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Exposure to environmental toxins left thousands of 9/11 responders suffering from more severe health problems than officials anticipated. Will it get worse?

Construction supervisor John Feal arrived at Ground Zero the day after the September 11 World Trade Center attacks to help with the recovery efforts. He only worked there for five days—forced to stop when a falling steel beam crushed his left foot—but the experience has never stopped haunting him.

A could of asbestos, mercury and other potencially hazardous materials hung over the city collapse

Feal, now 39, has had surgery on his foot more than two dozen times and still walks with a lopsided gait. But he’s developed other health problems, too, including gastroesophageal reflux disease, posttraumatic-stress disorder and respiratory problems. His lung capacity has diminished to the point that he occasionally stops to gasp for breath midsentence. Unable to work, and struggling to cover his mounting medical bills, Feal says at times he's felt like he's “slipping through the cracks.”

As health officials are discovering, Feal is not alone.

Only one responder’s death—that of New York City police detective James Zadroga, who succumbed to respiratory failure in January—has been directly linked by a medical examiner to his exposure to environmental toxins at Ground Zero. But at least six other deaths (from causes ranging from heart failure to lung cancer) have been reported among responders in their 30s and 40s who worked at the World Trade Center site. And thousands more are struggling with health problems far worse than officials initially anticipated. “People think that it’s just a few guys from 9/11 suffering,” says Feal, “but there are literally thousands of us.”

It’s too early to know with certainty how many deaths may result from the cocktail of asbestos, mercury, silica, fiberglass and other potentially hazardous materials released when the twin towers collapsed. Nor is it possible to say with certainty which health problems are related to the responders’ work in the rubble of the trade center. But it’s clear that many of the estimated 40,000 police, firefighters and other workers who came to the site to assist in rescue and recovery efforts have begun suffering from similar and sometimes serious ailments during the past four and a half years. “You can’t witness and be exposed to what these people were exposed to without it taking a toll,” says Dr. Stephen M. Levin, codirector of the World Trade Center Worker and Volunteer Medical Screening Program at Mount Sinai Hospital in New York. “To listen to how life has become for some patients, it’s absolutely horrifying.”

Dr. John Howard, who was appointed in February as federal coordinator of 9/11 health issues by the Bush administration, has said that the government will likely need to monitor the health of those who were at or near Ground Zero for 20 to 30 years. How much money—and manpower—that will require is unclear. But it’s likely more than the $125 million initially allocated by the federal government for 9/11 responders as part of a $20 billion federal aid package for areas affected by the terrorist attacks. “I don’t think we’re prepared to come up with a number [yet],” said Howard earlier this spring.

It's still not even clear how many may be suffering from related health problems since thousands have not yet been screened. Worse, some of the most serious health problems may not yet have emerged. “We have never done an adequate characterization of the nature and scope of the contamination, so we can’t quantify what kinds of problems people are going to face,” says David Newman, an industrial hygienist at the New York Committee for Occupational Safety and Health (NYCOSH). “There may be a whole group of people out there who may still become seriously ill.”

Dr. Levin at Mount Sinai, where more than 16,000 people have been screened, says, “We are seeing people for the first time now, more than four years later, who have been persistently symptomatic for all that time and haven’t been screened or gotten care.” He suspects there may be many more.

Unions have had a tough time persuading members to get medical checks, partly because of fears they’ll be told they can no longer work. Construction workers or emergency medical technicians can make $80,000 to more than $100,000 a year with overtime; New York Worker Compensation only pays about $400 a week. Dominick Marrocco, business agent for Local 282, which represents workers in building materials and construction, says 840 members worked at the site in the weeks following the September 11 attacks. Only 270 of them have been screened. “I wouldn’t doubt that there are people out there working still who have health problems,” he says.

Marianne Pizzitola, a pension and benefits coordinator for the uniformed Emergency Medical Services union says she’s also spoken with members who refuse to quit despite respiratory problems. “They’ve got mortgages and kids, and they can’t afford to stop working,” she says.

More than 10,700 Worker Compensation claims have been filed in New York, and nearly 94 percent have been “fully resolved,” according to Jon A. Sullivan, spokesman for the New York State Workers' Compensation Board.

But some ailing workers complain that their claims have been disputed or delayed for months—or even years. Industrial cleaner Alex Sanchez, 38, spent several days at Ground Zero clearing dust from the airshafts and indoor surfaces of the buildings around the World Trade Center site with just a washcloth or paper mask over his face. (Newman, from NYCOSH, says no more than 60 percent of workers at Ground Zero wore respirators on any given day and, on some days, just 20 percent wore them—in part, perhaps, because the Environmental Protection Agency issued a statement that the air was safe to breathe a week after the attacks, an assurance that later proved to have been dangerously premature.)

