Health Effects

Numerous studies have documented the physical and mental health effects  of the WTC attacks. WTC Federal Responder Screening Program Has Had Difficulties Ensuring the Availability of Screening Services, and NIOSH Was Considering Expanding the Program to Include Monitoring

HHS’s WTC Federal Responder Screening Program has had difficulties  ensuring the uninterrupted availability of services for federal responders. After resuming screening examinations in December 2005 and  conducting them for about a year, HHS again placed the program on hold  and suspended scheduling of screening examinations for responders from  January 2007 to May 2007. This interruption in service occurred because  there was a change in the administration of the WTC Federal Responder  Screening Program, and certain interagency agreements were not  established in time to keep the program fully operational. However, the program  stopped scheduling and paying for these specialty diagnostic services in  April 2006 because the program’s contract with a new provider network  did not cover these services. If federal  responders do not receive this type of monitoring, health conditions that  arise later may not be diagnosed and treated, and knowledge of the health  effects of the WTC disaster may be incomplete. NIOSH Has Not Ensured the Availability of Services for Nonfederal Responders Residing outside the NYC Metropolitan Area

NIOSH has not ensured the availability of screening and monitoring  services for nonfederal responders residing outside the NYC metropolitan  area, although it recently took steps toward expanding the availability of  these services. AOEC experienced challenges in providing these screening  services. Mount Sinai’s subcontract with AOEC ended in July 2004, and from August  2004 until June 2005 NIOSH did not fund any organization to provide  services to nonfederal responders outside the NYC metropolitan area. In June  2005, NIOSH began its second effort by awarding $776,000 to the Mount  Sinai School of Medicine Data and Coordination Center (DCC) to provide  both screening and monitoring services for nonfederal responders residing  outside the NYC metropolitan area. DCC, however, had  difficulty establishing a network of providers that could serve nonfederal  responders residing throughout the country—ultimately contracting with  only 10 clinics in seven states to provide screening and monitoring  services. NIOSH Awarded Funding for Treatment Services to Four WTC Health Programs

In fall 2006, NIOSH awarded and set aside funds totaling $51 million from  its $75 million appropriation for four WTC health programs in the NYC  metropolitan area to provide treatment services to responders enrolled in  these programs. In addition to the $44 million it awarded for outpatient services,  NIOSH set aside about $7 million for the FDNY WTC program and NY/NJ  WTC Consortium to pay for responders’ WTC-related inpatient hospital  care as needed. NIOSH, the administrator of the program, has been considering  expanding the program to include monitoring but has not done so. Therefore  we recommended in July 2007 that the Secretary of HHS take expeditious  action to ensure that health screening and monitoring services are  available to all people who responded to the attack on the WTC, regardless  of who their employer was or where they reside. As of early September  2007 the department has not responded to this recommendation. Appendix I: Abbreviations

Related GAO Products

September 11: HHS Needs to Ensure the Availability of Health Screening  and Monitoring for All Responders. GAO-07-892. Washington, D.C.:   July 23, 2007. September 11: Health Effects in the Aftermath of the World Trade Center  Attack.
Why GAO Did This Study

Six years after the attack on the World Trade Center (WTC), concerns persist about health effects experienced by WTC responders and the availability of health care services for those affected. Several federally funded programs provide screening, monitoring, or treatment services to responders. GAO has previously reported on the progress made and implementation problems faced by these WTC health programs. This testimony is based on and updates GAO's report, September 11: HHS Needs to Ensure the Availability of Health Screening and Monitoring for All Responders ( GAO-07-892 , July 23, 2007). In this testimony, GAO discusses the status of (1) services provided by the Department of Health and Human Services' (HHS) WTC Federal Responder Screening Program, (2) efforts by the Centers for Disease Control and Prevention's National Institute for Occupational Safety and Health (NIOSH) to provide services for nonfederal responders residing outside the New York City (NYC) area, and (3) NIOSH's awards to WTC health program grantees for treatment services. For the July 2007 report, GAO reviewed program documents and interviewed HHS officials, grantees, and others. In August and September 2007, GAO updated selected information in preparing this testimony.

What GAO Found

In July 2007, following a re-examination of the status of the WTC health programs, GAO recommended that the Secretary of HHS take expeditious action to ensure that health screening and monitoring services are available to all people who responded to the WTC attack, regardless of who their employer was or where they reside. As of early September 2007 the department has not responded to this recommendation. As GAO reported in July 2007, HHS's WTC Federal Responder Screening Program has had difficulties ensuring the uninterrupted availability of screening services for federal responders. From January 2007 to May 2007, the program stopped scheduling screening examinations because there was a change in the program's administration and certain interagency agreements were not established in time to keep the program fully operational. From April 2006 to March 2007, the program stopped scheduling and paying for specialty diagnostic services associated with screening. NIOSH, the administrator of the program, has been considering expanding the program to include monitoring, that is, follow-up physical and mental health examinations, but has not done so. If federal responders do not receive monitoring, health conditions that arise later may not be diagnosed and treated, and knowledge of the health effects of the WTC disaster may be incomplete. NIOSH has not ensured the availability of screening and monitoring services for nonfederal responders residing outside the NYC area, although it recently took steps toward expanding the availability of these services. In late 2002, NIOSH arranged for a network of occupational health clinics to provide screening services. This effort ended in July 2004, and until June 2005 NIOSH did not fund screening or monitoring services for nonfederal responders outside the NYC area. In June 2005, NIOSH funded the Mount Sinai School of Medicine Data and Coordination Center (DCC) to provide screening and monitoring services; however, DCC had difficulty establishing a nationwide network of providers and contracted with only 10 clinics in seven states. In 2006, NIOSH began to explore other options for providing these services, and in May 2007 it took steps toward expanding the provider network. NIOSH has awarded treatment funds to four WTC health programs in the NYC area. In fall 2006, NIOSH awarded $44 million for outpatient treatment and set aside $7 million for hospital care. The New York/New Jersey WTC Consortium and the New York City Fire Department WTC program, which received the largest awards, used NIOSH's funding to continue outpatient services, offer full coverage for prescriptions, and cover hospital care.