that mean that there were
dangerous levels of a minority of substances tested?
Ms. Clark. There were 3 percent of all of the samples that
we analyzed for all of those substances that I mentioned were
found to be at or above the permissible exposure level.
Mr. Nadler. OK. Thank you. Thank you.
Ms. Clark. Those were, however, within the protection
factor of the respirator we recommended.
Mr. Nadler. For any substance? For any substance?
Ms. Clark. Yes.
Mr. Nadler. OK.
Ms. Clark. I can----
Mr. Nadler. I do not want more details now. Please. Because
I do have to finish the real point of the question.
You go on about you tested a lot of things and 95 percent
were below detection limits for asbestos, etc. And you have out
all these respirators. And you also said that the ``key to
success at the World Trade Center site was working in
partnership.''
Given this, it was a success; yes, in the fact that no one
was killed. But how do you regard it as a success, and more to
the point, given all these low levels of contamination why are
the majority of workers who worked at the site have lung
impairments of one sort or another at this point? Why do we
have what I regard as a catastrophe of hundreds, maybe
thousands of people who have--not just people caught in the
cloud but of workers, of people who came and worked on the
pile, the majority of workers tested I've seen estimates of
some departments up to 78 percent have long lasting lung
incapacity problems of one or sort of other? And we have no
idea, obviously, yet how many are going to come down with
cancer 20 years from now.
Given the fact that there were these low levels of
contaminates and a wonderful job was done giving out
respirators, why do the majority of workers have very severe
health problems at this point?
Ms. Clark. Mr. Nadler, I am a physician so I cannot speak
to the health outcomes. I can tell you what we did, what we
found. I can talk about the fact that I had people there
everyday looking for safety and health issues. I had people
there around the clock asking employees, begging them,
sometimes almost coming to blows with them to wear respiratory
protection. We did hear from the employees that they were
uncomfortable, that they sometimes interfered with
communication. Clearly, they did not wear them all the time.
And that's very unfortunate, and I regret that very much.
I really feel, though, that on our part we and the other
safety health professionals did everything we could to get the
proper respiratory protection on the site and to have it
available in such a way that the employees understood why they
should wear it. We provided the risk communication.
Unfortunately, the risk communication sometimes suggested to
some of them that because we weren't finding high levels in
certain areas, that perhaps they did not wear it. I think that
if you look at, however, certain groups. The ones that were
doing more of the drilling operations, the ones that were doing
the welding and cutting where we did have some higher levels,
up to 5 percent of the samples sometimes over the permissible
exposure levels, you did find better compliance.
You also found better compliance from the trained
construction workers who were more accustomed to wearing
respiratory protection.
It was a very, very horrendous situation. Working 12 hours
a day, fires. It was not a situation where it was very easy.
Mr. Nadler. Let me just--let me----
Ms. Clark. I cannot answer, though, why the health
problems.
Mr. Nadler. Of course not.
Let me make a comment, if I may, Mr. Chairman.
Mr. Shays. Yes.
Mr. Nadler. I have looked at this for 2 years now. We have
been doing a lot of work with a lot of people. It is clear to
me that I fault nobody for lack of wearing respirators or
getting the respirators, etc., for the first few days, maybe a
week. Because you had to get in. There might be people alive.
You got to get in, you do the job and, you know, maybe
precautions take second place. But after the few days, or the
week or the first 2 weeks there were people working on that
pile for months and you have heard in our previous panel, whole
departments apparently--and it may not be your department's,
maybe some other departments or the city of New York, or
somebody--were not getting the proper protection.
And the second thing I want to say, and I am not going to
go into detail now. This has been at other hearings. But these
statistics on this testing of pollutants, they do not jive with
a lot of the other testing.
For example, the testing that the University of California,
Davis under contract with, I think, it was Department of Energy
when they put the instruments on the roof of 201 Varick Street
where my office happens to be located, Federal office building,
a mile north of Ground Zero. They were placed there on October
2nd and they stayed, I think, until mid-January. They found
levels of volatile organic compounds, dioxins, mercury;
everything known to man. They said the worst chemical factory
they had ever seen, worse than the Kuwaiti oil fires for
several months afterward. So this was a very, very bad
pollution. It should not be minimized. And the people who were
there were subjected to very bad conditions and we're seeing
the results now from the first panel. And, unfortunately, I
don't want to characterize a particular department because I do
not know, but the efforts that were made obviously were not
satisfactory. And I say that now not because I want to condemn
anybody, but we have to learn for, God forbid, the next time.