“We didn’t think about all the contamination,” says Sanchez. After just two days, his throat became irritated and he developed a chronic cough. But it was another year before Sanchez, a lifetime nonsmoker, was screened and diagnosed with several ailments—ranging from asthma and acid reflux to posttraumatic-stress disorder—and traced them back to his days at Ground Zero. He now takes 18 different medications a day and hasn’t been able to work for three years, nor can he pick up his 5-year-old son or play soccer on the weekends any longer. Some days, he can barely climb a flight of stairs and must use a cane because of the pain in his joints.

Sanchez filed for Worker Compensation in 2003. He says he was offered a lump-sum payment of $20,000 but turned it down. “People took those offers, but what happens after that money is gone?” asks Sanchez, who says he used to make about $1,100 a week before he was forced to stop working. “Respiratory illnesses don’t get better. I know the amount of World Trade Center dust I inhaled. I know what I am up against.”

He is still negotiating a settlement. In the meantime, he’s been relying on Medicaid to cover his health costs and on savings and aid from charities and his family for everything else. He’s hoping that the government might offer help. He and other ailing workers have read about the six- and seven-figure settlements for those injured at Ground Zero who filed with the September 11 Victim Compensation Fund (which stopped accepting claims in December 2003). But only responders who were hurt within 96 hours of the planes crashing into the twin towers were eligible for compensation through the fund and, in most cases, they had to have been diagnosed within three days. For many responders, the health problems emerged well after Sept. 15, 2001.

Of the 2,680 people awarded compensation (at an average payout of nearly $400,000), almost 60 percent of recipients were firefighters, and 8 percent were police officers. But only about 100 construction workers, 68 maintenance and janitorial workers and 25 EMTs and paramedics received compensation through the fund, according to the fund's special master, Kenneth Feinberg. It’s not clear how many workers in those categories applied. But out of 4,435 total injury claims filed, less than half received awards. Feal filed but was turned down since he was injured and treated on Sept. 17.

Eventually, he got about $50,000 in a Worker Compensation settlement and used it to help pay legal costs and overdue bills and rent. (Medicare covers about 75 to 80 percent of his health-care costs, he says.) When that money ran out, he sold his 1979 Corvette to supplement the $1,300 a month he gets in Social Security checks. “That’s about what I used to earn in a week,” he explains. “I pay more than that in rent.”

John Feal at Ground Zero on the morning of Sept. 17, 2001

Feal has now filed a lawsuit against his construction and insurance companies, which is under appeal. “I don’t want to be a millionaire,” he says. “I just want to be able to have the life I had before September 11.”

Several thousand other responders who’ve developed health problems since 9/11 have also turned to the courts. “Every day, people come into my office who have trouble breathing,” says attorney David Worby, who has filed a class-action lawsuit on behalf of more than 8,000 workers at Ground Zero against several defendants, including the city of New York, the Port Authority, the U.S. Environmental Protection Agency and contractors with workers at the site. “If we don’t get these people the help and treatment they need now, more of them may die than died on 9/11,” says Worby, who categorizes about 1,000 of his clients as “severely ill.”

Will the government create another fund for responders who didn't qualify for the Victim Compensation Fund? So far, it’s given no indication it will do so. But, as Mount Sinai’s Levin points out, billions of dollars in aid were recommended for recovery efforts after the attacks. “Out of such a vast amount of money, wouldn’t it be possible to set some aside to take care of this group of responders?” he asks. “I can’t see how any rational social policy can say it’s OK for these guys to suffer.”

Politicians from the tristate area have also been lobbying for more federal funds and an established protocol for tracking and treating the health problems suffered by those exposed to the toxins at Ground Zero. In March, the Centers for Disease Control said it would distribute $75 million of the $125 million already allocated in aid to help track and treat 9/11-related health problems—the first federal money to be spent directly on medical treatment for 9/11 health effects, says New York Democratic Congresswoman Carolyn Maloney. There are signs it won't be the last.

“There’s no doubt there’s a national responsibility here,” agrees Howard, the recently appointed federal coordinator of 9/11 health issues. “These people went down there to help without thinking about their own safety—they’re heroes. It’s important that we treat them that way.”

For those like Feal and Sanchez, such treatment couldn’t come soon enough.