ANNAPOLIS, Md. - During the anthrax mail attacks in 2001, Bill Paliscak, a gung-ho, hockey-playing postal investigator who had missed 3 days of work in 11 years, removed a filthy filter above a mail-sorting machine to preserve it as evidence. Anthrax-laden dust showered down on him.
David Scull for The New York Times
Bill Paliscak cannot live at his home until an elevator is installed.
Agence France-Presse
Workers in October 2001 cleaned the Brentwood postal facility in Washington, where employees like Mr. Paliscak were exposed to anthrax.
David Scull for The New York Times
Bill Paliscak, exposed to anthrax in 2001.
Four days later he began to feel feverish. Soon he was in intensive care. After spending the next three years in and out of the hospital, Mr. Paliscak, 41, now needs a wheelchair to move about, sleeps with a breathing device to get enough oxygen and takes dozens of pills a day.
His medical bills total more than $800,000, and he has been living in a motel here for more than a year because he cannot reach the shower on the second floor of his home.
Yet Mr. Paliscak (pronounced PAL-uh-sack) remains a medical puzzle. Blood tests never detected the bacteria that cause anthrax or the antibodies the immune system should produce in response. As a result, the federal Centers for Disease Control and Prevention never classified his disease with the 11 confirmed cases of inhalational anthrax, 5 of them fatal.
Mr. Paliscak's nondiagnosis ultimately has had little practical effect, because the Department of Labor agreed in 2002 that his illness was work-related, permitting workers' compensation to cover his medical bills and provide support of about $1,000 a week. But the C.D.C. decision rankles Mr. Paliscak, his family and his doctors.
"It sort of feels like - 'You don't believe me,' " says Mr. Paliscak, rocking in agitation in his wheelchair, his old Postal Inspection Service bag sitting on the floor nearby. "I've dedicated my life to law enforcement and the military. And an agency of the government I was sworn to protect won't accept this. That bothers me."
After consulting with dozens of specialists across the country, his doctors at Sinai Hospital of Baltimore remain convinced that his anthrax exposure produced his disease, in part because exhaustive testing found no other cause. They believe his experience may hold scientific lessons about anthrax, which experts consider the likeliest weapon in future bioterrorist attacks.
"I think we can still learn something from Bill's case," said Dr. Gary J. Kerkvliet, an internist at Sinai who has cared for Mr. Paliscak since 2001. Dr. Kerkvliet says he fears the C.D.C. "has its head in the sand." A colleague, Dr. Tyler C. Cymet, who spent months talking to the confirmed anthrax survivors and their doctors, said, "I come down strongly on the side that this is anthrax." Few diseases cause "whole-body symptoms" as does the toxin produced by anthrax, said Dr. Cymet, who, like Dr. Kerkvliet, is an assistant professor at the Johns Hopkins medical school.
The variety of symptoms Mr. Paliscak suffers would be enough for a hospital ward full of patients. His limbs swell with fluid, pushing his previous weight of 185 pounds as high as 310. His hormone-producing glands have shut down, setting off a cascade of secondary effects.
He experiences spells of overwhelming fatigue that can last for several days. His legs regularly are gripped by painful convulsions, the thigh muscles shaking as he struggles to hold them still.
But C.D.C. officials, who declined to discuss Mr. Paliscak's case, say they cannot bend diagnostic criteria. "Case confirmation is based on laboratory results and is an essential starting point in any public health investigation and for medical treatment," the agency said in a statement.People who knew the muscular ex-marine say they hardly recognize him now. "He was in tip-top shape," said Patrick T. Carroll of Quakertown, Pa., a former hockey teammate who was best man at Bill and Allison Paliscak's 1996 wedding. "He was the kind of guy who could skate the whole game."
Now, Mr. Carroll said, his friend is "a totally different person." At Mr. Paliscak's mother's funeral in 2003, "when they wheeled him in, my wife just lost it."
"I probably wouldn't have known him," Mr. Carroll continued.
One key to the mystery may be the paucity of data on the inhalational form of anthrax. "Historically, there haven't been a lot of survivors to study," said Dr. Philip S. Brachman, who studied five cases at a New Hampshire mill in 1957 - the largest cluster in the United States before 2001.
Before the anthrax letters, of the 18 cases of inhalational anthrax diagnosed in Americans during the previous century, 16 were fatal, he said.
