Part I: Originally published on July 23, 2006
Posted Wednesday, April 18th 2007, 8:55 AM
12,000 brave souls who worked in this toxic cloud after Sept. 11 are sick. For too long, their suffering has been ignored. This must end now.
Forty-thousand-strong, they labored at Ground Zero under miserable conditions in a time of crisis, working 10 and 12 hours a day to search for the lost, extinguish underground fires and haul off 2 million tons of rubble. As a direct result, well over 12,000 are sick today, having suffered lasting damage to their respiratory systems.
In increasing numbers, they are the forgotten victims of 9/11. The toll has risen steadily over the past five years, yet no one in power - not Gov. Pataki, not Mayor Bloomberg, not the state and city health commissioners, not the U.S. government - has acknowledged the epidemic's scope, much less confronted it for the public health disaster that it is.
Their heads and faces pound with the pressure of swollen sinuses.
They lose their breath with minor exertion.
They suffer the suffocation of asthma and diseases that attack the very tissues of their lungs.
They endure acid reflux, a painful indigestion that never goes away.
They are haunted by the mental and emotional traumas of having witnessed horror.
Many are too disabled to work.
And some have died. There is overwhelming evidence that at least four Ground Zero responders - a firefighter, two police officers and an Emergency Medical Service paramedic - suffered fatal illnesses as a consequence of inhaling the airborne poisons that were loosed when the pulverized remains of the twin towers erupted seismically into the sky.
The measure of how New York and Washington failed the 9/11 responders starts with the fact that after a half-decade, no one has a grip on the scope of the suffering. The known census of the ill starts at more than 12,000 people who have been monitored or treated in the two primary medical services for Ground Zero workers, one run by the Fire Department, the other by the World Trade Center Medical Monitoring Program based at Mount Sinai Medical Center.
In the Fire Department, more than 600 firefighters - soon to be 700 - have been forced into retirement because they were deemed permanently disabled. Most suffer from asthma that disqualifies them from battling blazes. And fully 25% of the FDNY's active fire and EMS forces have lung-related conditions - more than 3,400 people in all.
At the Mount Sinai program, where physicians are monitoring the health of 16,000 cops, construction workers and others, Dr. Stephen Levin estimates that from half to two-thirds of the patients are similarly sick. That works out to at least 8,000 people and pushes the tally of the ill over 12,000.
The count goes up from there among the thousands of responders who are not enrolled in either program. How far up, nobody knows. But doctors are all too aware that the general prognosis for the sick is not good. While treatment has helped many to improve, few have regained their health.
"I think that probably a few more years down the road we will find that a relatively small proportion will be able to say, 'I am as good as I was back on Sept. 10, 2001,' " said Levin.
Typical is the case of NYPD Officer Steven Mayfield, who logged more than 400 hours at the perimeter of what became known as The Pile and suffers from sarcoidosis, a disease that scars the tissues of the lungs; shortness of breath; chronic sinusitis, and sleep apnea. "My lungs are damaged; they will never be the same," said Mayfield, 44.
Still more frightening: Serious new conditions may soon begin to emerge. Top pulmonary specialists say lung-scarring diseases and tumors generally begin to show up five to 20 years after toxic exposure, a time frame that's about to begin.
Some responders have received excellent care. The FDNY's medical service, led by Dr. Kerry Kelly and Dr. David Prezant, has delivered first-rate monitoring and treatment to more than 13,700 active and retired firefighters and EMS workers. But the rest of the Ground Zero responders have not been nearly so well served.
Most of them - from police to construction workers - are eligible for monitoring and treatment through the Mount Sinai program. The center's leaders, Dr. Robin Herbert and Levin, are among the world's experts in occupational health, but they have been badly hobbled by a lack of funding. The wait for treatment is four months, and doctors are able to schedule followup appointments less frequently than they would like.
In even worse shape are an estimated 10,000 federal workers who participated in the Ground Zero effort. The government promised to create a program specially for them, and then reneged. The federal workers are on their own.
The big lie
The betrayal of the 9/11 responders began with a lie that reverberates to this day.
When the twin towers collapsed, the remains of 200,000 tons of steel, 600,000 square feet of window glass, 5,000 tons of asbestos, 12,000 miles of electric cables and 425,000 cubic yards of concrete crashed to the ground and then spewed into the air. To the mix were added 24,000 gallons of jet fuel burning as hot as 1,300 degrees.
At The Pile, the air was "darker than a sealed vault and thicker than pea soup," in the description of one deputy fire chief. But officials pronounced that would-be rescuers were safe.
As then-U.S. Environmental Protection Administrator Christie Whitman put it in a press release on Thursday, Sept. 14, 2001: "Monitoring and sampling conducted on Tuesday and Wednesday have been very reassuring about potential exposure of rescue workers and the public to environmental contamination." Two weeks later, Mayor Rudy Giuliani said rescue workers faced minimal risk because the air quality was "safe and acceptable."
In truth, those who rushed to the scene were at the epicenter of "the largest acute environmental disaster that ever has befallen New York City," according to a 2004 analysis by several dozen scientists in the journal Environmental Health Perspectives. In truth, every breath at Ground Zero was noxious to health and even to life.
A cauldron of toxins
The Environmental Health Perspectives report cited the presence in the air of highly alkaline concrete dust, glass fibers and cancer-causing asbestos, as well as particles of lead, chlorine, antimony, aluminum, titanium, magnesium, iron, zinc and calcium. The flaming fuel and burning plastics released carcinogens including dioxins, polycyclic aromatic hydrocarbons, polychlorinated biphenyls and polychlorinated furans.
Almost immediately, the toxic cloud began burning the lungs of the responders because most were not provided with, or did not wear, proper respiratory protection. Hundreds soon started coughing up pebbles and black or gray phlegm, and, for most, symptoms steadily worsened.
The false assurance of safety and the failure to adequately equip the workers has opened the city and its construction contractors to potentially huge liability. More than 8,000 responders have joined a lawsuit that has targeted a $1 billion federal insurance fund established after 9/11 to facilitate the recovery work. So the lawyers, not the doctors, have taken charge.
The city's chief attorney, Corporation Counsel Michael Cardozo, says, for example, that he is confident Ground Zero workers have been provided with appropriate medical attention and disability benefits. This may be wise to argue for the purpose of limiting liability, but it's destructive denial as a public health strategy.
Never did the state health commissioner, Dr. Antonia Novello, or the city health commissioner - Dr. Neal Cohen in the days immediately after 9/11, Dr. Thomas Frieden since January 2002 - step forward to lead a crusade that marshaled the resources of New York's vast public and private health systems.
Nor did Cohen or Frieden ever issue protocols advising physicians on recognizing and treating syndromes generated by World Trade Center exposures. Inexcusably, Cohen failed to disseminate advisories at a time when the Giuliani administration was declaring all was safe at The Pile, and Frieden's staff is only now getting around to completing its first bulletin.
Nor did the Police Department establish a system for tracking the prevalence of illnesses such as asthma among the thousands of cops who worked at The Pile. The police surgeon, Dr. Eli Kleinman, says he believes there hasn't been more than "a blip" in lung-related ailments - which would be a truly remarkable outcome compared with the 25% of the Fire Department that is counted as having 9/11 aftereffects.
The city Health Department in 2003 did establish the World Trade Center Health Registry, inviting people who worked at Ground Zero or lived in the area to report their health conditions. More than 71,000 provided information, and the department is in the midst of conducting a followup survey. The data are likely to prove highly valuable when the department finishes crunching the numbers. But that milestone is planned for next year, astonishingly long to wait when the unaddressed needs of the sick have been building since 2001 and are so large at this very moment.
Frustrated by the response to 9/11-related illnesses, Reps. Carolyn Maloney and Vito Fossella in February won the appointment of Dr. John Howard as federal Ground Zero health coordinator. Howard's valuable presence should be taken as a rebuke to all the local officials who allowed this health crisis to fester for half a decade.
But Howard is hardly the solution. As director of the National Institute for Occupational Safety and Health, the doctor has a schedule that is quite booked. Nor does Howard have the capacity to do a great deal. He has no special budget and no special staff, and he can only study and recommend. Far more is required.
A cry for leadership
What's urgently needed is dynamic leadership by someone with the muscle and brains to tackle the World Trade Center health crisis on all fronts - medical, legal, social, political and more. The person who best fits the bill today is Michael Bloomberg.
As the 108th mayor of the City of New York, Bloomberg commands vast municipal resources, occupies an unparalleled bully pulpit from which to prod other levels of government, has a deep, long-standing commitment to public health and, most important, knows how to get things done. And it is simply inconceivable that he would not act were he to inquire deeply into the facts.
Were the mayor to ask Herbert and Levin, he would find out that Mount Sinai's doctors succeeded only this year in getting the okay for the first federal funding for treatment, that patients frequently arrive at Mount Sinai after being misdiagnosed or improperly treated by family physicians and that Ground Zero responders are seeking help in increasing numbers because they haven't gotten better with time or have developed new illnesses.
Were the mayor to speak with Dr. Alison Geyh, assistant professor at his namesake Johns Hopkins Bloomberg School of Public Health in Baltimore, he would learn that a program aimed at tracking the health of Ground Zero's "invisible" recovery workers - heavy equipment operators, sanitation workers, truck drivers and laborers - stopped for lack of money after less than two years.
"It took a year to get this labor-intensive project up and running, only to have its funding stream cut off 18 months later," said Geyh. "It's been frustrating and a lost opportunity."
Were the mayor to talk to Kelly and Prezant at the Fire Department, or to Herbert and Levin at Mount Sinai, or to their colleague Dr. Alvin Teirstein, an eminent lung specialist, he would hear calls for long-term monitoring for cancers and other diseases that could emerge among Trade Center responders in the coming years.
And, were the mayor to spend time with any of the 8,000 responders who are suing the city, he would hear the voices of fury and fear. Their anger is well grounded in that they were lied to, but it is far less clear that each of their illnesses, among them brain and blood cancers, is attributable to Ground Zero exposures. Still, lacking authoritative, trustworthy information, they live under agonizing shadows.
It is vitally important for Bloomberg to take charge.
To take the full measure of this growing epidemic.
To devise appropriately funded treatment programs so that all 9/11 responders have access to the quality of care provided to firefighters.
To establish monitoring systems that can detect swiftly the emergence of new diseases or improved treatments.
To create a clearinghouse that would inform workers and physicians about illnesses and proper treatments, and keep them up to date on the latest developments.
To begin to acknowledge that service after 9/11 did, in fact, cause fatalities, rather than let city officials keep insisting that there is no absolute, total scientific proof that anyone died from illnesses contracted at Ground Zero.
To galvanize the federal government into supporting long-term monitoring and treatment programs.
To review disability and pension benefits afforded to 9/11 responders with an eye on eliminating gross inequities. While firefighters and cops have been granted extremely liberal, even overly liberal, line-of-duty retirement benefits, thousands are trapped in a workers' compensation system that is ill-suited to treat them fairly.
