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Health Risks Near Ground Zero?


A number of articles and stories suggest that some people who lived or worked near Ground Zero after the September 11 attacks have developed health problems.


Commentary/Opinion

Air Quality At Ground Zero
Gotham Gazette - May 2, 2002
Eric Goldstein, Gotham Gazette's Environment columnist, takes a look at the Environmental Protection Agency's reversal of policy this week concerning indoor cleaning and testing for air quality. Is it too little, too late? Or a triumph for New Yorkers?

Breathing the Air Downtown
New York Times - Feb 22, 2002
In this editorial, the Times criticizes the government's failure to provide leadership concerning the issue of air quality and its health effects downtown. In particular, it cites worries about the air quality of indoor environments.

Give Us Back Our Neighborhood
Gotham Gazette - December 10, 2001
Madelyn Wils, the only member of the Lower Manhattan Redevelopment Corporation who actually lives in Lower Manhattan, blasts the city for its inaction in helping the residents living near Ground Zero.

Environmental Aftermath
Gotham Gazette - October 22, 2001
The hundreds of government scientists who have been testing the air in lower Manhattan have reported that there is little to worry about. Yet in the last two weeks it has become increasingly apparent, Michael Burger charges, that the scientists are not looking for precisely the right thing -- or, if they are, they are not releasing that information to the public.


More Resources

Government Information

EPA Response to September 11
http://www.epa.gov/enviro/nyc/

Lower Manhattan air monitoring news
http://www.nyc.gov /html/dep/html/airmonit.html

NYC Department of Environmental Protection
http://www.nyc.gov/html/dep /home.html

NYC Health Department Responds to Concerns About Air Quality in Lower Manhattan
http://www.nyc.gov/html/doh/html/
public/press01/pr89-1005.html

OSHA Map of Asbestos Sample Data for Lower Manhattan
http://osha.gov/nyc- disaster/map.html

Reports

The Environmental Impacts of the World Trade Center Attacks
The National Resources Defense Council's new report lays out the facts about the environmental concerns downtown and analyzes the government's response.

St. Louis Post-Dispatch on Federal Withholding of Air Quality Test Results
This article from the St. Louis Post-Dispatch broke news that results from tests conducted by the U.S. Geological Survey that revealed the dust around the World Trade Center to be as "caustic as liquid drain cleaner" were never released to the public.

UC-Davis Report on Air Sampling Downtown
An independent study set a mile north of the World Trade Center reveals highly contaminated air downtown.

NYC Department Of Health Presents Findings From Indoor Air Sampling In Lower Manhattan
The city agency releases its initial findings from indoor tests of thirty buildings throughout the downtown area.


News Stories

Uncertainty Lingers Over 9/11 Air Pollution - Sep 7, 2003
The air in Lower Manhattan after Sept. 11 has swirled back into the news -- what people knew about it, when they knew it and what they said about it. The underlying issue, researchers, doctors and politicians say, remains just as unresolved today as it was back then in the chaotic, emotional days after the attacks: How do you communicate something about which no one has ever had any experience? Was there a standard of confidence about the environmental risks and unknowns that was scientifically or perhaps even morally appropriate under the circumstances? (New York Times)

300,000 Around WTC to be Studied for 20 Years - Sep 6, 2003
Some 300,000 people who lived, worked or were near Ground Zero after Sept. 11, 2001, are being asked to join an official registry to monitor any health effects from the World Trade Center debris plume. (New York Daily News)

EPA Assured Public Before Actual Testing - Aug 28, 2003
In the aftermath of the Sept. 11, 2001, attacks on the World Trade Center, testing to monitor levels of debris dust didn't begin for 10 days - and analysis of the findings didn't become available until October. Months later EPA scientists would conclude that the dust caused lung disease in test animals - ailments that mimicked those reported in people who lived and worked near Ground Zero. (Newsday)

Governor Wants To Know How Dangerous 9/11 Air Really Was - Aug 28, 2003
Six days after a federal report said the White House misled New Yorkers about the air around Ground Zero after Sept. 11, Gov. Pataki said yesterday he wants to know how dangerous it really was. But Pataki stopped short of criticizing President Bush, his fellow Republican, and didn't support a call from Sen. Hillary Clinton (D-N.Y.) and Rep. Jerrold Nadler (D-Manhattan) to reclean area buildings. (New York Daily News)

