A Fallen Hero - Video Inside

[Gold9472]

Update: Ex-EPA Chief Whitman Agrees to Testify

http://blogs.abcnews.com/theblotter/..._exepa_ch.html

Justin Rood and Maddy Sauer Report:
May 18, 2007 2:28 PM

Ex-EPA chief Christine Todd Whitman abruptly reversed herself Friday and agreed to testify before Congress on her agency's response to the environmental fallout of the Sept. 11, 2001 attacks.

Two days ago, Whitman's lawyer Joel Kobert had denied a request from a House panel chaired by Rep. Jerrold Nadler, D-N.Y., for his client to testify, noting she was named in two lawsuits related to the issue.

But today, Whitman herself told Nadler in a hand-delivered letter that she was willing to participate in a hearing "if you insist."

Nadler had originally invited Whitman to testify at a May 22 hearing. In a press release today announcing Whitman's decision, Nadler said he would reschedule Whitman's hearing to a date "in the near future."

On Sept. 18, 2001, then-EPA head Whitman released a statement declaring the results from air monitoring tests in New York showed "their air is safe to breathe."

Nearly two years after the attacks, the EPA's inspector general concluded that assurance and others were based on insufficient information. The report also said that EPA press releases were softened under pressure from the White House.

Multiple studies have documented health problems amongst 9/11 emergency responders and workers.

One study released last year by Mount Sinai Hospital in New York showed more than 70 percent of Ground Zero workers suffered health ailments or severe respiratory problems.

Whitman and the EPA face lawsuits from people who claim to have been harmed by air pollutants in the lower Manhattan area resulting from the attack. In her letter to Nadler, Whitman said she did not believe "it is appropriate for me to testify about matters that are currently pending in litigation."

An appeals court ruled last month that one lawsuit against Whitman, brought by a small number of government employees, could not go forward because the EPA chief could not be held constitutionally liable for her statements in the wake of the disaster.

"Officials might default to silence in the face of the public's urgent need for information," warned Judge Dennis Jacobs.

That recent ruling may also affect a class-action suit that has been brought against Whitman by residents of lower Manhattan.

In an e-mailed statement, Nadler expressed gratitude for Whitman's decision. "There are so many unanswered questions about why certain decisions were made," said the lawmaker, whose district includes lower Manhattan.

[Gold9472]

NYC links first death to 9/11 toxic dust
Woman died of lung disease five months after World Trade Center attacks

http://www.msnbc.msn.com/id/18831750/

NEW YORK - A woman who died of lung disease five months after Sept. 11 was added Wednesday to the medical examiner's list of attack victims, marking the first time the city has officially linked a death to the toxic dust caused by the World Trade Center's collapse.

Felicia Dunn-Jones, a 42-year-old attorney who was caught in the dust cloud while fleeing the collapsing towers on Sept. 11, 2001, died of sarcoidosis, a disease that causes inflammation and scarring in the lungs, on Feb. 10, 2002.

"Mrs. Dunn-Jones' exposure to World Trade Center dust on 9/11/01 contributed to her death, and it has been ruled a homicide," Chief Medical Examiner Charles Hirsch wrote.

The city said the Sept. 11 death toll at the trade center now stands at 2,750.

Dunn-Jones' family had asked last year that the medical examiner add her name to the death toll, but Hirsch wrote at the time that his office could not link her death to the exposure "with certainty beyond a reasonable doubt."

Since then, a doctor for the Fire Department of New York published a study that found firefighters who worked at ground zero contracted sarcoidosis at a much higher rate after the Sept. 11 attacks than before, linking the disease firmly to the dust exposure.

Previously, Dunn-Jones' estate received a $2.6 million death benefit from a federal fund to compensate victims' families.

Lawmakers say other ailments are connected
A class action lawsuit has claimed dozens of deaths have been caused by exposure to toxic trade center dust. A New Jersey medical examiner last year ruled that the January 2006 death of a retired police detective, 34-year-old James Zadroga, was "directly related" to his work at ground zero on and after Sept. 11.

New York lawmakers, some of whom urged the city to add Dunn-Jones to the death toll last year, said more people should be added in the future.

"Sadly, we have known that Felicia is not alone and that others have died from ailments caused by 9/11," said U.S. Rep. Carolyn Maloney, D-N.Y. "I hope that the medical examiner is no longer in denial about the trade center dust. Dr. Hirsch must review the cases of other 9/11 heroes who, like Felicia, died in the prime of their lives."