When the call came, the instant the first hijacked jet knifed into the north tower of the World Trade Center, the Ground Zero recovery army surged to the aid of their fellow human beings without a thought as to their own safety. After the buildings collapsed, they worked long and hard to bring New York back from the worst attack on U.S. soil. But they were lied to and they were badly equipped, and then, when they became sick, as many physicians predicted they would, far too many were abandoned.
Decency demands better.
Part II: Originally published on July 24, 2006
Posted Wednesday, April 18th 2007, 8:59 AM
Stephen Johnson served New York with valor for 21 years as a firefighter on the nation's preeminent force. He was a man who put the safety of others above his own. He loved the work - and it cost him his life.
On Aug. 6, 2004, Stephen Johnson died from service in the line of duty at age 47. Yet the rolls of honor do not bear his name, nor has the mayor or the fire commissioner stood in public tribute to this fallen hero.
For Stephen Johnson is a forgotten victim of 9/11.
The official record carries Johnson as a retired firefighter who passed away after a heart attack and a bout with a lung ailment two years after he left the force. This is because, callously and in disregard of overwhelming evidence, the City of New York has refused to acknowledge even the likelihood that working around the smoldering rubble of the World Trade Center proved fatal to anyone.
But that is precisely what killed Johnson, whose death stands as the earliest Ground Zero fatality from disease for which cause and effect has been established.
And it is precisely what killed Police Officer James Godbee.
And it is precisely what killed Detective James Zadroga.
And it is precisely what killed Emergency Medical Service Paramedic Debbie Reeve.
They were among the 40,000 people who pulled together in the drive to restore New York's footing after 9/11. Today, more than 12,000 members of that brave army are ill because they were exposed to the toxic cloud that hovered over what became known as The Pile. Officials falsely assured them the air was safe. Most were not provided with or did not wear respiratory protection.
The vast majority of the sick suffered damage to their respiratory tracts from breathing air thick with particles, including concrete dust, pulverized glass and asbestos. The materials, in effect, burned the air passages, causing inflamed sinuses, bronchitis and reactive airways dysfunction syndrome, or RADS, an irritant-induced asthma.
A smaller number of Ground Zero responders contracted even more serious illnesses, and some died. How many developed their conditions as a consequence of working at The Pile cannot now be established, and medical experts are skeptical about proving a causal relationship in most cases.
But there can be no reasonable doubt that Ground Zero service cost Johnson, Godbee, Zadroga and Reeve their lives. Where Johnson and Reeve are concerned, the FDNY's top physicians, Drs. Kerry Kelly and David Prezant, say they believe this is so. The evidence is just as strong for Godbee and Zadroga.
"How else do you account for it?" Kelly said, referring to Reeve's death.
It is long past time to set the record straight about fatalities among the forgotten victims of 9/11 - to honor those who have died, to keep faith with history and to provide the sick with the fullest information.
It's time for Mayor Bloomberg to recognize Johnson, Godbee, Zadroga and Reeve as heroes who died from illnesses sustained in the line of duty, and to express New York's gratitude to their loved ones.
It's time for the mayor, upon whom we have called to lead a campaign for all forgotten victims of 9/11, to declare that New York owes the Johnson, Godbee, Zadroga and Reeve families every possible benefit - and to order city lawyers to stop unconscionably fighting against giving the families their due.
It's time to confront what happened to Johnson, Godbee, Zadroga and Reeve in the knowledge that medical experts say others may well develop serious, even fatal, illnesses as the 9/11 health disaster unfolds. Let them not be forgotten, too.
Heroism came naturally to Stephen Johnson - as Linda Kalodner learned firsthand.
On March 11, 1999, Kalodner was the mother of 6-month-old twins, and she and the babies were trapped by a fire on the ninth floor of a Manhattan building. Up a fully extended tower ladder came Johnson and his partner Matt Barnes.
Strapped to the top of the aerial, arms and legs stretched as far as possible, Barnes took the infants from Kalodner and passed them to Johnson, who carried the babies to safety. The partners were feted at City Hall, and the Daily News named Barnes its Hero of the Month.
Less than two years later, Barnes was killed on 9/11 and Johnson went to work at Ground Zero, there when the toxic cloud was thickest, there when the job required wading in dust up to his knees. He was a big, strapping guy, fit and healthy, and his every breath moved him closer to death.
In April 2002, still healthy, Johnson retired from a job that was a joy of his life. "Next to me, it was the only other thing he loved," said his widow, Rose.
Early in 2004, Johnson became short of breath while shoveling snow. Over the next few weeks, his shortness of breath worsened. That March, he went to a hospital, where doctors feared he was suffering a heart attack. That wasn't the case, and that May he was diagnosed with interstitial lung disease, or ILD.
Caused by inhaling irritants, ILD is a rare condition found, for example, in miners who work amid coal dust. The presence of particles in the lung provokes the body to try to combat them as it would fight a germ. The immune system surrounds the particles with cells that build up into nodules known as granulomas. Granulomas retard breathing, can cause lesions and lead to irreversible scarring, called fibrosis, on oxygen-extracting tissues.
By the time Johnson was diagnosed, 80% of his lungs had been destroyed. He required oxygen 24 hours a day, and joined the waiting list for a lung transplant. But he never got that far. Suffocating, Johnson suffered a fatal heart attack.
After 15 years of marriage, Rose Johnson lives by herself in Queens. She shies from criticizing city officials for their failure to honor her husband as the first Ground Zero responder to die from an illness contracted there. Nor does she complain that, until today, the circumstances of her husband's illness and death have never been reported. But the pain is obvious in her voice when she recounts her memories of his loss. Only when she points out that the Bravest at her local firehouse give her all the
support she asks for does her voice brighten.
Rose Johnson has her husband's pension, but not the full-salary death benefit given to the widows of firefighters who die in the line of duty. Spouses of retirees are not eligible.
James Godbee was the next responder to die after contracting an interstitial lung disease.
A 19-year NYPD veteran and father of two, Godbee worked at Ground Zero for 12 to 15 hours a day for 80 days from Sept. 13, 2001, to June 2002. Never did he wear respiratory equipment.
In November 2003, Godbee developed a cough, shortness of breath, joint pains, fever, weight loss and swelling in his salivary and tear glands. Based on a chest X-ray three months later, his doctors suspected sarcoidosis, a form of ILD.
Dr. Frank Accera, a pulmonary specialist at Beth Israel Medical Center, performed a biopsy, during which Godbee's lung collapsed. The test confirmed the diagnosis.
Sarcoidosis is believed to be caused by contact with irritating foreign substances, but no irritant has ever been identified as its trigger. In addition to the lungs, the illness attacks organs such as the heart, skin and kidneys. Treatable and rarely fatal, sarcoidosis can lead to "progressive multi-organ failure in an unfortunate minority" of cases, according to a 1997 study published in the New England Journal of Medicine.
High dosages of a steroid got Godbee's symptoms under control, but the drug made him sick to his stomach. Over the next seven months, Godbee's lung distress fluctuated as he tried to wean off the steroid, and, feeling generally better, he stopped seeing Accera in October 2004.
Godbee's wife, Michelle, a school guidance counselor, said her husband continued to work. On Dec. 30, 2004, he felt "a little down, a little sick," but he nonetheless took the couple's daughter to a Jim Carrey movie, Michelle Godbee said. At 9:45, he returned to the family's apartment in Manhattan's Stuyvesant Town, gave his daughter "a long hug good night," and minutes later suffered a seizure.
"I called 911. They told me to put him on the floor," Michelle Godbee said. "I heard his lungs go down. He was pronounced DOA at the hospital."
James Godbee was 44. An autopsy found granuloma in his lungs, colon and heart. In his report on the case, Accera wrote: "It is with a reasonable degree of medical certainty that I conclude that Mr. Godbee's exposure to and inhalation of the toxic materials present at the WTC site after the events of Sept. 11, 2001, either caused or aggravated his sarcoidosis and ultimately caused his death."
Regardless, the NYPD pension board ruled Godbee had not contracted sarcoidosis in the line of duty, stating the condition is "not known to be related to employment in the police force." The board denied his family the enhanced benefits afforded to cops who die in the line of duty. When Michelle Godbee took the matter to court, city lawyers fought her petition - even barring FDNY doctors, experts in sarcoidosis, from testifying. A judge returned the matter to the board for further review.
On Jan. 5 of this year, homicide Detective James Zadroga became the third responder to succumb to interstitial lung disease.
On the force for six years, Zadroga was inside 7 World Trade Center as the building began to collapse. He escaped and returned to Ground Zero, spending more than 450 hours there and at the Staten Island landfill, where the rubble from the Trade Center was carted. He wore only a paper mask.
Within a few weeks, Zadroga began to cough. Over the next months, the formerly healthy 29-year-old developed severe shortness of breath, acid reflux and sleep apnea. He began passing out and, coughing incessantly, was unable to walk more than 100 feet without gasping.
Zadroga's downward spiral forced him onto extended sick leave. By 2003, he required oxygen 24 hours a day. He was rejected three times for a line-of-duty disability pension; the retirement system's medical board said he hadn't proven a connection between his Ground Zero work and his illness.
Only on Zadroga's fourth appeal did the doctors come around. He retired Nov. 1, 2004. Fourteen months later, with his 4-year-old daughter Tylerann asleep by his side, Zadroga died at age 34. He was a widower with $50,000 in medical bills. Grandparents took custody of the orphaned Tylerann.
The coroner's report listed the cause of death as "granulomatous pneumonitis."
"It is felt with a reasonable degree of medical certainty that the cause of death in this case was directly related to the 9/11 incident," wrote Ocean County, N.J., pathologist Dr. Gerard Breton. His report, often cited as the first official confirmation that service on The Pile had proven fatal, was dismissed by city officials as inconclusive.
Debbie Reeve joined the EMS in 1989, working first as an emergency medical technician and then as a paramedic. Assigned to a haz-mat unit, she spent more than six months collecting human remains from The Pile and staffing a Ground Zero morgue.
Early in 2004, Reeve developed a cough and shortness of breath after exertion. Her doctor diagnosed flu and pneumonia and prescribed antibiotics that proved useless. Out of sick time, she asked for clearance to return to work, which required a chest X-ray because of her haz-mat status. The X-ray led to the discovery of mesothelioma, a rare cancer caused by asbestos.
From late 2004 until late 2005, Reeve underwent chemotherapy, followed by removal of her right lung and part of her diaphragm. She had radiation and was declared cancer-free.
Six weeks later, Reeve starting having pain in her leg and hip, and X-rays showed mottling in her thigh bones - a sign the cancer had returned. In January 2006, doctors removed infected marrow from her legs, but a month later they found cancer in her back, lung and spine.
On March 15, Reeve died at age 41, leaving an 11-year-old daughter and a 6-year-old son.
