Long Shadows of September 11th Attack on U.S. are Detailed in New Book; Nine Years Later, Will Congress Act to Help First Responders and Other Survivors?

A new book by former New York Times reporter Anthony DePalma offers a comprehensive and fearless account of the environmental aftermath of the September 11th attack on the World Trade Center and the public health consequences of the worst environmental disaster in New York City history.

In "City of Dust: Illness, Arrogance, and 9/11" (FT Press), DePalma sets out to examine "the scientific, medical, political and legal scope of the disaster" in panoramic fashion. That's a tall assignment. But DePalma largely succeeds in capturing the environmental health saga of one of the most heartrending episodes in the nation's history.

The horrors of September 11, 2001 remain indelibly etched in the minds of millions. Just hours after two planes slammed into the World Trade Center's twin towers, the 110-story buildings came crashing down. "Billowing gray dust plumes rampaged through city streets like monsters unleashed from hell," DePalma writes. As a result of this attack, at least 2,752 people perished (along with 224 more in the Pentagon attack and in the downed plane in Shanksville, Pennsylvania).

The ensuing fires at Ground Zero "raged at over 1,000 degrees for days and then smoldered at lower temperatures for months." These fires, along with the jagged steel and unstable ruins, created what DePalma calls "the most dangerous workplace in the country" during the long, sad fall of 2001.

No precise numbers are available as to the total numbers of persons exposed to the toxic cloud that engulfed Lower Manhattan on 9/11 or the noxious smoke that seared the lungs of those at Ground Zero for weeks thereafter. When the federal government ultimately created a World Trade Center Health Registry -- designed to identify and track all first-responders, Ground Zero workers, and persons who lived or worked in the vicinity or who happened to be in the area on September 11th -- 71,000 people signed up. While most live in New York, New Jersey or Connecticut, Health Registry enrollees come from every state in the nation and 15 other countries.

DePalma reminds his readers of the government statements and actions that mislead the public on the scope of the health risks in the aftermath of the horrific attack.

"The air quality is not dangerous," Mayor Rudy Giuliani told the press on September 12th. And New York City's Departments of Environmental Protection and Health did little in the days and weeks that followed to clarify or refine that unknowing, oversimplified message.

"I am glad to reassure the people of New York and Washington D.C. that their air is safe to breathe and their water is safe to drink," the U.S. Environmental Protection Agency ("EPA") Administrator, Christie Whitman, said on September 18th.

But, as an EPA Inspector General's investigation later revealed, this and similar EPA statements were not accurate. One reason, DePalma recounts, is that all EPA press releases issued during the initial clean-up "were scrubbed by the White House and the [President's] Council on Environmental Quality" before being released. On some occasions, "the Bush White House made subtle word changes that effectively repackaged the message, slimming down the risks...."

"By not being clear about the risks," writes DePalma, "the federal and municipal governments - in what has been called a conspiracy of purpose - sacrificed a degree of safety for the quick recovery of Wall Street."

While he concludes that many bad decisions were made relating to the public health aftermath of the 9/11 attack, DePalma finds "no venality." Rather, he writes, "a long sequence of individual decisions - some made in haste, some made with arrogance - favored the recovery of the city over the recovery of its people."

An early consequence of government's failure to warn of the risks associated with direct exposure to the dust and smoke was the World Trade Center cough - a pulmonary syndrome that within a month hampered most of the firefighters and thousands of others who were present in Lower Manhattan on September 11th or the days that followed.

More serious have been the long-term lung impairments affecting thousands of first-responders. One study, conducted by Dr. David Prezant, chief medical officer at the New York City Fire Department and a heroic figure himself, confirmed that exposure to dust and smoke at Ground Zero left a substantial proportion of firefighters and Emergency Medical Service workers with abnormal lung function; about 5,000 were found to have symptoms that persisted even seven years later. Another noteworthy study concluded that between 17,400 and 40,000 new cases of adult asthma have developed among persons heavily exposed in the aftermath of September 11th.

DePalma is a good story-teller and he pulls his readers into some of 9/11's stories of personal tragedy and triumph. One example is his chapter on the Fullam brothers, Marty and Dave, both of whom were FDNY veterans who responded to the call on 9/11 and toiled at Ground Zero during the continuing rescue operations. "One brother came of the fire scarred but whole. The other nearly died and will spend every day of the rest of his life taking a medicine cabinet of medications ... and hoping against hope that with a new lung and a team of doctors who care, he can watch his three daughters grow into fine young women."

