City of Dust

by Anthony DePalma

  In 2003, Zadroga went to the Deborah Heart and Lung Center in Browns Mills, N.J., where biopsies were taken of his lungs. Three strips of lung tissue, each about an inch long, were sent to independent specialists. A doctor at the Mayo Clinic hospital in Scottsdale, Ariz., found the tissue scarred and tainted by prominent black streaks, typically found in smokers and people who work in dusty conditions, and usually not considered life-threatening. The slides of Zadroga’s lung tissue also were sent to the Armed Forces Institute of Pathology, a national forensic center with expertise in analyzing autopsy results. A doctor there found signs of mild fibrosis in the lung but said its cause was undetermined, and he suggested further testing. Zadroga appeared at a hearing before the medical board with a portable oxygen tank and a nasal cannula. Gasping for breath, he told the board that he was often so weak that he spent whole days in bed. He had seen a psychiatrist and was on 80 mg of Prozac and 10 mg of Valium daily. He was also taking medication for asthma and acid reflux, and when his breathing became excessively labored, he took prednisone. He looked gaunt and told the board that he had lost more than 70 pounds. He was sent to the Police Department medical offices for breathing tests, and his lung function was measured at about 66 percent of normal capacity. The board withheld action on Zadroga’s application and sent him back to Deborah for more testing. By July 2004, when the results of the additional tests came back, the Medical Board of the Police Pension Fund formally determined that Zadroga was disabled. And although the board was unable to determine the exact cause of the lung disease that had disabled Zadroga, his documented exposure to the trade center dust during the weeks he had worked there led to the board’s determination that Zadroga’s disability was work related.

  Zadroga was given a line-of-duty disability pension, equivalent to three-quarters of his salary. He had already won a large award from Feinberg’s compensation fund. His health continued to deteriorate, and when his wife died suddenly at the age of 29, Zadroga blamed her death on the stress caused by taking care of him and their baby daughter. He moved in with his father on the New Jersey shore and grew steadily worse.

  By January 2006, Zadroga was spending most of the day in his room. One night his daughter woke up, calling for a bottle. He got up to take care of her but never made it to her bed. When he didn’t come down for his medication the next morning, his father, Joseph Zadroga, checked in on him. He found his son on the floor, the baby’s bottle still in his hand.

  Joe Zadroga demanded an autopsy. The Ocean County New Jersey Medical Examiner’s office officially linked his son’s death to exposure to the dust. During the autopsy, Dr. Gerard Breton, then a 73-year-old retired pathologist who had been trained in Haiti, found “innumerable foreign body granulomas” containing material he described as “consistent with dust.” Breton concluded with standard medical phrasing that, in this case, carried great weight because it was the first formal scientific link between trade center dust and death. “It is felt with a reasonable degree of medical certainty that the cause of death in this case was directly related to the 9/11 incident,” Breton wrote. He had not tested the material, nor had he consulted with doctors who had seen other responders. In his New Jersey shore community, Breton normally saw very little but the diseases of the elderly. Yet he said that what he found in Zadroga’s lungs left no doubt about the cause: “I cannot personally understand that anyone could see what I saw in the lungs, and know that the person was exposed to ground zero, and not make the same link I made.” Zadroga’s death became a sentinel case that focused attention anew on the aftermath of September 11, playing on the fears of so many people that the dust represented a gathering storm of disease and death. For others, it was a reason for caution. “We’ll see what other doctors say,” Bloomberg remarked, unwilling to accept Breton’s conclusion as the last word. “Generally, there are lots of other contributing factors.”

  Within a few weeks of Zadroga’s death, the federal government responded to increased pressure from New York to take a greater role in the ground zero health issues. Michael Leavitt named Dr. John Howard coordinator of 9/11 federal health programs. Howard headed the National Institute for Occupational Safety and Health (NIOSH), a part of the Centers for Disease Control that had provided the earliest grants for the medical monitoring program at Mount Sinai. A distinguished pulmonologist, as well as a lawyer, Howard was a natural choice for the position. But his appointment reflected the Bush administration’s general lack of interest in moving beyond public relations when it came to ground zero. Howard was given responsibility for coordinating all federal 9/11 health responses but was not allotted additional staff or budget to get the job done. He was notified of his appointment by an assistant secretary of the Department of Health and Human Services, who told him rather apologetically, “You seem like a nice guy—I hate to do this to you.”

  Howard was put into a delicate and, ultimately, uncomfortable position. Because of his training in medicine and law, he understood the nexus between politics and medicine better than most. As head of NIOSH, he also knew the difficulties of the workplace and was dedicated to protecting workers. But he was part of an administration that didn’t share those views and that would be anything but cooperative as he tried to resolve specific problems. Howard soon found that the administration wasn’t willing to pour resources into taking care of an issue that it didn’t recognize in the first place. He became the government’s point man in New York, taking the heat when responders condemned Washington’s inaction, but playing it straight about the scale of the problems. When Maloney once asked him at a congressional hearing how long ground zero workers would need to be monitored, he answered, “For the rest of their lives,” which made the administration’s budget people shudder.