Before her death, Reeve had become the first WTC responder to be granted a three-quarters disability pension under a special bill signed in Albany, but she died before receiving a single check. Her husband, David, also an FDNY paramedic, is now battling for workers' compensation coverage of $90,000 in medical bills. Opposing him is the city Law Department, where attorneys have argued both that he didn't file his claim within a required deadline and that there's no proof Reeve developed mesothelioma from working at Ground Zero.
Johnson, Godbee, Zadroga and Reeve are but four of the 9/11 responders who have suffered serious illnesses. David Worby, a lawyer waging a suit on behalf of 8,000 WTC responders and their survivors, says, for example, that more than 170 of his clients have developed cancers and 57 have died.
Whether those cancers trace to Ground Zero is a matter of conjecture, but fear is widespread among those who served. This is understandable. What is not understandable has been the refusal of city officials to admit even a probability that 9/11 service led to any death.
Health Commissioner Thomas Frieden exemplified the attitude when he said he would be "surprised" if Zadroga's suffocation could be conclusively linked to particles breathed in at Ground Zero. The coroner, he said, had not tested the materials in Zadroga's lungs to see if they matched exactly with substances at The Pile.
True enough, but that hypertechnicality is far outweighed by the body of evidence.
Johnson, Godbee, Zadroga and Reeve were healthy, relatively young nonsmokers before they spent hundreds of hours in the poisonous cloud at The Pile.
They contracted diseases triggered by inhaling substances that irritate the lungs.
Other 9/11 responders came down with the same rare illness, interstitial lung disease, suffered by Johnson, Zadroga and Godbee and survived. Two firefighters and a civilian worker got the type of ILD that struck Johnson and Zadroga; 20 firefighters got the variation, sarcoidosis, that felled Godbee. Among the survivors, the conditions are generally accepted as being caused by WTC toxins.
Mesothelioma, Reeve's cancer, is found overwhelmingly in people who have breathed in asbestos. What's surprising is only the speed with which the disease came on after Reeve was exposed, said the FDNY's Kelly.
Stephen Johnson, James Godbee, James Zadroga and Debbie Reeve died because they served New York in a time of need. Then they were forgotten. Now Mayor Bloomberg must give them the honor they deserve.
The making of a health disaster
Part III: Originally published on July 25, 2006
Posted Wednesday, April 18th 2007, 9:14 AM
Ground Zero workers were sent into 'the largest acute environmental disaster that ever has befallen New York City' without proper respiratory protection - and thousands are paying the price.
For Christopher Hynes, life as a forgotten victim of 9/11 is a battle for breath. Five years ago, Hynes was a 30-year-old, healthy, nonsmoking New York City police officer. Then, in September and October 2001, he was assigned to Ground Zero duty, spending more than 100 hours patrolling the perimeter of the smoldering rubble of the twin towers. The air was thick with dust and smoky particles.
Today, Hynes, married and the father of a 4-year-old son, has sarcoidosis, a disease that scars lung tissues, and asthma, a disease that inflames and obstructs the airways of the lungs. He coughs constantly and cannot exert himself without losing breath. He survives with the help of steroids and performs restricted duties for the Police Department.
"I will probably have this for the rest of my life," he says.
For Winston Lodge, life as a forgotten victim of 9/11 is the torment of chronically inflamed and bleeding sinuses.
Five years ago, Lodge was a 44-year-old ironworker who helped build things. Then, called on to help dismantle The Pile, he pitched in at Ground Zero for 12 hours a day, seven days a week, for a month.
Today, Lodge's nose runs constantly and often bleeds. He suffers headaches from sinus pressure, has shortness of breath from chronic bronchitis and is bedeviled by acid reflux, a painful heartburn. He has undergone surgery to relieve sinus difficulties and is awaiting a second operation. Since 2004, Lodge, a divorced father of four, has been unable to work.
"I am sick to my bones and I need help," he says.
For Jeffrey Endean, life as a forgotten victim of 9/11 is a struggle with scarred lungs and ruined sinuses.
Five years ago, Endean was a 51-year-old division commander for the Morris County, N.J., sheriff's office. He was healthy, able to run several miles. Then, he was pressed into Ground Zero service because he had experience helping first responders cope at horrific scenes. He worked 12-hour shifts from Sept. 11 to Nov. 22, 2001.
Today, Endean has reactive airways dysfunction syndrome, or RADS, a rare, irritant-induced form of asthma, his sinuses often bleed and he is prone to headaches and upper-respiratory infections. Married, the father of three and grandfather of three, Endean retired in 2002.
"I start the day with four to five inhalers and a pill," he says. "Will I have cancer at 66? Will I live my life as long as I should?"
The forgotten victims of 9/11 are legion among the 40,000 people who massed at Ground Zero in New York's hour of greatest need. Well over 12,000 are afflicted with conditions similar to those that plague Christopher Hynes, Winston Lodge and Jeffrey Endean.
They gasp for air with asthma or illnesses that scar deep in the lungs. They lose their breath from exertion. They endure pain from persistently swollen sinuses and constant burning from acid reflux. At a minimum, they cough and cough, hacking with a syndrome known fittingly as World Trade Center cough.
And, beyond all doubt, at least four responders - Firefighter Stephen Johnson, Police Officer James Godbee, Detective James Zadroga and Emergency Medical Service paramedic Debbie Reeve - died as a direct consequence of their service.
The magnitude of the epidemic has worsened for five years as every level of government has failed to face the reality of what happens when large numbers of people without proper respiratory protection are exposed for long periods to air thick with toxic substances.
Responsibility runs from the federal government, where then-Environmental Protection Administrator Christie Whitman falsely assured 9/11 responders that the air was safe, to the New York State Health Department, which abandoned a program designed to monitor the health of 9,800 state and National Guard personnel, to the New York City Health Department, which has yet to issue treatment guidelines for physicians.
The failure to create the comprehensive public health campaign that was so obviously called for is especially outrageous because public health officials have long had access to evidence of a public health disaster in the making. Medical researchers have published at least 27 studies detailing how the toxic cloud that erupted with the collapse of the World Trade Center ate at the lungs of the workers who labored to find survivors and cart away the massive rubble.
To read the studies is to confront both governmental inaction and a question: Why? Why were recovery workers put in harm's way, falsely assured they were safe and lacking respiratory protection? And why has so little been done to aid them? The answers, it seems certain, were, first, ignorance; second, a determination to get New York moving at all costs; third, bureaucracies that let everyone dodge responsibility, and fourth, a desire to minimize liability.
All of which should have been swept aside as scientists reported their findings; all of which must be swept aside today. Too many people have gone without proper monitoring and treatment, and too many are threatened by worse illnesses, to allow further denial and lethargy.
The reports are available in publications such as the New England Journal of Medicine, the Journal of Occupational and Environmental Medicine, the American Journal of Respiratory and Critical Care Medicine, Chest, and the Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report. Many were written by the
Fire Department's own doctors, who are among a handful of officials who have performed in exemplary fashion since 9/11.
The collapse of the twin towers was, in the words of a 2004 report in the journal Environmental Health Perspectives, "the largest acute environmental disaster that ever has befallen New York City." The air became laden with highly alkaline concrete dust, glass fibers and particles of lead, chlorine, antimony, aluminum, titanium, magnesium, iron, zinc and calcium. Flaming fuel and plastics released carcinogens including dioxins, polycyclic aromatic hydrocarbons, polychlorinated biphenyls and polychlorinated furans.
Three days after the attack, rain helped cleanse the atmosphere, but particulate levels rose and fell for weeks, dropping at night when the air was still and rising with flareups in The Pile. Construction machinery added diesel exhaust to the stew, and caked gray-white dust was omnipresent. It was not until December 2001 that the fires were extinguished and dioxin levels returned to normal. The final pieces of steel were trucked away five months later.
The devastating consequences of laboring amid poisons became immediately evident.
In the first 24 hours, 240 firefighters and Emergency Medical Service workers sought treatment, half for dire respiratory symptoms. Three were hospitalized for life-threatening inhalation injuries, two of whom went into acute respiratory arrest.
Within 48 hours, more than 9,000 firefighters - 90% of the FDNY's earliest responders - suffered acute cough, nasal congestion, chest tightness or burning. Three out of four told researchers that for the first week, they didn't wear respirators, which cover the nose and mouth and filter out contaminants. Some used paper masks that were practically useless.
Two weeks after 9/11, a 38-year-old firefighter was admitted to Bellevue Hospital with acute eosinophilic pneumonia, a rare disease caused by exposure to extreme amounts of dust, according to the description of his case published in the American Journal of Respiratory and Critical Care Medicine. He had ash, fiberglass, silica, metal particles and asbestos in his lungs.
The firefighter, whom the FDNY declined to identify, had arrived at the Trade Center 20 minutes after the collapse and worked 16 hours a day for 13 days, wearing no respiratory protection for at least the first week. Early on, he coughed up black phlegm, and for two days before he was hospitalized he complained of fatigue, muscle pain, fever, dry cough, chest discomfort and breathlessness. He required three weeks of treatment before recovering.
A team of doctors, including David Prezant, the Fire Department's deputy chief medical officer, wrote up the case as an example of a condition known as interstitial lung disease. ILD affects tissues deep in the lungs that extract oxygen and is far rarer than illnesses that obstruct breathing passages, such as asthma. It is the type of illness that led to the deaths of Johnson, Zadroga and Godbee.
In October, doctors diagnosed almost 60 firefighters as suffering from airway hyperreactivity, a narrowing of breathing passages commonly found in miners after years of exposure to airborne particles. The firefighters' conditions worsened over the next six months.
In November and December, researchers for Beth Israel Medical Center and Johns Hopkins and Columbia universities examined hundreds of cops and cleanup workers and found that they, too, had coughing, wheezing and other lung ailments. For example, Beth Israel doctors checked 240 Emergency Service Unit cops and found that 77% had developed new or worsening respiratory symptoms within days after 9/11, and that one-quarter of the 240 still had symptoms three months later.
In February 2002, a study of 97 ironworkers who were at Ground Zero during the first five days found 77% had respiratory symptoms such as cough, chest tightness and wheezing.
Symptoms emerged among people who had not been on The Pile. Two-thirds of the residents in 414 randomly selected households in Battery Park City, Southbridge Towers and Independence Plaza reported eye or throat irritation six weeks after the attack, and nearly half had persistent coughs.
A survey of downtown women who were pregnant on 9/11 found shorter gestation periods and smaller babies than normal. The maternal and cord blood of women who lived within a mile of Ground Zero had elevated levels of PAHs in the month after the attack. PAHs are associated with genetic damage.
One woman told researchers at the Johns Hopkins Bloomberg School of Public Health in Baltimore that she had had an abortion because she feared birth defects.
Still, the Ground Zero recovery workers suffered the worst illnesses. Thirteen firefighters contracted pneumonia in the first three months, and by month six more than 30 firefighters had come down with reactive airways dysfunction syndrome, the asthma that struck Jeffrey Endean. An additional 332 firefighters and one EMS worker had a severe enough cough to require four weeks of sick leave - the first medical definition of what became know as World Trade Center cough.
