Confined Space

I wrote last week about the attempt of a couple of labor unions to deal with the slow-motion disaster of "popcorn workers lung." Today, we return to another slow-motion American disaster -- one that sickening, and probably shortening the lives of thousands of American heroes -- World Trade Center clean-up workers. It's been a while since I've written about this continuing American tragedy, and I'm astonished about the expanding scope and depth of the disaster that is seemingly hiding below the radar of the news media of this country -- with the exception of the New York City area.

***

When most of the country thinks of 9/11 and the destruction the World Trade Centers, they think of the planes, the people jumping from buildings, and those crushed to death when the buildings collapsed. The entire world recognizes that day as a disaster, but most of the world fails to not that the disaster that began on 9/11 continues to this day, as the victims of the "the largest acute environmental disaster that ever has befallen New York City" continue to get sick and die horrible painful deaths, while federal and state officials are only now -- five years later -- beginning to respond adequately.

The New York Daily News has published a multi-issue special report about the suffering of World Trade Center cleanup workers:

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.

Christopher Hynes is but one among thousands:

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.

The tragedy is human, and, like most workplace illness, it's also political:

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.

One article highlights several additional case studies among 40,000 "who stepped forward for New York and America after 9/11, and they speak here of the price they paid for serving." There are many stories here that you should read, but here's just one:

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

The individual stories are tragic, but the sheer numbers are staggering:

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.

Betrayal: "Safe and Acceptable"

It all began with a betrayal, 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."

Twelve Years Of Age-Related Decline

Another recent study has confirmed the extent of the damage caused to WTC workers:

The analysis of fire and Emergency Medical Technician workers conducted by the FDNY and Montefiore Medical Center-Albert Einstein College of Medicine could make Bloomberg reconsider his position. It found that firefighters in The Pit suffered a loss of lung power "equal to that of 12 years of age-related decline."

"Those who had more exposure, those who arrived earlier, had a more severe loss," said Montefiore's Dr. Gisela Banauch, also a co-author of the study, parts of which were released in May and all of which will be published next week in the American Journal of Respiratory and Critical Care Medicine.

Early Warning, Delayed Action

The effect of inhaling the dust were very clear, very early:

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.

As early as November of 2001, doctors at the Mount Sinai Medical Center had established a protocol, or guidelines for treating treating the responders who were already showing characteristic signs of illness, according to Dr. Robin Herbert, co-director of Mount Sinai's World Trade Center Health Monitoring Program.

But the officials declined, saying there was no clear consensus that the respiratory ailments were related to exposure at the site.

Almost five years later, with hundreds of former Ground Zero workers suffering from respiratory, gastrointestinal and mental ailments that doctors say resulted from their work there, city health officials are finally preparing the protocols, which they expect to be published this summer. But doctors who observed these medical problems right from the start are upset that it's taken the city so long.

"It's tragic that it's taken public health officials of New York almost five years," Herbert told me. "It's better late than never, but it's pretty late." She said there's no doubt that the lack of citywide guidelines has resulted in some patients' not being treated properly.<

The result was misdiagnosis and mistreatment.

Now, five years later, the city has finally developed its own protocols, but is still denying any connection between cleanup work and the illnesses suffered by responders.

With at least one class-action lawsuit pending against the city on behalf of plaintiffs claiming illnesses and even deaths as a result of Ground Zero exposure, the city has denied any deaths were related to exposure there. Some say the reason the city is moving on the protocols now is because John Howard, the federal official in charge of 9/11-related health issues, has asked for them. But the city can't waste any more time. How many people could have been spared prolonged discomfort and worsening illness if they had been available earlier?

State and federal authorities have also been excruciatingly slow in determining cleanup eligibility of sick and broke cleanup workers for workers compensation.

Getting relief from the workers' comp system is a grueling ordeal. And New York still hasn't received $56 million that was appropriated by Congress in December to pay the medical expenses of sick Ground Zero responders. Given his recent good news, Picurro considers himself lucky.

In fact, one attorney is claiming that the city is using federal funds to fight workers comp claims:

David Worby, who is waging a suit on behalf of 8,000 WTC responders and their survivors, said $20 million has been "spent on city lawyers to deny the claims of cops, firefighters and others who were sickened."

"That money should be used to help these people," he said. "Take $100 million from the billion, Mr. Mayor, and set up a proper registry" to monitor the health of those who toiled at Ground Zero.

There was no immediate response to Worby's accusation from Mayor Bloomberg, but the city contends it is allowed to tap funds from the World Trade Center Captive Insurance Company to defend itself against claims. The federally funded entity was set up after the 9/11 attacks because no commercial insurance company would take on the risk.

Bloomberg promised to look into whether the city stiffed its 9/11 heroes after being prodded to do so by hard-hitting Daily News editorials that described the plight of 12,000 ailing Ground Zero workers.

So far, he hasn't acknowledged that the deaths of at least four first responders - and the illnesses of thousands more - were directly related to their toiling amid the toxins of Ground Zero.

Why?

The problem was certainly not lack of information and evidence:

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.

As the Daily News series concludes:

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.

Labels: 9/11 World Trade Center Workers

Ground Zero Workers: Neglected Victims of "The Largest Acute Environmental Disaster That Ever Has Befallen New York City"