Of course, it is now widely recognized that thousands of first-responders have suffered lung-related ailments that proved to be more serious that initially thought. But much still remains unknown. "Even with the most advanced science," writes DePalma, "we do not yet know what the wicked concoction of dust, ash, and toxic materials did when it landed deep inside the lungs of responders."

One controversial issue that DePalma confronts head-on is the number of deaths that can be directly attributed to exposure to the witches' brew of 9/11 contaminants. Before he would certify a death as related to the September 11th attacks and add the names of the deceased to the official tally, Dr. Charles Hirsch, the city's chief medical examiner, has required that proof linking the death to contaminants must be established with "certainty beyond a reasonable doubt." This approach has caused great consternation, especially among the families of first-responders who believe their loved ones premature deaths were indeed linked to exposures received in the toxic aftermath of the Trade Center's destruction.

DePalma re-tells the tragic story of New York City Police Detective James Zadroga, who responded heroically, inhaling toxic dust on 9/11 and in the weeks that followed, and who died in 2006. Ultimately, however, medical examiner Hirsch ruled that Zadroga's death had not been directly caused by to exposure to 9/11 contaminants.

DePalma's discussion serves as a stark reminder of the importance of following the precautionary principle in responding to environmental disasters.

Many, although not all, of illnesses that surfaced in the weeks and months after the 9/11 attack itself could presumably been avoided or mitigated if government officials and other key actors were more diligent in seeking to prevent harmful exposures by first responders, at least after the initial rescue operations ended.

DePalma also relates how government delayed and then bungled the clean-up of Lower Manhattan residences. He tells of the anguish that even the most determined and sophisticated downtown dwellers, like Catherine McVay Hughes, went through as they struggled to obtain information, arrange for testing and secure clean-up of their apartments and their children's schools.

DePalma's comprehensive recap of the 9/11 health disaster identifies others who stood out in one way or another for their public service in the aftermath of the attack. Among them are Joel Kupferman and Juan Gonzalez (a crusading lawyer and newspaper columnist, respectively, who were among the first to alert the public to the persisting air quality dangers) and Paul Lioy, Steve Levin and Phil Landrigan (three of the many physicians who stepped up to document the pollution problems or provide first responders with expert medical care). To be mentioned in DePalma's book is, for sure, not to be canonized. But considering the unprecedented situation in which they all found themselves in the wake of the 9/11 attack, these individuals and their colleagues deserve public thanks.

DePalma's book -- part chronicle of tragedy and heroism, part detective story and part legal thriller -- is also something of a cliff hanger.

Two major subplots remain unresolved.

The first is the massive civil litigation filed in 2004 by approximately 10,000 first responders and other workers against the City of New York and other agencies and private firms, seeking compensation for the failure of government to protect them from exposure to 9/11 contaminants. DePalma shares the courtroom drama and commends federal district Judge Alvin K. Hellerstein for his handling of the extraordinarily complex litigation.

"Hellerstein's greatest concern as he promoted a settlement always had been to make sure that those who were most severely injured received the bulk of the compensation," writes DePalma. Early this year, Judge Hellerstein rejected the first settlement proposed by the parties, in part for this reason.

A revised settlement agreement was announced in June. Under this agreement, a maximum payout of $712.5 million is authorized to be paid to thousands of plaintiffs, with the exact amount of each payment based upon the severity of the illness and the strength of the link between the illness and exposure to 9/11 contaminants. Ninety-five per cent of all plaintiffs must accept the settlement terms by November 8, 2010 before the agreement can take effect.

The other outstanding matter is whether Congress will finally enact the long-delayed James Zadroga 9/11 Health Compensation Act. This legislation -- which has been spearheaded in the House by Representatives Carolyn Maloney, Jerrold Nadler, Peter King and Michael McMahon - would fund medical monitoring and treatment for first responders and others exposed to Trade Center contaminants and provide reasonable compensation to those who have not been compensated for losses suffered as a result of World Trade Center-related illnesses.

The House legislation seems to have considerable support, but has been held up for procedural reasons. In the Senate, passage of an identical bill, spearheaded by Senator Kirsten Gillibrand, also seems within reach.

Of course, there is much we still don't know about the ultimate health impacts of the thousands of Americans who were exposed to the toxic contaminants in the horrific aftermath of 9/11. It will take many years before the final accounting can be definitively recorded.

But anyone who reads DePalma's important new book will be hard-pressed to deny that the courageous first-responders and others who were exposed to the pollution aftermath deserve the medical care and fair compensation provided for under the legislation now pending in the United States Congress.