All of them had coughed up black or gray phlegm containing pebbles or particles in the first days after the attack, and one year later, more than half of those 332 showed only partial improvement. Almost nine out of 10 also suffered from persistent, severe heartburn or acid reflux, an ailment common among the forgotten victims of 9/11.
(Doctors believe that breathing concrete dust inflamed lungs and sinuses, and swallowing it damaged digestive systems, causing the release of acids. Vapors generated by those acids then worsen the respiratory inflammation, creating a vicious cycle. One retired firefighter had a cough so severe that the constant jarring of his teeth knocked out most of his fillings, said the FDNY's Prezant.)
Most stunningly, FDNY doctors calculated that the average lung capacity of Ground Zero firefighters and EMS workers had decreased by the equivalent of 12 years of aging. The doctors also saw sarcoidosis, the lung-scarring disease that afflicts Christopher Hynes, at more than five times the usual rate in the first two years.
That's where the scientific measurements of the Ground Zero health crisis end for the moment, but more is known because Fire Department physicians and doctors at the Mount Sinai World Trade Center Medical Monitoring Program have monitored or treated tens of thousands of patients.
Their conditions are similar to those suffered by Hynes, Lodge and Endean: asthma, RADS, interstitial lung diseases, bronchitis, sinusitis, acid reflux and, most commonly, World Trade Center cough. The doctors say that while aggressive treatment has helped many to improve, few have been restored to the health they enjoyed before 9/11. Many are severely debilitated.
The Daily News is calling on Mayor Bloomberg to lead a public health drive on behalf of the forgotten victims of 9/11. His long dedication to public health, his command of municipal resources and his ability to get things done ideally suit Bloomberg for the job. Not incidentally, he also occupies a position from which to mobilize the state and federal governments into fulfilling their responsibilities to the Ground Zero responders.
And those responsibilities are, indeed, huge. They belong to, among others, Gov. Pataki and his successor in Albany come January, state Health Commissioner Antonia Novello and her successor come January and U.S. Health and Human Services Secretary Michael Leavitt, who assigned Dr. John Howard, head of the National Institute for Occupational Safety and Health, to serve as federal WTC health coordinator. All must begin to accept their obligations.
Bloomberg responded to our call with a commitment to study "whether we are doing everything that we can," and a promise to do what he can "consistent with what our resources are, to make sure that this city acts responsibly and recognizes the great sacrifice and the hard work that people made down at the World Trade Center site."
To which we say, "Good, Mr. Mayor, take a close, hard look." Action will surely follow, and we look forward to seeing the start of a comprehensive, aggressive crusade, because the facts demand it. Even a cursory study will show that Trade Center responders were falsely assured the air was safe. And that they didn't get or use proper respiratory protection.
And that the primary medical program for most responders, the one run by Mount Sinai, has never been adequately funded so that cops and construction workers must wait four months for an appointment for treatment.
And that doctors at Mount Sinai and affiliated hospitals are experiencing a surge of new patients five years after 9/11.
And that many of Mount Sinai's patients arrive after having been misdiagnosed or ineffectively treated.
And that medical experts, including Dr. Kerry Kelly, FDNY's chief medical officer, and Prezant; Dr. Robin Herbert and Dr. Stephen Levin, who run Mount Sinai's program, and Dr. Alvin Teirstein, a noted Mount Sinaipulmonary specialist, are concerned that the forgotten of9/11 may be on the verge of more serious illnesses. Tumors and lung-scarring diseases have been known to emerge between five and 20 years after a toxic exposure. The responders are about to cross that five-year milestone.
They served New York and it cost them their health and even their lives. They deserve nothing less than long-term, gold-standard health care - now.
I Never Complained, Nor Sued, Nor Will I, But in Case I Die
Part IV: Originally published on July 30, 2006
Posted Wednesday, April 18th 2007, 9:27 AM
They were among the 40,000 who stepped forward for New York and America after 9/11, and they speak here of the price they paid for serving. Their stories are not unusual.
No, they are typical among the more than 12,000 men and women who were sickened by breathing the toxic cloud that shrouded Ground Zero. They tell of damaged lungs and psyches, of fears of worse to come and of beliefs that the cloud has brought on cancers and may bring death.
They feel betrayed by a government that said the air was safe and cast aside by officials who failed to address the sweeping nature of the resulting epidemic.
Above all, these personal accounts stand as an indictment of a neglectful city and country, which must now right the terrible wrong of forgetting those who did the extraordinary at great personal cost.
A smell you never forget
For 20 years, I served as a detective with the New York Police Department, and I retire tomorrow at half pay without medical disability.
I can still smell the debris of the Fresh Kills landfill. After you stepped off the bus for your 12-hour shift, the stench was just enormous, and as you walked around, you would see bubbling whirlpools. Fifteen minutes in, I would have splitting headaches. I'd go to the tents, where conveyer belts would bring debris to pick through for human remains.
For years after, I had headaches, and I still have bloody noses and sinus problems. I never complained, or sued, nor will I, but in case I die, I've kept everything since that day, every news article, so maybe my two kids will get some compensation for my life.
Steve Heberling, 44, Brewster, N.Y.
'Coughing up blood'
I was at the north tower as an Emergency Medical Services paramedic lieutenant when it collapsed. We ran up West St. We started setting up forward triage, and we treated people for the first three or four hours. When 7 World Trade Center came down, we started to treat sick responders. We were on site until 9 a.m. the next day. The air was indescribable.
We worked there until Oct. 1. You couldn't eat anything that wasn't covered with dust. We had paper masks, but they were no good. Condensation from breathing turned the mask into mud. It was worse to breathe with it on. We got respirators about a week into it, but they were not fit-tested, they just came in boxes and we grabbed one that might fit.
I worked more than 300 hours at Ground Zero. I considered it a thank you to America, a chance to do something for my country and for my fellow New Yorkers and for my co-workers who were buried in the rubble. We never expected anything to go wrong. Every day we were told the air was safe to breathe. Working down there as a team gave us healing. We could feel all the angels, all the people who had died there.
I started coughing up black mucus, and there was black stuff coming out my ears and when I blew my nose. In October 2001, I started coughing up blood clots and went to the FDNY Bureau of Health Services. They gave me an inhaler and said they would monitor it. I was also seeing my own doctor, who diagnosed reactive airways distress syndrome. I would get a sinus infection every six to eight weeks. I also got urinary tract infections. I also had post-traumatic stress syndrome. In 2003, I was diagnosed with acid reflux. I had a lump in my throat and couldn't swallow. I used prednisone for my lungs.
A few years before 9/11, I had contracted hepatitis C on the job. The FDNY did physicals in December 2001, and my liver values were normal. But they started increasing. In 2004, I had a liver biopsy, and the hepatitis was at stage 2. I was taking interferon and ribovirin, but the interferon seemed to make my lung condition worse.
Every time I went to the pulmonologist, my vital function was decreasing. Now I'm down to 58% lung capacity. Because of the hepatitis C, nothing was working for me. The prednisone was increasing my hepatitis C viral load so I can't treat my lungs, which have scarring.
I had to choose which to aggressively treat. I decided to treat the hepatitis C because that can affect other organs. I'm looking at 72 weeks of treatment. There's a 50% chance of eliminating the virus, then the options are interferon to keep liver damage from progressing, probably for the rest of my life. Last week, I was granted a three-quarters disability pension based on the hepatitis C.
Denise Bellingham, 57, Medford, L.I.
Leaving my kids
I was at the site as a volunteer EMT for three days - on 9/11, and then on the 13th and 14th. I was working triage from a deli as WTC 7 burned and fell. Going down there that morning, I left my two children at home. At the time, they thought I was dead, but when you have a job you are trained to do, and you do it well, then you just go do it.
And now, I've been officially disabled since 2003. I have acid reflux, migraine and sinus headaches, asthma, depression, post-traumatic stress disorder, shingles and flashbacks, but no health coverage because I was a volunteer.
I don't have lung disease from smoking. I don't have lung disease from a meth lab. I don't have it from doing something I shouldn't have been doing. I have it from the World Trade Center. What nobody's talking about is the next time something happens. You can't just run into buildings anymore. Those who did are on Death Row and being punished for what we did.
Reggie Cervantes, 45, Kansas City, Kan.
Running out of time
As an American, as a New Yorker, I thought I had an obligation to help. Somebody demolishes a building in my city, it's my duty to clean it up. I'm a union worker. But now, I'm living through a nightmare. The city employees got taken care of, but we didn't get anything.
Each time I go to Mount Sinai Medical Center, I lose more of my lung. The first time, it was 21% gone. The next, 33%. Now they say I've lost 44%. I can't even walk up a flight of stairs. I've got three kids and can't afford to take time off work, but I'm worried about the future, about my wife and my children. The lung specialist I went to couldn't diagnose my problem. He didn't know what to say to me, except to guarantee that in 10 years I wouldn't be walking around.
Daniel Arrigo, 51, Staten Island
I worked more than 100 hours doing search and recovery as a police officer. I was in the lobby when the building started collapsing, and I was there through the end of the cleanup. Now I have post-traumatic stress disorder. I've got acid reflux. I've got asthma and upper-respiratory infections. I can't go near large buildings anymore.
The Police Medical Board, four times now, denies medical liability. They say my diseases are not related to the World Trade Center, or that my paperwork isn't good enough, or that I need to go to their doctors instead of mine. I just want to be home with my kids. The money doesn't matter now. I'm never responding to a terrorist attack again: I'm just going to go right home with my wife and kids.
Robert Curcio, 34, Staten Island
Whitman's people lied
When we went out to The Pile, initially all we got was a Home Depot-type dust mask. Eventually, they gave us sturdier ones. I worked there from 9/11 until May as an EMS lieutenant and put in well over 100 hours.
Two years later, in March 2004, I had my first real asthma attack. That same month, I was forced into the process of retirement. Christie Whitman's EPA people lied: They said the air was safe. Eventually, I got three-quarters disability, but the city had played these little technicalities. The lawyer for the city said that because the department hadn't filed a form, there was no proof that the accident I was claiming for had actually occurred. The judge had to instruct the lawyer for the city that it can be taken for a given that 9/11 had happened. Because I did my duty on 9/11 and in the recovery operations, I'm now totally and permanently disabled.
William Gleeson, 45, Hicksville, L.I.
An incurable disease
On 9/11, I was a captain in the NYPD. I was home with my family when the attack came, and as the first tower fell, I left my pregnant wife and 3-year-old daughter. Both cried, pleading for me not to leave. I went with only one request to the city: Take care of my family.
I retired in 2004 at the age of 42, believing myself healthy. Within nine months, I was diagnosed with multiple myeloma, which is caused by asbestos, smoldering steel and benzene, all present at Ground Zero. Since then, most of my time has been spent at Sloan-Kettering, getting stem-cell transplants and chemotherapy. And now, after 20 years of service, I'm left with a half-pay pension and little more than an incurable, life-threatening disease and partial paralysis in both hands. Yet not a single city, state or federal agency will acknowledge the air at Ground Zero might be a problem.
