NEW YORK - It is not obvious when Dr. Stephen Levin is angry. He does not gesture wildly. His voice retains its soothing, clinical quality.
But as a doctor treating many of the people sickened by the attacks of Sept. 11, 2001, on the World Trade Center, Levin is unsparingly blunt about the government's failure to protect cleanup workers.
"From a public health perspective, we failed horribly," Levin said.
The 62-year-old Philadelphia native is director of a $12 million research and monitoring program at Mount Sinai Hospital for ground-zero workers - police, fire, rescue, construction, utility and volunteer workers - who helped in the aftermath of the attacks. Levin blames the government for failing to anticipate and then properly treat health problems caused by the attacks, the worst environmental disaster in the city's history.
Of the 12,000 workers and volunteers Mount Sinai has screened so far, sampling suggests that about half have persistent respiratory problems, such as asthma, inflammation and sinusitis, Levin said. For some, the illness is so severe that they can't work.
Of the estimated 6,000 with symptoms, none has recovered completely. About 300 firefighters have retired with disabilities from injuries and illnesses they believe are related to World Trade Center work.
The attacks sent up a toxic mix of asbestos, ground glass, concrete and dangerous chemicals such as benzene. The toxic cloud was bound to make some people sick. But Levin said the bigger priority for the government was reopening the financial markets and showing the world that America would not be cowed. People's health was secondary, he said.
On Sept. 18, 2001, the Environmental Protection Agency issued a statement saying the air in Lower Manhattan was safe to breathe even though the EPA had not finished tests for mercury, cadmium, lead, dioxin and other chemicals. The EPA Inspector General, an internal watchdog, released a report last summer seconding Levin's criticisms, and suggesting White House pressure affected the judgment that the air was clean.
"I understand the political and financial motivations, but at the sacrifice of what?" Levin asked.
The failures cascaded from there, he said. No one kept a list of people who worked at the site, meaning many of an estimated 35,000 workers and volunteers may never know that their future health problems can be traced to the cleanup.
Government agencies that regularly issue advisories on health topics never warned people about the full range of dangers of working at ground zero, Levin said.
As a result, he said, many people who got sick initially got the wrong treatment from their doctors - such as antibiotics for bronchitis caused by chemicals, not bacteria.
World Trade Center engineer Rick Collins developed Reactive Airways Disease, a type of asthma caused by exposure to irritants, after he was caught in the collapse of the south tower. Other doctors could not help him breathe. He eventually made his way to Levin, who gave him steroids, the proper treatment for Collins' asthma.
"The guy really saved my life," Collins said.
There is also no comprehensive program to medically monitor the people exposed after the attacks. The Mount Sinai program is the most extensive, but it does not cover all the people who worked or lived in the area. The program has funding to track people for just the next five years, even though cancer may take decades to develop.
The failure to monitor over a longer period means doctors may never know whether exposure to the dust and debris of ground zero will cause cancer. Levin is especially worried about workers who inhaled fumes while cleaning up the site and those who cleaned up apartments, often without training or protection, he said.
Some of those who developed ongoing health problems from their exposure lack health insurance. Mount Sinai received $1.5 million from the American Red Cross to treat patients with Trade Center-related health problems, and about 40 percent of the 880 people in that program lack insurance. Some of Levin's patients also have seen their workers' compensation claims turned down.
Levin developed his worker sympathies at Seventh and Oxford Streets. He lived there until he was 11, when the family moved to Oxford Circle.
The Franklin Institute was his playground.
"I loved to go there, push buttons, and see what happened."
His father, Sam, was a cabinetmaker and union member. Levin posts a sign from his father's union, the United Brotherhood of Carpenters and Joiners of America, in his cluttered Mount Sinai office.
"My father, even though he was by no means an activist, was very socially conscious," he said, "and my mother was sort of the block therapist. I grew up in a household where people talked about things and where there was no desire to sugarcoat anything."
His mother, Sarah, still lives in Northeast Philadelphia.
Levin graduated from Northeast High. He went on to Wesleyan University in Connecticut and then New York University School of Medicine.
After a residency in psychiatry, and an internship in surgery in New York, he worked as a community doctor in Pottstown, where he documented the risk of polyvinyl chloride fumes and helped union workers bring about workplace changes at what was then the Firestone plant.
In 1979, he stumbled on his life's calling. Mount Sinai offered him a chance to work in occupational health. Dr. Irving Selikoff headed the hospital's program in that field, gaining fame for proving the dangers of asbestos.
"I didn't know what I was walking into, but it was a really big chance and big luck," Levin said.
Selikoff died in 1992. Levin is now medical director of the Mount Sinai Irving J. Selikoff Center for Occupational and Environmental Medicine.
Levin said he tries to carry on Selikoff's tradition of educating workers about risks they face on the job.
After 9/11, Levin said, the politicians who should have ensured that people got help seemed more interested in photo-ops than good policy.
"In public, they call these [cleanup] people heroes, have their picture taken with them, and then leave them high and dry," Levin said. "I'm not sure the political will exists to make sure people are taken care of."
2004 Knight Ridder