GAO: HHS and NIOSH Services for 9/11 Workers Lacking

The report heavily criticized the Department of Health and Human Services' (HHS) WTC Federal Responder Screening Program as well as the National Institute for Occupational Safety and Health (NIOSH) for not being consistent in delivering health care services for those affected by the hazards associated with the collapse of the World Trade Towers.

Non-federal responders living outside of the New York City metropolitan area weren't offered screening and monitoring services from August 2004 until June 2005, when NIOSH funded the Mount Sinai School of Medicine Data and Coordination Center (DCC) to resume such services. Despite the efforts, DCC had difficulty establishing a nationwide network of providers and contracted with only 10 clinics in seven states.

As a result, NIOSH has begun taking steps toward expanding the provide network such as contracting an outside company, QTC Management, to provide screening and monitoring services. QTC, however, will not offer treatment services.

Services for Federal Responders Also Temporarily Halted

Federal responders working in New York City have not fared better as services for them have been halted between from January 2007 to May 2007 because of a change in the administration of the World Trade Center (WTC) Federal Responder Screening Program. In addition, certain interagency agreements were not established in a timely way to keep the program fully operational, the report said.

“If federal responders do not receive monitoring, health conditions that arise later may not be diagnosed and treated, and knowledge of the health effects of the WTC disaster may be incomplete,” GAO stated.

And despite having awarded treatment funds to four NYC-area programs, no reliable cost estimate for responder services has been calculated. In fall 2006, NIOSH awarded $44 million for outpatient treatment and set aside $7 million for hospital care. The New York/New Jersey WTC Consortium and the New York City Fire Department WTC program, which received the largest awards, used NIOSH’s funding to continue outpatient services, offer full coverage for prescriptions and cover hospital care.

Costs Estimates for Responder Services “Unclear”

Program officials expect that NIOSH’s outpatient treatment awards will be spent by the end of fiscal
year 2007. GAO noted that NIOSH “lacks a reliable estimate of service costs because the estimate that NIOSH and its grantees developed included potential costs for certain program changes that may not be implemented, and in the absence of actual treatment cost data, they relied on questionable assumptions”

Such assumptions include adjusting the proxy rates up or down by one-third would account for the differences in treatment utilization levels, despite there no data to support the accuracy of such adjustments and assuming that every responder would keep his or her appointment for periodic medical monitoring, whereas NY/NJ WTC Consortium officials told GAO that the rate at which responders have kept scheduled appointments is 50 to 60 percent.

As a result, it was unclear whether the estimate overstates or understates the cost of serving responders, GAO said.

To ensure that screening and monitoring services are available to all responders, GAO recommended that the Secretary of HHS expeditiously take two actions:

• Ensure that screening and monitoring services are available for federal responders.
• Ensure that screening and monitoring services are available for nonfederal responders residing outside of the NYC metropolitan area.