NEW YORK (AP) – Fresh from ruling that World Trade Center dust did not kill a police detective, a medical examiner offered the man’s relatives other reasons Friday for his death, an explanation the family found “not acceptable,” their lawyer said.

Chief Medical Examiner Charles Hirsch would not publicly elaborate on his findings in the death of James Zadroga, who had worked hundreds of hours in the toxic dust at ground zero after the Sept. 11 attacks, Hirsch’s spokeswoman said. Hirsch asked the family not to disclose what he told them, said Michael Barasch, the Zadrogas’ attorney.

“Dr. Hirsch felt that there were other reasons for Zadroga’s death. The family disagrees with it. I disagree with it,” Barasch said. The doctor “came up with reasons that were not acceptable to us,” the attorney said.

Zadroga became gravely ill within four years of the attack, was relegated to a wheelchair and wound up taking a potent mixture of prescription drugs to treat his illness. He died last year of respiratory failure at age 34, and health care advocates have cited his death as a “sentinel case” – the first health-related casualty linked to ground zero, suggesting there would be more to follow.

Rejecting another medical examiner’s autopsy, Hirsch said in a letter to Zadroga’s family this week that his death was not caused by exposure to trade center dust.

Hirsch agreed with a New Jersey medical examiner’s finding that there was foreign matter in Zadroga’s lungs. The New Jersey medical examiner had said the granular material in his lungs was consistent with dust, but Hirsch emphatically ruled out environmental exposure as the cause.

Experts say that one alternate medical theory for foreign granular matter in the lungs is a history of intravenous drug injections. In 1981, Hirsch co-wrote a key medical paper on the subject.

Zadroga was taking intravenous painkillers and had taken steroids, all prescribed by doctors for his respiratory problems, before his death, Barasch said Friday. He never took drugs that were not prescribed for him, he added.

“If the drugs contributed to his death, it makes no difference as far as what our perspective is. He was taking all the medication for all the toxins he inhaled,” Barasch said. “This was a squeaky clean New York City detective who was in tip-top shape.”

Zadroga spent 470 hours working in the smoking twin towers’ rubble, using only a paper mask. He developed a cough within weeks and retired within three years.

He became the face of post-Sept. 11 illness after his death, galvanizing lawmakers and health care advocates to lobby for research and treatment for thousands who said the debris-filled air at ground zero made them sick.

“What was in his lungs was consistent with what was down at ground zero,” said Michael Palladino, president of the Detectives’ Endowment Association, Zadroga’s union. “It just can’t be a coincidence that this 34-year-old kid who was healthy prior to 9/11 became deathly ill post-9/11.”

Palladino and others derided Hirsch’s ruling Friday, saying his conclusions defied other experts who performed Zadroga’s autopsy or treated him while he was alive. Palladino said a police medical board had concluded that Zadroga could leave his job on medical disability because of illness caused by his post-Sept. 11 work.

Zadroga’s family, who had become public advocates for the health of ground zero workers, had asked Hirsch to review the case and officially add Zadroga’s name to the Sept. 11 victims’ toll. In May, the medical examiner added the first health-related casualty to the victims’ list, a woman who died of a lung-scarring disease five months after she was caught in the dust cloud formed by the twin towers’ collapse.

Gerard Breton, the New Jersey pathologist who performed Zadroga’s autopsy, said that Zadroga had inflamed lung tissue, an enlarged heart and material that appeared to be dust in his lungs.

“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,” he wrote in March 2006. On Friday, he told The Associated Press, “I stick to that report.” He declined further comment.