September 11
HHS Has Screened Additional Federal Responders for World Trade Center Health Effects, but Plans for Awarding Funds for Treatment Are Incomplete Gao ID: GAO-06-1092T September 8, 2006Responders to the World Trade Center (WTC) attack--individuals involved in rescue, recovery, or cleanup--included New York City Fire Department (FDNY) personnel, federal government workers, and others from New York and elsewhere. They were exposed to numerous hazards, and concerns remain about the long-term effects on their physical and mental health. In February 2006, GAO testified that four of the five key federally funded programs that were monitoring health effects in responders had made progress but that the Department of Health and Human Services' (HHS) WTC Federal Responder Screening Program, implemented by the Office of Public Health Emergency Preparedness (OPHEP), lagged behind (GAO-06-481T). GAO also reported that the Congress appropriated $75 million in December 2005 to HHS's Centers for Disease Control and Prevention (CDC) for monitoring and treatment for responders and that CDC was deciding how to allocate the funds. This statement updates GAO's February 2006 testimony. GAO examined (1) progress made by HHS's WTC federal responder program and (2) actions CDC has taken to award the $75 million appropriated. GAO reviewed program documents and interviewed HHS officials and others involved in WTC monitoring and treatment programs.
The WTC federal responder program has registered and screened additional federal responders since February 2006, and arrangements are being developed to screen responders who are former federal workers residing outside the New York area. An additional 1,385 federal responders have registered for screening, including 1,134 current federal workers and 251 former federal workers, bringing the total number registered as of late August 2006 to 1,762, including 283 former federal workers. Because the total number of federal responders is uncertain, the proportion of the total who have registered is unknown. As of late August 2006, Federal Occupational Health Services (FOH) had completed screening of 907 federal workers, 380 of whom were screened since February 2006. Under an OPHEP agreement with CDC's National Institute for Occupational Safety and Health (NIOSH), former federal workers are being screened through the worker and volunteer WTC program, one of the five key federally funded programs. As of July 31, 2006, the worker and volunteer WTC program provided screenings to 13 former federal workers and scheduled 11 more, and 139 former workers had been screened by FOH as part of the 907 workers. Most of the former federal workers reside outside the New York area, where the worker and volunteer WTC program is located, and NIOSH is working to establish a national network of providers to screen these workers. CDC has awarded a small portion of the $75 million appropriated for screening, monitoring, and treatment and plans to make decisions about treatment coverage before awarding most of the funds. The agency plans to award the $75 million to the five organizations that the law identified as having priority for funding. CDC officials expect to make awards to the WTC Health Registry, the Police Organization Providing Peer Assistance (the POPPA program), and the New York City Police Foundation's Project COPE over a 3-year period and to award funds to the FDNY WTC and worker and volunteer WTC programs in response to the treatment costs they incur. CDC officials have a proposed spending plan that allocates about $53.5 million for the latter two programs' treatment costs, but the officials told GAO that because they are uncertain about how quickly treatment costs could deplete the available funds, they may need to make adjustments. Officials from the FDNY WTC and worker and volunteer WTC programs told GAO that they anticipated that their estimated portion of the funds would be depleted well before the end of 3 years. As of August 2006, CDC awarded about $4.5 million of the $75 million: about $1.9 million to the WTC Health Registry, $1.5 million to the FDNY WTC program, and almost $1.1 million to the worker and volunteer WTC program. In addition, CDC expects to award $1.5 million to the POPPA program and $3 million to Project COPE in September 2006. CDC is waiting to make further awards until it has reached certain decisions about the coverage of treatment services, such as which prescription drugs would be covered. CDC expects to begin making further awards around February 2007.
GAO-06-1092T, September 11: HHS Has Screened Additional Federal Responders for World Trade Center Health Effects, but Plans for Awarding Funds for Treatment Are Incomplete
This is the accessible text file for GAO report number GAO-06-1092T
entitled 'September 11: HHS Has Screened Additional Federal Responders
for World Trade Center Health Effects, but Plans for Awarding Funds for
Treatment Are Incomplete' which was released on September 8, 2006.
This text file was formatted by the U.S. Government Accountability
Office (GAO) to be accessible to users with visual impairments, as part
of a longer term project to improve GAO products' accessibility. Every
attempt has been made to maintain the structural and data integrity of
the original printed product. Accessibility features, such as text
descriptions of tables, consecutively numbered footnotes placed at the
end of the file, and the text of agency comment letters, are provided
but may not exactly duplicate the presentation or format of the printed
version. The portable document format (PDF) file is an exact electronic
replica of the printed version. We welcome your feedback. Please E-mail
your comments regarding the contents or accessibility features of this
document to Webmaster@gao.gov.
This is a work of the U.S. government and is not subject to copyright
protection in the United States. It may be reproduced and distributed
in its entirety without further permission from GAO. Because this work
may contain copyrighted images or other material, permission from the
copyright holder may be necessary if you wish to reproduce this
material separately.
Testimony:
Before the Subcommittee on National Security, Emerging Threats, and
International Relations, Committee on Government Reform, House of
Representatives:
United States Government Accountability Office:
GAO:
For Release on Delivery Expected at 10:30 a.m. EDT:
in New York, New York,
Friday, September 8, 2006:
September 11:
HHS Has Screened Additional Federal Responders for World Trade Center
Health Effects, but Plans for Awarding Funds for Treatment Are
Incomplete:
Statement of Cynthia A. Bascetta:
Director, Health Care:
GAO-06-1092T:
GAO Highlights:
Highlights of GAO-06-1092T, a testimony before the Subcommittee on
National Security, Emerging Threats, and International Relations,
Committee on Government Reform, House of Representatives
Why GAO Did This Study:
Responders to the World Trade Center (WTC) attack”individuals involved
in rescue, recovery, or cleanup”included New York City Fire Department
(FDNY) personnel, federal government workers, and others from New York
and elsewhere. They were exposed to numerous hazards, and concerns
remain about the long-term effects on their physical and mental health.
In February 2006, GAO testified that four of the five key federally
funded programs that were monitoring health effects in responders had
made progress but that the Department of Health and Human Services‘
(HHS) WTC Federal Responder Screening Program, implemented by the
Office of Public Health Emergency Preparedness (OPHEP), lagged behind
(GAO-06-481T). GAO also reported that the Congress appropriated $75
million in December 2005 to HHS‘s Centers for Disease Control and
Prevention (CDC) for monitoring and treatment for responders and that
CDC was deciding how to allocate the funds.
This statement updates GAO‘s February 2006 testimony. GAO examined (1)
progress made by HHS‘s WTC federal responder program and (2) actions
CDC has taken to award the $75 million appropriated. GAO reviewed
program documents and interviewed HHS officials and others involved in
WTC monitoring and treatment programs.