[Gold9472]

Killed by Sept. 11 poison
Historic city ruling on Island woman's fatal lung disease

http://www.silive.com/news/advance/i...l=1&thispage=1

By TOM WROBLESKI and SALLY GOLDENBERG
Thursday, May 24, 2007

STATEN ISLAND, N.Y. -- A New Brighton woman's 2002 death was officially linked yesterday to the dust she inhaled at Ground Zero -- a historic determination by New York City, which has never before attributed a post-9/11 death to exposure to toxins at the World Trade Center.

Felicia Dunn-Jones, a 42-year-old married mother of two, died of a lung disease four months after being exposed to the dust on 9/11.

"It is likely, with certainty beyond a reasonable doubt, that exposure to WTC dust was harmful to [Ms. Dunn-Jones] ... and that exposure to World Trade Center Dust on 9/11/01 was contributory to her death," city medical examiner Dr. Charles Hirsch wrote in a letter to Richard H. Bennett, the family's attorney. "The manner of death will be changed from natural to homicide."

The medical examiner's determination raised the 9/11 death toll to 2,750, said Ellen Borakove, a spokeswoman for the medical examiner.

"You can't bring her back, that's the thing," said Ms. Dunn-Jones' mother, Carmen Dunn of West Brighton. "It's good that she was recognized. She was at the right place at the wrong time: She was at work, and you know what happened."

PLACE ON THE MEMORIAL
Ms. Dunn-Jones will be listed on the Sept. 11 memorial when it opens in 2009, a spokeswoman for the World Trade Center Memorial Foundation said. Her name already appears on the Staten Island 9/11 memorial.

"Our thoughts and prayers are with the Dunn-Jones family on this difficult day," said Mayor Michael R. Bloomberg, who chairs the 9/11 memorial foundation. "It is on their behalf and on behalf of all those affected by 9/11 that we are now building a memorial that remembers and honors the thousands of innocents that died."

Ms. Dunn-Jones was an attorney for the U.S. Department of Education and was trapped in the dust cloud caused by the collapse of the first World Trade Center tower. She did not return to Ground Zero and became ill shortly after the attacks. She died of sarcoidosis, a rare and debilitating condition that attacks the lungs and other vital organs, on Feb. 10, 2002.

"I'm happy she's going to be listed as a victim," said her sister, Sharyn Alvarez of Falls Church, Va. "We believe that she is [a victim]."

DEATH BENEFIT
Her family applied for a death benefit through the federal September 11 Victim Compensation Fund, and eventually received $2.6 million.

Ms. Dunn-Jones was the only victim who didn't die on Sept. 11 to receive a death benefit from the fund.

The family then asked the city to include Ms. Dunn-Jones on the official list of 9/11 victims. The medical examiner initially said her death could not be linked to Trade Center dust "with certainty beyond a reasonable doubt."

Reps. Carolyn Maloney and Vito Fossella, along with the family, had lobbied intensely for the reversal.

"The city medical examiner has now accepted what thousands of people with 9/11-related illnesses and their doctors have long understood: That Ground Zero dust was harmful and even deadly," said Ms. Maloney (D-Manhattan-Queens). "I hope that the medical examiner is no longer in denial about the Trade Center dust. Dr. Hirsch must review the cases of other 9/11 heroes who, like Felicia, died in the prime of their lives."

Ms. Borakove had no comment on Ms. Maloney's statement.

DECISION IS HAILED
"While it took time for the medical examiner and others to reach this conclusion, it demonstrates that the health of innocent people was negatively affected by Ground Zero air," said Fossella (R-Staten Island/Brooklyn).

He said the federal government should release a comprehensive plan to monitor and treat all those who are sick or injured as a result of 9/11.

West Brighton attorney John D'Amato, who handled a number of 9/11 victim compensation cases, said yesterday's decision "gives credence to the argument that the fund should be reopened to compensate those injured as a direct result of their exposure, the rescue workers and emergency responders."

While agreeing that the dust was harmful to Ms. Dunn-Jones, Dr. Hirsch also writes that he has "reasonable doubt" that exposure to the dust actually caused her illness.

