DOCTOR TURNS PATIENT ADVOCATE

DOCTOR TURNS PATIENT ADVOCATE: Dr. Michael Crane, the medical director of the Selikoff Centers for Occupational Health at The Mount Sinai Hospital and of the WTC Health Program Clinical Center of Excellence at Mount Sinai, worries that not enough people who lived and worked in the area have been screened for possible illnesses stemming from the attacks, and that among employees who have been, their pension systems have been too quick to reject disability-pension applications. ‘Whatever needs to be done to have [pension-board] folks awakened to the injustice of what is happening here really needs to be done,’ he said.

The disclosure that the city and state retirement systems are rejecting more 9/11 disability claims than they are approving has the top doctor with the World Trade Center Health Program concerned about the stress placed on his patients who have to hire lawyers to battle the bureaucracy.

Officials from both systems first reported their rejection rates at an oversight hearing held on Nov. 15 by Sen. Martin Golden, chair of the Senate Committee on Civil Service and Pensions.

“The last thing we want to do for people that have had exposure to the World Trade Center toxins is to increase their anxieties about anything,” said Dr. Michael Crane, the Medical Director of the Selikoff Centers for Occupational Health at The Mount Sinai Hospital and of the WTC Health Program Clinical Center of Excellence at Mount Sinai. “We try and tell folks to take things one day at a time and take care of their issues and that we can help and support them…If, in fact, the various institutional situations they run into increase those tensions, it is something else we have to deal with, and the people have to deal with.”

The WTC disability-turndown rates have put both the New York City Employees’ Retirement System and the New York State and Local Retirement System on the hot seat with local and state lawmakers who say they have been inundated with constituent complaints about denials and delays that can drag on for years.

Lawyers representing the claimants say that both the delays and denials have a major impact on the ability of their clients to get the optimum payments that they and their families are entitled to from the Federally-endowed 9/11 Victims Compensation Fund. Such cases can require the expenditure of tens of thousands of dollars in legal fees by the claimants, who are simultaneously dealing with difficult medical prognoses.

‘Let’s Do What’s Right’

In a wide-ranging phone interview, Dr. Crane said in a number of cases he felt obligated to try to intervene. “I have been hearing that from people who have been turned down and I have written letters of appeal, often to no avail,” Dr. Crane said. “I don’t have the expertise on state boards. But whatever needs to be done to have those folks awakened to the injustice of what is happening here really needs to be done. It is long past time. On average, my responders are 54, 55 years of age. These guys are moving into retirement age. Let’s do what’s right for them.”

The NYCERS system covers the bulk of the city workforce, with the exception of cops, firefighters and education employees, who have their own pension funds. NYCERS is responsible for the FDNY Emergency Medical Service employees, correction, transit and sanitation workers, and staff in close to 200 other city agencies. The New York State and Local Retirement System handles the state workforce, the local police and fire departments outside New York City and the employees of the Port Authority.

In 2005, Gov. George E. Pataki signed a bill that extended a legal presumption that certain public workers who were part of the 9/11 cleanup operations, and who later developed related diseases including cancer, respiratory illness, and certain skin ailments, would qualify for the disability payment equal to three-quarters of final average salary, tax-free. To be eligible, a worker had to have put in at least 40 hours at the lower Manhattan site. The law also permitted civil servants to re-apply for that three-quarter disability if they got sick after they retired.

Federal Coverage

In 2011 President Obama signed the Zadroga Act, named for NYPD Detective James Zadroga, who died in 2006 from a 9/11-related illness. The legislation provided medical screening and health care for both first-responders and WTC survivors who lived or worked in the contaminated zone in lower Manhattan south of Canal Street. It was reauthorized in 2015 and will provide health care until 2090.

Officials estimate there were about 90,000 first-responders who played a role in the WTC response and clean-up that went on for months, and 400,000 local residents and workers, who were sufficiently exposed to WTC toxins that they should be screened.

During the Nov. 15 hearing held by Senator Golden, both the city and state retirement systems conceded that ensuring that they had sufficient medical expertise and staffing to evaluate the WTC responder claims was an ongoing challenge. Dr. Crane said he’s not surprised.