Anthrax remains largely an animal disease, with cattle or other mammals periodically infected by inhaling spores that can lie dormant for a century in soil. This very hardiness attracted biowarriors of a half dozen countries in the 20th century, who made anthrax the core of their arsenals.
Whoever mailed anthrax-laced letters in Princeton, N.J., on Sept. 18 and Oct. 9, 2001 - the case is still unsolved - proved its effectiveness as a killer and contaminant.
Two postal workers at the Brentwood mail processing center in Washington, where Mr. Paliscak removed the filter, died of inhalational anthrax and two others survived it. The cost of cleaning up the billions of spores that leaked into the building from two letters addressed to Democratic senators exceeded $100 million.
Even after gas had exterminated all the anthrax spores, workers re-entered the cavernous structure in moon suits, just in case.
But in the first days after the letter to Senator Tom Daschle was discovered in October 2001, the drive to act outpaced officials' understanding of the exotic bug. As Mr. Paliscak gathered evidence around Delivery Bar Code Sorter No. 17, an anthrax hot spot, he wore only a hardware-store dust mask for protection.
Testing would show that the filter he removed was thick with anthrax spores. He got sick four days after exposure, the mean incubation time of the confirmed cases. Some of his symptoms, though not all, would resemble theirs. Like him, they have recovered slowly and incompletely, complaining of a bewildering variety of ailments.
"I feel a little better," said David R. Hose, 62, of Winchester, Va., who was infected at a State Department mailroom. "I think my stamina is a little better. But I'm still on seven kinds of medication."
Mr. Hose and the other official victims tested positive for anthrax. Mr. Paliscak did not. Studies have shown that a dose of antibiotics can kill the bacteria while still allowing the toxin to do its damage, and Mr. Paliscak took two antibiotic pills in the first couple of days after exposure. Yet other tests - one to look for anthrax DNA, another to find antibodies - also found nothing.
As Mr. Paliscak became deathly ill, cycling in and out of Sinai Hospital, his wife and friends from the Postal Inspection Service pursued a workers' compensation claim. After initially rebuffing the case, the Department of Labor ruled in May 2002 that while it could not justify a formal diagnosis of anthrax without a positive test, some major symptoms - inflammation of the heart and lungs - were caused by dust exposure at Brentwood.
The department eventually assigned a top manager to track the case. But medical bills went unpaid for months on end, creating havoc with the Paliscaks' credit and causing several medical facilities to temporarily suspend services.
Though a hospital administrator herself, Allison Paliscak found the effort to get treatment and payment for it daunting. "It's a maze that no one has any directions to get through," she said.
After Mr. Paliscak finally went home in late 2003, he spent more than six months taking sponge baths, because the only shower is on the second floor. The Department of Labor agreed to put in an elevator and chose contractors for the work. But after a shaft was opened and the house became virtually uninhabitable, the elevator contractor disappeared.
They were to spend two weeks in the Marriott Residence Inn during a $10,000 house renovation. They have been in the motel for a year, at a cost to workers' compensation of $30,000. One night Mr. Paliscak's pizza dinner was interrupted when a car crashed through the motel wall and into his room. He switched rooms.
Shelby Hallmark, director of the office of workers' compensation programs at the Department of Labor, acknowledged that computer problems fouled up bill payments and blamed an unscrupulous contractor for the elevator delay.
But he said the program had spent nearly $1 million in medical bills and direct payments on the case, even assigning a nurse to help coordinate Mr. Paliscak's therapy, transportation to appointments and home renovations.
Anthrax experts asked about Mr. Paliscak's illness had varying views. Dr. Brachman, of Emory University, said he would not rule out anthrax as a cause, despite the test findings. Dr. Ken Alibek, a former Soviet bioweapons expert now at George Mason University, was more skeptical. "You cannot make the diagnosis without laboratory confirmation," Dr. Alibek said.
Both wondered whether Mr. Paliscak's illness might be a devastating reaction to some other substance on the filter, such as yeast or mold spores. But Mr. Paliscak's doctors said they could find no evidence for that possibility.
Dr. Leonard A. Cole, a Rutgers University professor who reviewed Mr. Paliscak's case for his 2003 book, "The Anthrax Letters: A Medical Detective Story," said the C.D.C. should have at least labeled Mr. Paliscak a "suspect" case of anthrax.
