True to his word, after reversing himself on the death certificate of Felicia Dunn-Jones, Hirsch reconsidered other cases that were brought to his attention by surviving family members who, like Joe Jones, believed that their loved one’s name belonged on the official 9/11 memorial. Given the growing awareness of the tragic death of James Zadroga and his wife, and the role that Zadroga’s name was playing in Washington’s efforts to get more assistance for injured responders, Zadroga’s case became a priority.
The customary way for a coroner to determine the manner of death is the autopsy, which can reveal many secrets. But in Zadroga’s case, it was far too late for Hirsch to conduct his own. He was forced to reconstruct the physical trail. Among the most important findings was the death certificate from the Ocean County, N.J., coroner, who had found “with a reasonable degree of medical certainty” that Zadroga’s death could be linked to ground zero dust. And Zadroga had received help from the September 11th Victim Compensation Fund, the same entity that had recognized the connection between Dunn-Jones’s death and the dust. By going over the documents in both those proceedings and reconstructing as best he could the time between the detective’s work at the site and his death just over four years later, Hirsch hoped to reach his own science-based conclusion.
Zadroga had first called in sick before 2001 ended, and he had deteriorated so rapidly afterward that he was able to apply for help from the victims’ compensation fund before the cutoff date at the end of 2003. Kenneth Feinberg reviewed Zadroga’s medical records and determined that his worsening condition had likely been caused by his exposure to the dust. Using the standard of a preponderance of evidence, Feinberg judged that Zadroga, who had been 29 on 9/11, a former football player and weightlifter, was unlikely to be able to work again or support his family. Zadroga was given an award of more than $1 million. By then, he had moved to central Florida with his wife, Ronda, and their baby, Tyler Anne, who had been born just three weeks after September 11. The police department had put him on long-term disability, and his doctors believed the warm air would do him good. His police career over, he bought a 15-acre mini ranch with six longhorn steers and a bull not far from his wife’s parents. He wanted to get as far away from New York and the dust as he could.
Zadroga could not run far enough, and tragedy followed him to Florida. The family lived in a comfortable house surrounded by the open spaces that Zadroga had been looking for. Ronda, who had been brought up in Florida, was happy to be back and living only a mile from her mother and father. But by fall 2003, when she was only 29, Ronda, a slender woman with shoulder-length dark blonde hair, was going through a bad time and decided to spend time with her parents, though Zadroga visited. Her parents have consistently refused to talk about what happened, but police records paint a disturbing picture. After one of those visits from Zadroga, Ronda’s parents found a black purse under her bed. In it were several hypodermic needles, a bottle containing different types of pills, and two spoons. Her mother, Rosalie, also found needles under the bedspread and on the floor. When Rosalie asked what they were doing there, Ronda replied, “It’s nothing, Mom.” Two days later, Ronda had to be taken to a local hospital. She was later transferred to a county hospital, where she died on October 12, 2003.
When Zadroga called his parents in New Jersey to tell them what had happened, they were at a garage sale looking for items to stock their new family dream. Arcadia, Fla., where James and Ronda had lived, was becoming a hot new center for antiques, with several dozen thriving businesses. The plan was for the entire Zadroga family, including Zadroga’s older brother, John, a furniture restorer, to open an antiques shop there. After hearing about Ronda’s death, Joseph and Linda Zadroga got in their car and drove overnight to Florida.
While the Zadrogas were making the long trip, Ronda’s family was meeting with the DeSoto County, Fla. Sheriff’s office to express their concerns about her death. According to files from the sheriff’s office, Ronda’s father, Roger Byrd, told a detective that his son-in-law had admitted that both he and Ronda were abusing drugs and that they had shared intravenous drugs shortly before her death. They told the detectives that Zadroga was a heavy prescription drug user with an “alleged disability” who couldn’t take care of himself or his daughter.