Residents Angry, but not Surprised at Premature E.P.A. 9/11 Air Reports - Aug 21, 2003
Downtowners expressed outrage but little surprise last week at the news that the White House allegedly influenced statements the Environmental Protection Agency made soon after the collapse of the World Trade Center about air quality in Lower Manhattan. (Downtown Express)

Downtown Moms Question W.T.C.Baby Study Findings - Aug 14, 2003
Despite research showing a possible link between trade center toxins and lower baby birth weight, several downtown mothers who participated in a recent study said last week that the preliminary results did not appear to describe them or their babies. Mount Sinai School of Medicine tracked 182 women who were pregnant and in the vicinity of the World Trade Center on Sept.11, 2001, or within three weeks thereafter. In results released last week, researchers found that women who were exposed to dust from the trade center collapse were twice as likely as a control group to have babies who were slightly small for their gestational age, or for the amount of time they spent in the womb. (Downtown Express)

WTC Health Problems Persist - Aug 11, 2003
Thousands of New Yorkers say they still suffer from the World Trade Center attacks - and they are reaching out to help hot lines in numbers greater than last year, The Post has learned. Callers are seeking assistance for health complaints - ranging from respiratory ailments and pneumonia to acid reflux - that many link to the toxic plume created when the Twin Towers fell, as well as for post-traumatic stress disorder, anxiety and depression. (New York Post)

Feds Launch Long-term WTC Health Studies - Aug 10, 2003
Long-term studies to monitor the health effects of the World Trade Center attacks on New Yorkers are getting under way. A 20-year study conducted by the city Department of Health and the federal Agency for Toxic Substances and Disease Registry will begin in September or soon after to identify patterns of physical and psychological illness attributable to 9/11. (New York Post)

Smoke and Dust at World Trade Center Is Linked to Smaller Babies - Aug 6, 2003
Scientists say they have measured a slight but significant rise in the percentage of small babies born to women who were around the World Trade Center during or after the terror attack compared with babies of a large sample of pregnant women who were elsewhere at the time. The researchers, from the Mount Sinai School of Medicine, proposed that air pollution from the pulverized, smoldering wreckage was the most likely cause of the difference. (New York Times)

The Nursing Shortage


Joanne Rosenberg has been a registered nurse at North Shore Hospital in Forest Hills, Queens, for almost 30 years. Her job has always been difficult, but today as she scrambles to tend to more patients, she worries that she is unable to provide the care she would like to give. "Every patient deserves full attention, but it's not realistic," she said. "Sometimes you have to do shortcuts… You don't want to do that, but there's only so much the body can do."

New York has a nursing shortage. Last April, 59 city hospitals reported a total of 2,000 vacancies, or nearly 8 percent of their nursing workforce. By 2005, New York State estimates it will have 17,000 fewer nurses than it needs, and that number could double by 2015.

"We are edging closer to a precarious situation," said Kenneth E. Raske, president of the Greater New York Hospital Association. "We must make sure that we have enough nurses to care for future generations." The shortage comes at a time when the demand for nurses is increasing as the baby boom generation ages and requires more medical care. And unlike some of the previous shortages, it could last for many years, if not decades, to come. Fewer young people are choosing careers in nursing, and many nurses are nearing retirement age themselves or just quitting from stress and overwork. Proposed cuts in government spending for health care threaten to make the situation worse.

The shortage in the city is not only taking its toll on nurses and hospitals, but on patient care -- lines at emergency rooms are longer, surgeries are delayed, and even the risk of dying in a hospital may be increasing.

"There is absolutely no question that you cannot have quality care without nurses," said Georgia Persky, vice president of Mount Sinai Hospital in Queens. "Patients need someone constantly, critically looking at them in a unique way that only a nurse can provide."

THE EFFECT ON CARE

Nurses generally provide about 80 percent of direct patient care in hospitals. They assess the patient's condition, administer medications and maintain medical records. They look out for symptoms and report them to physicians.

"Nurses are the eyes and ears in a hospital," said Nancy Webber of the New York State Nurses Association. "If they have too many patients to care for they simply can't do that to the extent they should and want to."

Nurses' workloads vary widely. But more than 25 percent of nurses in the state say they do not have time to complete all the tasks involved in caring for patients, and 45 percent say they do not have time to provide a thorough assessment of their patients, according to a 1999 survey conducted by the New York State Nurses Association.

This can put patients' lives in jeopardy. Whenever a patient is added to a nurse's workload, the chance that one of that nurse's patients will die within 30 days of admission increases by 7 percent, researchers at the University of Pennsylvania found.