"It's more than just an academic question," he said. "The bigger our base of knowledge about this disease, the better off we'll be."
Dr. Mary E. Wright of the National Institute of Allergy and Infectious Diseases is conducting a follow-up study on the anthrax victims and has included Mr. Paliscak in her research. But through a spokeswoman, she declined to comment on his case, saying she does not want to discuss her study until it is published.
Mr. Paliscak is tired of the debate about his illness and simply wants to get back to work. "I was one of those lucky people who really love what they do," he said.
Some of his colleagues in the Postal Inspection Service are still investigating the anthrax case, as the fourth anniversary of the attacks draws nearer. He would like nothing more, he said, than to rejoin the hunt for the person responsible for killing five people and sickening 17 others - or 18, if Mr. Paliscak and his doctors are right.
A year ago, Mr. Paliscak was honored by a law enforcement group and had a chance to talk with the speaker, Robert S. Mueller III, the director of the Federal Bureau of Investigation, whose agency has overseen the anthrax investigation.
"I told him I'd like to be well enough when we catch this guy to put the handcuffs on him," Mr. Paliscak said.
April 1, 2005, New York Times, The Intelligence Critique: Biological Weapons; Panel Warns That Defense Against Germ Attack Is Weak, by Eric Lipton, Archived,
March 31, 2005, New York Times, Lawmaker Charged In an Anthrax Scare, Archived,
March 16, 2005, New York Times, Anthrax Scare Is Attributed to a Testing Error, by Scott Shane, Archived,
November 30, 2001 [11:49 PM EST] AP, Anthrax Found on Connecticut Letter, by Matthew Daly, Associated Press Writer,
HARTFORD, Conn. (AP) -- Traces of anthrax were found on a letter in Connecticut for the first time Friday, prompting the governor to suggest the 94-year-old woman who died mysteriously of the disease last week might have gotten it from her mail after all.
Gov. John Rowland said no direct connection had been made between the letter found at a home in Seymour and the death Nov. 21 of Ottilie Lundgren, who lived about a mile away in Oxford.
But Rowland said her mail -- like the Seymour envelope -- may have been contaminated, perhaps indirectly, by anthrax-tainted letters sent to Sens. Tom Daschle and Patrick Leahy in Washington.
"I don't think that anyone suspects that Mrs. Lundgren was a target," he said. "We all believe, again unscientifically because it's not proven, that she was a victim of cross-contamination."
Authorities described the Seymour letter as a personal piece of mail that was processed at the Hamilton facility near Trenton, N.J., on Oct. 9.
They did not disclose details about its postmark or any addresses, but John Farkas of Seymour that he received the letter.
"All our daughters are fine. All the people who visited our house are fine," he told WICC-AM of Bridgeport. "There is absolutely nothing wrong with us."
The letters sent to Daschle and Leahy were postmarked at the Hamilton facility on Oct. 9. Rowland said the Seymour letter moved through a sorting machine within seconds of one of the Washington letters.
The Washington letters are blamed for contaminating a number of Washington buildings and for killing two postal workers.
Late Friday, authorities planned to pump chlorine dioxide gas into Daschle's office at the Hart Senate Office Building, where the letter sent to him was opened last month. Officials said they would make sure none of the deadly chemical escaped as they cleaned the office.
The Seymour letter was among about 300 pieces of mail that moved through a sorting machine at about the same time as the tainted letters sent to Daschle and Leahy.
Those letters were destined for addresses all over the United States, said Jon Steele, Northeast vice president for the Postal Service. He said he did not know whether the Postal Service would be tracking down and testing the other letters.
The Hamilton facility, which has been closed since Oct. 18, also handled anthrax-tainted letters sent to news organizations in New York.
Federal health authorities said they still do not know how Lundgren was exposed. The discovery of the letter simply supports the theory that cross-contamination in the mail is possible, said Dr. Jeffrey Koplan, director of the Centers for Disease Control and Prevention.
"This is not an unexpected finding. We have had other possible cross-contamination mail in other locations," Koplan said.
Rowland said it was possible that hundreds or thousands of pieces of mail have "second- or third-generation" contamination from letters that moved through New Jersey at the same time as the Daschle and Leahy letters "but not enough to harm anyone or make anyone sick."