  Before he completed his first year as 9/11 health czar, Howard was picked to appear on 60 Minutes to defend the administration’s attitudes, which he clearly did not share. Katie Couric had decided to do her first 60 Minutes segment on the health effects of the attacks. Her producers wanted to talk to Leavitt, but the secretary decided that Howard should stand in for him. The department hired a media consultant to give Howard two days of preparation for being interviewed in front of television cameras. During the session, a nervous Howard asked what he was supposed to say if Couric wanted to know whether he talked to Leavitt regularly about the health issues. He had been the national 9/11 health coordinator for eight months and had not spoken to Leavitt once. Aides quickly set up a meeting with Leavitt and other top-ranking officials of the department, who again asked why the New York state workers’ compensation system wasn’t fit to take care of the problem.

  The discussion reflected one of the Bush administration’s principal problems with ground zero health claims. The administration believed the federal government should be the payer of last resort and that workers’ compensation and private health insurance should pay first. Howard argued that New York’s workers’ compensation system was not set up to respond to this kind of crisis. It is a confrontational system, more suited to handling broken arms and other physical injuries than environmental ailments that might not develop for years. Even if, following extended adversarial proceedings, claimants are successful, the maximum compensation provided by the New York system was the $400 a week that Kevin Rogers of Con Ed received until he died. For most disabled workers, it was not nearly enough to cover living expenses or medications.

  Howard argued that there was a moral issue involved, because many union workers have health insurance plans that peg coverage to the number of days they work in a year. In the economic slowdown that followed 9/11, many went long periods without work and, therefore, had little or no insurance to cover their mounting health expenses. Illegal immigrants who had taken jobs cleaning apartments and offices had no insurance at all, while many workers who held legitimate jobs had inadequate coverage. In Howard’s view, Washington was obliged to help.

  When he testified before Congress, Howard could tell that the doubt and skepticism tha
t had arisen in the early days after the attacks had pervaded the views of congressmen outside the New York region. Ground zero workers were mostly faceless, which made them easier to ignore. That’s why the death of Zadroga became so important. Zadroga’s name became synonymous with the worst fears of all those who had been exposed to the dust. His father, a rugged former cop who habitually wore black suits and got teary eyed when he narrated the sad saga of his son, became a regular witness at public hearings about mounting health concerns. The Zadroga name also was wrapped around a legislative attempt by Democrats to fund an ambitious program to monitor and treat ground zero workers. The James Zadroga Act, sponsored by Maloney, Nadler, and others, sought to reopen the September 11th Victim Compensation Fund so that all those who had developed breathing problems, stomach issues, post-traumatic stress, and a long list of other ailments would get the care they needed and the compensation they felt they were owed.

  During the remainder of the Bush administration, the bill would go nowhere.

  Another opportunity to personalize the tragedy for Washington’s sake arose later in the same year Zadroga died. This time, attention was focused on the plight of a single American family and the police officer father who had become so sick after working at ground zero that he was dying. That officer, Cesar A. Borja, had been hospitalized with pulmonary fibrosis, the same serious lung disease that had struck Marty Fullam. Officer Borja deteriorated quickly after entering the medical monitoring program at Mount Sinai in 2006. He was 52 and needed a lung transplant to survive. His son, Ceasar, a 21-year-old journalism major at Hunter College in New York City, had sent e-mails to every New York City reporter he could reach over the Christmas holidays pleading for help finding a new set of lungs for his father. He found a sympathetic ear at the New York Daily News.

  Ever since Juan Gonzalez had published his first damning columns on the dust in fall 2001, the Daily News had a special hold on the ground zero story. In July 2006, the tabloid had begun an unusual series of articles on 9/11 responders. It clearly was a campaign to force the government to take care of those who had become sick, regardless of the lack of scientific certainty linking their illnesses to the dust they had inhaled. It was a classic newspaper crusade that made every responder who came forward to tell his or her tearful story a tragic hero. Most of the accounts were based on the worker’s own diagnosis that the injuries had been caused by the dust. The Daily News ran the pieces at the front of the paper, as though they were news articles. But they were called editorials, and that gave them the journalistic dispensation from the usual requirements of objectivity. The newspaper expressed outrage at the way the ground zero workers were being treated, without worrying about first obtaining proof that their sicknesses, in fact, had been caused by the dust. The editorials accused the city, state, and federal governments of not only failing to protect the workers during the recovery, but of letting them down again now that they were sick and needed help. The editorials repeatedly referred to Christie Whitman’s early statement about the air as “the big lie,” and they supported Gonzalez’s earliest columns about the 9/11 fallout, including the ones his editors had initially questioned.

  The Daily News wasn’t the only news outlet to pick up the Borja story, but no one else ran with it the way the tabloid did. In an article on January 16, the paper used emotional tones to describe the way Officer Borja had rushed to the trade center on 9/11. According to the News, Borja volunteered to “work months of 16-hour shifts” in the rubble of the fallen towers. After toiling there for hundreds of hours, the articles said, Borja had become progressively sicker. He retired in 2004, and in 2006 doctors at Mount Sinai told him that spending so much time at the trade center site without respiratory gear had permanently damaged his lungs. Only a transplant could keep him alive.