Thank you, Mr. Chairman.
Mr. Shays. I thank the gentleman.
And let me just say, I thank the questions from all our
panelist. I know how heartfelt this is, and I know how
important this.
And I also want to say to our three primary witnesses and
also to Ms. Callahan who also responded, that I have been very
impressed with your testimony. I have been very impressed with
your sincerity.
And I said to both my colleagues on both sides, Ms. Clark,
you did a terrific job. You did. And you were under lots of
pressure, you have been, but you have done a terrific job.
We do know that we have our challenges. I am concerned that
the administration seems so reluctant to release some data from
EPA and to answer questions, which it makes me feel that they
have a story that they do not want to tell. And yet when I hear
the story, I think it is a fairly good story, if not a great
story.
I thought, Dr. Gilman, your presentation was very helpful.
I would have liked to have seen it sooner, and I know it is a
work in process.
I totally agree with Mr. Turner. There is not a person who
did not know that whoever went to Ground Zero was dealing with
a building in absolute flames, with gases, with every
conceivable thing burning; plastics, to asbestos to whatever. I
even know that there was talk about whether people should go
down, like Members of Congress, to visit. But, you know, we
wanted to at least thank people for what they were doing.
And it is probably likely the first week was the most
horrific and everything else went down in terms of its ultimate
impact. It is surprising to me there were so many respirators.
Not surprising to me that people did not use them. Having built
part of my own home and knowing I should use and knowing I did
not want to, and forcing myself to. And they are not easy to
work with, especially when you want to get a lot accomplished.
But we need questions answered. And I think, Dr. Gilman,
you know that.
Ms. Porter, I have a particular concern with how money has
been allocated. I mean, the first panel described one or two
instances where they are not feeling they are getting the money
in due time. And if anything could happen from this hearing, I
would like to think that we could see some quicker response
there.
I would like Mrs. Maloney just outline some issues, and
maybe you could respond to them.
Mrs. Maloney. In December 2001, $12 million was released
for the monitoring and FEMA released another $20 million for
the registry. And $4 million out of the $90 that we appropriate
quite a while ago, practically a year ago, was released for
emergency continuation. But my question, as we heard from the
fire department earlier and as we heard from Mount Sinai, the
$25 million that the fire department was allocated and
earmarked for them has not been released. And the $65 million
for the monitoring has not been released.
Now we are told that you are reviewing how you are going to
release the money. But it seems like we have a system in place
that seems to be working and it seems that we should make sure
that it continues. We have people on waiting lists trying to
get in for monitoring. And there is some concern that there
will be a gap in the services. And basically since the money
has been sitting there for well over 6 months, why has it not
gotten out of Washington and into the hands of the people that
are providing the services for the sick first responders?
Ms. Porter. We have been working very aggressively with
Mount Sinai and the other clinics in New York that are
providing services to these workers as well as with the fire
department. And as you've all mentioned, this is a new and
unique experience that we are going through. There has not been
a long term medical monitoring program set up like this in the
country ever before. And we are wanting to ensure that it is as
comprehensive, that it reaches as many workers as possible, and
with our partners have been working aggressively to put it
forward.
I can guarantee you that there will be no lapse in funding
between the baseline screening and the long term medical
monitoring. The funding will be out no later than March 2004.
Mrs. Maloney. Well, that is good.
Ms. Porter. And the solicitation for that funding will come
out on November 10th giving people enough time to write their
application and put forward their proposal.
Mrs. Maloney. Also, they testified on the first panel that
the money is not there for long term screening. They testified
that medical experts are saying that this should be tracked at
a minimum for 20 years.
Ms. Porter. Right.
Mrs. Maloney. Because many of the health problems may not
emerge. We are hearing they are merging a year after, 2 years
after, 5 years. One doctor testified he anticipated cancer 15
years out.
And I am told from the first panel that the funding that is
in place is not enough for the 20 year monitoring. And have you
looked at how much it will cost for the 20 year monitoring? How
far does the $90 million go?
Also, it seems that you want to branch it out to other
places, which seems to counteract the whole idea of
coordination and having it one place.
Ms. Porter. Right. What we want to do is through this
committee that we will establish is to have clinics working
from the same protocol, working together so that the data is
comparable. But we want to make sure that workers have access
and that workers have choice as to where they want their
medical care--excuse me. Medical screening program delivered.