"It's more dangerous to cross the street than it is to open your mail in America right now," Rowland said.
In Seymour, residents said they were worried.
"They better check everybody around here," said Frank Ajello. "We all have the same mail man."
Connie DeRosa of Oxford said she called her doctor for antibiotics when she heard the news. "I'm going on a trip for eight days. I'm scared to leave my family behind," she said.
Lundgren is the fifth person to die since the nation's anthrax scare began in early October. Investigators have not determined how the widow who rarely left home contracted inhaled anthrax, the rarest and deadliest form of the disease.
Tests of her home, mail and the handful of places she visited in Connecticut on a regular basis have so far come up negative.
Using envelope bar codes, authorities said they had determined that a small amount of mail for the Oxford area passed through the Hamilton facility.
Rowland said investigators looked at the Seymour envelope after they started probing the death of an 84-year-old man who lived next door. Tests have ruled out anthrax as the cause of his death.
CDC officials, however, said they were led to the letter through the bar code data. The Seymour letter was the only one processed Oct. 9 that went to the Seymour or Oxford ZIP codes, said Dr. David Fleming of the CDC.
"We're continuing to work with Post Office to assess if there were letters went through on subsequent days," he said.
Investigators continue to look for any similarities to the baffling case of a 61-year-old New York City woman who died Oct. 31, also from the inhaled form of anthrax. Both women lived alone.
EDITOR'S NOTE -- Associated Press Writer Laura Meckler in Washington contributed to this report.
November 26, 2001, New York Daily News, Conn. Victim Interviewed Before Dying, But Few Anthrax Clues, by Gregg B. Smith, Archived,
Within hours after a hospital lab technician first saw signs that Ottilie Lundgren might have anthrax, doctors immediately began questioning the 94-year-old widow about her life.
That interview may now hold the key in the scramble to solve America's anthrax mystery. That's because Lundgren's is one of only two anthrax cases not linked to the mail, and the only case in which the victim was actually questioned about anthrax before she died. That questioning already has helped narrow the focus of the investigation into how Lundgren somehow came in contact with deadly inhalation anthrax that killed her the day before Thanksgiving. Coherent while at hospital Lundgren arrived at Griffin Hospital in Derby, Conn., before noon Nov. 16, driven there by her niece Shirley Davis, according to hospital Vice President William Powanda.
"She at that point was clearly lucid and communicative while she was in the emergency department from Friday into Saturday," Powanda said. When tests showed she might have anthrax, doctors immediately began asking her anthrax-related questions to determine the point of contact.
"She was becoming much less lucid and much less coherent, so there was only a relatively short window of time when these questions were being asked," Powanda said. Doctors first asked Lundgren whether she gardened or had any recent contact with farm animals.
"She said, 'I haven't done that in many, many years,' " Powanda said. She was asked where she'd been recently: "She said, 'I go to church, I go out to eat frequently and I go to the hairdresser,'" Powanda said. She listed specific restaurants, including Fritz's Snack Bar in Oxford, Conn., and another local spot where she recently had begun eating lunch. She mentioned the Nu Look salon and Immanuel Lutheran Church, where she had attended service the previous Sunday. That information later allowed investigators to quickly test those locations for traces of anthrax. She also told doctors she had not recently traveled out of her small town, nor did she recall anything unusual in the previous few weeks. But the questioning was limited because the doctors were working under the theory that Lundgren got anthrax from a natural source. She was not asked about her mail, or whether she had encountered any strangers, or even if she had done anything out of her normal routine in recent weeks.
"It was kind of counterintuitive that a 94-year-old lady living in Oxford would be a victim of something intentional," Powanda said. "The questioning was focused on natural occurrence."
Less progress in N.Y. case
Still, the questioning of Lundgren marked a vast improvement over the situation involving Kathy Nguyen, the 61-year-old Manhattan hospital worker who died Oct. 31 of inhalation anthrax. In Nguyen's case, investigators were unable to ask her anything, because by the time they suspected she had anthrax, Nguyen had physically deteriorated and was incoherent. Investigators say Nguyen kept to herself much more so than Lundgren, who gave up driving last year and was accompanied nearly everywhere she went by others. That Lundgren's niece collected her mail and helped her open most of it also helped quickly eliminate the mail system as a possible point of anthrax transmission. Last week, FBI and postal inspectors were able to interview dozens of people who had regular contact with Lundgren.