  As Officer Borja sank into a coma, his son redoubled his efforts to keep his father alive. He contacted Clinton’s office, begging for help. The State of the Union speech was coming up, and in the past, that event had provided a highly visible stage for the responders’ pleas for help. Sensing an opportunity to bring special attention to the dire situation facing Borja and other responders, Clinton invited the officer’s son and several others involved in the fight—including Joseph Zadroga and Marty Fullam—to attend the 2007 State of the Union Address. Clinton provided a gallery pass for Borja, and the News paid for his flight to Washington and back.

  Clinton, who had been pushing for treatment and long-term health monitoring for ground zero workers, wrote directly to President Bush about Officer Borja, portraying him as a symbol of the ills of so many others: “Cesar Borja was a hero who served his country in her hour of need and sacrificed dearly for that service. Since the attacks of September 11, 2001, as Cesar’s health deteriorated, he and his family endured a great deal of hardship but never lost sight of the needs of the other workers, volunteers, first responders, and victims who survived the attacks but did not survive unharmed.”

  Two hours before President Bush began his address, Ceasar Borja Jr. was having dinner with congressional staffers at a D.C. restaurant called Bullfeathers when he received a call from New York. He abruptly left the table, and when he came back, he announced that his father had died before receiving his new lung. The congressional staffers offered to help him get back to New York. Ceasar said no. He felt duty-bound to remain in Washington to plead for help, if not for his father, then for all the other responders who were battling ground zero illnesses.

  After the State of the Union speech, the younger Borja returned to New York vowing to continue to call attention to the needs of responders who, like his father, had sacrificed so much to help the city recover. “Nine eleven did not end that day,” he told reporters. The Borja episode, with its irresistible combination of pathos, heroism, and outrage, had lured in reporters and editors hungry for a way to bring an immense story into some kind of human perspective. The intersection of politics and science had, in this instance, combined to make Borja a tragic symbol. His son’s presence in Washington on the night of his death seemed to highlight Washington’s impotence and proved to be an embarrassment for the administration.

  And for the congressional staffers who had cooked up the idea of the trip and watched it all come together, Borja seemed for a time to have pried open a soft spot in the nation’s conscience.

  A degree of compassion fatigue had settled over ground zero once the cleanup was completed in 2002. But years later, with treatment money allocated and Howard proving to be a receptive and understanding coordinator of 9/11 programs, with Zadroga and Borja as sympathetic figures the public could identify with to put a face on the issues, Maloney felt confident about completing her mission. She thought she had beaten back the skepticism of those who had called New Yorkers money grubbers. And she had reason to believe that national opinion was shifting to her side and the side of the responders. Proof of that seemed to come when Jon Stewart skewered the administration’s handling of ground zero on the Daily Show. Stewart grabbed a videotaped segment of Whitman’s testimony at a hearing before Rep. Nadler. In it, she defended her statements about safety in September 2001 as truthful. She insisted that her goal then had been to protect the residents, but also to get the city back to work. If Wall Street had not reopened quickly, she testified, the terrorists would have won. That gave Stewart a caustic opening: What Whitman seemed to have stated so emphatically, he mocked, was that “If we didn’t breathe asbestos, the terrorists win.”6

  Endnotes

  1 Krugman, Paul, “Money Grubbing Games,” The New York Times, 8 February 2002, p. 23.

  2http://maloney.house.gov/documents/olddocs/Sept11/TheChart/TheChart.pdf.

  3 Landis Dauber, Michele, The War of 1812, September 11 and The Politics of Compensation, Stanford Public Law and Legal Theory Working Paper Series, December 2003.

  4 Feinberg, Kenneth R., “Final Report of the Special Master for the September 11 Victim Compensation Fund of 2001,” 17 Novermber 2004. Available at www.justice.go
v/final_report.pdf.

  5 Statement submitted by James Zadroga to the 9/11 Commission June 2003, published by The Daily News 23 October 2009. Available at www.nydailynews.com/opinions/2009/10/23/2009-10-23_the_pain_of_911__the_days_after.html.

  6 27 June 2007.

  10. Degrees of certitude

  Doubts about the safety of the air in lower Manhattan that arose immediately after the attacks occured generated a lingering skepticism that quickly spread from New York to Washington and then to large swathes of the country. As time went on, it became increasingly difficult to know whether the air was safe, as officials insisted, or whether it was life-threatening, as Joel Kupferman and Juan Gonzalez had charged. No one knew with certainty whether an epidemic was brewing in Lower Manhattan or whether New Yorkers really were money-grubbing opportunists, trying to exploit a nation’s goodwill. Science had yet to prove that a series of deaths among ground zero workers was just the beginning of an epoch of misery and pain, not merely the actuarial consequence of an aging population subject to the same diseases and environmental insults as the rest of the country. Because almost everything ended up being questioned, almost nothing was certain—not even the number of people who had died as a result of the attacks.