‘DON’T HAVE ALL WE NEED’

‘DON’T HAVE ALL WE NEED’: World Trade Center Medical Director Michael Crane said some of those with WTC-related illnesses have difficulty getting the appropriate treatment, and he lamented that those with post-traumatic stress disorder don’t qualify for Victims Compensation Fund benefits.

One of the World Trade Center Health Program’s top doctors says that as Congress contemplates a reauthorization of the 9/11 Victim’s Compensation Fund, it must right a wrong baked into the original program, which is set to expire at the end of 2020 and may run out of money before that.

Dr. Michael Crane, who is the medical director of the WTC Health Program at Mt. Sinai Hospital, told this newspaper that any new version of the 9/11 VCF must include World Trade Center mental-health-connected illnesses on the list of 9/11 related afflictions that are eligible for monetary compensation.

NO PTSD Coverage

As of the last filing, the VCF had paid out more than $4.6 billion on 22,000-plus claims from first-responders and survivors, some of it covering the economic loss that stemmed from their developing WTC-related health conditions.

Yet Dr. Crane said the VCF is prohibited from covering post-traumatic stress disorders, depression or anxiety disorders.

While both responders and survivors are entitled to WTC Health Program medical treatment for these afflictions, no matter how disabling they may be, Congress chose to exclude mental health from the list of diseases eligible for monetary compensation.

“Inside the treatment program I think we are doing pretty well,” he said. “We essentially have parity [between mental health] and the physical health conditions and we have outstanding practitioners I believe in all the clinical programs to address the patients’ needs.”

Dr. Crane continued, “That doesn’t mean that we have everything that we need. There are always folks who aren’t able to get to the treatment or have other personal needs that come. And the treatment itself, not to take anything away from any practitioner, it is extremely difficult, both for patient and practitioner.”

Like Combat Veterans

But he said the VCF program fails to account for the serious impact on the life and well-being of the responders/survivors and their families who are dealing with the long-term fallout of WTC-related mental health conditions.

Dr. Crane said the failure of the government and the broader society to come to terms with the consequences of WTC related mental illness on patients and their families was part of “a recurrent story in the society” that includes a similar collective avoidance “of the guys that came back from Vietnam and Iraq.”

“I think the treatment part of the program got it right here: make it absolutely upfront a certifiable condition and get that treatment to them,” he said. “But I guess we didn’t get there with the benefit side, and that is the correction I would go for.”

He continued, “When people are traumatized, lots of things happen to them. We know from lots of experience with lots of different patients that PTSD is horrible. You feel like your life is worthless and yet you feel like you are so revved up you have to kind of keep moving, so you are dragging yourself along.”

Self-Medicating Woes

Dr. Crane said it was not uncommon for PTSD to prompt other serious complications, as patients struggle to cope in a world that may, or may not, recognize their affliction.

“You get jumpy and you get jittery and you can’t really feel comfortable around people, so for some folks alcohol and substance abuse are an avenue where they are trying to treat their [underlying] condition. We know that happens,” he said. “We know it is not something necessarily that happens. But some folks get in that situation and it is a hell of a deal. It makes for yet another very, very difficult problem added to the ones that already occur in folks that have these exposures, and may have physical conditions as well. So, yes, it is a tremendously thorny and difficult problem and we struggle with it.”

According to the WTC Health Program website, the program has 73,025 out of 90,000 known responders enrolled, and 17,600 out of at the cohort of 400,000 possible survivors, who were not part of the rescue and recovery but lived or worked in the contaminated zone in lower Manhattan and a small portion of Brooklyn.

The survivor category includes thousands of Federal, state and municipal civil servants.

Mental Health No. 2

Aerodigestive diseases, related to the respiratory tract and upper digestive tract, rank as the most-common class of illnesses in the WTC program, affecting 31,337 responders and 6,150 survivors. Mental-health-related issues are the second-most-common, afflicting 10,850 responders and 3,582 survivors.

Cancers linked to 9/11 exposure rank third-most-prevalent, with 7,942 responders and 2,136 survivors battling a myriad of WTC strains of the disease.

Dr. Crane observed that a considerable number of the program’s participants are battling multiple conditions simultaneously, with more than a third of the 90,000-plus responder/survivors dealing with four or more ailments at the same time.

No matter what disease or diseases WTC Health Program participants are dealing with, Dr. Crane said there’s evidence that patients who can continue to work have the best overall outcome.

‘Advantages to Work’

“Clearly statistics show that the working population, so-called healthy worker is healthier than the guys who can’t work and usually can’t work for a variety of reasons, including illness and the availability of jobs,” he said. “So, there are great advantages to work. We have lot of folks that are still working here. We also have lots of folks who have stepped away from the workforce.”

He continued, “Where they can work, we are so happy that they are back there doing what she or he loves to do. For us, that is a sign of success of the program. It makes us feel terrific.”

But Dr. Crane said program participants, who are still trying to convince their employer/agency to let them stay on the job or collect their disability pension, need support from the bureaucracies they encounter.

He said, “I think that the more that we communicate across the board about our patients to all kinds of groups; to management groups, to labor groups, to employers, to patient groups, the more people will understand the toll that these conditions are taking. In some cases, it is killing them. In other cases, people are fighting like hell for their lives and showing once again their courage…and we want to support our patients at every single level of that possible outcome.”

‘A Clear Distinction’

While the responder and survivor WTC Health programs have much in common, there are some critical differences that are particularly relevant to the tens of thousands of public employees whose place of employment was in the WTC zone and were exposed, but lack the time at the recovery site to qualify as responders.

“I think when the program was put together, they were making the clear distinction between the responder doing rescue and recovery and the folks who were going to work and their daily jobs in a contaminated space,” Dr. Crane said.

“We have the capability on the responder side to monitor asymptomatic people. In other words, if you are a responder and you went down there and in Year Four you were feeling great—well, OK, we will just see you next year…We could keep doing that for responders,” he said.

“Unfortunately, that was not written into the survivor side, and they really need to have certified conditions to come in. So, as my colleague at Bellevue says, they have to ‘come in sick,’ and so it tends to push back the intervention that you would like to have on the case to prevent illness from getting worse.”


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