What GAO Found:
The WTC federal responder program has registered and screened
additional federal responders since February 2006, and arrangements are
being developed to screen responders who are former federal workers
residing outside the New York area. An additional 1,385 federal
responders have registered for screening, including 1,134 current
federal workers and 251 former federal workers, bringing the total
number registered as of late August 2006 to 1,762, including 283 former
federal workers. Because the total number of federal responders is
uncertain, the proportion of the total who have registered is unknown.
As of late August 2006, Federal Occupational Health Services (FOH) had
completed screening of 907 federal workers, 380 of whom were screened
since February 2006. Under an OPHEP agreement with CDC‘s National
Institute for Occupational Safety and Health (NIOSH), former federal
workers are being screened through the worker and volunteer WTC
program, one of the five key federally funded programs. As of July 31,
2006, the worker and volunteer WTC program provided screenings to 13
former federal workers and scheduled 11 more, and 139 former workers
had been screened by FOH as part of the 907 workers. Most of the former
federal workers reside outside the New York area, where the worker and
volunteer WTC program is located, and NIOSH is working to establish a
national network of providers to screen these workers.
CDC has awarded a small portion of the $75 million appropriated for
screening, monitoring, and treatment and plans to make decisions about
treatment coverage before awarding most of the funds. The agency plans
to award the $75 million to the five organizations that the law
identified as having priority for funding. CDC officials expect to make
awards to the WTC Health Registry, the Police Organization Providing
Peer Assistance (the POPPA program), and the New York City Police
Foundation‘s Project COPE over a 3-year period and to award funds to
the FDNY WTC and worker and volunteer WTC programs in response to the
treatment costs they incur. CDC officials have a proposed spending plan
that allocates about $53.5 million for the latter two programs‘
treatment costs, but the officials told GAO that because they are
uncertain about how quickly treatment costs could deplete the available
funds, they may need to make adjustments. Officials from the FDNY WTC
and worker and volunteer WTC programs told GAO that they anticipated
that their estimated portion of the funds would be depleted well before
the end of 3 years. As of August 2006, CDC awarded about $4.5 million
of the $75 million: about $1.9 million to the WTC Health Registry, $1.5
million to the FDNY WTC program, and almost $1.1 million to the worker
and volunteer WTC program. In addition, CDC expects to award $1.5
million to the POPPA program and $3 million to Project COPE in
September 2006. CDC is waiting to make further awards until it has
reached certain decisions about the coverage of treatment services,
such as which prescription drugs would be covered. CDC expects to begin
making further awards around February 2007.
[Hyperlink, http://www.gao.gov/cgi-bin/getrpt?GAO-06-1092T].
To view the full product, including the scope and methodology, click on
the link above. For more information, contact Cynthia A. Bascetta at
(202) 512-7101 or bascettac@gao.gov.
[End of Section]
Mr. Chairman and Members of the Subcommittee:
Thank you for inviting me to participate in today's hearing on programs
that monitor and provide treatment for health effects of the World
Trade Center (WTC) terrorist attack on September 11, 2001.[Footnote 1]
My testimony today updates information we reported to you in February
2006.[Footnote 2] An estimated 40,000 people served as responders in
the aftermath of the WTC disaster, including New York City Fire
Department (FDNY) personnel, federal government personnel, and other
government and private-sector workers and volunteers from New York and
elsewhere. By responders we are referring to anyone involved in rescue,
recovery, or cleanup activities at or near the vicinity of the WTC or
Staten Island site.[Footnote 3] These responders were exposed to
numerous physical hazards, environmental toxins, and psychological
trauma. Five years after the destruction of the WTC buildings, concerns
remain about the long-term physical and mental health effects of the
attack on responders as well as other affected individuals, including
residents and workers.
As we testified in September 2004,[Footnote 4] in the aftermath of the
WTC attack, five key federally funded programs were implemented to
assess the short-term, and in some cases long-term, effects on the
physical and mental health of WTC responders. These programs are the
FDNY WTC Medical Monitoring Program; WTC Medical Monitoring Program,
which we refer to as the worker and volunteer WTC program;[Footnote 5]
New York State responder screening program; WTC Health
Registry;[Footnote 6] and the Department of Health and Human Services'
(HHS) WTC Federal Responder Screening Program. We provided information
on the progress of these monitoring programs[Footnote 7] in our
February 2006 testimony.[Footnote 8] We noted that federal employees
who responded in an official capacity in the aftermath of the WTC
attack were eligible only for the federal responder program but that it
had accomplished little and lagged behind the other four programs. The
other programs had provided thousands of health screenings and
collected information that could contribute to better understanding of
the health consequences of the attack and improve treatment for
affected individuals. Officials of the three programs that planned to
conduct long-term health monitoring--the FDNY WTC program, the worker
and volunteer WTC program, and the WTC Health Registry--told us they
were concerned, however, that federal funding for their programs could
end before sufficient monitoring occurred to identify all long-term
health problems related to the WTC attack, some of which, such as
cancer, might not appear until decades after exposure to a harmful
agent.[Footnote 9] We also reported that HHS's Centers for Disease
Control and Prevention (CDC) had recently received a $75 million
appropriation to fund programs providing health screening, long-term
monitoring, and treatment for WTC responders and was deciding how to
allocate those funds.[Footnote 10]
My testimony today revisits these issues. I will discuss (1) progress
made by HHS's WTC Federal Responder Screening Program, and (2) actions
CDC has taken to award the $75 million that the Congress appropriated
to the agency in December 2005 for programs that provide screening,
monitoring, or treatment for WTC responders.
To assess progress made by HHS's WTC Federal Responder Screening
Program, we obtained and reviewed program data and documents from HHS,
including applicable interagency agreements and budget documents. We
interviewed officials from the Agency for Toxic Substances and Disease
Registry (ATSDR); CDC's National Institute for Occupational Safety and
Health (NIOSH); Federal Occupational Health Services (FOH);[Footnote
11] and the Office of Public Health Emergency Preparedness (OPHEP). To
determine actions taken by CDC to award funds from the $75 million
appropriated, we obtained documents and interviewed officials from
NIOSH and ATSDR. We also interviewed officials from organizations
implementing programs designated in the appropriations act as having
first priority for receiving the funds--including the Mount Sinai-
Irving J. Selikoff Center for Occupational and Environmental Medicine,
one of the clinical centers of the worker and volunteer WTC program;
FDNY's Bureau of Health Services (FDNY-BHS); the New York City
Department of Health and Mental Hygiene; the Police Organization
Providing Peer Assistance (the POPPA program); and the New York City
Police Foundation's Project COPE--and officials from the American Red
Cross, which has funded treatment services for responders. We relied on
data provided by agency officials and contained in government
publications and did not independently verify the data we obtained.
Although we could not independently verify the reliability of all of
this information, we compared it with other supporting documents, when
available, to determine data consistency and reasonableness. Based on
these efforts, we believe the information we obtained is sufficiently
reliable for this report. We conducted our work from July 2006 to
September 2006 in accordance with generally accepted government
auditing standards.