So, that is why we are----
Mrs. Maloney. But have you done any studies as to how far
the funding will go for the--for the expected 20 year review
period?
Ms. Porter. Yes, ma'am. We believe that in fact the money
that has been appropriated this far will serve us for the next
5 to 6 years. And beyond that we will be working in concert
with our partners to define what needs are subsequent to that.
We agree that the 20 year followup program is what is
necessary.
Mrs. Maloney. Get back to us with how much more you think
is needed.
Ms. Porter. Right.
Mrs. Maloney. Also, you testified that there were
environmental health studies being done. And what are these
projects that were listed in your testimony and what are the
status of them. And, as I said, some of the victims are saying
they were treated in Brooklyn. That the plume effected health
in Brooklyn. That the number of people that went to the
hospitals were up as much as 23 percent. Have you done any
studies on what happened in the intake in other hospitals as a
reaction to September 11?
Ms. Porter. Yes. There have been some studies that have
been funded with the NIH, and we will be happy to provide you
the data on when those studies are expected to be completed and
the results of them.
Mrs. Maloney. Thank you.
Mr. Shays. Ms. Porter, I am going to suggest that maybe we
could get the Members here to meet with you and to just go over
some of those dollars. Just so we are clear about that as well.
Ms. Porter. Great.
Mr. Shays. I think Major Owens had a few more questions,
and then we are going to kind of close this panel up in a
second.
Mr. Owens. Just one or two questions related to the workers
who were involved in the clean up of the apartment houses and
the offices adjacent to the World Trade Center.
You said you made 156 inspections, did I hear correctly, of
those particular sites?
Ms. Clark. That was the clean up that EPA did of the
residential facilities in lower Manhattan from May on.
We also conducted evaluations of prior. And these were
enforcement inspections. For areas outside of the 16 acre
project. That was during the time from, basically October on.
We started an emphasis program, especially to look at the
buildings that were most heavily effected around the site where
there was the greatest level of clean up. So we did----
Mr. Owens. It was documented that contractors had brought
in a large number of immigrant workers, undocumented workers.
There was even a mobile unit set up to encourage those workers
to be tested. Are you familiar with that? And what was OSHA's
role in protecting those workers?
Ms. Clark. I am familiar with the mobile testing van. And,
actually, we provided some information. At the van we took over
our poster in both English and Spanish, realizing that there
were some immigrant, possibly non-English speaking people
coming through there. And we also provided the sampling result
summaries that I had talked about that we provided to workers
onsite. We also provided those to that mobile van as well.
And we were, again as I indicated, doing inspections
outside of the project. It took us a little while to come back,
because as I indicated, we lost our whole office and we were
having so many involved at the site. But we did start--we
resumed enforcement inspections overall.
Mr. Owens. Do you know who those contractors were? You have
listings of them?
Ms. Clark. We never received any--do you mean the ones that
we inspected? Yes.
Mr. Owens. The ones who were employing the immigrant
workers?
Ms. Clark. I do not have any specific names. None were ever
provided to us in that regard, no.
Mr. Shays. Is there a way we could find out these names,
and so on? How would we track that down?
Ms. Clark. I suppose we could ask the group that had the
mobile van if they had any names of contractors. We did not
receive any complaints out of our posting of our information
there. And we did attempt to try to determine if we could get
any referrals for inspections. But we did not receive any. But
we could certainly ask that of the individuals who ran that
van.
Mr. Shays. Just to continue. We are interrupting you. If
the gentleman would yield, Mrs. Maloney has some point.
Mrs. Maloney. We know that there were five general
contractors who were assigned to the site, so we could merely
ask those contractors whether or not they were involved in
this.
Ms. Clark. Those five contractors, I am quite familiar
with. They were the partners in the project.
Mrs. Maloney. Yes.
Ms. Clark. I think what Congressman Owens was talking about
would have been actually was occurring outside of the project.
Mrs. Maloney. Outside of the project?
Ms. Clark. That were not contractors working for those
general contractors.
Mrs. Maloney. Then the city of New York would have a
listing of the organization that oversaw that.
Mr. Shays. But we'll track it down, though. It needs to be
tracked down. I think that is a good point.
Mr. Owens. I can assume that there were no--OSHA did not go
into a nonenforcement mode for those mode and agree that there
was no enforcement?