However, because the dust has been found to cause sarcoidosis in some people, Dr. Hirsch wrote that it is "highly likely that the dust would have aggravated pre-existing sarcoidosis."

"My sister was in good health before 9/11," said Ms. Alvarez.

NEW JERSEY RULING
A New Jersey medical examiner ruled last year that the January 2006 death of a retired police detective, 34-year-old James Zadroga, was "directly related" to his work at Ground Zero on and after Sept. 11.

A construction worker who lost half his foot while working at Ground Zero and is suing the city said the reversal of Ms. Dunn-Jones' cause of death vindicates the rescue and recovery workers who have suffered since the attacks.

"We're not the little boys crying wolf anymore. It's a 'told you so.' This whole time we weren't just running around saying we're sick. We now have legitimate proof," said Long Island resident John Feal. "But the fact that it took five years is insulting. The federal government's lack of compassion in helping heroes is insulting."

Feal, who heads the not-for-profit Feal Good Foundation to call attention to the issue, is hoping this development helps the thousands of ongoing cases brought by rescue and construction workers against the city.

[Gold9472]

Calls for city to reexamine some post '9/11' deaths
Push came after first death is linked to toxic dust at Ground Zero

http://abclocal.go.com/wabc/story?se..._11&id=5337691

By Lisa Colagrossi

(New York -WABC, May 25, 2007) - There is renewed demand to reexamine the medical records in the deaths of at least eight responders at Ground Zero on "9/11". The city medical examiner's decision to link the toxic dust cloud to the death of a woman may be just the first step.

Eyewitness News reporter Lisa Colagrossi is live in Lower Manhattan with the story.

Activists, politicians and those suffering from 9/11 illnesses will gather at Ground Zero for a rally at 11:30 a.m. Their goal is to get the victim's compensation fund to reopen.

"About a month ago they had to rush me to the hospital because I couldn't breathe," said Marvin Bethea,

Marvin Bethea got a chestful of that 9/11 smoke. The cloud from more than a million tons of pulverized concrete, computers, glass, asbestos, lead and toxic chemicals.

He's gone from an athlete, to two pills a day, to 15 medications.

"Now that's very frustrating. My career got cut short..the fact that I cannot go up three flights of stairs right now. I'm 47 years old," said Bethea.

Bethea, and those organizing today's gathering, want the government to reopen the victim's compensation fund.

They want the money to be available to bystanders and first responders, still getting sick and sometimes dying from exposure to that toxic cloud.

"I wouldn't wish this on my worst enemy. We did what we were supposed to do and yet we have to fight for everything. It's just simply not right.

The call for a reexamination of old cases, got a big push when the city medical examiner agreed this week that attorney Felicia Dunn-Jones died from lung disease brought on by her exposure to the plume of dust and smoke on 9/11.

"The fact that so many are sick now and the government for the longest has been in denial is just simply not right," said Bethea.

The family of Felicia Dunn-Jones did receive money from the 9/11 victim's compensation fund, but many people have not.

[Gold9472]

Higher 9-11 death toll raises questions

http://www.kansascity.com/440/story/121732.html

By AMY WESTFELDT
Associated Press Writer
5/25/2007

Family members of ground zero workers who died after breathing in toxic dust from the collapsed World Trade Center say they want their relatives officially recognized as victims of the terrorist attacks of Sept. 11, 2001.

The official list of victims grew by one this week after the city agreed to include a New York attorney who died of lung disease months after the attack, confusing Sept. 11 family members about what distinguished this death from the scores of others attributed to the aftermath.

The city medical examiner's office said Thursday that Felicia Dunn-Jones' death was the only Sept. 11-related fatality it has been asked to review and definitively link to the twin towers' collapse. In the future, spokeswoman Ellen Borakove said, the medical examiner will review any case if a family makes such a request.

"We certainly never turn anybody down," she said.

That raises the prospect of an ever-increasing death toll nearly six years after the attacks. The count now stands at 2,750 after the inclusion of Dunn-Jones. It's up to Chief Medical Examiner Charles Hirsch to decide whether to reclassify any deaths.

"It's his definition that we will follow in this city," said Mayor Michael Bloomberg.

A police union leader said first responders who became ill and died after working at ground zero should also be added to the city's official victim list.

"First responders who expired as a result of their 9/11-related injuries should in fact be given that same honor," said Michael Palladino, president of the Detectives Endowment Association.