In summary, since February 2006, HHS has registered and screened
additional federal responders, and arrangements are being developed for
screening responders who are former federal workers residing outside
the New York metropolitan area. An additional 1,385 federal responders
have registered for screening examinations, including 1,134 current
federal workers and 251 former federal workers, bringing the total
number registered on the WTC Federal Responder Screening Program Web
site as of late August 2006 to 1,762, including 283 former federal
workers. Because the total number of federal responders involved in the
WTC disaster is uncertain, it is not possible to determine what
proportion of the total number of federal responders have registered.
As of late August 2006, FOH had completed screening examinations for a
total of 907 federal workers; 380 of the 907 were screened since
February 2006. Under an OPHEP agreement with NIOSH, screening
examinations for former federal workers are to be provided through the
worker and volunteer WTC program. As of July 31, 2006, the worker and
volunteer WTC program provided screening examinations to 13 former
federal workers and scheduled 11 more. Most of the former federal
workers reside outside the New York metropolitan area, where the worker
and volunteer WTC program is located, and NIOSH is working to establish
a national network of providers to screen these workers.
CDC plans to award the $75 million appropriated for screening,
monitoring, and treatment to the five organizations that the law
identified as having priority for funding. CDC officials expect to make
awards to the WTC Health Registry, Project COPE, and the POPPA program
over a 3-year period and to award funds to the FDNY WTC and worker and
volunteer WTC programs in response to their treatment costs. CDC
officials have a proposed spending plan that allocates about $53.5
million for the latter two programs' treatment costs, but the officials
told us that because they are uncertain about how quickly treatment
costs could deplete the available funds, they may need to make
adjustments. Officials from the FDNY WTC and worker and volunteer WTC
programs told us that they expected that their estimated portion of the
appropriated funds would be depleted well before the end of 3 years. As
of August 2006, CDC awarded about $4.5 million of the $75 million. The
agency awarded about $1.9 million to the WTC Health Registry, $1.5
million to the FDNY WTC program, and almost $1.1 million to the worker
and volunteer WTC program. In addition, CDC expects to award $1.5
million to the POPPA program and $3 million to Project COPE in
September 2006. CDC is waiting to make further awards until it has
reached certain decisions about the coverage of treatment services,
such as which prescription drugs would be covered in the FDNY WTC and
worker and volunteer WTC programs. CDC expects to begin making further
awards around February 2007.
Background:
When the WTC buildings collapsed on September 11, 2001, an estimated
250,000 to 400,000 people in the vicinity were immediately exposed to a
noxious mixture of dust, debris, smoke, and potentially toxic
contaminants in the air and on the ground, such as pulverized concrete,
fibrous glass, particulate matter, and asbestos. Those affected
included people residing, working, or attending school in the vicinity
of the WTC and thousands of emergency responders. Subsequently, an
estimated 40,000 responders who were involved in some capacity in the
days, weeks, and months that followed, including personnel from many
government agencies and private organizations as well as other workers
and volunteers, were also exposed.[Footnote 12]
Health Effects:
A wide variety of physical and mental health effects have been observed
and reported among people who were involved in rescue, recovery, and
cleanup operations and among those who lived and worked in the vicinity
of the WTC.[Footnote 13] Many health effects have persisted or worsened
over time.
Physical health effects included injuries and respiratory conditions,
such as sinusitis, asthma, and a new syndrome called WTC cough, which
consists of persistent coughing accompanied by severe respiratory
symptoms. Almost all firefighters who responded to the attack
experienced respiratory effects, including WTC cough. A recent study
suggested that exposed firefighters on average experienced a decline in
lung function equivalent to that which would be produced by 12 years of
aging.[Footnote 14]
Commonly reported mental health effects among responders and other
affected individuals included symptoms associated with posttraumatic
stress disorder--an often debilitating disorder that can develop after
a person experiences or witnesses a traumatic event, and which may not
develop for months or years after the event. Behavioral effects such as
alcohol and tobacco use and difficulty coping with daily
responsibilities have also been reported.
Monitoring Programs:
The five programs that were created for monitoring the health of WTC
responders vary in aspects such as the implementing agency (i.e.,
federal, state, or local governments or private organizations) and
eligibility requirements. (See table 1.) Each program received federal
funding, the majority of which was provided by the Department of
Homeland Security's Federal Emergency Management Agency
(FEMA),[Footnote 15] as part of the approximately $8.8 billion in
federal assistance that the Congress appropriated to FEMA for response
and recovery activities after the WTC disaster.[Footnote 16] FEMA is
authorized to use a portion of its WTC-related funding for screening
and long-term monitoring of responders.[Footnote 17] With regard to
treatment, however, FEMA may generally fund only short-term care after
a disaster, such as emergency medical services, and not ongoing
clinical treatment.[Footnote 18] FEMA entered into interagency
agreements with HHS to fund most of the health monitoring programs.
OPHEP, which coordinates and directs HHS's emergency preparedness and
response program, entered into separate interagency agreements with FOH
to implement the federal responder screening program for current
federal workers and with NIOSH to implement the screening program for
former federal workers.
Table 1: Key Federally Funded WTC Health Monitoring Programs:
Program: FDNY WTC Medical Monitoring Program[B];
Implementing agency or organization: FDNY Bureau of Health Services
(FDNY-BHS);
Eligible population: Firefighters and emergency medical technicians;
Completed monitoring activities, as reported by GAO in September
2005[A]: Through June 2005, 15,284 firefighters and emergency medical
technicians received screening examinations, and 522 of these
participants completed a follow-up examination;
Federal funding: $4.8 million was provided beginning in October 2001
for initial program; additional $25 million is available through June
2009.
Program: WTC Medical Monitoring Program (worker and volunteer WTC
program)[B];
Implementing agency or organization: Five clinical centers, one of
which, the Mount Sinai-Irving J. Selikoff Center for Occupational and
Environmental Medicine, also serves as a data and coordination
center[C];
Eligible population: Rescue and recovery workers and volunteers,[D]
excluding NYC firefighters and emergency medical technicians;
Completed monitoring activities, as reported by GAO in September
2005[A]: Through June 2005, 14,110 people received screening
examinations, and 1,699 of these participants completed a follow-up
examination;
Federal funding: $15.9 million was provided for initial program;[E]
additional $56 million is available through July 2009.
Program: New York State responder screening program[F];
Implementing agency or organization: New York State Department of
Health;
Eligible population: New York State employees and National Guard
personnel who responded to the WTC attack in an official capacity;
Completed monitoring activities, as reported by GAO in September
2005[A]: As of November 2003, 1,677 employees and National Guard
personnel received screening examinations;
Federal funding: $2.4 million was provided in January 2002 and is
available through mid-January 2007.[G].
