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Abandoned heroes
Mayor must face WTC health crisis They rallied for New York and America in the terrible hours after the World Trade Center collapsed - and ever since, thousands have paid with their health. Some have given their lives.
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.
They cough.
They wheeze.
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 lieThe 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 toxinsThe 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 leadershipWhat'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.
TOMORROW
The fatalities among the forgotten
Originally published on July 22, 2006
