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A physician’s perspective on the Zadroga Act

Posted by Jacqueline Moline, MD, MSc, Director, Queens World Trade Center Clinical Center of Excellence | January 4, 2013

As an occupational and environmental physician based in New York, I have had the privilege to have been a part of the World Trade Center Medical Monitoring and Treatment Program since its inception, which set out first to describe the medical conditions affecting first responders.  We diagnosed many different physical and mental ailments – but had to fight for our responders against authorities who doubted any lasting health effects. At the start of the program, we were only abole to diagnose individuals with World Trade Center related health problems, but were unable to treat them under program funding. We then sought federal funding to cover medical costs for ailments arising out of the response to the World Trade Center disaster, which finally became available around the fifth anniversary in 2006.

The tragedy on September 11th was an attack on our nation, not just New York City.  More than nine years after 9/11/01, Congress finally passed the James Zadroga Bill to provide first responders and area residents with comprehensive medical coverage for WTC related health problems. After years of uncertainty regarding funding, we at last had some stability, as the Bill allowed the program clinicians to monitor and treat patients with WTC exposures for the next five years. We were able to move away from year-to-year funding, dependent on the Appropriations Committee, to “long-term” funding. I was no longer concerned that a patient wouldn’t receive their medication because program funding was uncertain. As part of the Zadroga Bill, the conditions we have been treating for years: upper and lower respiratory problems, including asthma,  persistent sinus problems, gastroesophageal reflux disease, post-traumatic stress disorder, anxiety, depression were all considered to be WTC-related health conditions. After completing forms for certification, WTC responders could receive care with no out-of-pocket expenses for physician visits, medications, and medical procedures that might be needed to properly care for their WTC-related problems. After ten years, many individuals still had symptoms and conditions related to their exposures, which will not go away; they require chronic treatment, and will for the rest of their lives. But “long term” to me as a doctor is not a program that ends in five years while medical problems continue, and other conditions develop. While the Zadroga Bill covers their care for the next five years, what will happen in 2016? Their conditions will remain, and may become even become more severe. Some individuals have developed such scarring in their lungs that they have received or are being evaluated for lung transplants. This requires a promise of lifelong treatment.

In October 2012, in addition to the physical and mental health conditions already covered under the Zadroga Bill, over 50 cancers were added to the list of “WTC-covered conditions”.  In essence, the government is acknowledging what we as clinicians have seen for years-increased rates of cancers, often occurring at an earlier age than normally seen among those who had WTC exposures. Multiple studies are already showing increased rates of certain cancers among WTC exposed individuals. Following standard guidelines for treatment followed by all leading cancer providers, WTC exposed individuals now can receive care for these additional, WTC-related medical problems. We can now improve the chances that individuals with cancer will survive through state of the art therapies.  We know that it is likely that more WTC exposed individuals will develop cancer in the years to come – the latency period, which is the time from the onset of exposure to a substance or substances, to the development of disease, is many years for most cancers. Given the toxic combination of known carcinogens that were released for weeks and months from the WTC site, we expect cancer rates to rise over time.

The medical coverage for cancer, like the other WTC treatment dollars, is long overdue and equally hard fought.  But this needed cancer care, like all other WTC-related care, will come to an abrupt end in 2016 without re-authorization of the Zadroga Bill, just as we expect cancer rates to increase among those who had WTC exposure. We know asbestos was at the WTC site and cancers related to asbestos, a well-known carcinogen, take decades to develop. The Zadroga Bill must last for more than five years – and it has to truly provide long-term care for those who were exposed.

These brave men and women made sacrifices for all of us, and they deserve accolades and enduring gratitude.  They don’t need to worry if the program will be there for them when they become ill because they had World Trade Center exposures. Let us never forget our duty to care for those who responded on that fateful day.


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