When Joe Zadroga arrived at his son’s house, the place was a mess. James’s three dogs had been left inside for days, and urine and feces were everywhere, including on some of the baby’s toys. Zadroga’s father quickly cleaned up. Soon two detectives from the county sheriff’s office, along with an investigator for the state Division of Child and Family Services, showed up. Zadroga was out making funeral arrangements, and his father identified himself as a former police chief, a cop with 27 years of experience. He thought they had come to take the baby away. “We have nothing to hide,” he said, and let them in. The detectives later reported that the house had clearly just been cleaned, and they had noted spots on the rugs. They asked who was going to take care of the baby, and Joe said he and his wife planned to bring her and their son back to New Jersey. The detectives and the investigator then left.
Despite a request from Ronda’s parents, the local medical examiner’s office refused to perform an autopsy. The official cause of death was listed as a massive staph infection, which could have come from the hospital or from dirty needles, but nothing definitive was noted. The medical examiner did observe multiple needle puncture marks on both of her arms, and a urine test showed traces of methadone, which is used in treatment programs for drug addicts.
Zadroga and his baby daughter moved back to New Jersey after the funeral, leaving behind the dream of ranching and antiquing for the reality of the New Jersey shore. With the money from the compensation fund, he helped his parents buy a large house in Little Egg Harbor, where the hotels of Atlantic City are visible in the distance across the salt marsh behind their backyard.
The extended Zadroga family moved into the big house at the end of a cul-de-sac in January 2004. Zadroga and the baby took an upstairs bedroom, where he spent much of his time. Joe Zadroga administered his pills four times a day and generally oversaw his medical care. When his son developed a serious infection that had to be treated with antibiotics, a shunt was put in his arm and he used hypodermic needles to flush out the tubes. Zadroga still had an IV attached when he died, and his body was brought to the Ocean County Medical Examiner’s office to be autopsied.
A little over a year later, Joe asked Hirsch to review those findings. He said he did so only for one reason. He wasn’t interested in suing the city. In fact, he couldn’t because of the money from the 9/11 compensation fund, which prohibited such lawsuits. He simply wanted was to see Zadroga’s name inscribed on the 9/11 memorial. For a tough-as-nails former police chief, that was something worth fighting for, an honor retrieved from the horror of losing a son. Hirsch asked Joe to send his son’s complete medical record, from Breton’s autopsy report to the documents that had been presented to the 9/11 fund and the police pension board, along with anything else that would help him retrace what had happened. If Hirsch could link Zadroga’s death to the dust as the New Jersey coroner had, he could classify the detective’s untimely death as another homicide, making him the 2,751st victim of the terrorist attack on New York.
In reviewing the material that Joe provided, Hirsch, who had lasted 18 years in the hothouse of the New York City medical examiner’s office without scandal, had to rely on the results of an autopsy he had not supervised, something that made a belt-and-suspenders kind of man like him uneasy. He knew well the difference between the expertise of his office, which had handled more than 100,000 autopsies during his tenure, and the one in Ocean County, with its aging suburban population, where most autopsies would find a narrow range of heart disease and cancers. Hirsch and his team understood death to be a creative demon filled with mystery and mischief, always willing to make the obvious unfathomable. He had become a detective of the human body, assessing all available medical evidence but lo
oking beyond that to social background, personal habits, travel, and other bits of personal information to help provide the answer to what he routinely referred to as the state of being “inconsistent with continued life.”
Hirsch ended up with a substantial amount of material on which to base his decision. Among the most complete portfolios was that of the medical board of the Police Pension Fund. Zadroga had applied for a line-of-duty disability pension in 2002. The board had found that Zadroga was unable to work, but it had not determined that his symptoms were job related. The ruling had an impact on Zadroga; a line-of-duty pension would have provided substantially more money for him and his family. In 2004, Zadroga had applied to the board again, this time presenting more documentation. Among the records were the medical opinions of several private doctors who believed that his respiratory problems were related to his work at ground zero. Unlike the questions surrounding Borja, there was little doubt that Zadroga had been at ground zero the first day. He submitted attendance and overtime records showing that he had arrived on September 11.
