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The clinicians and outreach workers at New York's Mt. Sinai Medical Center were foreordained to lead in testing and treating the rescue and recovery workers for toxic exposures.

First, its doctors have been internationally renowned in the esoteric field of environmental hazards to workers even before Dr. Irving Selikoff, a noted researcher there, found proof in the 1960s of the fatal risks of asbestos.

The Selikoff Center at Mt. Sinai has some of the country's top experts on work-related diseases, such as those acquired from carcinogens. Its clinicians monitor the workers themselves, treat them or refer them to other specialists. Environmental scientists from the Environmental Protection Agency, for example, monitor air quality but do not test individual workers.

The staff received within days of Sept. 11, 2001, people who were in Lower Manhattan when the towers collapsed, and by October handled a growing flood of rescue and recovery workers. By the close of 2001, its routine capacity to test and treat more workers was exhausted.

The Selikoff Center then negotiated a grant from the National Institute of Occupational Safety and Health to perform one-time exams on anyone wanting to be tested for Sept. 11-related exposures. Work under this grant began in early 2002. A year later, in 2003, NIOSH awarded the Selikoff Center a five-year grant for repeated monitoring, again voluntary.

On the third anniversary of the attack, in September 2004, Mt. Sinai clinicians reported the results of 1,138 examinations. They wrote, "New and persistent respiratory problems" affected more than a half of the workers. They also found that more than a half had "persistent psychological problems."

Mt. Sinai-based clinicians released a report on the fifth anniversary saying, "the prevalence of pulmonary function abnormalities" was very high. For this report they examined about 9,000 workers.

With the 2003 NIOSH grant, the clinicians set up a registry into which all concerned individuals could enroll for periodic monitoring. By the end of 2006, 70,000 rescue and recovery workers and Lower Manhattan residents and office workers were participating.

Ironically, medical attention was not getting to the rescue and recovery workers through the established channels of workers' compensation--employers, their insurers and state regulators. The state's workers' comp board sat on millions of federal funds for outreach and management even as symptoms of disease became more pronounced.

Shortly after President George W. Bush's 2007 State of the Union address, the federal government gave $25 million to Mt. Sinai to further its testing and treatment.

But critics said that $25 million was just a fraction of what will be needed to treat the impending health crisis among the thousands of people affected by the Sept. 11 cleanup.

In a spring interview, Jacqueline Moline of Mt. Sinai's World Trade Center health program said the center expected to be out of funds by the summer. "There are 34,000 patients that are supposed to be treated with the $25 million, and that's not going to go very far."

Experts estimate the hospital needs $250 million a year to treat sick workers, and Sen. Hillary Clinton, D-N.Y., has said that $1.9 billion in funding will be needed over several years.

The federal Office of Management and Budget, responding to those statements, said the $25 million was just a "starting point" toward paying for WTC health care. Once it's in the president's budget, OMB says, it will always be in line for federal funds.

Further, "we will make sure that no ground zero worker lacks care because of funding," says OMB spokesman Sean Kevelighan.

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September 1, 2007

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