Winthrop University Hospital local site for care of 9/11 illnesses

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More than ten years after the World Trade Center attack, the image of three ophthalmologists vying with each other to jointly wash the dust encrusted eyes of a weary first responder binds and brings into stark relief Dr. Marc Wilkenfeld’s career, life and beliefs. “Everyone wanted to help, they were anxious to be involved; there were not enough patients,” he said. “They were either dead or fine. There was nothing much to do after the first day.” But that image, he recalled, made him think of three Leviim (Levites) vying to wash the hands of one Cohen before duchenin (giving the Priestly blessing). Currently, Wilkenfeld is Chief of the Division of Occupational and Environmental Medicine at Winthrop University Hospital in Garden City. His expertise was the hazards found in the workplace or home until that fateful day. It still is, but now he also deals with those who came to help or lived in the area of Ground Zero, working with, living with and inhaling the acrid toxic dust and fumes spewing out of the wreckage that continued to burn until January 2002. On June 13, Dr. John Howard, the administrator of the World Trade Center Health Program, proposed adding over 30 cancers to the list of WTC-related health conditions. This new development, if approved, will supplement the James Zadroga 9/11 Health and Compensation Act of 2010 and will expand the free coverage of these and the previously covered illnesses. “The rule was proposed by the Federal government,” said Wilkenfeld, noting that the addition of cancer to the list of covered conditions was proposed, but “nothing is definite yet and no one knows what the final regulation will be.” As far as the currently covered conditions, “as long as the doctor believes that it is related to 9/11,” the patient can be treated in the program. The patient “needs proof that they were there, they have to get certified as eligible for the program.” It covers medications, the co-pay, surgeries, CAT scans, breathing tests, sleep apnea. “It’s all covered.” He noted that the patients receive “excellent care, the doctors have expertise. We hear the same stories every day, we know what to do.” The proposal states that: “Title I of the James Zadroga 9/11 Health and Compensation Act of 2010 amended the Public Health Service Act (PHS Act) to establish the World Trade Center (WTC) Health Program. The WTC Health Program, which is administered by the Director of the National Institute for Occupational Safety and Health (NIOSH), within the Centers for Disease Control and Prevention (CDC), provides medical monitoring and treatment to eligible firefighters and related personnel, law enforcement officers, and rescue, recovery, and cleanup workers who responded to the September 11, 2001, terrorist attacks in New York City, at the Pentagon, and in Shanksville, Pennsylvania, and to eligible survivors of the New York City attacks. In accordance with our regulations, which establish procedures for adding a new condition to the list of health conditions covered by the WTC Health Program, this proposed rule would add certain types of cancer to the List of WTC-Related Health Conditions.” The 9/11 Act was named after Detective James Zadroga of the New York City Police Department. He was on site following the attack and spent over 470 hours digging through the debris. He died on January 6, 2006 of respiratory disease directly related to his work following the terrorist attack on the World Trade Center. Dr. Wilkenfeld has practiced occupational and environmental medicine for over 20 years at Columbia, Gouverneur, and now at Winthrop. Some of the concerns he has addressed were illness in the workplace and chemical exposure. He has traveled and consulted on environmental and occupational medicine in industries, educational and government institutions across the United States, Canada, Europe and Asia. Wilkenfeld was living in Lower Manhattan at the time of the attacks and went to Ground Zero on September 12th. “We walked through the checkpoints,” he said. “It was like a nuclear bomb hit. You couldn’t see where anything was, everything was covered with dust.” He noted that at the time, the federal government had said that it was “ok” to breathe the air. “We ask patients ‘did you wear a mask?’ and they all say ‘no, everybody said that it was ok.’” On September 14, Christine Whitman, then administrator of the Environmental Protection Agency, said that the air was safe to breathe, said Wilkenfeld, after the federal government sampled the air. Councilman Alan Gerson of district one in lower Manhattan brought industrial hygienists from outside of New York and tested the dust. They found asbestos in the dust. “All the patients said that ‘just being there they knew that they couldn’t breathe,’ that it smelled bad.” “If there is dust on a carpet eight blocks away and a baby is playing on that carpet,” said