Hirsch also had in front of him the report of Breton’s one-hour autopsy. Zadroga’s body still had an electrode sticker pasted on his right side. He had weighed 216 pounds, far below his normal weight of close to 300. Breton had noticed multiple tattoos on both of Zadroga’s arms, as well as on both legs, on his neck, over his right chest, and on his upper back. He also described slight, barely discernable scars from stab wounds on his stomach.
Breton’s report indicated that Zadroga had serious health issues. His heart was markedly enlarged, as were his lungs. Breton described the lungs as brownish colored, somewhat fleshy, and finely granular. Under the microscope, he had found countless small cysts, or granulomas, throughout the lung tissue. Cutting them open, he had found foreign material he couldn’t identify but that he described as being “consistent with dust.” He sent samples to the Armed Forces Institute of Pathology, which had reviewed the lung tissues taken at Deborah Hospital several years earlier. Breton consulted with other doctors who had treated Zadroga, and also spoke to his father. Putting that history together with the autopsy results, Breton wrote in the final report that “it is felt with a reasonable degree of medical certainty that the cause of death in this case was directly related to the 9/11 incident.”
Without the body itself, the records were all Hirsch had to confirm or contest Breton’s findings. But he did have one important document that Breton apparently had not had when he made his final report. The Armed Forces Institute of Pathology analysis of the lung tissue had been sent to Breton on November 2, 2006, months after the autopsy report was completed. When he finally did see it, Breton did not find anything that required a revision of the death certificate. But the two-page report contained the kind of information that was a starburst signal for someone with Hirsch’s background and experience. When the tissue sample slides were exposed to supersensitive light microscopy, they sparkled brightly. “I do not exaggerate,” Hirsch recalled. “It’s as bright as the sky is going to be on the night of the Fourth of July.” He recognized the material causing the flashing light as talc and cellulose that the biopsy analysis had identified.
Hirsch then compared the slides to the biopsied tissue samples that had been taken at Deborah Hospital in 2003, which were included in the documents from the pension board. The 2003 biopsies had not shown any talc or cellulose crystals. If Zadroga had breathed in the materials at ground zero, they should have been present in his lungs in 2003. But the record showed they were not.
The dead speak to Hirsch and reveal secrets that otherwise would be lost forever. For him, talc was a telltale sign of a junkie habit of grinding up prescription painkillers like oxycontin, mixing them with water, and injecting them directly into the bloodstream. This put the drugs in overdrive, making them work both faster and more powerfully. The drugs could be absorbed quickly, but the talc, the inorganic material that pharmaceutical companies use to hold together the medication in the shape of a pill, cannot easily be absorbed in the blood. It usually has to be broken down in the stomach and then passed through the waste system. When pills are injected, the talc can clog blood vessels in the lungs, triggering an inflammatory reaction. Ultimately, some of the material works its way through the walls of the blood vessel into surrounding air sacs, causing the lungs to fail. The condition is known as “mainliner’s lung.”
On October 16, 2007, five months after he reversed course on Felicia Dunn-Jones, Hirsch sent a letter to Joe Zadroga. Trying to be both judicious with his words and straightforward with his message, Hirsch wrote that after studying the medical records and supporting documents, he had come to a conclusion that was “markedly different” from the one the New Jersey coroner had reached. Hirsch said, “It is our unequivocal opinion, with certainty beyond doubt, that the foreign material in your son’s lungs did not get there as the result of inhaling dust at the World Trade Center or elsewhere.” Hirsch had said what he believed had not caused Zadroga’s fatal lung problems, but he had not laid out what he thought had been the cause. Hirsch invited Joe to a personal meeting where he would provide the details of his investigation, apologizing in advance for what he understood would be a shocking conclusion. “We regret that we cannot agree with your belief, but we must interpret the facts as we see them, without regard to personal considerations,” Hirsch wrote, a statement that summed up his attitudes toward the difficult work of the medical examiner and the strict code by which he had run the office for nearly two decades.