Program: WTC Health Registry[H];
Implementing agency or organization: NYC Department of Health and
Mental Hygiene;
Eligible population: Responders and people living or attending school
in the area of the WTC, or working or present in the vicinity on
September 11, 2001[I];
Completed monitoring activities, as reported by GAO in September
2005[A]: As of November 2004, the program completed baseline data
collection through interviews with the 71,437 people who enrolled in
the registry;[J] in 2005, the program updated contact information
obtained at the time of enrollment;
Federal funding: $20 million was provided beginning in July 2002,[K]
and as of September 2005, additional funding of about $3 million had
been provided.l.
Program: WTC Federal Responder Screening Program;
Implementing agency or organization: HHS Office of Public Health and
Emergency Preparedness (OPHEP); Federal Occupational Health (FOH)
Services; and CDC's National Institute for Occupational Safety and
Health (NIOSH);
Eligible population: Federal workers who responded to the WTC attack in
an official capacity[M];
Completed monitoring activities, as reported by GAO in September
2005[A]: From June 2003 through March 2004, 394 screening examinations
were completed. When the program resumed in December 2005, an
additional 133 examinations were completed as of early February 2006;
Federal funding: $3.74 million was provided beginning in March 2003 and
is available through December 2006.
Source: GAO analysis of information from ATSDR, FDNY, Mount Sinai,
National Center for Environmental Health, New York City Department of
Health and Mental Hygiene, New York State Department of Health, and
NIOSH. Some of the information in this table originally appeared as
tables 1 and 2 in GAO-06-481T.
[A] GAO-05-1020T. The monitoring activities completed by the WTC
Federal Responder Screening Program are as reported by GAO in February
2006 (GAO-06-481T). The monitoring methods used by all programs except
the WTC Health Registry consist of screening examinations that include
a medical questionnaire and physical examination; the Registry's
monitoring method is a telephone-based health and exposure interview.
[B] The FDNY WTC Medical Monitoring Program and the WTC Medical
Monitoring Program constitute the WTC Responder Health Consortium.
NIOSH established the consortium in March 2004 to coordinate the health
monitoring of the two programs and to facilitate data sharing.
[C] The other clinical centers are located at the Long Island
Occupational and Environmental Health Center, the New York University
School of Medicine, the City University of New York's Queens College,
and the University of Medicine and Dentistry of New Jersey's Robert
Wood Johnson Medical School. The responsibilities of the Mount Sinai
data and coordination center include coordination of the clinical
centers, outreach and education, quality assurance, and data
management.
[D] The worker and volunteer WTC program excludes NYC firefighters and
emergency medical technicians, as they are eligible for FDNY's program.
The program initially excluded responders who were paid as New York
State employees for their WTC work and were eligible for the New York
State responder screening program. That program ended its screening
examinations in November 2003, and as of February 2004, New York State
responders became eligible for the worker and volunteer WTC program.
Beginning in February 2006, former federal workers enrolled in the HHS
WTC Federal Responder Screening Program were eligible to be screened in
the worker and volunteer WTC program.
[E] Of this amount, $11.8 million was provided beginning in July 2002
through funds appropriated to CDC, and $4.1 million was provided in
fiscal year 2003 through an interagency agreement with FEMA.
[F] The New York State program ended its screening examinations in
November 2003.
[G] The primary program activity since November 2003 has been data
analysis.
[H] The registry includes health and exposure information obtained
through interviews with participants and was designed to track
participants' health for 20 years and to provide data on the long-term
health consequences of the WTC attack.
[I] Participants in the other WTC monitoring programs may also
participate in the registry program.
[J] Registry officials told us that final enrollment numbers may be
revised pending internal verification of data.
[K] The grant agreement is between ATSDR and the New York City
Department of Health and Mental Hygiene. However, ATSDR contracted
directly with Research Triangle Institute, a private not-for-profit
organization, for most of the work to establish the registry, and about
$16 million of the $20 million went directly from ATSDR to Research
Triangle Institute.
[L] The Environmental Protection Agency provided $2 million of these
funds. In addition, CDC and ATSDR provided $500,000 each.
[M] Screening examinations for current federal workers are provided by
FOH under an agreement with OPHEP. Screening examinations for former
federal workers are provided by NIOSH through the worker and volunteer
WTC program.
[End of table]
We reported in February 2006 that four of the five monitoring programs
had made progress in screening and monitoring affected individuals and
gathering data.[Footnote 19] (See table 1.) These four programs--the
FDNY WTC Medical Monitoring Program, the worker and volunteer WTC
program, the New York State responder screening program, and the WTC
Health Registry--had collected information that monitoring officials
said could be used by researchers to help better understand the health
consequences of the attack and improve treatment, such as by
identifying which types of treatment are effective for specific
conditions. In contrast to the progress made by the other programs, the
HHS WTC Federal Responder Screening Program had lagged behind and
accomplished little.[Footnote 20] The program was established to
provide free voluntary medical screening examinations for federal
workers[Footnote 21] whom their agencies sent to respond to the WTC
disaster from September 11, 2001, through September 10, 2002,[Footnote
22] and who were not eligible for any other WTC health monitoring
program.[Footnote 23] Through March 2004, the program--which started
about a year later than the other WTC monitoring programs--completed
screenings of 394 federal workers.[Footnote 24] HHS put the program on
hold in January 2004, when it stopped scheduling new examinations,
because it wanted to resolve several operational issues, including
HHS's determination that FOH did not have the authority to provide
examinations to people who are no longer in federal service. Under an
agreement between OPHEP and FOH that was established in July 2005, the
program resumed providing examinations for current federal workers in
December 2005, and in February 2006, OPHEP executed an agreement with
NIOSH calling for NIOSH to arrange for the worker and volunteer WTC
program to provide examinations to former federal workers.
Many participants in the monitoring programs required additional
testing or needed treatment for health problems that were identified
during screening examinations. The FDNY WTC Medical Monitoring Program
referred participants to the FDNY Bureau of Health Services, but the
other programs primarily referred participants to their primary care
physician or to privately funded programs available to responders, such
as treatment services provided by the Mount Sinai clinical center that
are funded by the American Red Cross. We previously reported that
officials told us that finding treatment services for such participants
was an important, but challenging, part of the programs'
responsibility.[Footnote 25] For example, officials from the worker and
volunteer WTC program stated that identifying providers available to
treat participants became a major part of their operations, and was
especially difficult when participants lacked health insurance.
New Federal Funding for Monitoring and Treatment:
In December 2005, the Congress appropriated $75 million to CDC to fund
programs providing baseline screening, long-term monitoring, and health
care treatment for emergency services and recovery personnel who
responded to the WTC disaster. The law required CDC to give first
priority to programs coordinated by the FDNY-BHS, Mount Sinai-Irving J.