Still looking for a link
Unfortunately, there are similarities between the Lundgren and Nguyen cases that have frustrated investigators. In each case, no other relative, friend or even acquaintance has shown any symptoms of anthrax exposure - which means that when the contact was made, each woman was most likely alone. Over the weekend, however, it was clear investigators were searching for a link between the Lundgren and Nguyen cases. They have checked, for instance, to see whether the two women shared the same medicines. An NYPD detective and a case agent assigned to the Nguyen case traveled Saturday to Connecticut to help in the Lundgren investigation, FBI officials said.
Lisa Bull, spokeswoman for the FBI's Connecticut office, declined to comment on links between the two cases, except to note, "New York has been particularly helpful, I'll put it that way."
HARTFORD, Conn. (AP) -- Traces of anthrax were found on a letter in Connecticut for the first time Friday, prompting the governor to suggest the 94-year-old woman who died mysteriously of the disease last week might have gotten it from her mail after all.
Gov. John Rowland said no direct connection had been made between the letter found at a home in Seymour and the death Nov. 21 of Ottilie Lundgren, who lived about a mile away in Oxford.
But Rowland said her mail -- like the Seymour envelope -- may have been contaminated, perhaps indirectly, by anthrax-tainted letters sent to Sens. Tom Daschle and Patrick Leahy in Washington.
"I don't think that anyone suspects that Mrs. Lundgren was a target," he said. "We all believe, again unscientifically because it's not proven, that she was a victim of cross-contamination."
Authorities described the Seymour letter as a personal piece of mail that was processed at the Hamilton facility near Trenton, N.J., on Oct. 9.
They did not disclose details about its postmark or any addresses, but John Farkas of Seymour that he received the letter.
"All our daughters are fine. All the people who visited our house are fine," he told WICC-AM of Bridgeport. "There is absolutely nothing wrong with us."
The letters sent to Daschle and Leahy were postmarked at the Hamilton facility on Oct. 9. Rowland said the Seymour letter moved through a sorting machine within seconds of one of the Washington letters.
The Washington letters are blamed for contaminating a number of Washington buildings and for killing two postal workers.
Late Friday, authorities planned to pump chlorine dioxide gas into Daschle's office at the Hart Senate Office Building, where the letter sent to him was opened last month. Officials said they would make sure none of the deadly chemical escaped as they cleaned the office.
The Seymour letter was among about 300 pieces of mail that moved through a sorting machine at about the same time as the tainted letters sent to Daschle and Leahy.
Those letters were destined for addresses all over the United States, said Jon Steele, Northeast vice president for the Postal Service. He said he did not know whether the Postal Service would be tracking down and testing the other letters.
The Hamilton facility, which has been closed since Oct. 18, also handled anthrax-tainted letters sent to news organizations in New York.
Federal health authorities said they still do not know how Lundgren was exposed. The discovery of the letter simply supports the theory that cross-contamination in the mail is possible, said Dr. Jeffrey Koplan, director of the Centers for Disease Control and Prevention.
"This is not an unexpected finding. We have had other possible cross-contamination mail in other locations," Koplan said.
Rowland said it was possible that hundreds or thousands of pieces of mail have "second- or third-generation" contamination from letters that moved through New Jersey at the same time as the Daschle and Leahy letters "but not enough to harm anyone or make anyone sick."
"It's more dangerous to cross the street than it is to open your mail in America right now," Rowland said.
In Seymour, residents said they were worried.
"They better check everybody around here," said Frank Ajello. "We all have the same mail man."
Connie DeRosa of Oxford said she called her doctor for antibiotics when she heard the news. "I'm going on a trip for eight days. I'm scared to leave my family behind," she said.
Lundgren is the fifth person to die since the nation's anthrax scare began in early October. Investigators have not determined how the widow who rarely left home contracted inhaled anthrax, the rarest and deadliest form of the disease.
Tests of her home, mail and the handful of places she visited in Connecticut on a regular basis have so far come up negative.
Using envelope bar codes, authorities said they had determined that a small amount of mail for the Oxford area passed through the Hamilton facility.