Patrick DeSarlo, 44, New City, N.Y.
I volunteered first from the Red Cross then later on with the Salvation Army, working 12-hour shifts with no protection. While most of my duties left me inside, I was exposed to the air going between buildings and as I brought coffee and warm clothes to the men on The Pile.
Ever since, I've had chronic sinus infections, and many other volunteers have worse. We weren't paid workers, so we can't retire or go on disability, and there's no way to pay our medical bills. We gladly did what we did - but we are now forgotten.
Kathy Davy, 45, Manhattan
Save lives with $150 lung exam
Part V: Originally published on Aug. 7, 2006
Posted Wednesday, April 18th 2007, 9:35 AM
WTC workers' chilling death shows need for screening
And the story of how this 41-year-old husband and father of three descended to death in less than four months this year is a case study in why public health authorities must establish comprehensive medical screening and treatment programs for Ground Zero responders, complete with advisories about perils that may be coming.
Too many of the 40,000 people who served after 9/11 are sick now, and too many are at risk of more serious illnesses, and too many face even a chance of death to allow for further inaction. Even basic steps could save lives.
Chief among them: seeing to it that everyone who labored amid the pulverized remains of the Twin Towers has their lungs checked - and finding the money to test people who aren't covered by health insurance.
The procedure is simple - little more than breathing in and out of a hand-held tube - and at $150, relatively inexpensive. It measures how well lungs are functioning and, repeated over time, will signal whether they're deteriorating. (For more information, please see the explanatory graphic on opposite page.)
As Dr. Neil Schluger, chief of the division of pulmonary, allergy and critical care medicine at Columbia Presbyterian Medical Center, put it, "Every person who was down there should have a baseline lung function study, and be followed closely over the coming years for signs of pulmonary symptoms. They should see a doctor and get a lung function test."
DeBiase's death tragically proves the point.
Summoned to duty because he installed and maintained cellular networks for what was then AT&T Wireless, DeBiase worked for 64 hours at Ground Zero and at the Fresh Kills landfill, where the dust of the Trade Center was carted. Like most other recovery workers, he was not equipped with respiratory protection.
According to his medical records, DeBiase spent 16 hours at The Pile on Sept. 12, when the air was thick with atomized concrete, glass fibers and particles of lead, chlorine, antimony, aluminum, titanium, magnesium, iron, zinc and calcium, among other toxins. In the ensuing days, he was stationed for 48 hours at the landfill as an endless convoy of trucks began arriving with the same materials.
Then he resumed life as a husband and father in Jackson, N.J., and more than four years passed without any sign that helping to establish emergency communications was taking a toll. DeBiase was active in Little League and the Knights of Columbus, and as late as last December he and his wife, Jeanmarie, enjoyed ballroom dancing lessons. By all outward appearances, he was robust and fit, as evidenced in the photograph to the right.
Actually, DeBiase was on the verge of death. Inch by inch, his lungs were turning into scar tissue, slowly losing the ability to infuse his blood with oxygen and to cleanse it of carbon dioxide.
As 2005 turned to 2006, he began to experience shortness of breath. He went to the doctor Jan. 10 for what became the start of a losing 89-day battle for air. He died April 9 while hoping for a lung transplant.
The cause of death was interstitial lung disease, or ILD, an insidious condition that typically shows up in workers who are exposed to concentrations of inhaled substances - coal miners, for example.
"It is my opinion to a reasonable degree of medical certainty that exposure to dust from the World Trade Center disaster site was the cause of Mr. DeBiase's respiratory disease, which was the cause of his death," wrote Dr. James Strauchen, a professor of pathology at the Mount Sinai School of Medicine who was retained by DeBiase's family to review why he had died such a sudden, suffocating death.
DeBiase's family declined an autopsy, the results of which could have pushed Strauchen's finding beyond a "medical certainty" into conclusive fact.
That DeBiase's death in the University of Pennsylvania Medical Center went unnoticed until now testifies to how poorly the public health system has tracked the aftereffects of 9/11. It comes to light only because his father contacted the Daily News after reading this series of editorials.
"I believe the same thing could happen to many others and they don't know it, just like my son had no reason to think anything was wrong," said Angelo DeBiase, a retired truck driver from Staten Island.
In fact, the same thing has happened to others: DeBiase is now the fourth World Trade Center responder known to have died of interstitial lung disease. Firefighter Stephen Johnson, Police Officer James Godbee and Detective James Zadroga all preceded him to the grave.
In fact, the same tragedy may well occur again: Numerous medical experts have predicted that interstitial lung disease will afflict an increasing number of World Trade Center recovery workers in the five to 20 years after they were exposed to the cloud at Ground Zero. The disease is rare enough that no one expects a vast outbreak, but, when the condition does show up - perhaps in just a relative handful of people - the consequences could be fatal.
To quell unwarranted fears, some distinctions are in order. More than 12,000 WTC responders are already sick, but not with ILD. The vast majority damaged their air passages by inhaling toxins, leaving them with inflamed sinuses, bronchitis and reactive airways dysfunction syndrome, or RADS, an irritant-induced asthma. These conditions do not transform into interstitial lung disease.
ILD, which has a variety of forms, attacks not the airways but the very tissues of the lungs. Typically, the body senses the presence of foreign particles and tries to combat them as it would fight a germ. The immune system surrounds the particles with cells that build up into nodule-like bodies known as granulomas. Granulomas lead to fibrosis, an irreversible scarring that prevents the lungs from extracting oxygen from the air. Some ILDs are very treatable. Others are uniformly fatal.
The need for a public health campaign is obvious. So, too, the need for someone to take charge. We have urged Mayor Bloomberg to be that person. Citing his long commitment to public health, his command of vast government resources and his ability to prod other levels of government into action, we have called on the mayor "to tackle the World Trade Center health crisis on all fronts - medical, legal, social, political and more."
Establishing full-scale health monitoring and treatment programs must be a priority, starting with a drive to have all 40,000 responders undergo lung function tests and building toward a sophisticated system for tracking the progress of the epidemic. For it is only by taking the measure of the epidemic that authorities can both tailor treatment strategies and provide reliable information to responders and physicians - perhaps saving the life of the next Mark DeBiase.
There's much work to be done. No one maintained a master list of the Ground Zero workers, making it impossible now to inventory their conditions. The U.S. Department of Health and Human Services began and disbanded a surveillance program for 10,000 federal workers. The state Health Department dropped a similar effort covering 9,800 state and National Guard personnel.
And despite a long battle by Sen. Hillary Clinton and Reps. Carolyn Maloney and Vito Fossella, the Bush administration and Congress have balked at providing the primary health resource for cops, construction workers and others - the World Trade Center Medical Monitoring Program at Mount Sinai Medical Center - with remotely sufficient funding.
Since 2001, it has had to beg for every dollar. And the federal government's latest promised funding will allow doctors to monitor and care for patients for only a year.
The program has affiliated doctors at medical centers around the metropolitan area and across the country. It is open to all responders except firefighters, who are covered by the FDNY, but it would quickly run out of money if large numbers began enrolling for yearly medical screening and treatment referrals. Even so, large numbers should consider taking advantage of the services. For information, call (212) 241-3355.
DeBiase's father speaks with bitterness about the fact that then-Environmental Protection Administrator Christie Whitman and Mayor Rudy Giuliani falsely assured the Ground Zero workers that the air was safe to breathe. And the family has consulted attorney Joseph Belluck about a possible suit.
Jeanmarie DeBiase said she and her husband had no sense he was in danger, or that services were available at Mount Sinai - until it was too late.
She said her three sons, Nicholas, 12, Christopher, 9, and Michael, 7, were, of course, hit hard by the death of a father to whom "everything was about the boys." And she described his decline as a bewildering, ever more painful downhill rush. First a worry about shortness of breath, then visits to doctors, then an attempt to keep working with an oxygen tank, then admission to the Deborah Heart and Lung Center in N.J., then a biopsy and a collapsed lung, then consultations with a doctor at the Mayo Clinic, then prayers for a lung transplant at the University of Pennsylvania Medical Center, then gasping for air, then organ failures as her husband's body was starved for oxygen, and then, finally, a decision to let go.
"I sometimes think it is a dream," said Jeanmarie DeBiase. "The only thing that gets us through is that it came from 9/11, and we had him five more years than the people who died that day."
Her son Christopher shares a similar gracious philosophy.
"Christopher's fear is that there are going to be a lot of other children who will lose a parent," she said. "He just feels that maybe this can help somebody."
THE TEST THAT SAVES LIVES
A lung function test measures how well your lungs move air in and out.
You inhale and exhale through a tube that gauges the speed and volume of your airflow.
If you score below normal, doctors may order further tests, such as a chest X-ray or CT scan, that can diagnose interstitial lung disease, asthma and other respiratory illnesses.
If your score is normal, you still would be retested periodically to check for declining lung function.
WHAT THE EXAM LOOKS FOR
Most of the 12,000 sick WTC
responders suffered damage to their
airways from inhaling toxic dust.
In the upper airways, dust causes sinusitis and laryngitis.
In the lower
bronchitis and asthma.
Interstitial lung disease attacks lung tissues. Irritating foreign particles cause the tissue to form nodules called granulomas that leads to scarring, called fibrosis.
tissue stops the lungs
putting oxygen into the bloodstream, leading, in the worst
cases, to suffocation.
WHERE TO GET HELP
Contact the Mount Sinai World Trade Center Medical Monitoring Program
at (212) 241-3355.
Please help me go on living
Part VI: Originally published on Aug. 10, 2006
Posted Wednesday, April 18th 2007, 9:38 AM
WTC volunteer needs swift action to survive
A man's life is at stake. His name is Vito Valenti. On Sept. 11 he was caught in the maelstrom and stayed at Ground Zero as a volunteer to help in the frantic rescue and recovery operation. And today he is dying.
He is 42 years old.
He cannot work.
He has no pension.
He has no health insurance.
He has no money for medications.
His lungs are being destroyed by pulmonary fibrosis.
His only hope is a double lung transplant, but he cannot afford even the oxygen he needs to make it day by suffocating day.
Only through the good graces of a generous medical supply company is he being sustained with the fundamental requirement of life: breath.
"After hearing that he was a 9/11 volunteer, we decided to donate the oxygen," said Ed Brown, sales representative for Homecare Concepts in Farmingdale, L.I.
Someone in power must help Vito Valenti, for he will die without it.
Numerous officials have responded to this series of editorials by pledging to aid the forgotten victims of 9/11. Today, they can be of critical service.
Mayor Bloomberg, Gov. Pataki and every elected and health official who let the 9/11 epidemic expand unaddressed ought to knock this morning on Valenti's door. Inside the upstairs apartment of a two-family house at 1320 A St. in Elmont, L.I., they would meet a man who personifies how seriously ill some Ground Zero responders are. And they would see, in the most extreme way, that many are being denied proper assistance.