Selikoff Center for Occupational and Environmental Medicine, and New
York City Department of Health and Mental Hygiene, which have existing
monitoring programs, and to programs coordinated by the POPPA program
and Project COPE.[Footnote 26] The mission of the POPPA program, which
offers peer-to-peer mental health counseling to New York City Police
Department (NYPD) officers, is to reduce unresolved emotional trauma
that can result in problems ranging from poor performance to suicide.
The POPPA program counseled over 5,000 NYPD officers in the 10 months
following the WTC attack. Project COPE, a collaboration of the New York
City Police Foundation and Columbia University Medical Center, uses a
hotline and outreach efforts to encourage NYPD uniformed and civilian
employees to obtain mental health services, which are provided by
Columbia University Medical Center and private providers. As of August
2006, over 18,000 employees had attended educational sessions held at
police facilities, and over 5,000 had received individual counseling or
therapy consultations.
HHS Has Registered and Screened Additional Federal Responders, and
Arrangements for Screening Former Federal Workers outside the New York
Metropolitan Area Are under Development:
Since February 2006, an additional 1,385 federal responders have
registered for screening examinations, bringing the total number
registered on the WTC Federal Responder Screening Program Web site to
1,762 as of late August 2006, including 283 former federal workers.
Because the total number of federal responders involved in the WTC
disaster is uncertain, it is not possible to determine what proportion
of the total number of federal responders have registered. HHS's
efforts to conduct outreach to federal agencies resulted in the
identification of 2,200 federal responders. As of late August 2006, FOH
had completed screening examinations for a total of 907 federal
workers, 380 of whom were screened since February 2006. Through OPHEP's
agreement with NIOSH, the worker and volunteer WTC program has provided
screening examinations to 13 former federal workers and scheduled 11
more. Most of the former federal workers reside outside the New York
metropolitan area, where the worker and volunteer WTC program is
located, and NIOSH is working to establish a national network of
providers to screen these workers.
HHS's Outreach Resulted in Registration of Additional Federal Workers
Involved in WTC Disaster Response:
HHS reported that as of late August 2006, a total of 1,762 federal
responders had registered for screening examinations on the WTC Federal
Responder Screening Program Web site, including 1,479 current federal
workers and 283 former federal workers. Of the 1,762 federal responders
who registered, 1,385 had registered since February 2006, including
1,134 current federal workers and 251 former federal workers. It is not
possible to determine what proportion of the total number of federal
responders involved in the WTC disaster have registered because the
total number involved is uncertain. In determining the total number of
individuals eligible for its program, the WTC Health Registry developed
an estimate of 8,621 federal responders, based on information from 31
federal agencies in the New York area and information from FEMA on 22
Urban Search and Rescue teams that were deployed to the WTC
area.[Footnote 27] This estimate does not account for all federal
responders from other geographic areas.
As we reported previously, in the aftermath of the WTC disaster, HHS
did not have a comprehensive list of all federal agencies and federal
responders who were involved. In an effort to develop such a list,
OPHEP and ATSDR entered into an agreement in April 2005 for ATSDR--
which had developed the WTC Health Registry--to identify and register
federal responders.[Footnote 28] Under the agreement, ATSDR, through a
contractor, contacted federal agencies, developed a list of WTC federal
responders, and conducted outreach to encourage the responders to
register on the new Web site that the contractor established.[Footnote
29] As a result of this effort, 46 federal agencies were identified and
provided contact information for 2,200 federal responders.[Footnote 30]
The agreement between OPHEP and ATSDR expired on April 30, 2006, ending
the outreach efforts to federal agencies.[Footnote 31] Under an
agreement with OPHEP, NIOSH assumed responsibility for maintaining the
WTC Federal Responder Screening Program Web site through December 31,
2006.[Footnote 32]
HHS Has Screened Additional Current Federal Workers:
As of late August 2006, FOH had completed screening examinations for a
total of 907 of the federal workers who had registered;[Footnote 33]
380 of the 907 were screened since February 2006.[Footnote 34] Under
its agreement with OPHEP, FOH is responsible for regularly retrieving
from the registration Web site requests for screening examinations for
current federal workers and for assigning individuals to a provider for
screening.[Footnote 35] FOH officials told us that they contact the
individual and the provider to inform them of the need to arrange an
appointment for screening. The program relies on individuals to call
the designated provider and schedule their appointment. FOH officials
told us that individuals who have registered do not always contact the
provider to schedule an appointment or may not keep an appointment or
call to reschedule it. FOH officials said that they have attempted to
contact such individuals but often received no response.
We reported in our February 2006 testimony that under the July 2005
agreement FOH clinicians can refer current federal workers for follow-
up care if the screening examination--which includes a medical
questionnaire, clinical tests such as a chest X-ray, and a full
physical examination--reveals significant physical or mental health
symptoms.[Footnote 36] On July 31, 2006, FOH told us that it had
referred 39 current federal workers with mental health symptoms to an
FOH employee assistance program (EAP) for counseling;[Footnote 37] 24
to ear, nose, and throat specialists; 19 to pulmonary medicine
specialists; and 1 to a cardiology specialist.
Screening of Former Federal Workers Has Resumed, but Group Is Widely
Dispersed and Nationwide Network of Providers Is Still Being
Established:
As of late August 2006, 283 former federal workers had registered to
receive screening examinations, which under OPHEP's agreement with
NIOSH are to be provided by the worker and volunteer WTC
program.[Footnote 38] Under the agreement, former federal workers
receive a one-time examination comparable to the examination that FOH
is providing to current federal workers. As of July 31, 2006, 13
screening examinations had been completed and 11 were scheduled. These
completed and scheduled examinations are in addition to the 139 former
federal workers that FOH screened after the WTC Federal Responder
Screening Program resumed because FOH thought they were current federal
workers.[Footnote 39]
A key challenge in providing screening examinations to former federal
workers has been that a large number do not reside in the New York
metropolitan area, where the worker and volunteer WTC program is based.
The 283 former federal workers who have registered for screening
examinations reside in 40 states, and about 240 of them reside outside
the New York metropolitan area. NIOSH officials said that making
arrangements to screen these widely dispersed responders has presented
challenges, such as ensuring that the arrangements comply with federal
privacy protections. NIOSH is negotiating with the Association of
Occupational and Environmental Clinics (AOEC)[Footnote 40] in an effort
to establish a national network of providers to screen these federal
workers.
