A 9/11 responder with life-threatening pancreatic cancer was told this week that he couldn’t start chemotherapy. Two others with new cancer diagnoses were also denied treatment, according to Dr. David Prezant, chief medical officer of the New York City Fire Department and director of its World Trade Center Health Program.
“We postponed chemotherapy for a firefighter this week, hoping this could be fixed,” Prezant said “He’s too young for Medicare, and this delay may cost him his life.”
All three patients were part of the federally funded World Trade Center Health Program — a system created to care for those who risked their lives on Sept. 11, 2001. But the program has come to a standstill, Prezant said.
The program’s longtime leader, Dr. John Howard, was removed in February — and then rehired after bipartisan backlash. But according to Prezant, it remains unclear whether his legal role as administrator was actually restored.
Sen. Kirsten Gillibrandspeaks at a press conference on April 6, 2025, calling on the Trump administration fully restore key staff for the World Trade Center Health Program.
Ron Adar/Sopa Images via Sipa USA via AP
“It appears that Dr. John Howard, Director of the National Institute of Occupational Safety and Health (NIOSH) and the Administrator of the World Trade Center Health Program (WTCHP) was not properly reinstated as Administrator of the World Trade Center Health Program, as the Health and Human Services Department told the NY Republican Members of Congress which they announced on April 5,” Citizens for the Extension of the James Zadroga Act, an advocacy group, said in a statement on its website.
Prezant said that although he has asked numerous times for clarification from the World Trade Center Health Program, he has provided no information as to why Howard has not been fully reinstated or why the certifications cannot continue.
He said he was not clear if Howard’s position was in limbo due to DOGE cuts or some other reason. Advocates also said they believed that Howard’s limbo status appears separate from earlier staffing cuts and budget shortfalls worsened by inflation.
But without formal certification, treatment for new conditions cannot proceed, he emphasized.
ABC reached out to the Department of Health and Human Services for an explanation but did not hear back. In a statement sent earlier this week in response to staffing cuts, an agency spokesperson said, “The Program continues to accept and review new enrollment applications and certification requests.”
However, an internal email from HHS sent earlier this month that was shared with ABC News said, “We have been directed not to process any new certifications.”
Until this week, clinics were allowed to begin treating patients under “initial approvals,” Prezant said, while waiting for formal certification from the federal program. But that emergency workaround was shut down this week, he explained.
The process of attaining formal certification required submitting documentation such as biopsy results, lung scans, and other medical evidence — and then acquiring a signature from the program administrator, which should have been Howard.
This is “a clear sign that Dr. Howard hasn’t been fully reinstated,” according to Prezant.
To receive care through the program, a responder or survivor must first enroll — and then have their illness formally certified by the federal program as being related to 9/11 exposure. Certification is a separate and critical step.
Clinics must submit medical evidence, such as biopsy results or lung scans, and only after the program approves it can treatment move forward or compensation claims be filed. Without someone in place to authorize these certifications, patients with newly diagnosed conditions are stuck waiting.
In addition to its freeze on certifying illnesses, Prezant said it seemed that the program can no longer enroll new members or approve life-saving treatments like chemotherapy, lung transplants, or stem cell therapy.
Sixteen of the program’s doctors, nurses, and support staff were laid off in early April — depleting the program by approximately 20%.
A firefighter helmet with the words “We will never forget” is seen during the 9/11 remembrance event.
Peter Zay/Anadolu via Getty Images
Howard’s unclear status follows layoffs earlier this month that followed a previous round of cuts in February — but those were reversed after bipartisan backlash. It hasn’t yet been established if any of the newly terminated employees were part of the original group.
Either way, the decision once again left the program critically understaffed, according to clinic leaders and advocacy groups.
The program now serves more than 150,000 people nationwide, up from about 76,000 in 2015, according to data from the Centers for Disease Control and Prevention. A bipartisan bill, HR 1410, was introduced in February to close the funding gap as enrollment surged, but it remains stalled in Congress.
“We don’t decide who qualifies,” said Prezant, noting that eligibility rules and certification decisions are set by the federal program under the Zadroga Act. “That protects the system from fraud — and it works.”
He pointed to FDNY data showing that five years after a cancer diagnosis, 86% of program patients are still alive — compared to just 66% among those diagnosed in New York State who are not enrolled in the program.
Now, according to Prezant and others, patients in all 50 states who rely on care from the program are being turned away without clear answers about when, or if, the system will be restored.
“No one is asking for anything more than what was promised under the law,” Prezant said, referring to the Zagroda Act’s commitment to provide lifelong medical care and monitoring for 9/11 responders and survivors whose illnesses are linked to their exposure. “We just want the federal government to honor that promise before more lives are lost.”