Medical examiner's ruling sparks debate on 9/11-related deaths

The Associated Press
6/2/2007, 7:34 p.m. EDT

NEW YORK (AP) — Long before the city medical examiner amended Felicia Dunn-Jones' death certificate, Kenneth Feinberg decided that the 42-year-old attorney caught in the choking, toxic dust of the fallen World Trade Center was dead because of Sept. 11.

"She was a murder victim," Feinberg said of Dunn-Jones, who died of lung disease five months after the 2001 terrorist attacks. Feinberg, who oversaw a federal fund to compensate Sept. 11 victims, paid her family a death benefit of over $2 million in 2004.

His was the first of many decisions since then to officially link a death to post-Sept. 11 exposure, although none was more dramatic than Chief Medical Examiner Charles Hirsch's ruling last week to add Dunn-Jones to the Sept. 11 death toll.

The ruling means Dunn-Jones will be listed on the Sept. 11 memorial, a status several other families said they would seek from the city in the future. And the decision renews debate over who, or what standard, can definitively link a death after Sept. 11 to the toxic dust caused by the towers' collapse.

Mayor Michael Bloomberg said after Dunn-Jones was declared a homicide victim that Hirsch would decide, and suggested that he would only rule in cases where the victims were exposed to dust on Sept. 11, instead of in the months afterward.

"We have to decide who died on that day as a result of the plane crashes into the buildings. That is a decision for the medical examiner to make," the mayor said.

Dr. Lorna Thorpe, deputy commissioner for the city's Department of Health and Mental Hygiene, said that decision is hard to come by.

"This question won't be resolved by any one medical examiner. There's no definitive test to say, is this a World Trade Center death," Thorpe said. "It's very frustrating."

Hirsch declined to be interviewed about his decision. He said in a statement last week that "accumulated scientific research" indicates that exposure to trade center dust can cause sarcoidosis, an inflammatory, lung-scarring disease that killed Dunn-Jones on Feb. 10, 2002.

He was also a co-author of a draft of autopsy guidelines that the federal government considered issuing across the nation, before ruling last year that the guidelines could be misinterpreted.

The draft said that because people exposed to post-Sept. 11 air live around the country, "consistent standards are a need not only for New York, but for the entire nation." The guidelines, which asked doctors to preserve tissue samples of exposed patients, would help doctors better treat those who are sick, the draft said.

Hirsch's spokeswoman, Ellen Borakove, said the office would review any deaths at the request of families, no matter where or when the victim died. The office could add future names to the official Sept. 11 death toll, she said.

Experts say that though the city's ruling may seem definitive, it is not the first or last word on a Sept. 11-related death.

A New Jersey medical examiner ruled over a year ago that the death of 34-year-old James Zadroga, a city police detective, was "directly related to the 9/11 incident." Zadroga was at ground zero for the collapse of 7 World Trade Center, the third building to collapse on Sept. 11, and spent hundreds of hours working at the site before he became ill. He died of respiratory failure in January 2006.

His death prompted then-Gov. George Pataki to sign a bill offering full death benefits to public employees who became sick and died after toiling in the dusty air that hung over the ruined trade center. A court will ultimately decide whether more than 100 people named in the largest lawsuit to be filed over post-Sept. 11 exposure are dead because of their time breathing the air at ground zero.

And before the victims' compensation fund overseen by Feinberg expired in 2004, Feinberg paid more than $1 billion to 2,000 others besides Dunn-Jones. Those people, he said, showed a "causal connection" between respiratory illnesses and post-Sept. 11 exposure. Feinberg said he doesn't know if any of those patients have died since then.

Doctors and experts warn that it will take many years to be sure of which illnesses and deaths can be directly attributed to Sept. 11. An article published this week in the New England Journal of Medicine predicted that as people exposed to Sept. 11 dust get older, "and develop malignant and nonmalignant respiratory diseases as a result of smoking and other factors, some will undoubtedly attribute these diseases to their exposure at ground zero."

The article by Johns Hopkins University and University of Rochester researchers suggests using a city-based health registry of more than 71,000 people to get more information. "Decades of commitment" are needed to the registry before illnesses and deaths can be definitively linked to exposure, it said.

Thorpe said some deaths have been reported in the registry, but the city needs more time to verify their causes. The state Department of Health is tracking commonalities in post-Sept. 11 deaths as well to try to find a stronger link.

"One study does not make a definitve case," she said, adding that researchers may have a "detection bias" to make connections. "If you're looking for a disease," she said, "you might find it more frequently."