James Zadroga died on January 6, 2006, of respiratory disease, black lung disease and mercury on the brain, leaving behind his parents and his four year old daughter. Zadroga was 34. During the final 13 years of his life he’d worked for the New York Police Department (NYPD), rising to the position of Detective with the Manhattan Homicide Task Force, before going off work on a 75% pay disability pension at the end of 2004, when he also received a compensation payment in excess of US $1 million.

As this large payout suggests, Detective Zadroga’s case was not a typical workers’ compensation claim. Prior to 2001, Detective Zadroga had been a healthy non-smoker. However, as a 9/11 first responder who spent around 450 hours working on the World Trade Centre “pile”, Detective Zadroga was exposed to a toxic cocktail of dust,  containing pulverised (alkaline) cement, glass fibres, asbestos, polycyclic aromatic hydrocarbons (PAHs), polychlorinated biphenyls (PCBs), and polychlorinated furans and dioxins.

As a result, he developed a chronic cough, shortness of breath, acid reflux and persistent headaches. His condition worsened over time and in 2006, Detective Zadroga became the first NYPD officer whose death was attributed to 9/11 related illness.

This milestone has not gone unmarked. When, in late December 2010, the US Senate finally passed a bill providing health treatment and extending compensation provisions for 9/11 first responders, it was called the James Zadroga 9/11 Health and Compensation Act.

Costed at US $4.3 billion, the Act establishes the World Trade Centre (WTC) Health Program, which will provide medical monitoring and treatment for up to 25,000 more WTC responders and survivors. (55,000 have already claimed under an existing program. Their ongoing treatment will be covered by the new funds.)

Given the patriotic rhetoric of American politicians, you’d be forgiven for assuming that a measure to assist 9/11 heroes like James Zagroda would receive bipartisan support. However, an earlier version of the bill was defeated on the floor of the Senate, where the majority of Republicans voted against it. Why? Well, that’s where things get complicated.

Under George W. Bush, Republicans had begun to roll out tax cuts to upper income brackets, but had not managed to finish the job before Obama was elected. Senate Republicans wanted to make their vote for the James Zagroda bill contingent upon the continuation of these tax cuts.

Following the initial defeat of the bill, Democratic New York Senator Kirsten Gillibrand was scathing in her assessment of this Republican tactic.

“The idea that tax cuts for millionaires would derail this legislation is simply outrageous and offensive. The men and women who rushed to the burning towers and worked for hundreds of hours on the pile did not delay and the Senate should not have delayed either, certainly not to give tax breaks for millionaires. We should not have to wait for tax deals to do what’s right.”

However, the Democrats themselves had opted to use a special voting protocol for the Bill, requiring a two thirds majority to ensure its passage, in order to prevent “embarrassing” Republican amendments to the legislation in an election year. If they had not, the legislation may have been amended as feared, but would almost certainly have passed in some form.

Both Republican and Democratic Senators were criticised for putting political strategy before their obligations to 9/11 responders. Comedian Jon Stewart spoke out so strongly against these political manoeuvrings that advocates for 9/11 first responders later credited him for the eventual passing of the Bill. (You can watch Stewart’s denunciation of Republicans and Democrats here.)  

Stewart’s angry satire suggests that compensation for 9/11 first responders is a black and white issue. But are questions of compensation ever so uncomplicated?

In 2006, Dr. Charles S. Hirsch, New York City’s chief medical examiner, concluded that it was the misuse and injection of prescription medication, not World Trade Center dust, that caused Detective James Zadroga’s lung ailments. When questioned about this development the Mayor of New York City, Michael Bloomburg, said "We wanted to have a hero, and there are plenty of heroes, it’s just in this case, science says this was not a hero." He backed away from this comment almost immediately, but despite a subsequent medical report naming Detective Zadroga as a 9/11 victim, questions about his drug use persist.

And there are broader questions about causation. In her bid to pressure Republicans into passing the James Zadroga Act, Democratic Senator Kirsten Gillibrand publicised news that three to four years after the WTC collapse, four first responders under the age of 45 were diagnosed with multiple myeloma, a haematological cancer generally seen only in old age. However, most research on multiple myeloma indicates that it takes 10 to 20 years for someone to develop that form of cancer after exposure to an environmental carcinogen. So was 9/11 really responsible? Should these individuals be compensated?   

When the James Zadroga 9/11 Health and Compensation Act finally made it through the US Senate, Republicans had won a suite of concessions that reduced the cost of the bill by US $1.2 billion and changed the way it was paid for. The concessions included:

• A 15 year reduction in the life of the Victim’s Compensation fund;
• No access to civil claims for claimants who are found to be ineligible under the terms of the fund; and
• A hard cap on attorney’s fees at 10%, with the capacity to reduce this percentage if 10% of the reward would result in an “excessively high dollar figure”.

Was the Republican refusal to vote for the bill in its earlier form really motivated by political expediency alone, or do these adjustments suggest that genuine fiscal concerns also came into play?

There is no easy answer to any of these questions. Given the context, should they even be asked?

According to Dr Stephen Levin, Co-Director of the World Trade Centre Worker and Volunteer Medical Screening Program, large numbers of these workers and volunteers suffer “persistent, substantial effects on their respiratory and psychological health as a result of their efforts”.

What role should financial pressures, organisational strategy, suspicions about authenticity and the ins and outs of medical causation play in such a situation? When is compensation simply about moral obligation; about doing what needs to be done, regardless of the costs?