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Mr. SHAYS. Thank you. I thank the gentleman very much.

I am just going to do a little housekeeping here and ask unanimous that all members of the subcommittee be permitted to place an opening statement in the record. And that the record remain open for 3 days for that purpose.

Without objection, so ordered.

I ask further unanimous consent that all witnesses be permitted to include their written statement in the record. And without objection, so ordered.

I ask even further unanimous consent that Representative Towns, a member of the Government Reform Committee and any other member of the Government Reform Committee who may show up, and Representative Jerry Nadler sit with this committee as a full participant. And without objection, so ordered.

Before recognizing the witnesses, I want to say since this is the first hearing, this hearing will raise many questions, a number will not be answered today nor will we even seek to get some questions answered. We have heard very important statements from all the participants at this hearing. Ultimately, it would be the goal of this committee to have every one of those questions answered and every problem dealt with.

At this hearing, and I want to say I am going to be pretty focused on this and pretty strict in adhering to it, at this hearing we are focused on the workers and first responders' health conditions, their diagnoses, their treatment, their compensation. This hearing does not focus on residents, it does not focus on other workers who may work there. It does not focus yet on the clean up of facilities there. And we will. We will focus on those issues and we will make sure that any Member who has raised his questions, gets answers to those questions.

At this time, I would recognize our participants. We have our first panel.

Dr. Robin Herbert, co-director of the World Trade Center Worker and Volunteer Medical Screening Program, Medical co-director of Mount Sinai. And she is accompanied by Dr. Stephen Levin, co-director of the World Trade Center Worker and Volunteer Medical Screening Program.

So Dr. Herbert will be giving the statement.

We then have Commissioner Thomas Frieden, a doctor at New York Department of Health and Mental Hygiene. Dr. Michael Weiden, medical officer, New York Fire Department; Mr. Phil McArdle, health and safety officer, Uniformed Firefighters Association; Mr. Jimmy Willis, vice chair for conductors, assistant to the president, Transportation Workers Union; Mr. John Graham, health and safety instructor, Carpenters Union, and; Mr. David Rapp, former worker at the World Trade Center site.

We don't usually have this many panelists. I have been liberal when we have a smaller panel of being able to go over the 5-minutes. I would really respectfully ask that you submit your statement in 5 minutes. And if you think you need to redo it a little bit, I can skip over you to give you a little time. But if you go 5° minutes, maybe a little longer, but we would like you stay somewhere within that range.

And so at that time I need to do one more. If you can all stand up in this cozy area we have, but I do need you to stand. I do need to swear you in.

[Witnesses sworn.]

Mr. SHAYS. Note for the record all the witnesses have responded in the affirmative.

We are going to start with you, Dr. Herbert, and we are just going to kind of go down the line here. And we will do a lot of good listening, that is why we are here.

STATEMENTS OF DR. ROBIN HERBERT, CO-DIRECTOR OF THE WORLD TRADE CENTER WORKER AND VOLUNTEER MEDICAL SCREENING PROGRAM, MEDICAL CO-DIRECTOR OF MOUNT SINAI; DR. STEPHEN LEVIN, CO-DIRECTOR OF THE WORLD TRADE CENTER WORKER AND VOLUNTEER MEDICAL SCREENING PROGRAM; COMMISSIONER THOMAS FRIEDEN, A DOCTOR AT NEW YORK DEPARTMENT OF HEALTH AND MENTAL HYGIENE; DR. MICHAEL WEIDEN, MEDICAL OFFICER, NEW YORK FIRE DEPARTMENT; PHIL MCARDLE, HEALTH AND SAFETY OFFICER, UNIFORMED FIREFIGHTERS ASSOCIATION; JIMMY WILLIS, VICE CHAIR FOR CONDUCTORS, ASSISTANT TO THE PRESIDENT, TRANSPORTATION WORKERS UNION; JOHN GRAHAM, HEALTH AND SAFETY INSTRUCTOR, CARPENTERS UNION; AND DAVID RAPP, FORMER WORKER AT THE WORLD TRADE CENTER SITE

Dr. HERBERT. Thank you. Thank you for asking me to testify today.

The September 11th terrorist attacks on the World Trade Center resulted in horrific loss of life. Amid the shock and grief we all experienced immediately after the attacks, some failed to recognize that the terrorists had also created one of the worst acute urban environmental disasters ever to occur in U.S. history.

Soon after the attacks, various New York area health care providers, including ourselves, began seeing workers and others with serious health problems due to their World Trade Center exposures. Many of us participated in the working group assembled by NIOSH to develop common approaches to the diagnoses and treatment of World Trade Center related health problems.

