July 24, 2006

Delayed action prolonged the pain for 9/11 responders

By Sheryl McCarthy

Sheryl McCarthyIn November 2001, a small group of doctors from Mount Sinai Medical Center and the city's fire department, along with others who'd been seeing Ground Zero responders since right after the disaster, assembled a set of medical guidelines for treating the responders, which was posted on Mount Sinai's Web site.

The "protocols" were based on the kinds of illnesses these doctors were observing in the responders and were meant to help all doctors in the city properly diagnose and treat patients who'd been exposed to the toxic smoke and dust at Ground Zero.

In December of that year, the doctors' group urged New York City health officials to issue citywide guidelines, according to Dr. Robin Herbert, co-director of Mount Sinai's World Trade Center Health Monitoring Program. But the officials declined, saying there was no clear consensus that the respiratory ailments were related to exposure at the site.

Almost five years later, with hundreds of former Ground Zero workers suffering from respiratory, gastrointestinal and mental ailments that doctors say resulted from their work there, city health officials are finally preparing the protocols, which they expect to be published this summer. But doctors who observed these medical problems right from the start are upset that it's taken the city so long.

"It's tragic that it's taken public health officials of New York almost five years," Herbert told me. "It's better late than never, but it's pretty late." She said there's no doubt that the lack of citywide guidelines has resulted in some patients' not being treated properly.

Medical protocols help doctors who are presented with certain symptoms to ask the right questions, such as whether a patient who suddenly comes down with a persistent cough had any exposure to Ground Zero. Mount Sinai doctors also say it's important that doctors examining a Ground Zero-exposed patient check for conditions that are now known to be associated with exposure.

Dr. Jacqueline Moline, co-director of the program, said many of the responders who were treated right after 9/11 were diagnosed with acute bronchitis and given antibiotics for bronchial infections. Many of them didn't have infections, she said; they had lung inflammations, for which the proper treatment would have been inhaled steroids or anti-inflammatory medicine.

"This was a classic example [of misdiagnosis and improper treatment] because people didn't know what they were seeing," Moline said, "which is what prompted us to put those guidelines on our Web site."

The burning question is whether the city's slow-footedness in issuing its own protocols has anything to do with official concerns about potential liability the city might have growing out of the Ground Zero-related health problems. The city's Department of Health and Mental Hygiene sends bulletins by mail and on its Web site to more than 60,000 doctors, providing protocols for a variety of diseases. Coming from public officials, these bulletins influence how doctors treat patients.

City health officials deny that concerns about potential lawsuits have influenced their policy. Dr. Lorna Thorpe, deputy city health commissioner for epidemiology, said that after Sept. 11 officials were concerned about "getting it right."

Early on, they believed the main health impact from 9/11 would be mental problems, and it wasn't clear that there was a link between the respiratory problems doctors were seeing and Ground Zero exposure, she said. Now that the connection has been established, the city is moving forward.

With at least one class-action lawsuit pending against the city on behalf of plaintiffs claiming illnesses and even deaths as a result of Ground Zero exposure, the city has denied any deaths were related to exposure there. Some say the reason the city is moving on the protocols now is because John Howard, the federal official in charge of 9/11-related health issues, has asked for them. But the city can't waste any more time. How many people could have been spared prolonged discomfort and worsening illness if they had been available earlier?

Sheryl McCarthy can be reached at