Hirsch had not revealed anything to anyone but the family. He is famously averse to the kind of high-intensity buzz that an office like his, in a city like New York, can provoke. In all his years as chief medical examiner, he never held a news conference, and he did not intend to make an exception in this instance. However, Zadroga’s father was so upset by the findings that he had released Hirsch’s letter to reporters. After his long career in law enforcement, he knew when something bad was going down. He drove to New York so Hirsch would have to tell him face to face about what he had found. When he, his wife, and their lawyer, Michael Barash, talked to Hirsch, Zadroga first placed a framed portrait of his son on the conference room table. “While you’re talking, look at Jimmy,” he told Hirsch. “I want you to understand that Jimmy was a person and not just an object.”8 The news was worse than Joe had expected. Hirsch told him that he believed Zadroga had been injecting himself with painkillers, just as the Florida detectives had been told four years earlier. Hirsch said the slides from the Armed Forces lab were definitive. “Certainty beyond doubt,” the phrase he used in his letter, essentially means the alternative is impossible. Joe was devastated, as shocked as he was angry. “I never saw needle marks on his arms. I was a cop for 27 years—I would have seen needle marks.” His wife rushed out of the conference room, upset. “I’m lucky that Barash was there,” Joe said. “Otherwise, I would have lost my temper.” As the Zadrogas drove off, Barash talked to reporters. “We got an explanation,” he said. “We just don’t agree with it.”
Despite Hirsch’s firm defense of his conclusion as having “certainty beyond doubt,” his explanation did not satisfy everyone. Among those who remained suspicious was his predecessor, Dr. Michael Baden, who had reviewed the tissue slides and doubted that they showed what Hirsch said they showed. Since serving as medical examiner, Baden had become a media star, with his own cable television program about forensic pathology. He was not afraid to critique the work of others. Baden said that when he checked the tissue samples and saw the 2006 report from the Armed Forces Institute, he concluded that the talc and cellulose were among the many materials loosed by the collapsing towers. He also said that when he examined the slides, he saw glass fibers and other particles that could not have come from pills, but had been inhaled at the trade center site. He took issue with Hirsch’s argument that the foreign material had been found in the blood vessels of the lungs. Baden was familiar with mainliner’s lung and decades earlier had written about the effe
cts of injecting prescription drugs in a classic medical text. But in this case, he concluded that the areas in question on Zadroga’s slides were packed so closely together that it was just as likely that the dust was in the alveoli of the lungs as in the blood vessels laced between them, meaning they had been inhaled, not injected.
Hirsch strongly disagreed with Baden and those who asked what difference it made—after all, Zadroga unquestionably had been exposed to the dust:9
The lesson exemplified by Zadroga is very clear cut. Decisions that we make cannot transcend the information that they are based upon. I believe that the doctor who did Zadroga’s autopsy, and then also his consultant, failed to take into consideration the entire history. Zadroga allegedly inhaled foreign material in his lungs when working at the site of the World Trade Center in 2001. Zadroga retired and had lung biopsies done in 2003. They were extensive lung biopsies. They were generous. I’ve read the reports. There isn’t a question of sampling error or anything like that. There were appropriate samples taken from more than one part of his lung. In 2003 there was no cellulose and there was no talc in his lungs. He died and was autopsied in 2006, and his lungs are full of talc and cellulose. Furthermore, it got there by way of the bloodstream and not by way of the air passages. But that’s a matter of technical interpretation how it got there. I believe that it’s categorically, unequivocally demonstrated in the autopsy that it got there by way of the bloodstream. But even forgetting that, if his lungs are full of talc and cellulose in 2006 and it wasn’t there in 2003, how can you opine that it got there because he inhaled it in 2001? I don’t see how the pathologist could have concluded that those crystals got there because of his work on the site of the World Trade Center. I don’t think they took into consideration the fact that his lungs were free of those crystals in 2003. It’s impossible.
City of Dust Page 27
