9/11 care for residents who can’t cough up cash


By Skye H. McFarlane

Dr. Joan Reibman is a busy woman. So busy, in fact, that she didn’t have time to come up with a job title for the work she does at the Bellevue Hospital World Trade Center Care Center, the 9/11 health clinic that will officially reopen this month with expanded space and services, thanks to a $16 million, five-year infusion of cash from the city.

“She runs it,” clinic program director Kymara Kyng said of Reibman’s involvement, shrugging her shoulders.

“So, I guess I’m the ‘runner,’” replied the energetic Reibman, flashing a smile. In addition to running the clinic, Reibman, a pulmonary (lung) specialist, is also the medical director of Bellevue’s Asthma Clinic and its associated research laboratory.

It was Reibman’s experience in treating asthma and other lung conditions that led her to become involved in post-9/11 health care, eventually creating the only treatment program that is open to the people who lived and worked in Lower Manhattan on or immediately after 9/11.

Other screening, monitoring and treatment programs for 9/11-related health conditions, such as those run by the Fire Department and Mt. Sinai Hospital, have strict eligibility requirements and are open only to first responders, cleanup workers and volunteers who worked in and around the World Trade Center site.

“There is the feeling that the first responders and the cleanup workers did something that was unbelievably heroic, and that’s absolutely true,” said Reibman. “So, many residents feel a little embarrassed that they actually are in need. But this is a population that did not choose to be impacted by this and who also need help.”

Reibman’s commitment to helping anyone affected by exposure to the asbestos- and fiberglass-filled dust and smoke created by the collapse of the Twin Towers has made her something of a hero to local community groups.

“She is the one doctor who sees Downtown residents. She’s been here since the beginning,” Catherine McVay Hughes, Community Board 1 co-chairperson, said at a Dec. 11 board meeting during which Reibman laid out the Bellevue clinic’s plans for its new funding.

Though the clinic has remained, and will remain, open throughout the expansion process, the “new” clinic will have its formal ribbon-cutting on a to-be-decided date in January. It is currently funded to run until the end of 2011, with a budget of just over $3 million per year.

The program has its roots in a 2002 door-to-door survey of residents’ health conducted by the Bellevue asthma clinic and the state Department of Health. That interaction with the community led to a 2003 plea from the Beyond Ground Zero Network, a group that advocates for low-income residents and workers.

Beyond Ground Zero asked if the asthma clinic would be willing to treat the uninsured residents and workers who were suffering respiratory problems after 9/11 — a population that couldn’t seem to find help anywhere else. Though short on personnel, space and funding, Reibman agreed and the asthma clinic began seeing 9/11 patients informally. In 2005, a $2.4 million grant from the Red Cross turned the informal service into an official W.T.C. clinic.

To qualify for treatment at the Bellevue clinic a patient need only feel that he or she is suffering from ill health related to World Trade Center dust and smoke exposure. However, because the program has a waiting list, the neediest patients — those with the most severe symptoms and no insurance — are prioritized for treatment.

Common symptoms that Reibman has seen include respiratory problems such as sinusitis, cough and shortness of breath. There have also been cases of acid reflux and skin rashes. Based on an extensive interview as well as blood tests, chest X-rays and breathing tests, Reibman and her staff determine whether or not a patient’s condition is W.T.C. related and then decide on a course of treatment.

Many patients have responded well to basic breathing medications, but others have needed referrals to specialists to treat nose, throat and gastric problems. Still others need referrals for non-9/11-related health problems like diabetes, which have worsened due to a lack of insurance. While the clinic provides its services and many of its medications for free, Reibman wishes she could do more to help her patients with their other health needs. Though the clinic provides referrals, the low-income patients, many of whom live or work in Chinatown, often cannot afford to follow up with another doctor.

In the expanded clinic, Bellevue will have more space and more physicians to accommodate an 800-patient roster that is growing. The clinic is spreading out on the second floor of Bellevue’s new ambulatory wing, an airy, glass-enclosed addition that wraps around the front of Bellevue’s main building at First Ave. and 27th St. The clinic also plans to add in-house psychological treatment as well as evening hours one day a week. The clinic currently sees 15 to 20 patients each day and can now serve these patients in nearly any language through the hospital’s high-tech translation system. Everything is so new that Reibman meticulously wipes dirt off her conference room table. She wants it to stay looking nice for a while, she says.

The changes and challenges of expansion have been both exciting and stressful for Reibman and her team. Hiring and training new full-time doctors and nurses to bolster the current staff of seven mostly part-time physicians has been particularly tricky, as World Trade Center ailments are an unstudied medical specialty. Therefore, a desire to work hand-in-hand with the community and its complex populations is imperative, Reibman said.

“It’s absolutely rewarding,” Kyng, whose background is in public health, said of working at the clinic. “You’re dealing with a lot of people with no access to health care. Many of them don’t speak English. The obstacles they face are nearly insurmountable.”

As a freelance sound designer with a rent-controlled apartment two blocks south of the World Trade Center site, Esther Regelson got to see those obstacles first-hand when her health started to suffer after 9/11. First, there was a thyroid problem. With no insurance, Regelson paid for treatment out of pocket. But then her asthma began getting progressively worse and she developed severe acid reflux. Still, the 47-year-old cycling enthusiast tried to ignore it, telling herself that she was “just getting old.”

“As a person without medical insurance, you try to avoid medical treatment. You don’t know how the other half lives,” Regelson said.

Despite working extensively with environmental groups to promote the cleanup of W.T.C. toxins and the safe demolition of contaminated buildings like 130 Liberty St. and Fiterman Hall, it never occurred to Regelson that her own worsening symptoms might be related to her 9/11 exposure. In addition to being in her 109 Washington St. apartment on 9/11, Regelson returned frequently in the subsequent months to supervise cleanup efforts in her building, moving back in for good just six months later. Like many tenants in the Greenwich South area, Regelson viewed her rent-controlled apartment as a set of “velvet handcuffs”— a wonderful thing, but something she could never find elsewhere in the city. So she stayed, dust or no dust.

In 2005, Regelson’s friend Kimberly Flynn, who heads up 9/11 Environmental Action, finally convinced her to get her symptoms checked out at the Bellevue clinic. The results have been very encouraging. After just one treatment cycle with a cocktail of respiratory medications, Regelson’s lung capacity jumped from 42 percent to 62 percent. She goes in for checkups every three months and her boyfriend compliments her on how quickly she can now speed up hills on her bicycle. The hospital was even able to arrange low-cost access to her thyroid medication.

“It’s invaluable,” Regelson said of the Bellevue program. “I never would have been treated. I had sort of accepted my lot in life with it, but I never realized alternative.”

To get treatment for a 9/11-related condition at the Bellevue W.T.C. clinic, potential patients should call 212-562-1720 and leave a message that includes their contact information and the best time to reach them. The clinic can respond to messages in English, Spanish, Mandarin, Polish and Cantonese.