Wilkenfeld, “it is more complicated then it sounds. That’s why we are concerned about the dust.” Wilkenfeld pointed out that there was a lawsuit, brought against the EPA by people who were exposed to the dust. He said the “EPA commissioned a technical advisory panel but ended it before any final recommendations could be issued. The question remains if the clean up was proper. The government set up a medical program to treat people who were there.” Aside from the cancers, the initial ailments that developed from the toxic cocktail that people at the site inhaled and were exposed to included chronic illnesses, gastroesophageal reflux disease (GERD), asthma, sleep apnea, depression, PTSD, and mental health issues. “They saw body parts,” explained Wilkenfeld, “they saw people jumping from the buildings; they were searching for survivors and found body parts, they were sifting through the Arthur Kill landfill on Staten Island. These are usually very tough guys. A lot saw bad things. People say that they lost their best friend to illness; a number of police officers died in the actual event.” The caustic substances burnt their nasal and sinus passages and their stomachs. “It was like breathing lye,” he said. Some of the toxins included asbestos, silica, lead, mercury, dioxins and volatile organic solvents such as benzene. Some of the sources of these toxins included 5000 tons of chrysotile asbestos that was used as a fire retardant in one of the towers of the WTC. Wilkenfeld noted that Mayor John Lindsay halted the spray of the asbestos on the second tower when Dr. Irving Selikoff of Mt. Sinai hospital said it was dangerous. Wilkenfeld said that there was lead in computer monitors, mercury in lighting, and other agents from burning diesel fuel. He said that the people working there after the attacks should have been warned of the hazards and should have been provided with respiratory protection. “They should have had full face respirators with a strong filter,” similar to the masks distributed in Israel, he stressed. Patients can be evaluated anywhere in the country, he pointed out. He was part of the initial advisory panel for the EPA. The first treatment was at Mount Sinai Hospital in 2002. Charities and private insurance paid for the treatment then. He said that “hundreds of thousands of people came with medical conditions and the government began funding in 2006 with centers in Mount Sinai, Bellevue, Stonybrook, Robert Wood Johnson Clinic, and at Queens College.” Another is now open in Brooklyn near Downstate Medical Center. The clinics had to request funding yearly until the Zadroga bill passed, providing $2 billion over five years. Dr. Wilkenfeld explained that patients include police officers, construction workers, electricians, operating engineers, volunteer fire fighters, civilian fire department workers, carpenters, and medics (the city fire department has its own program). The program has coverage in California and Florida as well. “They know the cancers the chemicals cause from industrial hygiene and epidemiological studies,” Wilkenfeld explained. “We don’t want to wait till it’s proven 20 years from now and they then die and realize that it should have been covered. We treat now and keep doing studies. Early studies show a rise in cancer. Congress may need to appropriate more money to fund the program.” The Winthrop University Hospital center where Wilkenfeld works is modern, with state-of-the-art equipment, and full service, able to treat all aspects of care, and concerned, friendly staff. The hotel-like sleep disorders clinic is across the hall. His specialty, he said, “is a good field. I can influence public policy for the good of public health. I can help people.” He feels a unique tie to his work. Growing up, he said, “My parents’ balcony faced the World Trade Center. I saw them building it. I thought, ‘wow’ they are building a castle.” At the time of September 11, “I had just returned to New York from a factory in Quebec and went to check on my dad. He was close to 90 and he was sitting on his terrace. He knew something was happening and he watched the towers collapse. I was looking for comfort and asked him if it was like Pearl Harbor, trying to find some commonality. ‘No, this is much worse,’ he had said. He said in 1941, when he was listening to the radio, he asked his dad where Pearl Harbor was and he didn’t know. ‘These are our neighbors,’ said the senior Wilkenfeld about the World Trade Center, ‘this was a personal attack.’ That’s why I take the whole thing very personally. It was great flying around visiting factories. But this is very fulfilling; I’m very happy to be a part of something that helps people that were affected by the tragedy. I’m trying to help, diagnose and treat them. The patients are the most important.” The WTC Health Program—Long Island Clinical Center can be reached at 631-855-1200. To learn more about the WTC Health Program, go to www.cdc.gov/wtc or call 1-888-WTC-HP4U (1-888-982-4748).