Those responders would include 34-year-old James Zadroga, a police detective who became sick and died of respiratory disease after working hundreds of hours in the ground zero cleanup. A New Jersey medical examiner has ruled his 2006 death was "directly related" to his work at ground zero and exposure to trade center dust.

Zadroga's father said he wanted the city to review his son's case.

"I'm going to go through the process, definitely," Zadroga said. "All these guys were heroes there. They're all dying."

David Reeve, whose wife, Deborah, died last year of an asbestos-related cancer after working for months around ground zero and at the morgue, said he would like her to be recognized as an attack victim.

Attorneys wondered whether the official listing of Dunn-Jones, a 42-year-old civil rights attorney who fled the collapsing towers from her office a block away, would make a difference in lawsuits accusing the city of negligence for failing to protect workers and residents from toxic air at the site.

"I have clients who are starting to call saying, should we dig up the bodies and have autopsies and have tissue samples," said David Worby, who represents 10,000 plaintiffs in a negligence lawsuit against the city. He said at least five of his clients recently died of sarcoidosis, the same disease that killed Dunn-Jones.

Bloomberg said that Dunn-Jones' case is different from those of workers who toiled for months at the site.

"This one case ... the woman was killed as a result of being there at the time of the attack," he said. "Think of it as though somebody had gotten - had a beam fall on them and it just took a little while for them to succumb to their injury. Not somebody who was injured the next day if a beam fell on them during the cleanup. That's a very different situation."

[Gold9472]

Politicians: 9/11 Responder Deaths Are Homicides
Dunn-Jones May Not Be Only One Added To Memorial

http://wcbstv.com/topstories/local_story_145185817.html

Marcia Kramer
5/28/2007

(CBS) NEW YORK Pressure is mounting on officials to declare the deaths of more than 100 9/11 responders as homicides.

There are also new calls for the victims' names to be added to the 9/11 Memorial.

Joseph Jones wears his wife Felicia Dunn-Jones' wedding rings around his neck, a poignant reminder of the woman whose death from lung disease in 2002 is now the first to officially be linked to the toxic dust from the World Trade Center attacks.

"She didn't die that day, but she died from wounds she suffered that day," Jones said. "Felicia was a casualty of an act of war."

Jones and his 15-year-old daughter, Rebecca, joined politicians at ground zero on Friday to demand the city Medical Examiner probe the deaths of others at ground zero to see if they are linked to the toxic cloud of dust from the attack.

"Thousands of people with 9/11 related illnesses, and the doctors have long understood that the ground zero dust was harmful and even deadly," Rep. Carolyn Maloney said.

First responders say its well past time for officials to admit they got sick from working on the pile.

"I applaud the medical examiner for making this direct link, but its six years late and we need more doctors to come forward and say these brave souls are sick because of the aftermath of 9-11," responder John Feal said.

Attorney David Worby represents thousands of 9/11 victims

"We have over 100 people who have died," Worby said. "What this case points out is that toxicity the woman was exposed to on one day killed her. We have people who were there for six months, thousands of hours, every day breathing it, ingesting it."

There was at least some good news for 9/11 responders on Friday. On Thursday night, Congress appropriated an additional $50 million for their health care needs.

Dunn-Jones' name will now be listed on the 9/11 Memorial at ground zero as an official casualty of the attack. Officials feel that others who have died from 9/11 illnesses should be given the same honor.

[Gold9472]

THE SEARCH FOR TRUTH ABOUT THE 9/11 PLUME

http://www.nypost.com/seven/05292007...ditorials_.htm

May 29, 2007 -- Chief Medical Examiner Charles Hirsch this month officially tied the 2002 death of a bystander, Felicia Dunn-Jones, to Ground Zero dust - and thereby heightened fears over the health fallout from the 9/11 attack.

Yes, the ruling provided relief to folks like Dunn-Jones' husband. He had lobbied hard for the designation, and saw it as justice being served.

Others, like Mayor Bloomberg, understandably are concerned that such linkage might unfairly tilt lawsuits filed against City Hall by rescue workers who seek compensation for injuries both real and, sometimes, exaggerated. Ultimately, such cases could cost the city a fortune.

Mayor Mike last week rightly noted one important distinction - between ill workers and folks injured on 9/11 as a direct result of the attacks.