Like thousands of others, Valenti is at the mercy of a workers' compensation system that is ill-suited, if not hostile, to reimbursing them for lost wages and picking up health care costs. New York's compensation law was written to cover standard accidents, such as falling off a ladder, and illnesses directly related to a specific occupation, such as repetitive stress nerve damage among meat cutters. The law was not designed for illnesses that emerge over time from the inhalation of unprecedented amounts of toxins by 40,000 workers with disparate jobs.
As a result, Valenti is among a vast legion who are barred from filing claims because they realize they are sick more than two years after 9/11, the time limit for starting a case. His only hope rests in legislation that would extend the filing period for
9/11 responders. Such a bill is on Pataki's desk. So Valenti lives on $1,430 a month in Social Security and cannot afford drugs to treat his illness and prepare him for a transplant.
"He is dying," said Dr. Maria Padilla, medical director of Mount Sinai Medical Center's lung transplantation program, who began seeing Valenti in April 2005. "Unless he can get coverage for his medications and get ready for a transplant, there is no hope."
Valenti is a divorced father of two. He lives with his 74-year-old father, who is battling heart problems and cancer, and he lost his mother to cancer in February. For more than a decade, Valenti worked as a lunch aide in a Queens middle school and then became a grievance representative for his union, Local 372, with half his $60,000 salary paid by the union and half by the school system.
Valenti's office was at 125 Barclay St., directly behind the World Trade Center, making him witness to the full horrors of 9/11 and positioning him to serve as a volunteer. Over the next two days, in the thick of a toxic cloud, he distributed water and supplies and remembers escorting a dazed and bleeding firefighter to a triage nurse. He slept on West St. with a roll of paper towels as his pillow.
"The smell of death was everywhere," Valenti said. "It was like hell."
The nightmare took a toll. Diagnosed with posttraumatic stress disorder, Valenti went on paid leave for six months and unpaid leave for four. Because he filed on time for PTSD, workers' comp reimbursed the Education Department for his sick pay.
By February 2002, Valenti was also coughing. Over the coming months, his respiratory distress worsened, leading eventually to a diagnosis of pulmonary fibrosis in March 2004. Fibrosis is a scarring of the lungs that prevents the body from oxygenating the blood. It is a form of interstitial lung disease, the illness that took the lives of Firefighter Stephen Johnson, Police Officer James Godbee, Detective James Zadroga and telephone worker Mark DeBiase.
Valenti exhausted his health benefits in December 2005, making it impossible for him to afford more than a dozen medications. The company that provided his oxygen supply took its equipment back.
Lacking his medications, Valenti gave up on the lung transplant program. Two weeks ago, he was admitted to Winthrop-University Hospital in Mineola in the throes of a respiratory failure. Doctors stabilized him, gave him a 30-day supply of medicine, and a nurse secured free oxygen for him from Homecare Concepts.
Many city workers who were disabled after responding to 9/11 are eligible for special three-quarter-pay pensions under legislation enacted in 2005. The law says their illnesses are presumed to have been caused by the event. But here, too, Valenti is out in the cold.
First, he had declined to join the city retirement system before 9/11, a decision that may make him ineligible for the special pension. Second, he would need to prove that he served at Ground Zero for 40 hours. His only witness, union Vice President Santos Crespo, said he believes Valenti served for the required time. But Crespo lost track of Valenti in the chaos and so can't swear to it.
State Sen. Michael Balboni's office is trying to figure out whether Valenti is entitled to a disability pension. The law is unclear, leaving Valenti to wait for the end of a long, bureaucratic process, when he has no time to wait. The life expectancy of people with his disease may be as little as three years. Much of that time is already gone.
"I'm begging for someone to help me," Valenti said. "I do not want to die."
He shouldn't have to beg.
GOV GETS WTC BALL ROLLING
Part VII: Originally published on Aug. 15, 2006
Posted Wednesday, April 18th 2007, 9:41 AM
Pataki program must be start of major campaign
Watching Gov. Pataki at Ground Zero yesterday, there was a sense that someone in government was starting to address the needs of the forgotten victims of 9/11 - however incompletely, however late. The governor's program holds the promise of helping thousands of World Trade Center responders by providing them medical coverage through the workers' compensation system and by boosting the availability of line-of-duty disability pensions and death benefits.
Case by heartbreaking case, the impacts are likely to be profound for men and women who served in the aftermath of 9/11 to the severe detriment of their health, as well as for the families of those who lost their lives due to illnesses that were brought on by exposures to the toxins released by the collapse of the twin towers.
Vito Valenti - terminally ill, lacking health insurance and praying for a lung transplant - should be among the many who can secure medical coverage after they were shut out by workers' comp on technicalities.
Rose Johnson, whose husband, Firefighter Stephen Johnson, died of lung disease two years after retiring, should be among the widows who can win line-of-duty death benefits for the rest of their lives.
Tylerann Zadroga, whose father, Detective James Zadroga, fell to lung disease when she was 4, should be among the children who are guaranteed support until they reach majority age.
And yet, there is so very much more to do about the devastating health consequences that are still emerging among Ground Zero workers.
In the first editorial in this series three weeks ago, we wrote, "No one in power - not Gov. Pataki, not Mayor Bloomberg, not the state and city health commissioners, not the U.S. government - has acknowledged the epidemic's scope, much less confronted it for the public health disaster that it is."
Our words are only slightly less true today. The forgotten victims of 9/11 still wait for a leader who will tackle the sweep of the health crisis that has beset them - someone who will assess its scope, devise properly funded treatment programs, establish monitoring to watch for trends in diseases and treatments, honor the fallen and persuade the federal government to meet its obligations to the ill.
We called on Bloomberg to be that leader, also urging him to review the inequities in disability, pension and workers' comp benefits afforded to Ground Zero responders. The mayor has yet to present a plan, and Pataki stole a march on him yesterday on the benefits front. Bloomberg was left to sound crabbed and cold-hearted in finding fault with the fiscal implications of the governor's actions.
Pataki saw correctly that those implications pale in comparison with the toll inflicted on the selfless heroes of 9/11, especially those who may pay with their lives for having served. Still, some accountability is in order, starting with workers' comp. Thousands of responders - civilians and city workers other than cops and firefighters - turned to this state-controlled program for medical coverage and lost wages of up to $400 a week only to be trapped in a dead-end bureaucratic nightmare that has lasted for almost five years.
In extending the time for responders to apply for benefits and pressing the system to be less hostile, Pataki is righting injustices that were allowed to proliferate under his watch for years. At the Mount Sinai Medical Center World Trade Center Monitoring Program, doctors expect to be able to move swiftly to help patients - as they should have been able to do all along.
Pataki made it easier for survivors of 9/11 responders to win line-of-duty death benefits by signing a bill that was pushed by municipal labor unions and sent to his desk by Assembly Speaker Sheldon Silver and Majority Leader Joe Bruno. The gist is that responders who die from specified illnesses, including lung disease and cancer, will be presumed to have contracted their illnesses at Ground Zero.
This is the provision to which Bloomberg objects because it exposes the city to liability in cases where there is no provable connection between 9/11 and a fatal illness. There is merit to the argument, and we, in fact, have looked dimly on similar so-called presumption bills in the past. But this is different. This is a time to be more generous.
The federal and city governments told the 40,000 people who gave their all at Ground Zero that the air was safe to breathe. It wasn't. And, now, more than 12,000 are sick and medical experts predict that even more serious illnesses are soon to show up. At least five responders have died already - and their families have had to fight like hell trying to prove their deaths stemmed form 9/11.
It is unacceptable to say that each family should prove the merits of its case while rejecting all the cases virtually out of hand. And, in this age of terror, it is wrong, counterproductive and unfair to ask first responders to rise to acts of heroism unless they are sure their families will be taken care of in the event that the worst happens.
$400M for lawyers? the sick and dying of 9-11 deserve better
Part VIII: Originally published on Sept.
Posted Wednesday, April 18th 2007, 9:51 AM
Within weeks of 9/11, it was already clear to New York officials that Ground Zero rescue and recovery workers were serving under such hazardous conditions that the city and its cleanup contractors were likely to face more than $2 billion in damage claims.
As 40,000 firefighters, cops, construction workers and others labored amid the caustic dust and carcinogens released by the World Trade Center collapse, consultants retained by the Law Department predicted that responders would wind up seeking compensation for injuries stemming from exposure to toxins, including asbestos.
The forecast, which surfaced recently in court papers, has proven tragically accurate. As is by now well-known, thousands of the men and women who helped bring New York back from tragedy were sickened. The toxic cloud that shrouded The Pile seared their airways and scarred their lungs, bringing debilitation and, in the worst cases, death.
They are owed.
And many are being victimized yet again.
Demanding compensation from the city and the major construction companies called in to dismantle the rubble, more than 8,000 people have enlisted to join a mass lawsuit that is mushrooming into a monumental legal ripoff that could extend for decades.
At issue is who, if anyone, should be entitled to a share of $1 billion in federal money that was set aside by Congress to insulate the city and the contractors against liability. But the warring in court is so intense and tangled that high-priced lawyers could siphon up to $400 million away from the forgotten victims of 9/11 in legal fees.
That math is obscene: All those responders get a shot - someday, long in the future - at dividing, maybe, $600 million, while a couple dozen attorneys reap an amount that's almost as large. Correction, the math is not obscene; it's sinful.
As a matter of justice, those who were sickened at Ground Zero should not have to fight this hard for compensation, nor should they have to wait years for payment. They deserve the overwhelming share of the available monies; the trial lawyers on both sides of the table don't.
There's a better way. The process of apportioning financial restitution should be removed from court, ideally through no-fault payments. Proof of an injury stemming from Ground Zero service should trigger the issuance of a check, with the amount governed by clear guidelines.
The 9/11 Victim Compensation Fund, administered by lawyer Kenneth Feinberg, used such a system with great success to distribute $6 billion to the survivors of 2,880 people killed in the terror attack and $1 billion to 2,680 people who were injured. Sens. Chuck Schumer and Hillary Clinton, the New York congressional delegation, Gov. Pataki and Mayor Bloomberg must now join forces to push Congress to reauthorize the fund in order to take care of people who were left out only because their illnesses emerged too late for them to file claims.
A Feinberg-like compensation fund is the surest way to efficiently provide reasonable payment to people who were hurt because they acted with valor, as they were asked to. Among that legion are James Nolan and Michael Valentin.
Nolan, 41, a Local 608 carpenter, rushed to Ground Zero on the night of 9/11 with shovels, picks and seven cases of bottled water. In the thick of the toxic cloud, he searched for bodies and he "burned steel" to perform demolition. He was there for almost two weeks straight and then shifted to carpentry work at the site for the better part of a year.
Two months in, Nolan developed what's now known as World Trade Center cough and the acid reflux that's common among responders. Then came asthma, and the skin that peels from his hands, and an oversize liver, and gasping for air. He weeps when recounting his experience. "I get up in the morning and I feel like I am 80 years old," said Nolan, who struggles to work because without a job he has no health insurance.
