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It was late in the night when James Zadroga, sleeping beside his 4-year-old daughter, woke up to fetch her some milk. It was no easy errand: The former New York City police detective's lungs were so scarred that he needed supplemental oxygen to breathe.
In 2001, after the attack on the World Trade Center, he had donned a paper mask and toiled at Ground Zero on rescue and recovery missions. Then he developed a cough and damaged lungs. Four years later, the 34-year-old was dying.
Sometime in that January night, Zadroga fell to the bedroom floor. At dawn, his father came into the room and found him, then gently woke the girl to tell her that Zadroga was dead. Her bottle was still in his hand. "I told her that her daddy has passed and she cried, 'No, no, he's just sleeping, he just got up to get me a bottle,'" says Joseph Zadroga, of Little Egg Harbor Township, N.J., who is now raising his granddaughter, Tyler Ann. Her mother died two years earlier.
An autopsy done by a New Jersey coroner attributed James' death to dust from Ground Zero. He had never been a smoker and had no previous respiratory problems. "No one should have to go through this," his father says.
Nearly five years after the terrorist attack, thousands of workers who toiled at the World Trade Center site continue to experience health problems, according to doctors at Mount Sinai Center for Occupational & Environmental Medicine in New York.
Zadroga's death -- the first death linked by an autopsy to toxins at the site -- has galvanized union leaders and politicians such as Sen. Hillary Rodham Clinton, D-N.Y., to call for more aid and investigation.
Concern over ongoing ailments plaguing World Trade Center workers is also leading to accusations that federal safety oversight at Ground Zero was lax -- a charge that federal officials vigorously deny. Environmental Protection Agency (EPA) officials said in a statement issued to USA TODAY in May that they responded immediately as events unfolded, with the highest priority being to protect the environment and health of the people of New York.
The agency took more than 10,000 samples of air, water and dust, which yielded more than a quarter of a million results, and worked with other federal agencies to caution that workers should wear protective gear. Officials acknowledge that some workers from the site now are ill.
A class-action lawsuit has been filed alleging that the agency made false reassurances about the air quality at the site. No trial date has been set.
"The EPA said there was no danger, but this was the perfect storm of environmental toxins, and now we're paying the price," says Thomas Cahill, an air pollution expert and professor emeritus at the University of California, Davis, who studied the air quality around Ground Zero. "It was wildly toxic, and the EPA knew that. Hopefully, this will lead to a renewed effort not to forget these people."
About 40,000 workers toiled at Ground Zero, including immigrant day laborers, contractors, volunteers from other towns, paramedics, firefighters and police officers. They carried out myriad tasks, from digging through rubble in search of survivors to delivering ice and water. It's uncertain how many may now be sick.
A medical screening and monitoring program coordinated by Mount Sinai Center for Occupational & Environmental Medicine in New York indicates that more than half need immediate medical or mental health treatment. The estimate is based on a sample of the 16,000 workers screened to date. In fact, demand is so great that the waiting list for care through an independent treatment program offered by Mount Sinai is 16 weeks. The study looks at those who worked at the site during or shortly after the disaster.
Rare lung diseases emerge
One concern now is the emergence in first responders of rare lung-scarring diseases that could be fatal, says Robin Herbert, director of the World Trade Center program at Mount Sinai. Another concern is the potential for an increased rate of cancer in coming years. Asthma, chronic sinusitis and mental health problems also are common among those who were first on the scene.
"It's tragic. Our work has identified large numbers of heavily exposed workers who were never provided with appropriate respiratory protection," Herbert says. "A more vigorous public health approach might have prevented illnesses we're seeing today."
Glenn Greene, a Department of Justice lawyer representing former EPA administrator Christine Whitman, declined to comment on allegations that safety precautions were lax, as did the DOJ's press office. "From the moment the planes hit the World Trade Center, the men and women of the (EPA) ... began to do everything in their power to protect the people of New York," Whitman said in a February statement.
The city of New York, which has also been criticized for its handling of safety issues, said in a 2002 release from the law department that it "did everything in its power to assist people" and that "decisions were made with the best possible information available."
Vinny Forras just doesn't want his sacrifices to be forgotten. He believes more funding for treatment of first responders, as well as some sort of memorial for those who die after 9/11 of diseases related to exposure, is vital.