Meanwhile, because Dunn-Jones was exposed to the plume only briefly as she fled the area, the M.E.'s ruling is sparking fears that countless others who breathed the air that day also may have been harmed - and may not even know it.

The question of 9/11's impact on public health is far too important to be decided on the basis of fears, well-meaning sympathy for those who become ill or the financial ramifications of compensating victims.

For New York City and the nation, it is crucial to establish the precise extent of the damage inflicted by the terrorists on that awful day. And to do so solely on the basis of solid evidence - and conclusions that emerge from rigorous, dispassionate scientific inquiry.

This, after all, is a matter of great historical and political import; accuracy and precision count. And neither overstating nor understating the consequences serves the city or the nation.

Alas, emotion and monetary considerations seem to play an increasingly large role in the shaping of this story.

Politicians (no surprise), their minds made up long before any serious investigation ever began, have fueled the trend.

"The city medical examiner has now accepted what thousands of people with 9/11-related illnesses and their doctors have long understood: that Ground Zero dust was harmful and even deadly," Rep. Carolyn Maloney said last week of Hirsch's decision.

Added New York's junior senator and presidential hopeful Hillary Clinton: "This ruling is an important step toward acknowledging . . . the devastating and growing health impact of 9/11."

Who needs an examination of evidence or serious medical probing, in other words? Everyone's long "known" that 9/11 dust sickened countless people. The only thing research can do, they believe, is confirm conclusions that folks like Maloney, Clinton and Rep. Vito Fossella have espoused all along.

Indeed, Maloney and Fossella lobbied Hirsch to link Dunn-Jones' death to 9/11 dust long ago. They challenged him when he ruled in 2004 that there was insufficient proof of any connection.

Last Friday, they - along with Rep. Jerrold Nadler - urged him to review several other cases of people who died after working at Ground Zero.

This may play well politically, of course. But it does truth a big disservice.

Recall the case of Police Officer Cesar Borja. News reports brazenly attributed his death from lung disease to his service as a first-responder at Ground Zero.

This story buoyed those who blamed 9/11 dust for a widespread health crisis. Clinton invited Borja's son to attend the president's State of the Union Address. President Bush had him to the White House.

But later, The New York Times disclosed that, in fact, Borja never worked downtown until Dec. 24, 2001 - well after the plume had cleared. And that he only worked near the World Trade Center, not directly at the pile of rubble.

Now the question is: What made Hirsch suddenly change his opinion in the Dunn-Jones case?

Hirsch says mounting research convinced him. In a letter this month, he wrote that "accumulating evidence indicates that in some persons exposure to World Trade Center dust can cause or contribute to sarcoidosis with cardiac involvement."

That disease, a lung tissue-scarring illness, had earlier been cited as the cause of death in the Dunn-Jones case.

Hirsch said that, based on new research, he "concluded that Mrs. Dunn-Jones' exposure to World Trade Center dust on 9/11/01 contributed to her death and it has been ruled a homicide."

Yet, as it turns out, Dunn-Jones had sarcoidosis before 9/11. Hirsch cited the air as a possible contributing factor because experts believe exposure to dust can cause the disease to flare up - and that could have been what precipitated her death.

But how can anyone be sure it was exposure to 9/11 dust, and not some other factor, that aggravated the disease?

And even if it were the air, isn't it likely that some other irritant eventually might have set it off anyway, even if she'd managed to avoid the 9/11 plume?

The fact is, the underlying cause of death was her pre-existing sarcoidosis.

Did Hirsch succumb to pressure?

Maybe - or maybe not.

But in an emotion-driven, politically fueled climate, New Yorkers can't be sure.

And that does no one any good.

Let's be clear: Felicia Dunn-Jones' death was a tragedy, and our hearts go out to her family.

Rescue workers, too, can only be viewed as true heroes - if for no more than their willingness to risk the consequences and search for survivors.

And should sound research find post-9/11 air to be the primary cause of any illness, New York, and the nation, have a duty to respond to anyone affected.

In that case, the M.E. must establish causal links to determine each case. And he must resist the efforts of politicians and others - some perhaps searching for grounds for a lawsuit - to influence his decisions.

But Dunn-Jones' death simply was not persuasively linked to 9/11 - at least as the medical examiner explained it.

Politics and science rarely mix well.