Valentin, an NYPD detective, got to Ground Zero on the afternoon of 9/11. "It looked like winter out, like dust devils all over the place," he said. He also recalled "seeing fluorescent green smoke, the most beautiful green you could see. It was really eerie."
Every day for two months, Valentin, now 41, worked a bucket brigade that searched for body parts, checked nearby properties for human remains and performed perimeter security. His only respiratory protection was an American flag bandanna purchased by his wife.
After a few months, Valentin began coughing up blood, got acid reflux, had numbing in his hands and suffered night sweats. His lung capacity began to drop, he developed a mass the size of a lemon outside his lungs and the lining of his lungs began to thicken. He breathes with pain, depends on 10 medications and uses a nebulizer every three or four hours.
Michael Valentin is owed.
James Nolan is owed.
Many thousands more are owed.
Congress and President Bush must be made to understand the terrible and growing toll that was inflicted by the attack on America, and they must be shown the gross inequities in how responders have been treated. Through the 9/11 fund, Feinberg wrote checks to almost 2,700 Ground Zero workers who came down with respiratory conditions like those that now afflict thousands. But he went out of business before the scope of the epidemic began to emerge.
Quite likely, Washington will not be immediately receptive to a new compensation fund. There would have to be an open-ended commitment to help responders if and when it's proven that Ground Zero exposures are producing diseases like cancers, as many medical experts predict will happen in the coming decades. And Congress would have to cap the liability of the major builders, such as Bovis Lend Lease and Tully Construction, that threw themselves into the cleanup out of patriotism, not out of profit. The long-term purpose for protecting these companies is simple: American businesses will be a lot less likely to respond with similar vigor to another terror disaster if bankruptcy will be the reward.
Should Congress refuse to create a compensation fund, Bloomberg and Corporation Counsel Michael Cardozo will have to act independently to remove the claims of the forgotten victims of 9/11 from the courts. No less an authority than Feinberg supports this approach.
"The city has over a billion dollars sitting in the bank, just sitting there," Feinberg said. "Why not replicate the 9/11 fund on a local basis to compensate these 8,000 people? Isn't the answer to design a system cooperatively that compensates eligible victims, denies those who can't meet the minimum requirements and puts some money aside for future illnesses as they arise?"
Legally, this may be easier said than done, because Congress placed the money in the WTC Captive Insurance Co., a special entity that is supposed to defend the city and 140 companies from liability. And there is no guarantee that $1 billion would cover all claims that may arise. Still, compensating people with proven Ground Zero-related illnesses through arbitration would be a lot more efficient and dignified - and a lot less costly - than waging, literally, 8,000 individual lawsuits in a war without end.
In one battlefield trench, trial lawyers David Worby and Paul Napoli represent the mass of people who allege they suffered respiratory ailments from inhaling the toxic cloud of 9/11, are afraid they are going to become ill, or believe they contracted cancers, such as leukemia and malignancies of the brain and kidney, at Ground Zero. Worby and Napoli argue that the city and contractors should be held liable because the workers were placed in unsafe conditions in violation of labor laws.
Worby recognized the emerging Ground Zero health crisis early on, beginning with a chance encounter in 2003 with NYPD Detectives John Walcott and Richard Volpe, partners who had searched for survivors at Ground Zero. Walcott was suffering with leukemia and Volpe with kidney disease, sicknesses they attributed to toxic exposure.
The face and voice of the suit, Worby mixes zeal for winning treatment for the ill, including Nolan and Valentin, with assertions that an unprecedented combination of carcinogens, cancer accelerants and immunosuppressants has caused malignancies to develop far faster than medicine has ever seen before. There is no scientific proof for such a theory, and it is dismissed out of hand by many experts.
If Worby is the mouth of the court action, Napoli is the muscle. His firm invests millions of dollars waging mass suits against the likes of, say, a major drug company, essentially gambling on winning big. After a loss, he gets nothing. After a win, he stands to collect up to a third of any settlement.
With $1 billion up for grabs, Worby and Napoli are eying a cut of as much as $333 million - enough, Worby said, "to make some people think about buying a Gulfstream" private jet. For his part, Napoli said that after paying expenses, such as lawyers' salaries and office overhead, the typical profit margin in a mass-tort suit is about 25%. In this case, that would be more than $80 million. Neither would discuss specific arrangements with clients.
In the opposite trench are Cardozo, the city's chief lawyer, and the hired guns who represent the Captive Insurance Co. They have asked Manhattan Federal Judge Alvin Hellerstein to dismiss the suit on the grounds that the city and its agents are, by law, immune from liability because they were responding to an emergency.
Hellerstein and appeals courts will decide the matter - but whatever the outcome, the forgotten victims of 9/11 will be the losers. On the one hand, the judges could throw the case out of court, leaving the responders at the mercy of Congress. On the other hand, the judges could let all or some of the suits proceed - draining ever more of the available monies into the lawyers' bank accounts.
Just getting this far, the insurance company has spent more than $28 million on attorney fees, and it is perfectly plausible that the costs could eventually rise to $100 million. In fact, Ernst & Young, the accounting and consulting company, projected in 2001 that the bills could hit $267 million.
There, again, is that sinful math: As much as a third of a billion dollars to the responders' legal teams, at least $100 million and perhaps much more to the city's battery - and a prayer for one eight-thousandth of whatever is left to each responder in the suit. And that leaves out others who have not joined the case or who may become sick in the future.
Now, as the lawyers like to say, let's stipulate: Every one of the attorneys is representing clients honorably and with passion, and each of their positions has powerful merit. But the perverse result is Pyrrhic combat among parties - the workers, the city, the companies - who rushed nobly into action five years ago. And the forgotten victims of 9/11 are again bearing the brunt, this time in a fleecing of epic proportions. It must be stopped.
They must be protected.
They are owed.
Enough studies: We need action
Part IX: Originally published on Sept. 6, 2006
Posted Wednesday, April 18th 2007, 9:59 AM
In reporting that the health crisis afflicting Ground Zero rescue and recovery workers is deeper and more persistent than even they had recognized, doctors at Mount Sinai Medical Center yesterday put a rapier-fine point on the urgent need for aggressive action.
By Mount Sinai's count, almost 70% of the workers suffered respiratory symptoms during or after their time at Ground Zero, and more than 60% remained ill long after. Those numbers, higher than previous estimates, certify that thousands of men and women who served at the site of the destroyed World Trade Center are sick because they did their duty.
The findings produced by the Mount Sinai World Trade Center Medical Monitoring Program also stand as an indictment of five years of government inattention and continuing, inexcusable inaction. For even now, no one - federal, state or city - is stepping forward to lead the broad public-health campaign that is so obviously necessary.
Mayor Bloomberg may someday take full command, but yesterday he unveiled programs that were largely focused on defining the scope of an epidemic that should no longer need any definition. That he did so without having a grasp of the Mount Sinai findings - and without coordination with Mount Sinai's doctors - spoke volumes about how disjointed New York's 9/11 health programs remain. And that the mayor left an impression - wrong, his aides say - that he wasn't sure there was a provable connection between Ground Zero exposures and respiratory diseases was mind-boggling.
With his administration far behind the curve, Bloomberg dispatched two deputy mayors to survey how his agencies are responding to Ground Zero health issues and - take a deep, deep breath - to "review the availability and sufficiency of resources aimed at assisting those who have been affected by WTC-related illness, and recommend strategies to ensure the ongoing adequacy of those resources."
The mayor gave his aides three months to report back. Perhaps he will then be in a position to attack this "health crisis on all fronts," as we have urged, and to "galvanize the federal government into supporting long-term monitoring and treatment programs."
Bloomberg also said he would devote $22 million to a Health Department unit that would monitor the WTC epidemic and keep everyone abreast of developments. Perhaps this will become the information "clearinghouse" that we have called for, and perhaps the department will finally awaken to its obligations.
Finally, the mayor said the city would spend $16 million on a Bellevue Hospital clinic that will treat a range of people who were exposed to Trade Center dust, from residents and undocumented workers who cleaned up surrounding buildings to city employees who participated in debris removal. There is a need for this service, and programs for 9/11 responders are in dire need of similar financial aid.
On that front, U.S. Secretary of Health and Human Services Michael Leavitt, is to meet tomorrow with the city's congressional delegation and mayoral aides. Oh, how we wish we could participate, if only to point out that this emperor is buck naked.
Leavitt is the official who named Dr. John Howard, head of National Institute for Occupational Safety and Health, to "coordinate" the federal response to 9/11 health problems without giving Howard a penny of budget or a smidgen of power. What Howard has instead is guts. He spoke the truth about Washington's paltry support for treatment programs, telling The New York Times, "You don't have to go to cancers years from now, or asbestosis, to be able to say, 'Gee, John, how far do you think this money is going to go?' I don't think it will go that far."
No one sees the need for treatment funding more clearly than Dr. Robin Herbert, director of the Mount Sinai 9/11 program, which has treated thousands of responders who suffer with damaged lungs. Nearly half are uninsured, and Herbert fears that even more serious illnesses are looming.
"There should no longer be any doubt about the health effects of the World Trade Center," she said. "Our patients are sick. Our patients were very, very highly exposed, and are likely to suffer health consequences as a result of that for the rest of their lives."
That's all any official should need. The forgotten victims of 9/11 critically need help.
From new infamy must come honor
Part X: Originally published on Dec. 7, 2006
Posted Wednesday, April 18th 2007, 10:01 AM
After this act of war exactly 65 years ago, America came to the aid of citizen responders...now, the U.S. owes care to those who rallied when the twin towers were attacked. On Pearl Harbor's anniversary, history issues a call to duty
No sooner had Japan's planes left the smoke-filled skies over Pearl Harbor 65 years ago today than Americans began to fight back. Among them were brigades of ordinary people - civilians - who joined in recovering the dead and salvaging the sunken fleet.
It was difficult work performed under dangerous conditions. Much of the effort took place underwater, with divers patching holes in bombed-out hulls and bringing live explosives to the surface. Trapped in many of the ships were flammable gasoline vapors, toxic hydrogen sulfide gas and waterlogged bodies. Oil coated everything. A diver was killed when his air hoses were severed.
As the war moved across the Pacific, more civilians stepped up in service to the nation. And America recognized that it had obligations to these citizen responders. Secretary of War Henry Stimson so stated in a letter to Congress dated July 2, 1942:
"Many cases of personal injuries and deaths of employees of government contractors already have occurred, particularly at Pearl Harbor, Wake Island and in the Philippines. It is believed that relief for such injured persons and dependents of those sustaining death should be afforded by the Congress."
Five months later, Congress passed the War Hazards Compensation Act, providing the wounded with health care and reimbursement for lost wages, and blunting the pain of fatalities with family death benefits. The law was made retroactive to Dec. 7, 1941.