Ms. Clark. That is correct. The only area that was a
consultative mode was within the 16 acre World Trade Center
site itself. The recovery project specifically. And it was only
because that site was still controlled by the FDNY as the site
commander and eventually the city Department of Design and
Construction. They were the incident commanders. And so within
that area we did consultation. Outside we resumed enforcement.
Mr. Owens. Thank you.
Mr. Shays. Thank the gentleman.
Is there anything that any of our witnesses and Dr. Wagner
and Dr. Williamson. Sometimes I notice that people who say
nothing ultimately in the end have the most important things to
say. Not to put pressure on you. But if any of you would like
to say anything, please feel free.
So, is there any comment that you would like to make?
Dr. Gilman. Yes, if I may.
Mr. Shays. Yes, Dr. Gilman.
Dr. Gilman. During your remarks you suggested that there
was data available or data that EPA had that they had not made
available. I am not aware of anybody asserting that we withheld
data associated with these monitoring activities.
Mr. Shays. Yes. I would not want the data, but information
about specifics. There are questions asked and there do not
seem to be some answers to them. And we would love those
answers.
Dr. Gilman. OK. And I know we are processing some
information requests for the Congressmen. And I know they are
working on that right now.
Mr. Shays. Yes, sir.
And let me just say, Members of Congress feel very
protective of a Member who, in his own district or her
district, needs information. So you would find both Republicans
and Democrats alike wanting Mr. Nadler to get this information
and it is information, obviously, that we are all interested
in.
I guess my only point was the more I hear the story, the
more I feel that it is a story that has some answers to. I am
struck also by the fact that data was available to a lot of
different agencies and no government agency said to another do
not share this information.
I do know this, though. I do know the administration
shortly after September 11th in general about a lot of things
was trying to calm people down. And I got in a little bit of a
dispute with some of them about how I thought they were
understating the risk of terrorism, overstating the safety of
flying airplanes and so on, you know, to try to calm people
down.
I think you tell the American people the truth, whatever it
is, and they then want you to do the right thing, whatever that
may be. And so your point is well taken about the data.
Dr. Wagner, did you want to say anything?
Dr. Wagner. Well, only I think a number of the questions
that were unanswerable today point out the need for high
quality continuous collection of the best information that we
can on the effected workers and others as well as the
importance of the continuing analysis and research so that we
can understand the nature of the health effects, the best
treatments and the ways to minimize the adverse outcomes.
Mr. Shays. Ms. Porter is nodding her head, so you spoke for
her in that instance.
Dr. Williamson, any comment?
Dr. Williamson. Yes. I would like to thank you, Congressman
Shays, for acknowledging the importance of the registry. I
would also like to reenforce the fact that we do think that
this is a unique opportunity for folks to participate in a data
base that will allow us to track and determine what the health
impacts have been of the World Trade Center, both long and
short term.
I would also like to respond to one question about the
lessons learned. And one of the things that I would like to
reenforce is, obviously, the collaborations are critical. But I
think another thing that we are doing at CDC and ATSDR is
putting together a mechanism which will help us, God forbid, we
are ever in a situation as we have been in September to have a
rapid response registry so that with perhaps a quick funding
mechanism, along with a rapid response registry we can gather
some of the important scientific data that Dr. Wagner mentioned
and yet at the same time get it out in a timely fashion so that
the funding and the infrastructure is there.
Mr. Shays. Thank you. Let me thank, obviously, my
colleagues for their participation in this hearing. And I want
to also thank both panel one and panel two. You have been an
excellent panel.
I want to thank our audience for its cooperation.
And also to say that it is clear to me that there is more
to the story that we have to deal with, more issues. It is
clear that there are residents in the area who have concerns.
There are workers in the area who have concerns, that these
concerns need to be addressed.
We have learned a lot of lessons on September 11th. We know
we have a lot more lessons to learn.
I want to also thank the staff of Mount Sinai Medical
Center for the use of this facility and all their help
preparing for the hearing.
I want to thank Congresswoman Maloney and her staff. They
have been terrific.
I would also like to thank David Rapallo of the minority
staff for the full committee. And Larry Halloran, my chief of
staff for my subcommittee. And let me also recognize the work
of Kristine McElroy and Bob Briggs of the subcommittee staff.
Kristine did a tremendous job preparing us for this hearing.
And finally, thanks to the official reporter, Jennifer
Rosario. Thank you very much.
And to all that made this a very important hearing. Thank
you.
With that, this hearing is adjourned.
[Whereupon, at 2:29 p.m., the subcommittee was adjourned.]
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