Some of this results from the strain of an excessive workload. "If you don't get enough rest you may give the wrong medications to the patient. And that's scary," said Pui Ching Mak, who worked at Bellevue Hospital and is now a nursing manager at Visiting Nurse Service of New York. "I had this nurse one time who gave a chemo medication to another patient."

The nursing shortage also forces people to wait for care. "Sometimes we [have] had to reschedule an operation because there was not enough staff," said Freddy Haro, who worked as a medical technician at Memorial Sloan-Kettering Cancer Center for 12 years and recently got his nursing degree.

In nursing homes, where vacancy rates are 10 percent, the shortage of nurses and of nursing assistants, who take care of residents' personal needs, has a particularly dramatic effect.

"Residents in nursing homes often do not have their diapers changed appropriately, or they are not assisted in toilet training, call bells are not responded to promptly, because there is not enough staff," said Randy Blom, a counselor at Friends and Relatives of Institutionalized Aged, an advocacy group.

A DIFFICULT JOB

Nursing has traditionally been a women's profession, but as job opportunities for women have expanded, fewer have chosen nursing careers. According to a survey by the American Association of Colleges of Nursing, over the last five years, the number of graduates from nursing programs declined by an average of 1,030 students each year.

Many are deterred because nursing can be dirty, intense, demanding work -- far different from a job in an office. "When you are a nurse you need to handle dirty stuff - urine, sputum, body fluids. Not everybody wants to do that," said Mak.

Many people do not want to deal with the tension that's prevalent in healthcare facilities." In nursing, there is not much room for you to make a mistake, and when you do make a mistake you pay for it severely," said Vetah Okuomose, a registered nurse who works in a school in Queens. "It's a rewarding profession, but it's a very serious profession."

Caring for a terminally ill patient or seeing a person die is not something everybody can handle. Susan Hertz, a recent graduate of the nursing program at Kingsborough Community College, said, "It's a challenge when someone is in great pain and you can't take that away from them," she said. "We are in a role where we want to make a difference, but if we can't make a difference for somebody, that's tough."

Nurses also complain they do not get the respect they deserve.

"Nurses are often treated horribly by doctors," said Naomi Zauderer, director of New York Professional Nurses Union. "It helps if they are unionized, but without some serious changes in workplace conditions the profession will continue to hemorrhage nurses."

And the pressures are increasing because of managed care. Because patients do not stay in hospitals as long as they once did, those who are left there are there are usually sicker and require more nursing than patients 20 years ago.

Faced with such challenges, many nurses leave the profession. The U.S. Department of Health and Human Services found 19 percent or about 240,000 registered nurses in New York State are not employed, by their own choice. Over the past four years about 8,000 nurses in New York have quit their jobs.

Perhaps the most alarming factor affecting the shortage is that the average retirement age for nurses in New York State is 49, and the average age of a registered nurse in New York is 46.

"In the next five or ten years we all are going to retire," said Diane Mapp, a registered nurse at Long Island College Hospital in Brooklyn, who has been a nurse for 28 years. "I can't see myself at 60 doing this anymore."

RECRUITMENT EFFORTS

Healthcare providers and educators are struggling to come up with strategies to recruit more nurses.

Hospitals in New York generally offer nursing graduates salaries ranging from $48,000 to $55,000. Some provide tuition reimbursement or scholarships. New York Presbyterian Hospital, for example, offers $10,000 in tuition benefits at Columbia Medial Center to nurses who want advanced training. New York University Hospital gives monetary remuneration for nurses who receive certification in specialty areas.

"It's absolutely critical to make nursing a very appealing job, which starts at a threshold level with paying a competitive salary, but [also improving] the job design and the working conditions," said Denise Davin, vice president for Human Resources at Visiting Nurse Service of New York, which employs over 2,000 nurses.

Training programs are also being expanded.

City University of New York has not been able to accommodate all the applicants to its nursing programs because there are not enough professors. Borough of Manhattan Community College, which has the largest nursing program of all CUNY schools, had to turn down 70 applicants to the nursing program in 2001, the New York Times reported. To address this, CUNY is adding 30 instructors to its nursing programs.

"It's expensive, but we have an obligation to provide work-force training where there is such a great need," CUNY Chancellor Matthew Goldstein has said.

Last year, CUNY created a special program for immigrant nurses with poor language skills who want to get licensed in New York. The 18-month program helps them master English and prepares them to pass the licensing examination. Currently 40 immigrant nurses are enrolled in the program.