Rowland said investigators looked at the Seymour envelope after they started probing the death of an 84-year-old man who lived next door. Tests have ruled out anthrax as the cause of his death.
CDC officials, however, said they were led to the letter through the bar code data. The Seymour letter was the only one processed Oct. 9 that went to the Seymour or Oxford ZIP codes, said Dr. David Fleming of the CDC.
"We're continuing to work with Post Office to assess if there were letters went through on subsequent days," he said.
Investigators continue to look for any similarities to the baffling case of a 61-year-old New York City woman who died Oct. 31, also from the inhaled form of anthrax. Both women lived alone.
EDITOR'S NOTE -- Associated Press Writer Laura Meckler in Washington contributed to this report.
November 26, 2001, New York Daily News, Conn. Victim Interviewed Before Dying, But Few Anthrax Clues, by Gregg B. Smith, Archived,
Within hours after a hospital lab technician first saw signs that Ottilie Lundgren might have anthrax, doctors immediately began questioning the 94-year-old widow about her life.
That interview may now hold the key in the scramble to solve America's anthrax mystery. That's because Lundgren's is one of only two anthrax cases not linked to the mail, and the only case in which the victim was actually questioned about anthrax before she died. That questioning already has helped narrow the focus of the investigation into how Lundgren somehow came in contact with deadly inhalation anthrax that killed her the day before Thanksgiving. Coherent while at hospital Lundgren arrived at Griffin Hospital in Derby, Conn., before noon Nov. 16, driven there by her niece Shirley Davis, according to hospital Vice President William Powanda.
"She at that point was clearly lucid and communicative while she was in the emergency department from Friday into Saturday," Powanda said. When tests showed she might have anthrax, doctors immediately began asking her anthrax-related questions to determine the point of contact.
"She was becoming much less lucid and much less coherent, so there was only a relatively short window of time when these questions were being asked," Powanda said. Doctors first asked Lundgren whether she gardened or had any recent contact with farm animals.
"She said, 'I haven't done that in many, many years,' " Powanda said. She was asked where she'd been recently: "She said, 'I go to church, I go out to eat frequently and I go to the hairdresser,'" Powanda said. She listed specific restaurants, including Fritz's Snack Bar in Oxford, Conn., and another local spot where she recently had begun eating lunch. She mentioned the Nu Look salon and Immanuel Lutheran Church, where she had attended service the previous Sunday. That information later allowed investigators to quickly test those locations for traces of anthrax. She also told doctors she had not recently traveled out of her small town, nor did she recall anything unusual in the previous few weeks. But the questioning was limited because the doctors were working under the theory that Lundgren got anthrax from a natural source. She was not asked about her mail, or whether she had encountered any strangers, or even if she had done anything out of her normal routine in recent weeks.
"It was kind of counterintuitive that a 94-year-old lady living in Oxford would be a victim of something intentional," Powanda said. "The questioning was focused on natural occurrence."
Less progress in N.Y. case
Still, the questioning of Lundgren marked a vast improvement over the situation involving Kathy Nguyen, the 61-year-old Manhattan hospital worker who died Oct. 31 of inhalation anthrax. In Nguyen's case, investigators were unable to ask her anything, because by the time they suspected she had anthrax, Nguyen had physically deteriorated and was incoherent. Investigators say Nguyen kept to herself much more so than Lundgren, who gave up driving last year and was accompanied nearly everywhere she went by others. That Lundgren's niece collected her mail and helped her open most of it also helped quickly eliminate the mail system as a possible point of anthrax transmission. Last week, FBI and postal inspectors were able to interview dozens of people who had regular contact with Lundgren.
Still looking for a link
Unfortunately, there are similarities between the Lundgren and Nguyen cases that have frustrated investigators. In each case, no other relative, friend or even acquaintance has shown any symptoms of anthrax exposure - which means that when the contact was made, each woman was most likely alone. Over the weekend, however, it was clear investigators were searching for a link between the Lundgren and Nguyen cases. They have checked, for instance, to see whether the two women shared the same medicines. An NYPD detective and a case agent assigned to the Nguyen case traveled Saturday to Connecticut to help in the Lundgren investigation, FBI officials said.
Lisa Bull, spokeswoman for the FBI's Connecticut office, declined to comment on links between the two cases, except to note, "New York has been particularly helpful, I'll put it that way."
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