Hardly a single federal lawmaker holding office today would find fault with the decision to do right by those who had served and suffered for their country. Now, after another unprovoked attack on America, Washington must tend to the needs of another group who answered the call for their country, performing difficult, dangerous work amid jagged metal and toxic substances: the forgotten victims of 9/11.
The White House and Congress must stand behind the principle that in a time of war, the United States, as a nation, has a duty to ease the tolls borne by people who have put the national interest above their own. And the U.S. must do so in this instance by guaranteeing medical care for the more than 40,000 firefighters, police officers, construction workers, volunteers and others who served at Ground Zero.
The afflictions are concentrated naturally where the act of war was perpetrated, but the illnesses extend across the country because thousands of Americans rallied from at least 35 states to do their part. Citizens from California, Florida, Texas, Oregon and points in between labored shoulder to shoulder with citizens from the metropolitan area in the poisonous cloud that was released by the collapse of the World Trade Center. Falsely assured, like New Yorkers, that the air was safe, they are just as sick as the local responders. And, dispersed to home, they are perhaps even more forgotten.
Dorothy Hall, 70, a Red Cross volunteer from Burns, Tenn., worked for six weeks at Ground Zero and now suffers from interstitial lung disease - the same type of ailment that killed Trade Center responders Detective James Zadroga, Officer James Godbee, Firefighter Stephen Johnson and AT&T Wireless technician Mark DeBiase.
Nancy Hachmeister, 50, a search-and-rescue dog handler from Bountiful, Utah, spent 10 days with her German shepherd Ivey scouring The Pile for signs of life and human remains. Ever since, Hachmeister has been plagued by sinus infections and a persistent cough, sometimes hacking so violently that she vomits. Ivey died last year of cancer at the age of 9.
Hachmeister wants Washington, including Health and Human Services Secretary Michael Leavitt, a former Utah governor, to dedicate research dollars toward 9/11-related diseases. "He needs to know there is a definite problem, and not just for the New Yorkers who were there," Hachmeister said. "They need to be aware and do what they can as far as putting money into research to figure out what's going on here."
The focus on Leavitt is spot-on. It has been three months since the secretary - caught in the glare of the fifth anniversary of the terror attack - assigned his "A-team" to formulate what, if anything, his agency would do for the forgotten victims of 9/11. Since then, Leavitt and his aides have relapsed into the torpor that has become a hallmark of their record.
Slow to recognize that debilitating asthmas, potentially fatal lung-scarring diseases, chronic coughs and other respiratory illnesses are prevalent among Trade Center responders, they have provided only piecemeal aid - and only under determined prodding by Sen. Hillary Clinton and Reps. Carolyn Maloney and Vito Fossella.
It was only in October that HHS finally delivered federal funding to actually provide care to stricken rescue and recovery workers - $40 million that will allow specialists at the Fire Department and Mount Sinai Medical Center's World Trade Center clinics to treat, rather than simply screen and monitor, the ill. The money was, of course, appreciated, but at present rates of spending it will likely run out next summer.
More money will be crucial because Mount Sinai projects that its patient census will grow from 2,000 today to 13,000. The Fire Department also will expend its funding, and responders who are scattered across the country require care - and their unaddressed needs are beyond dispute.
In Menlo Park, Calif., Frank Fraone, 46, copes with permanently damaged lungs after working at The Pile 12 hours a day for 12 days as a member of a FEMA Urban Search and Rescue team. In Kittery, Maine, ironworker Bob Glancy, 51, developed Reactive Airways Distress Syndrome, a form of asthma, after he cut Trade Center steel for a month. In Huron, Ohio, the Rev. Stephen Petrovich, 55, an Eastern Orthodox priest, lives with shortness of breath and coughs up a half cup of phlegm a day, conditions that began after he spent 11 days at Ground Zero's morgue.
As Dr. Robin Herbert, director of Mount Sinai Medical Center's World Trade Center Medical Monitoring Program Data and Coordination Center, put it in September when a study showed that almost 70% of responders in her program had new or worsening lung conditions: "There should no longer be any doubt about the health effects of the World Trade Center. Our patients are sick and will need ongoing health monitoring and treatment for the rest of their lives."
These facts should be well known to Leavitt because they are well known to Dr. John Howard, director of the National Institute of Occupational Safety and Health, who served as the secretary's 9/11 health coordinator for seven months before that "A-team" took over and promptly receded into the mists. In light of this abdication, Congress must act.
Clinton, Maloney and Fossella must continue to lead the way toward providing first-class, long-term medical care to Trade Center responders. They have urged President Bush to include a line for funding in the federal budget, and Clinton has pressed the Senate to approve a five-year $1.9 billion appropriation. Her long efforts bore fruit Tuesday: California Sen. Barbara Boxer, who will head the Senate's environment committee when the Democratic majority takes over in January, got foursquare behind Clinton's proposal.
Referring to the Ground Zero workers, Boxer said: "We definitely owe them the help to get well, yes, because they were down there because we were attacked."
Full-scale congressional hearings are the next order of business in compelling Leavitt to fulfill the responsibility of designing and implementing a complex, fully robust health care program. One that covers a broad range of defined illnesses; provides outpatient and inpatient services; takes care of diagnostic tests and medications; treats patients without regard to health insurance; monitors for the anticipated arrival of cancers linked to exposure to Ground Zero carcinogens for years to come, and serves patients across the country through affiliated clinics staffed by the most knowledgeable specialists. Mount Sinai's program could well be the model.
There is clear precedent for a congressional inquiry of this nature. It is to be found in the history of what happened after an earlier generation of Americans stepped to the fore in response to an act of war. On Sept. 17, 1942, Subcommittee No. 1 of the House Judiciary Committee convened to delve into the national obligation to the thousands of civilians who joined the cause of World War II, starting at Pearl Harbor.
In that zone of devastation, brigades of men in the employ of contractors helped raise five sunken ships and recover weapons and equipment from two more. Of the 5,000 dives during the two-year salvage effort, half were performed by civilians.
"The Navy was fortunate indeed to once again have the personnel and the experience of the Pacific Bridge Co.," wrote retired Vice Adm. Homer Wallin in "Pearl Harbor: Why, How, Fleet Salvage and Final Appraisal," a ship-by-ship account of the salvage effort published by the Navy in 1968. "Without them the work could not have been done."
But as civilians, the responders were not entitled to military benefits when they were injured, disabled or killed. At the same time, they were excluded from workers' compensation, which covered only employment in their home states. Appeals for help rose as the battle zone expanded.
Subcommittee No. 1, chaired by Rep. Emmanuel Celler, who represented Brooklyn in Congress for half a century, confronted the question of duty in testimony by Lt. Col. Reese Hill of the War Department's Quartermaster Corps. As Rep. Earl Michener of Michigan put it, "Colonel, we appreciate your problem exactly and I am sure we all want to help, but you can see where the burden falls. It comes back to Congress."
And, indeed, it did. After a dissection of benefit regulations and a discussion of who should bear the cost of aiding the wounded, captured and killed, Hill responded, "It is a responsibility which, in my personal opinion, should be borne by the people as a whole, since it is a part of the war activity."
True then, true today, true timelessly.
Pulitzer for news
Our series on WTC health repercussions wins journalism's highest honor
BY DAVID SALTONSTALL
DAILY NEWS SENIOR CORRESPONDENT
Posted Tuesday, April 17th 2007, 4:00 AM
Daily News staffers celebrate Pulitzer Prize win for editorial series '9/11: The Forgotten Victims.'
The New York Daily News' Editorial Board won the Pulitzer Prize yesterday for its groundbreaking series of editorials, "9/11: The Forgotten Victims," which documented the growing medical fallout from the World Trade Center attacks.
In riveting, persuasive prose, the five-month series established how breathing the atomized air of the World Trade Center after 9/11 had sickened more than 12,000 emergency responders, at least five of them fatally.
The series, produced by Arthur Browne, Beverly Weintraub and Heidi Evans, also forced all levels of government to reexamine their initial medical response to the attacks, and in many cases react with a range of new benefits and services for rescuers, volunteers or their surviving family members. "Our greatest satisfaction is that these editorials became a force that helped thousands of ailing men and women after 9/11," said Browne, the Daily News editorial page editor. "And we are very proud that the Pulitzer board has recognized our work. We remain committed to advocating on behalf of the Ground Zero responders."
Many of the editorials were written almost as profiles of rescuers - men like retired Firefighter Stephen Johnson, whose lungs had turned to scar tissue but whose death had never been acknowledged by the city as 9/11-related; Vito Valenti, a Ground Zero volunteer who had to live on donated oxygen because workers' comp had denied him coverage, and Detective James Zadroga, who left behind a 4-year-old daughter when he died in January 2006 from his service at Ground Zero.
"What gave the series its power is that we marshaled medical evidence and married that with very painful stories of suffering by individuals who had come forth for the country and New York after an act of war," Browne added.
In awarding the prize, the Pulitzer board commended The News "for its compassionate and compelling editorials on behalf of Ground Zero workers, whose health problems were neglected by the city and the nation."
As a result of the series, the federal Department of Health and Human Services released $75 million to monitor and provide health care to 9/11 volunteers exposed to deadly toxins - the first federal funds dedicated explicitly to 9/11 health problems.
Then-Gov. George Pataki signed a bill to provide line-of-duty death benefits to responders' families; Mayor Bloomberg committed more than $37 million to monitor and treat victims, and Congress filed legislation seeking an additional $1.9 billion over five years.
Soon after the fifth anniversary of 9/11, President Bush added another $25 million to the federal budget - with a White House promise of more to come.
The prize was celebrated by The News with champagne and toasts yesterday afternoon beneath the wooden clock that has stood sentry over the paper's newsroom for decades. Daily News Chairman and Publisher Mortimer B. Zuckerman said the series continued the paper's proud tradition of defending the interests of the city's working people. "This is a great honor for the Daily News, and it reaffirms my belief that this newspaper fights for people who too often have no voice in this city," Zuckerman said.
The editorials were written by Browne; Weintraub, a member of the Editorial Board, and Evans a reporter who was assigned to the Editorial Board for the project. They detailed the enormous and growing medical toll paid by 9/11 responders in 13 separate pieces.
In the end, the paper's submission to the Pulitzer board was supported by 11 members of Congress, as well as doctors at Mount Sinai Medical Center's World Trade Center screening program and the New York Committee for Occupational Safety and Health, a nonprofit coalition of 200 local unions.Sen. Hillary Clinton (D-N.Y.) and Rep. Carolyn Maloney (D-Manhattan, Queens) - two key advocates in Washington for 9/11 health funding - both congratulated The News yesterday for the paper's 10th Pulitzer Prize in its 88-year history.
"The Daily News' powerfully written editorials helped change public policy to help thousands of Americans suffering as a result of 9/11," said Maloney. Added Clinton: "Through their eloquent and moving account of the 9/11 health crisis and the relative failure to confront it, the editorials helped to demonstrate the immediate and vital necessity of addressing this emergency."