The state and federal governments have also taken steps to address the problem.

In January, 2002, Governor George Pataki signed the Health Care Workforce Recruitment and Retention Act, which granted $1.85 billion to hospitals, nursing homes, and other health care facilities. The money would help the facilities recruit and retain workers and increase salaries and would encourage employees to advance in their profession. The current state budget crunch could, however, undermine parts of this program.

The Nurse Reinvestment Act, signed by President Bush last summer, authorized more loans and scholarships to nursing students and offered grants to healthcare providers to help them recruit and keep nurses. The Senate has approved $20 million in new federal funds for the act for the fiscal year 2003.

Training programs, hospitals and colleges are reaching out to the younger generation, trying to encourage them to become nurses. Borough of Manhattan Community College allows high school students to take college credit pre-nursing courses. Kingsborough Community College has been working with several high schools in Brooklyn to raise awareness of the importance of health careers and the need for more people to enter them. "We really need to go into the schools at a very young age, get to the younger population and sort of market nursing, not just for women, but also for men," said Willie Manzano, vice president for Patient Care Services at Columbia Presbyterian Medical Center. Fewer than 6 percent of nurses in New York are men.

Visiting Nurse Service of New York, which faces a 10 percent vacancy rate, is going to the army and the Fire Department to recruit potential nurses. It currently employs five firefighters. Patrick Murpagh, a visiting nurse who is also currently a firefighter, believes this is a good time to try to bring these workers into nursing.

"Both [nursing and firefighting] are service orientated occupations," he said. "After 9/11 there have been a lot of retirements, so I think that [firefighters] will be looking to going into different careers and nursing would be a perfect opportunity for a lot of them."

In the 1980s, many hospitals relied on nurses from abroad to alleviate the problem. But, while some still do this, the tactic is less effective than it once was because many other countries also face a nursing shortage.

RETENTION INCENTIVES

To retain nurses, health care providers and lawmakers try to make the job as attractive as possible. That often entails offering flexible hours and bonuses, lowering the nurse-patient ratio and not requiring overtime. Many hospitals offer 12-hour shifts, which some nurses prefer to shorter, more frequent workdays.

New York State Assemblywoman Catherine Nolan and Senator Thomas Morahan have proposed a bill that would prohibit hospitals from requiring a nurse to work more than eight hours a day or 40 hours a week, unless her regular schedule allows for more. The requirement could be suspended during "health care disasters" and publicly declared emergencies.

Hospital management however, argues that some overtime is unavoidable when there is a sudden surge in patients or nurses call out sick. "When we have sick calls, and we can't cover the sick calls with either a per diem nurse or an agency nurse, then we end up asking people to stay. Sometimes they don't do it happily, but we work it out," said Manzano.

Assemblymember Richard Gottfried and State Senator Kemp Hannon have introduced a bill that would require the State Department of Health to establish universal staffing standards for health care facilities, based on the severity of the patient's condition.

Another bill, also introduced by Gottfried, would apply only to nursing homes. It would ensure that in every nursing home during the day shift there are no more than 15 residents for every registered nurse. Many nursing home nurses care for 30 or more residents.

While overworked nurses support the legislation, some health care organizations claim that a universal nurse-patient ratio would only worsen the current situation. "You can't offer some formula and say x number of nurses for x number of patients for this floor," said Monica Mahaffey of the Healthcare Association of the New York State. "The healthcare providers know the . . .needs of the patients, and they should be the ones ensuring that those patients are getting the best care they can." Health care organizations have been lobbying for decreasing the amount of paperwork for nurses. The law requires that nurses maintain records on the evaluation and treatment of each patient. Some nurses at Bellevue Hospital stay an hour and a half extra every day to complete the required records.

"For every hour of patient care, nurses do at least another hour of paperwork," said Mahaffey. "Let's find a way to get them back to the bedside. Let's use the nurses we have to provide direct care and find some other way to take care of these paperwork requirements."

THE FUTURE OF NURSING IN NEW YORK

New York will not be able to alleviate the shortage of nurses unless ideas and incentives are backed up by money. And money is in short supply these days.

On January 29, Governor Pataki released a proposed budget imposing more than $1 billion in cuts that would have a great impact on health care providers, their staff and patients.

"When you take a billion dollars out and 60 percent of the cost of a hospital is labor, you run the risk of jeopardizing the workforce supply," Daniel Sisto, president of Healthcare Association of New York State, said on Capital News 9.