Forras, 48, was a volunteer firefighter at the South Salem (N.Y.) Fire Department who was dispatched to the World Trade Center the day of the attack. The first thing he saw was the firetruck that his best friend had been riding in smashed by the debris from the collapsing towers; his friend had been killed. Forras worked at the site night and day.
On his second day, he woke up at a triage center gasping for air; he was given steroids by the medical staff, he said, and sent back to work. At one point, Forras was working on rescue and recovery when he tried to climb down a beam; instead, he found himself buried briefly under the rubble. For an hour and a half, he says, he remained trapped underground.
Three months later, his breathing problems began, he says. Forras, who has never smoked, used to be able to run 2 or 3 miles a day. Now, he can get winded walking from the car to his home, he says.
He uses steroids and inhalers to breathe, antidepressants to help combat post traumatic stress disorder and sleep medications. He lives on disability payments from workers' compensation and Social Security. "It's very hard to see your own kids taking care of you," says Forras, founder of the Gear Up Foundation, a non-profit that donates fire equipment, prevention and training around the world. "We humbly did what we did. It was our job. But in 10, 15 years, we'll be ghosts. We're the Ground Zero walking wounded."
And that has become a growing fear: that some first responders at the scene could develop lung diseases and other ailments that will kill them -- adding to the attack's death total. Many responders, such as volunteers from other cities, may not realize their health problems are related or get the assistance they need.
One million tons of dust
An estimated 1 million tons of dust rained down on the city and the 16-acre disaster zone, showering the area with asbestos, Freon, carcinogens, concrete, glass fibers, lead and other hazards. Workers inhaled caustic fine cement dust and a mixture of sulfuric acid, a byproduct of combustion, which defeated the lungs' defense system and allowed particles to become deeply embedded, Cahill says.
David Worby, a lawyer in White Plains, N.Y., represents about 8,000 clients with health problems who are suing supervisors, the EPA, the Port Authority of New York & New Jersey, contractors and others involved in the cleanup. He says more than 50 families have lost loved ones due to their twin towers work. No trial dates have been set.
"There are thousands of people who will get cancer and will die from this, and the government isn't doing anything," Worby says. "Every week I get one or two calls from a cop saying, 'What do I do for my wife and kids? I've just been diagnosed with leukemia or sarcoidosis (an inflammation that creates scar tissue, often in the lungs).'"
The Port Authority declined to comment on any pending litigation.
There has been financial assistance, including a $125 million federal package that will help fund a health registry of World Trade Center first responders and nearby residents. The money includes $75million for screenings, exams and treatment for rescue and recovery workers, as well as $50 million to the New York State Uninsured Employers Fund for reimbursement of 9/11-related claims. But some, such as Mount Sinai's Herbert, say more will be needed, because even a few severe illnesses can run up staggering medical costs. An April study from the Centers for Disease Control and Prevention found more than half of survivors reported new or worsening respiratory symptoms after the attacks.
EPA says it gave help
EPA officials say in a statement that the agency "provided masks and goggles for rescuers and crew workers. EPA also encouraged rescue workers to wet down the debris to help protect themselves from asbestos, smoke and dust."
The agency says it provided more than 22,000 respirators, more than 32,000 respirator cartridges and other protective gear and emphasized the need for respiratory protection at daily operations meetings at the site.
"As our nation continues its effort to keep Americans safe from future attacks on our country, EPA remains passionately committed to protecting the health of our citizens and our environment," the agency said in a statement.
But the EPA and other federal offices are coming under criticism for their response.
In an 82-page pretrial ruling in a class-action lawsuit filed by residents and workers in the area, U.S. District Court Judge Deborah Batts said Whitman's "deliberate and misleading" statements about the air quality "shocks the conscience. "
She also said in her February opinion that the EPA knew as soon as Sept. 12, 2001 -- the day after the attack -- that one of the first air samples contained an asbestos level four times higher than the EPA threshold for danger. The judge was ruling on motions to dismiss counts in the case; Batts agreed to let the lawsuit continue.
Whitman responded with a release that said, "every action taken by the EPA during the response to this horrific event was designed to provide the most comprehensive protection and the most accurate information to the residents of Manhattan. To imply otherwise is completely inaccurate."
Health troubles persist for 9/11 rescue workers