dojN002550.xml

dojN002550.xml

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2002-01-21

January 21, 2002

Special Master Kenneth Feinberg
September 11th Victim Compensation Fund of 2001

Re: 24-hour medical treatment rule -
28 CFR Part 104 [104.2 (c) (1)]

Dear Special Master:

I am writing to request that you rescind the above-captioned proposed regulation
requiring a patient to seek "medical treatment" [presumably in a formal,
professionally documented setting] "within 24 hours of the injury having been
sustained" to qualify as "physical harm," and, therefore, for compensation by the
September 11th Victims Compensation Fund.

This proposed regulation is not consistent with commonly known and accepted
medical practice and is particularly unrealistic and, therefore, unjust in light of the
extraordinary circumstances [and their medical consequences] of the attack of
9/11/01.

Although life-, limb-, or organ-threatening injuries sustained during the 9/11/01
attack could reasonably be expected to have resulted in the injured person seeking
medical attention within 24 hours (barring the mental incapacitation to do so),
many other serious and frequently more chronically crippling injuries do not, in
common medical practice, either frequently result in, or even benefit from, formal
medical attention within 24 hours.

One such class of injuries prevalent amongst victims of the 9/11/01 attack is
musuloskeletal injuries involving damage to bone, muscle, and/or joints. Such
injuries, especially ones of the spine or other joints, such as of the shoulders or
knees, can be chronically disabling and yet frequently do not receive formal
medical attention for days, and sometimes weeks, precisely because they are not
life-, limb-, or organ-threatening.

Another class of injury related to the 9/11/01 attack is lung injury caused by
inhalation of microscopic particulate matter and/or of organic fumes and smoke
caused by the burning of plastic-based and other materials (such as jet fuel and

Special Master Kenneth Feinberg (2)

PVC pipes), to which occupants were exposed during the attack and subsequent
collapse of the towers. Such injury, which at times can be immediately life-
threatening, can also lead to chronic and even insidiously progressive respiratory
distress syndromes. These are frequently tolerated for days or weeks before formal
medical attention is sought but, nevertheless, can become chronically debilitating.

Aside from the delays commonly seen by medical practitioners in seeking medical
attention for the aforementioned conditions are the extraordinary circumstances of
this attack and the devastating psychological and emotional impact of this
particular event, which as not been experienced in most people's lifetimes. The
post-traumatic stress disorder and/or depression of many of the survivors is real
and profound. Aside from being, at times, incapacitating in and of itself, these
psychological conditions, quite understandably, have resulted in further delays in
seeking medical attention for physical injuries as survivors contemplated, and to
this day relive daily the magnitude of this unspeakably horrific event, which
occurred to both themselves and to co-workers who did not survive.

The proposed "24-hour regulation" would constitute a gross injustice in fairly
administering the "9/11/01 Fund" and, in addition, would result in egregious
discrepancies in judging the merit of claims for medical injury. An example of
such a discrepancy is a person with a large laceration of the arm or leg (but no
other significant injury) having the laceration sutured shortly after the attack
qualifying for compensation. On the other hand, a person sustaining injury to their
back, which can lead to serious disability but is frequently not considered
sufficiently emergent by physicians to require evaluation within 24 hours, would
be automatically disqualified.

I urge you to rescind the 24-hour regulation since it excludes from consideration
people who sustained serious and at times long-lasting injuries, which are
commonly accepted as such by the medical profession and which legitimately
deserve consideration on an equal footing with those reported within 24 hours.
The 24-hour deadline is not consistent with sound medical practice and should not
define eligibility for inclusion for benefits from a fund created specifically for
victims of the 9/11/01 attack.

Sincerely,

Individual Comment
Trauma Specialist
Board Certified in
Emergency Medicine

New York, NY

2002-01-21