The governor also proposed reinstating a tax on hospital revenue. According to the New York Times, that will cost hospitals more than $228 million a year and "could, along with cuts to Medicaid reimbursements of another $317 million, lead to layoffs of hospital workers."

It is unclear whether the governor's proposals will be enacted. But such ideas, along with the $343 million in operating losses that New York health providers experienced in 2001, cuts in federal Medicare funds, and rising costs, do not bode well for the nursing situation.

"The nursing shortage is a scary problem," said Persky. "I would not venture to guess what the future is. It will only be what effort we put into it."

Related links on nursing and the nursing shortage in New York:

Links on the national situation:

Health Care Changes Could Hurt New York


So far, 2003 is proving to be a hot year for health policy developments, both locally and nationally. Here is an update:

Unfortunately, most of the dire budget predictions made here earlier are coming true. The city asked that the state pay an additional $200 million of its Medicaid costs; instead, Governor George Pataki wants the city to pay a greater share of hospital and clinic costs than it does now. In exchange, the state would provide more money for prescription drugs. This shift would benefit many upstate counties, but would hurt the city because 35 percent of city Medicaid payments go to cover inpatient hospital costs while only 15 percent go for drugs. Medicaid is the federal health insurance program that provides coverage for the poor.

The New York Times estimated that the change would cost the city an additional $140 million and wrote in an editorial that the cuts would devastate the city's teaching hospitals, which educate about 15 percent of all doctors in the United States.

The governor also wants to reduce the number of people eligible for Medicaid. He has proposed lowering the maximum income that people can have and still qualify for the program. In the past, this has proved to be counterproductive because many of those kicked off Medicaid remain uninsured. Then, when they turn up in emergency rooms needing treatment, the city is forced to cover 100 percent of the cost. If these people had stayed on Medicaid, the federal government would have paid 50 percent of their treatment costs.

The federal government also has its eye on Medicaid. States, including New York, put many people on Medicaid who do not meet all the federal rules for being in the program. In fact, one third of people currently on Medicaid in the United States fall into this category and receive a full package of benefits. But the Bush administration is proposing that this change - that people who states voluntarily add to the Medicaid program no longer get all benefits.

Under current rules, states must apply for a federal waiver to change eligibility requirements and benefit packages in many cases. With the new system, they would no longer have to do so.

Critics-including some Republicans -say that the Bush proposal looks remarkably similar to a plan vetoed by President Clinton, who said at the time that it would lead to cuts that would be "devastating" for the poor.

"I don't see how New York would benefit with this kind of arrangement," says James R. Tallon, president of the United Hospital Fund. "New York has a significant Medicaid program, therefore, one has to be skeptical about any standard federal formula. New York probably has more to lose than gain."

The National Governor's Association, which might be expected to enthusiastically support anything that offers Medicaid spending relief (since Medicaid spending makes up approximately 20 percent of most state budgets) did not endorse the proposal but simply thanked the administration for putting Medicaid spending in the spotlight.

The president has put Medicare reform on his agenda as well. During his State of the Union address last month, Bush proposed adding a prescription drug benefit to the program. But to take advantage of the benefit, the elderly would have to enroll in health maintenance organizations. The administration, through its administrator of the Center for Medicaid and Medicare Services, Tom Scully, denied that the program would "force" beneficiaries into HMOs, but few details of the plan have yet been released.

There is some unequivocal good news for Medicare patients and their doctors, however. Scully told a Senate subcommittee on January 30 that the administration did not support actually going through with the 4.4 percent cut in doctor's fees that is scheduled to go into effect on March 1. This will now be considered along with the federal budget. Experts had said that, following a 5.4 percent reduction that went into effect last year, another cut would drive even more doctors out of the program.

And Pataki had some positive news for one group of health care consumers-the seriously mentally ill. After the Times revealed that nursing homes were warehousing mentally ill patients and that many of the group homes serving them provided worse care than the mental institutions they replaced, the governor appointed a commission to look into the problem. Taking its recommendations, Pataki has proposed spending $80 million to create new housing to replace the current system. While Democrats want more, advocates for the mentally ill are pleased to get a substantial increase during a fiscal crisis.

Maia Szalavitz is author, with Dr. Joseph Volpicelli, of "Recovery Options: The Complete Guide: How You and Your Loved Ones Can Understand and Treat Alcohol and Other Drug Problems." She writes frequently on health, science and public policy for the New York Times, New York Magazine, the Village Voice, and other publications.



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