This finding sets an unhappy precedent; it may serve the interests of the tort bar and like-minded advantage-seekers.

But it does not serve justice.

[Gold9472]

New cancer concerns for 9/11 responders

http://abclocal.go.com/wabc/story?se..._11&id=5356926

Eyewitness News

(New York - WABC, May 31, 2007) - There are new health concerns surrounding 9/11 responders.

Doctors say the responders are getting blood cancers at unusually young ages, and they blame toxins at ground zero.

Eyewitness News reporter Joe Torres is in Lower Manhattan with the story.

Doctors diagnosed 42-year-old former NYPD detective Ernie Vallebuona with non-Hodgkins Lymphoma in October of 2004. Forty two-year-old John Walcott, also a former city detective, learned he had leukemia in May of 2003.

"Maybe if someone took us serious four years ago, more people would've been tested. We wouldn't be talking about autopsies, this and that. More people would've gotten tested," Walcott said.

"I've been on a crazy ride ever since ... chemotherapy, radiation, stem-cell transfer, all types of treatment. It's been tough," Vallebuona said.

According to researchers, more and more relatively young 9/11 first responders now show signs of cancer -- cancer conditions seemingly triggered by their exposure to a wide range of chemicals and carcinogens at ground zero.

"We know we have a handful of cases of multiple myloma in very young individuals and multiple myloma is a condition that almost always presents later in life," said Dr. Robin Herbert of Mt. Sinai Medical Center.

Attorney David Worby, who represents thousands of 9/11 workers, says he warned federal and city officials of these health problems years ago. Now he says it's time for government leaders to do the right thing.

"There are a series of tests that people with a significant exposure need to have. That's got to come from the federal government and the city," Worby said.

[Gold9472]

Dr. Cate Jenkins' New Article in the Journal of 9/11 Studies

http://www.911blogger.com/node/9094

Dr. Steven Jones
6/1/2007

Dr. Cate Jenkins holds a PhD in Chemistry and works for the Environmental Protection Agency. She has written an important article -- a Request for Senate Investigation regarding the WTC Dust, here:

http://www.journalof911studies.com/v...nOnWTCdust.pdf

In an addendum, she also requests an FBI investigation:
http://www.journalof911studies.com/v...n_WTC-Dust.pdf

The reader will note that Dr. Jenkins is not reluctant to criticize EPA and other officials and politicians in her quest for correct science regarding the toxicity of the WTC dust -- and fairness for those people who were injured by that toxic dust. Hundreds even thousands were hurt by the stuff. In an email, Jenna Orkin writes:

"I've worked with and relied on Cate Jenkins for over five years. As far as I know, her science is sterling and she is among the handful of people who spoke up forcefully and truthfully in the beginning when it counted the most but few were able or willing to do so.

"Cate's expertise on contamination has been relied on by journalists, activists and politicians working on this and other issues for decades. I have never heard of anyone who could find fault with her science and believe me, some people wanted to."

It is time to consider such "requests for investigation" of 9/11 issues at the highest levels as Dr. Jenkins has done. If such an investigation is opened, we may join in with some startling facts of our own about the WTC dust...

[Gold9472]

Police Union Sues City Seeking Compensation For 9/11 Responder

http://www.ny1.com/ny1/content/index...id=6&aid=70319

June 01, 2007

The Police Benevolent Association filed a lawsuit Friday to force the city to pay the medical bills of an officer who says he got sick from working at the World Trade Center site after the September 11th terror attacks.

The PBA filed the suit on behalf of 36-year-old Officer Christopher Hynes who claims he inhaled some 400 lethal toxins, shards of shards, and pulverized concrete at the site.

He says he was never given a proper respiratory apparatus and was later diagnosed with sarcoidosis. He remains on restricted duty.

Hynes’ insurance company sued him for $5,000 after he was unable to keep up with his medical bills related to his treatment.

The PBA says firefighters with September 11th-related sarcoidosis are routinely granted line-of-duty status and the city pays all their medical bills.

The NYPD has denied Hynes line-of-duty designation benefits, and the PBA says that shows the department does not believe there's a medical link between Hynes' illness and his work at the WTC site.

A department spokesman had no comment on the lawsuit.

Last week, the city medical examiner ruled Felicia Dunn-Jones's death a homicide – after the examiner says her death from the same disease was partially caused by toxins at the site.