‘Not Set Up for This’

“I don’t think necessarily the institutions were typically set up to handle a situation like that,” Dr. Crane said. “If you want to take just another example, let’s look at the Workers’ Compensation Board. If we had functioning workers’ compensation systems in the United States that really worked well and protected workers, we wouldn’t need the Zadroga Act. We have a system that is very splotchy in all the states and is often weighted against the worker now more and more.”

He continued, “So, no, typical institutions have not and were not prepared to really take on the challenge of having 90,000 responders become ill and maybe 400,000 members of the community. It is a huge challenge for any institution.”

Dr. Crane said that about three-quarters of the first-responders have been medically screened but that only 12,000 people are in the survivor program. “My understanding is that there is a tremendous influx now of patients who are becoming ill, or recognizing their illness and trying to get care,” Dr. Crane said. “That is a very small percentage of the exposed population. And that is another real challenge for the Zadroga mechanism.”

Post-9/11, tens of thousands of public employees were required to report to their workplaces in lower Manhattan, well within the WTC contamination zone throughout the clean-up period, which included close to three months when the site was still burning.

Survivors Need Testing

Dr. Crane said, “Certainly we know very well by the studies from the World Trade Center Registry, which combine the population both of responders and survivors, that the folks who went to work opened their windows, sat in rooms that had air-conditioning ducts full of dust, went to school, had significant exposures and those exposures are adding up to ongoing illness…And what that has come to mean to us is that there will be disease. So those officers, Teachers, those Manhattan Community College students, those students at Stuyvesant High School, all of these folks are at risk for illness based on what we have learned.”

The exposure was partly a consequence of a steep learning curve for officials, according to Dr. Crane. “Downtown it seems there was a generalized lack of coordination and lack of understanding about the need to get this stuff cleaned up and cleaned out. Over time it has happened,” he said. “Before, people were living in it and breathing it.”

Much Still To Learn

Dr. Crane said that it is critical that people who were exposed get screened, not just for their own well-being, but so that doctors can accurately map the dozens of known ailments and cancers as well as identify medical issues that researchers have so far missed. “It has always been a civic act to be screened,” Dr. Crane said.

He continued, “My personal concern and my personal fear is that the family of cancers that are going to be highly prevalent in our population will be very, very rare ones, ones that are like usually ‘one in a million’…concentrated in the people we have not seen yet and will never know about and will never be reported.”

Dr. Crane praised Congress for re-authorizing the Zadroga Act, but regrets that the Federal Victims Compensation Fund, which was set up to compensate for economic losses to 9/11 families for their long-term WTC-related disability, excluded mental-health diseases and conditions like post-traumatic stress disorder. He says his research indicates that between 20 to 30 percent of the first-responder population groups he has studied are also dealing with PTSD.

‘Crippling Illnesses’

“There was no mental health covered by the Victims Compensation Fund in any formulation. That is simply not right,” he said. “These illnesses are crippling. They are often associated with other physical illnesses that are equally crippling. It was a wrong-headed move. We have not really seen the consequence of that yet.”

And the potential for PTSD extends, he said, to the wider survivor WTC community as well. “Particularly for those who were around when those towers came down and before that, when people were jumping off the buildings,” Dr. Crane said. “This was horrible and it has to be recognized that group is at this risk for those conditions and for many, those conditions have gone untreated, and that is something that we ­really have to address. We don’t want people with untreated post-traumatic stress walking around and being miserable.”

Individuals with undiagnosed and untreated PTSD can be at a high risk of self-medicating with alcohol and drugs. “Absolutely we have seen that. It has been documented that all the heavy drinking that occurred after the event, anecdotal reports about increased drug abuse, and cigarette consumption,” Dr. Crane said. “If you were trying to forget that event, many people choose alcohol, chose drugs. We would like to have mental-health systems that were robust enough to accommodate all these fears…and terrible flashbacks and memories. I think it is better than it was in terms of the fact that is recognized as a clear result of the trauma.”

“You are really talking about a kind of mass movement of people into this kind of care, between our veterans returning from war and now our survivor populations and the continuation of your responder populations. We have to be ready to meet this need,” he said. “There is still a stigma in this country about mental health and mental-health conditions…It is a form of fear and discrimination that is unjustified and has to be met with an open acceptance. All of us are susceptible to this stuff, and we really just can’t close our eyes and put it in the basement somewhere.”

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