Public Testimony

	New York City Department of Health & Mental Hygiene Bureau of Intergovernmental Affairs

Good afternoon Chair Addabbo and members of the Committee. I am Lorna Thorpe, Deputy Commissioner for Epidemiology at the New York City Department of Health and Mental Hygiene (DOHMH). On behalf of Commissioner Frieden, thank you for the opportunity to testify regarding the health effects of the 9/11 World Trade Center tragedy.

The collapse of the Towers on 9/11 was an unprecedented urban environmental disaster. In the days and months that followed, millions of people were affected emotionally, physically, and financially. This large and diverse population had a wide variety of individual experiences and exposures, and health impacts will vary. While we don't know all that we would like to know, we do know that many people have experienced respiratory symptoms and psychological distress including post-traumatic stress disorder (PTSD). We share a commitment with others in this room to do whatever we can to understand health problems better, and to link those who are in need of care to effective services.

The DOHMH World Trade Center Health Registry, which was conceived immediately after 9/11, is the main platform to enable us to better understand possible WTC-related illnesses and also a major means of assessing for gaps in treatment needs. More than 71,000 individuals who were highly exposed to the WTC disaster voluntarily enrolled in the WTCHR, making it the largest effort ever in the United States to systematically monitor the health of persons exposed to a large-scale disaster.

Since its establishment, the Registry has maintained a frequently-updated Resource Guide of 9/11-related resources and services to help enrollees and the public locate specialized care and learn about additional services in New York City. Enrollees are informed through periodic newsletters about Registry findings, research findings from other WTC-related studies, and important WTC-related news in general. The Registry also receives several hundred calls per month with WTC-related health questions from WTCHR enrollees and the general public. Staff provides referral information to callers about specialized medical and mental health services, including LIFENET, a free, confidential, crisis intervention, referral and information service.

Baseline interviews with 71,327 registrants were completed over a period of about 13 months, and we reported preliminary findings immediately upon completion of data collection in November 2004. Nearly half of adult enrollees in the survey reported new or worsened sinus or nasal problems after 9/11. Shortness of breath, wheezing, persistent cough, and throat irritation were also common respiratory complaints. One in four enrollees reported new or worsened reflux symptoms. Two to three years after the event, registrants also reported higher levels of psychological distress than the citywide average.

In April of 2006, we also published a study of the physical and mental health conditions of more than 8,000 registrants who were survivors of the collapsed or damaged buildings on 9/11. Many (57%) of the building survivors reported new or worsening respiratory symptoms. Presence on 9/11 in the dust or debris cloud caused by the Towers' collapse was the strongest factor associated with reported physical and mental health effects. Survivors caught in the dust cloud were twice as likely as those not caught in the cloud to report newly-diagnosed asthma. This study adds to the growing body of literature suggesting that exposure to the dust cloud on 9/11 in particular was a major risk factor for respiratory illness.

The first follow-up survey of the health of 71,000 Registry enrollees is beginning this fall. This survey will provide critical information on the persistence and resolution of health symptoms 5 years after the attacks, and it will also help us determine if new symptoms or conditions have emerged. An important goal for the follow-up survey is not only to identify persistent or new WTC-related illnesses, but also to identify and help address gaps in medical treatment among participants. Collecting follow-up information on 71,000 participants is expected to take at least nine months. We will release initial key findings as soon as possible upon the completion of the survey, as we did with our baseline survey, and we will also conduct additional investigations based on the updated data.

In addition, during the past year, the DOHMH led an initiative to update and disseminate clinical guidelines on how to treat adults exposed to the World Trade Center disaster who present with physical or mental health conditions. The guidelines update previously-released DOHMH guidelines on depression, post-traumatic stress disorder, and substance abuse disorders, as well as guidelines previously developed by Mt. Sinai and FDNY physicians on the diagnosis and treatment of respiratory, gastrointestinal, and sinus diseases.

These updated guidelines were prepared in collaboration with medical experts from the WTC Medical Monitoring and Treatment Programs, the New York City Fire Department, the NYU/Bellevue treatment program and other clinical and mental health specialists. They incorporate the latest available published information on physical health care, as well as new national guidelines on treatment of chronic cough. Their aim is to help physicians and other health professionals recognize and effectively treat conditions that are possibly WTC-related. They outline appropriate diagnostic and treatment approaches and they prompt health care providers to assess for possible association to WTC exposures. They received broad expert peer review, as well as repeated input from our labor and community advisors, and are being widely disseminated through the NYC DOHMH's City Health Information (CHI) publication and website. So that they will be available to health care providers outside the NYC area, the guidelines are also being posted on the U.S. Department of Health and Human Services web sites. We expect to update the guidelines periodically based on published scientific data.

Last week, the Mayor announced that the City is funding a series of initiatives that will augment medical and mental health screening and treatment programs, including establishing a new WTC Environmental Health Center at Bellevue Hospital, the expansion of the World Trade Center Unit at DOHMH, and the creation of a Mayoral review panel to ensure maximum coordination among City agencies and assess the sufficiency of state and federal resources to address ongoing needs.

The center at the Bellevue Hospital, in collaboration with NYU Medical Center, will focus on medical coverage gaps and provide evaluation and treatment for anyone exposed to the WTC attacks including people experiencing symptoms that are not covered by the existing WTC medical screening programs. This will include Lower Manhattan, Brooklyn and residents of all the boroughs, privately contracted workers, school children, and commercial building inhabitants. It will make available comprehensive medical and mental health assessments and specialty treatment to a broader range of people with suspected WTC-related health problems. DOHMH will evaluate and monitor the screening findings as part of its active surveillance efforts.

The initiatives also include an expanded unit at the Health Department to increase monitoring for potential WTC-related health conditions; increase communication with affected individuals, treating physicians, and the public; and expand risk reduction, linkage to care, and mental health services for those who continue to suffer after 9/11. These funds will be used to track, investigate, and better understand health problems potentially associated with the WTC attack. To the extent possible, we will monitor a range of health conditions, and routinely share that information with health care providers and the public. We will also collaborate with expert academic partners in this endeavor to systematically look for patterns of lung diseases, cancers and deaths, using data matches between the WTC Health Registry, death records, and cancer registries, as well as to conduct investigations of specific conditions.

Mental health services will be provided for people who were exposed to the WTC disaster, and who continue to suffer the psychological effects of 9/11, including uniformed services workers and their families. The DOHMH will also target risk reduction efforts to WTC-affected adults, including provision of information on environmental triggers for asthma, and will establish and promote a clearinghouse for information of interest to persons concerned about WTC health effects, health care providers, and the public.

Federal funding has supported the medical and mental health monitoring and treatment programs for WTC responders at the NYC Fire Department, Police Department and the various centers coordinated by the Mt. Sinai Medical Center, among others. These programs provide valuable screening and treatment to thousands of rescue and recovery workers and they must be continued. DOHMH has partnered with, and looks forward to continued collaboration with, the medical monitoring programs and other medical and academic institutions as well as labor and community groups to address health concerns related to the WTC disaster.

In closing, I would like to reiterate that while there is much we still do not know, there is much we are doing to better understand and better address health conditions, to share information with doctors, patients, and the public, and to facilitate appropriate medical care for those who are ill. The response involves many levels of government and private institutions. It will also require a long-term commitment of federal and state resources. Working together, we can make sure that all those who experience illness from the attacks on 9/11 have access to appropriate medical evaluation and treatment.

Thank you for the opportunity to testify. I would be happy to answer any questions.

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