CDC Has Awarded a Small Portion of the $75 Million Appropriation and
Plans to Make Decisions about Treatment Coverage before Awarding Most
of the Funds:
CDC plans to award the $75 million appropriated for screening,
monitoring, and treatment to the five organizations that the law
identified as having priority for funding. CDC officials expect to make
awards to the WTC Health Registry, Project COPE, and the POPPA program
over a 3-year period and to award funds to the FDNY WTC and worker and
volunteer WTC programs in response to their treatment costs. CDC
officials have a proposed spending plan but told us that because they
are uncertain about how quickly treatment costs could deplete the
available funds, they may need to make adjustments. Officials from the
FDNY WTC and worker and volunteer WTC programs told us that they
expected that their estimated portion of the appropriated funds would
be depleted well before the end of 3 years. As of August 2006, CDC
awarded about $4.5 million of the $75 million--about $1.9 million to
the WTC Health Registry, $1.5 million to the FDNY WTC program, and
almost $1.1 million to the worker and volunteer WTC program. In
addition, CDC expects to award $1.5 million to the POPPA program and $3
million to Project COPE in September 2006. CDC is waiting to make
further awards until agency officials have reached certain decisions
about the coverage of treatment services, such as which prescription
drugs would be covered in the FDNY WTC and worker and volunteer WTC
programs. CDC expects to begin making further awards around February
2007.
CDC Plans to Award the $75 Million to the Five First-Priority
Organizations:
CDC has decided to award the $75 million for screening, monitoring, and
treatment that was appropriated to the agency in December 2005 to the
five organizations identified as having first priority for
funding.[Footnote 41] The organizations to which CDC plans to provide
funds are:
* the FDNY WTC program, for monitoring and treatment;
* the worker and volunteer WTC program, for monitoring and treatment;
* the WTC Health Registry, for monitoring;
* Project COPE, for treatment; and:
* the POPPA program, for treatment.
CDC plans to make awards through cooperative agreements with the
programs.[Footnote 42] In general, it plans to send letters to the
organizations inviting them to submit applications for funding; the
applications would then undergo a two-stage peer review process. At the
first stage a panel of outside experts would assess the merit of the
application, and at the second stage CDC officials would determine the
amount of funding the applicant would receive.
CDC has made preliminary decisions about how to allocate the $75
million among the five organizations. As of September 1, 2006, CDC's
proposed spending plan indicated that awards would be made in the
following way:
* $53.5 million for treatment and $8 million for monitoring, to be
divided between the FDNY WTC and worker and volunteer WTC
programs;[Footnote 43]
* $9 million for the WTC Health Registry;
* $3 million for Project COPE; and:
* $1.5 million for the POPPA program.
CDC officials expect to make awards to the WTC Health Registry, Project
COPE, and the POPPA program over a 3-year period, but are not sure over
what period they will make awards to the FDNY WTC and worker and
volunteer WTC programs. A CDC official told us that the agency would
award funds to the latter two programs in response to the treatment
costs they incur. He said that agency officials are uncertain about how
quickly treatment costs could deplete the available funds, because CDC
does not know how many additional people will seek monitoring and what
the extent of their treatment needs will be. For example, previous
media reports about illnesses diagnosed in responders have resulted in
increases in responders seeking examinations. Officials from the FDNY
WTC and worker and volunteer WTC programs told us that they expected
that their estimated portion of the appropriated funds would be
depleted well before the end of 3 years. CDC has developed a proposed
spending plan that indicates that about 36 percent of the funds would
be awarded by the end of fiscal year 2007 and about 63 percent would be
awarded during fiscal year 2008, although a CDC official told us that,
depending on the extent of treatment needs, the funds could be used
more quickly. The current plan is based in part on an agreement CDC
made with the American Red Cross in April 2006.[Footnote 44] According
to a CDC official, under this agreement, American Red Cross funds would
be used for the treatment services that are eligible for American Red
Cross support--such as basic clinical examinations and certain tests--
for as long as such funds are available and the CDC funds would be used
to cover other program expenses--such as infrastructure costs, more
sophisticated diagnostic tests, and the conversion of medical records
into an electronic format.
CDC Has Awarded about $4.5 Million of the $75 Million Appropriated:
As of August 2006, CDC had awarded a total of about $4.5 million of the
$75 million to the WTC Health Registry, FDNY WTC program, and worker
and volunteer WTC program. According to CDC officials, the WTC Health
Registry applied for about $1.9 million in April 2006 for continuation
of its collection of health data, and CDC awarded the registry $1.9
million in May 2006 and about $56,000 in July 2006.[Footnote 45] On
August 10 and 11, 2006, respectively, the worker and volunteer WTC and
FDNY WTC programs submitted applications to CDC for funds related to
treatment services. In response to these applications, CDC made what an
agency official termed emergency awards to the FDNY WTC and worker and
volunteer WTC programs on August 11, 2006.[Footnote 46] CDC provided
$1.5 million to the FDNY WTC program for leasing treatment space that
previously had been provided by New York City at no cost. CDC provided
almost $1.1 million to the worker and volunteer WTC program to hire an
additional physician to help reduce the 3-to 4-month waiting time for
treatment appointments that recently developed at the Mount Sinai
clinical center, as well as to hire three administrators and a medical
assistant. Officials from the clinical center told us that this waiting
time had developed because additional people were seeking monitoring
due to media reports about illnesses diagnosed in responders and
because the proportion of responders who needed to be referred for
treatment had increased.
In addition to having awarded about $4.5 million, CDC plans to award an
additional $4.5 million in September 2006. In spring 2006, CDC invited
Project COPE and the POPPA program, two programs that provide mental
health services to members of the NYPD, to apply for funding through a
peer review process. In their applications, the POPPA program requested
$1.5 million over 3 years, and Project COPE requested funding of $3
million over 3 years. CDC received their applications in June and July,
respectively, and plans to implement the application review process in
time to be in a position to make awards in September 2006.
CDC Is Waiting to Award Additional Funds for Treatment Until It Makes
Decisions about Coverage:
CDC does not plan to award additional funds from the $75 million to the
FDNY WTC and worker and volunteer WTC programs until it makes certain
decisions about the coverage of treatment services. These decisions
include determining which medical conditions will be covered;[Footnote
47] developing a prescription drug formulary, that is, the list of
drugs that will be covered; and determining the extent to which
inpatient care will be covered. CDC officials said that they expected
to make the coverage decisions in late 2006 and that they would obtain
input from the American Red Cross and the programs.
A CDC official told us that making decisions about which prescription
drugs to cover could be the greatest challenge CDC and the programs
face, because of the potentially high cost of drugs needed to treat
responders. An FDNY WTC program official said that prescription drug
costs are a looming financial problem for the FDNY WTC program. The CDC
official told us that the most common diagnoses of WTC responders--
gastroesophageal reflux disease, obstructive pulmonary disease, and
mental health conditions--frequently are treated with prolonged and
expensive drug therapy. For example, medications for respiratory
therapy can cost $1,000 a month and may continue for a year. The FDNY
WTC program official estimated that 100 percent coverage of
prescriptions for firefighters and emergency medical technicians could
cost $10 million to $18 million per year and potentially consume all of
the funding that CDC would provide to the program. Clinicians at the
worker and volunteer WTC clinical center at Mount Sinai stated that
spending on prescription drugs at their center was increasing by $5,000
to $10,000 each month and amounted to $60,000 in July 2006.