In June 2002, Mt Sinai received $11.8 million in Federal funding to establish the World Trade Center Worker and Volunteer Medical Screening Program. This funding enabled us to design and coordinate a consortium of health care centers in the New York metropolitan area, and nationally, to provide free medical screening examinations for World Trade Center responders who were involved in various rescue and recovery efforts.

In January 2003, we released some preliminary findings from analysis of 250 of the first 500 people who had come through the program. We reported that 78 percent had at least one World Trade Center related pulmonary symptom while working or volunteering at the site, and 46 percent were still experiencing at least one pulmonary symptom in the month before the screening exam up to 10 months after September 11th. Eighty-eight percent had at least one World Trade Center related ear, nose or throat

symptom while performing World Trade Center response work, and 52 percent were still experiencing at least one ear, nose and throat symptom in the month before the screening examination.

Finally, 52 percent reported mental health symptoms requiring further evaluation when they came for screening.

We have now seen over 8,000 men and women in our screening program and we now know that a substantial number of World Trade Center responders have developed upper and lower respiratory problems that are lasting as long as 2 years. However we do not know what the long term effects of the World Trade Center exposures will be, and in particular we are concerned about can

cers.

Because of the high prevalence of persistent World Trade Center related health problems we were seeing, as well as the worry about what the long term consequences might be, it became clear that there was a need for both long term medical monitoring of responders as well as a need for medical treatment for those who have developed World Trade Center illnesses. For these reasons we joined with fellow occupational health experts, labor leaders and concerned Federal legislators in an intensive year long lobby for Federal resources for long term medical monitoring.

Last February it was announced that this money had been appropriated. Although we still await the final award of the funding, we join with thousands of ill and injured workers and volunteers in our appreciation of your efforts to secure those resources. Of the $90 million allocated in the early winter of 2003, $4 million has been provided to allow us to expand the baseline medical screening program so that 3,000 additional workers and volunteers will receive free comprehensive medical screening examines.

Another $25 million is allocated specifically for examinations of New York City firefighters. And the remaining funding, approximately $56 million, will be used to establish, coordinate and conduct a program for long term medical monitoring of World Trade Center responders. However, these funds are unfortunately insufficient to provide periodic medical examinations of World Trade Center responders for the 20 years that we would advocate.

We estimate that the current funding will support a program to conduct screening examinations of 12,000 responders every year and a half for 5 years only. However, we would recommend screening for a minimum of 20 years because the World Trade Center responders sustained exposures without precedent. These exposures may cause new, unexpected health consequences, including possibly cancers, which would be unlikely to show up for at least 15 years after the time of exposure. This means that the screening program as currently funded will not last long enough to ensure that diseases that develop only after years have passed, can be detected when they're still treatable.

Equally pressing at this time is the need for treatment. We're identifying many people who need ongoing treatment for World Trade Center related physical and mental health problems. But, unfortunately, there is still not an adequately funded treatment program. At Mount Sinai we've sought and received funding from private philanthropic sources to establish a treatment program for a limited number of World Trade Center responders. But philan

thropy simply cannot provide all the sources necessary to provide care who need it.

Among the first 350 patients we have seen in our treatment program, we have found that 75 percent have persistent World Trade Center related upper respiratory problems; 44 percent have persistent World Trade Center related lung problems, and; 40 percent have persistent mental health consequences related to the disaster. But, 40 percent do not have medical insurance and about one-third are now unemployed. It is, thus, urgent that funding be made available to provide access to medical and mental health care for all whose sustained health consequences from the World Trade Center disaster; workers and volunteers involved in rescue and recovery, workers from the immediate area and area residents as well as their children.

In conclusion, funding is vitally needed to: One, to supplement the current appropriated dollars in order to extend the duration of the long term medical monitoring program for a minimum of 20 years; two, to ensure access to treatment for all World Trade Center related health problems identified in screening programs; three, to ensure that those who develop future health problems related to World Trade Center exposures are able to receive treatment for those conditions, and; four, to support clinical research to better understand the human health consequences of the exposures, and most importantly, to identify treatment modalities for those conditions.

Surely those who responded so selflessly to the disaster deserve no less.

Thank you.

[The prepared statement of Dr. Herbert follows:]

TESTIMONY
Before

The United States Congress

House of Representatives

Committee on Government Relations

Subcommittee on National Security, Emerging Threats, and International Relations

Assessing September 11th Health Effects: What Should Be Done?

Robin Herbert, M.D.

Medical Co-Director, Mount Sinai Center for Occupational and Environmental Medicine
Co-Director, World Trade Center Worker and Volunteer Medical Screening Program
Associate Professor, Department of Community and Preventive Medicine
Mount Sinai School of Medicine
New York, New York

October 28, 2003

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