Another coverage decision that CDC faces is to determine the extent to
which inpatient care will be covered. Currently, the FDNY WTC and
worker and volunteer WTC programs provide only outpatient care, but
officials involved with these programs believe that the treatment funds
from the $75 million should cover some inpatient care, such as when a
responder's WTC-linked asthma becomes exacerbated to an extent that
requires hospitalization.
CDC officials told us that they plan to reach decisions about treatment
coverage in fall 2006. They also plan to invite the FDNY WTC and worker
and volunteer WTC programs to submit applications for treatment funding
in the fall. If the applications are submitted by December 2006, CDC
officials expect to be able to review them in time to provide funding
to the programs by February 2007.
CDC is also in the process of resolving issues related to providing
access to screening, monitoring, and treatment services for WTC
responders, including former federal workers, who reside outside the
New York metropolitan area. CDC is negotiating with AOEC about possibly
using AOEC clinics around the country to provide these services. CDC
officials told us they intend that monitoring and treatment services
available to responders around the country would be comparable to
services provided by the worker and volunteer WTC program.
Mr. Chairman, this completes my prepared remarks. I would be happy to
respond to any questions you or other members of the subcommittee may
have at this time.
Contact and Acknowledgments:
For further information about this testimony, please contact Cynthia A.
Bascetta at (202) 512-7101 or bascettac@gao.gov. Contact points for our
Offices of Congressional Relations and Public Affairs may be found on
the last page of this statement. Helene F. Toiv, Assistant Director;
Fred Caison; Anne Dievler; Keyla Lee; and Roseanne Price made key
contributions to this statement.
[End of section]
Appendix I Abbreviations:
AOEC: Association of Occupational and Environmental Clinics:
ATSDR: Agency for Toxic Substances and Disease Registry:
CDC: Centers for Disease Control and Prevention:
EAP: employee assistance program:
FDNY: New York City Fire Department:
FDNY-BHS: New York City Fire Department Bureau of Health Services:
FEMA: Federal Emergency Management Agency:
FOH: Federal Occupational Health Services:
HHS: Department of Health and Human Services:
NIOSH: National Institute for Occupational Safety and Health:
NYPD: New York City Police Department:
OPHEP: Office of Public Health Emergency Preparedness:
POPPA: Police Organization Providing Peer Assistance:
WTC: World Trade Center:
FOOTNOTES
[1] A list of abbreviations used in this testimony is in app. I.
[2] GAO, September 11: Monitoring of World Trade Center Health Effects
Has Progressed, but Program for Federal Responders Lags Behind, GAO-06-
481T (Washington, D.C.: Feb. 28, 2006). See also GAO, September 11:
Monitoring of World Trade Center Health Effects Has Progressed, but Not
for Federal Responders, GAO-05-1020T (Washington, D.C.: Sept. 10,
2005).
[3] The Staten Island site is the landfill that is the off-site
location of the WTC recovery operation.
[4] GAO, September 11: Health Effects in the Aftermath of the World
Trade Center Attack, GAO-04-1068T (Washington, D.C.: Sept. 8, 2004).
[5] This program was formerly known as the WTC Worker and Volunteer
Medical Screening Program. In this testimony, we refer to the program
as the worker and volunteer WTC program.
[6] The WTC Health Registry also includes residents and other workers
affected by the attack.
[7] In this testimony, we use the term monitoring program to refer to
both one-time screening programs and programs that include initial
screening and periodic follow-up monitoring.
[8] GAO-06-481T.
[9] At that time, funding for the FDNY WTC and worker and volunteer WTC
programs was available through mid-2009, and funding for the WTC Health
Registry was available through April 29, 2008.
[10] See Department of Defense Appropriations Act, 2006, Pub. L. No.
109-148, §5011 (b), 119 Stat. 2680, 2814 (2005). These funds are
available to CDC until expended.
[11] FOH is a part of HHS's Program Support Center.
[12] The responders included firefighters; law enforcement officers;
emergency medical technicians and paramedics; morticians; health care
professionals; and other workers and volunteers, including those in the
construction and ironwork trades, heavy equipment operators, mechanics,
engineers, truck drivers, carpenters, day laborers, and
telecommunications workers. Numerous federal, state, and New York City
agencies sent personnel to respond to the WTC disaster.
[13] See, for example, CDC, "Mental Health Status of World Trade Center
Rescue and Recovery Workers and Volunteers--New York City, July 2002-
August 2004," Morbidity and Mortality Weekly Report, vol. 53 (2004);
CDC, "Physical Health Status of World Trade Center Rescue and Recovery
Workers and Volunteers--New York City, July 2002-August 2004,"
Morbidity and Mortality Weekly Report, vol. 53 (2004); CDC,
"Surveillance for World Trade Center Disaster Health Effects among
Survivors of Collapsed and Damaged Buildings," Morbidity and Mortality
Weekly Report, vol. 55 (2006); and G.I. Banauch et al., "Pulmonary
Function after Exposure to the World Trade Center in the New York City
Fire Department," American Journal of Respiratory and Critical Care
Medicine, vol. 174, no. 3 (2006).
[14] Banauch et al., "Pulmonary Function," vol. 174, no. 3 (2006).
[15] FEMA is the agency responsible for coordinating federal disaster
response efforts under the National Response Plan.
[16] FEMA provided funds to HHS to support screening and long-term
monitoring efforts from funds appropriated for disaster relief and
emergency response to the September 11, 2001, terrorist attacks. See
Consolidated Appropriations Resolution, 2003, Pub. L. No. 108-7, 117
Stat. 11, 517; 2002 Supplemental Appropriations Act for Further
Recovery from and Response to Terrorist Attacks on the United States,
Pub. L. No. 107-206, 116 Stat. 820, 894; Department of Defense and
Emergency Supplemental Appropriations for Recovery from and Response to
Terrorist Attacks on the United States Act, 2002, Pub. L. No. 107-117,
115 Stat. 2230, 2338; and 2001 Emergency Supplemental Appropriations
Act for Recovery from and Response to Terrorist Attacks on the United
States, Pub. L. No. 107-38, 115 Stat. 220-221.
[17] Consolidated Appropriations Resolution, 2003, Pub. L. No. 108-7
117, Stat. 11, 517.
[18] The Robert T. Stafford Disaster Relief and Emergency Assistance
Act, as amended, authorizes FEMA to, among other things, make
appropriated funds available for disaster relief and emergency
assistance. Pub. L. No. 93-288, 88 Stat. 143 (1974), as amended. The
Stafford Act does not specifically authorize ongoing clinical
treatment.
[19] GAO-06-481T.
[20] GAO-06-481T.
[21] For this program, a federal worker is defined as being either a
permanent, temporary, or intermittent federal employee.
[22] In addition to the federal responder program, we identified three
other, smaller-scale programs that were implemented by two federal
agencies to assess the health of their own employees who responded in
the aftermath of the WTC attack. The Army established two screening
programs--one specifically for Army Corps of Engineers personnel and
one that was designed as a voluntary medical screening for Army
military and civilian personnel, including contractors. As of August
2004, 92 Corps of Engineers employees had participated in the first
program, with 40 receiving follow-up examinations, and 162 employees
had completed and returned questionnaires in the second program. In the
third program, 88 employees of the U.S. Marshals Service, within the
Department of Justice, had obtained a one-time assessment including a
screening questionnaire and a medical examination as of August 2005.
[23] According to a FEMA official, federal workers who did not receive
official orders from their agencies to respond to the WTC disaster are
not eligible for the WTC Federal Responder Screening Program. According
to an official of the worker and volunteer WTC program, federal workers
who volunteered on their own in the aftermath of the disaster were
eligible to participate in that screening program.
[24] We testified in February 2006 that OPHEP entered into an agreement
with FOH in April 2003 to provide screening examinations for federal
workers who had responded to the WTC disaster and that these
examinations began in June 2003.
[25] GAO-06-481T.
[26] Both organizations operate independently of the New York City
Police Department.
[27] This estimate consisted of 5,122 responders from the 31 federal
agencies and 3,499 responders from the 22 Urban Search and Rescue
teams.
[28] Before the federal responder program was placed on hold in January
2004, its principal action to communicate with the federal responders
had been to place program information and registration forms on FEMA's
National Disaster Medical System Web site.
[29] See "The WTC Federal Responder Screening Program,"
https://wtcophep.rti.org/, downloaded Aug. 30, 2006.
[30] Of the 90 other agencies contacted, 60 were determined to be
ineligible because some were found to be nongovernmental agencies, some
did not have federal workers at the WTC or Staten Island site, and
some, such as the Department of Defense, participated in other
screening programs; 21 opted to contact their federal workers on their
own; and 9 refused to provide information.
[31] ATSDR spent $372,961 of the $491,000 OPHEP originally allocated to
the activities carried out under this agreement. The $491,000 was part
of $3.74 million that FEMA had provided to OPHEP to develop and
implement a monitoring program for federal responders. According to
OPHEP, it will reallocate the $118,039 remaining from its expired
agreement with ATSDR to FOH or NIOSH for screening, depending on where
there is a need.
[32] According to OPHEP officials, FEMA funds are to expire at this
time.
[33] Some of these federal workers registered on FEMA's National
Disaster Medical System Web site, which was used before the WTC Federal
Responder Screening Program Web site was created.
[34] The 907 workers screened by FOH include 139 former federal workers
that FOH screened after the program resumed because FOH thought they
were current federal workers. In addition, FOH also screened an unknown
number of former federal workers before the federal program was placed
on hold, and they would also be included in the 907. FOH officials told
us that they have taken steps to ensure that they can better identify
which registered workers are current federal employees.
[35] Individuals are assigned to either an FOH clinic or a private
provider participating in FOH's network, based on their proximity to
either type of provider. Appointments are made within 50 miles of an
individual's designated zip code.
[36] The estimated cost of each screening examination is between $400
and $500, and additional costs may be incurred depending on the need
for further diagnostic testing.
[37] FOH can refer individuals with mental health symptoms to an FOH
EAP for a telephone assessment. If appropriate, the individual can then
be referred to an EAP counselor for up to six in-person sessions.
[38] This agreement also provides for examinations for other federal
responders who are ineligible to receive examinations from FOH, such as
Department of Defense employees, and responders having intermittent
periods of federal employment such as Urban Search and Rescue workers.
[39] When FOH officials realized those individuals were former federal
workers, they communicated this information to NIOSH so NIOSH could
take responsibility for any follow-up care the workers might need.
[40] The AOEC is a nonprofit organization committed to improving the
practice of occupational and environmental health through information
sharing and collaborative research. The AOEC consists of a network of
university-affiliated and other private clinics across the United
States and in other countries.
[41] Within CDC, NIOSH has lead responsibility for making decisions
about the $75 million, and ATSDR is involved in decisions relating to
the WTC Health Registry.
[42] A cooperative agreement is a mechanism used to provide financial
support when substantial interaction is expected between a federal
agency and a state, local government, or other recipient carrying out
the funded activity.
[43] Any funds not needed for monitoring could be used for treatment.
[44] This agreement provides for the American Red Cross to assist CDC
in estimating program costs and developing the federally funded
treatment programs.
[45] The registry subsequently applied for an additional $1 million to
support its operations through April 2007.
[46] The official told us that CDC was able to make these awards so
quickly after receiving the applications because agency officials had
been discussing the programs' needs for treatment funds with program
officials for several months and the programs had provided draft
applications a week before submitting the final applications.
[47] The medical conditions that now receive treatment funded by the
American Red Cross provided the baseline for conditions that will be
included. CDC will determine whether any additional conditions will be
included and will continue to assess whether all appropriate conditions
are included over time.
GAO's Mission:
The Government Accountability Office, the audit, evaluation and
investigative arm of Congress, exists to support Congress in meeting
its constitutional responsibilities and to help improve the performance
and accountability of the federal government for the American people.
GAO examines the use of public funds; evaluates federal programs and
policies; and provides analyses, recommendations, and other assistance
to help Congress make informed oversight, policy, and funding
decisions. GAO's commitment to good government is reflected in its core
values of accountability, integrity, and reliability.
Obtaining Copies of GAO Reports and Testimony:
The fastest and easiest way to obtain copies of GAO documents at no
cost is through GAO's Web site (www.gao.gov). Each weekday, GAO posts
newly released reports, testimony, and correspondence on its Web site.
To have GAO e-mail you a list of newly posted products every afternoon,
go to www.gao.gov and select "Subscribe to Updates."
Order by Mail or Phone:
The first copy of each printed report is free. Additional copies are $2
each. A check or money order should be made out to the Superintendent
of Documents. GAO also accepts VISA and Mastercard. Orders for 100 or
more copies mailed to a single address are discounted 25 percent.
Orders should be sent to:
U.S. Government Accountability Office 441 G Street NW, Room LM
Washington, D.C. 20548:
To order by Phone: Voice: (202) 512-6000 TDD: (202) 512-2537 Fax: (202)
512-6061:
To Report Fraud, Waste, and Abuse in Federal Programs:
Contact:
Web site: www.gao.gov/fraudnet/fraudnet.htm E-mail: fraudnet@gao.gov
Automated answering system: (800) 424-5454 or (202) 512-7470:
Congressional Relations:
Gloria Jarmon, Managing Director, JarmonG@gao.gov (202) 512-4400 U.S.
Government Accountability Office, 441 G Street NW, Room 7125
Washington, D.C. 20548:
Public Affairs:
Paul Anderson, Managing Director, AndersonP1@gao.gov (202) 512-4800
U.S. Government Accountability Office, 441 G Street NW, Room 7149
Washington, D.C. 20548:
