Time for Less Talk, More Action

Last August we wrote about how lead poisons too many of DC’s children—and what should be done to end the tragedy. One year later—with a new mayor in charge—are children being protected?

By: John Pekkanen

A year ago The Washingtonian published an article on childhood lead poisoning in the District of Columbia. It described the irreversible harm that lead inflicts on children. Besides IQ loss, early lead exposure is strongly linked to school failure, behavioral disorders, violence, and criminality. At high levels it can cause convulsions and death. Lead poisoning remains the nation’s most significant environmental-health disease of children and probably the most preventable.

The article focused on the long-term failure of the DC government to protect children from lead exposure. Typically, 200 to 300 District children a year are found to have elevated blood-lead levels, according to DC’s Department of Health; because most children are not tested, the actual number of affected youngsters is thought to be higher. Over the years, lead exposure has harmed thousands of District children, far more than in all of the suburbs combined.

When he assumed office on January 2, 2007, Mayor Adrian Fenty promised to move on DC’s lead-poisoning problem in the first 100 days of his administration. Child advocates say that promise has gone unfulfilled.

“We’re no closer to solving the lead problem now than when Fenty took office,” says Dr. Jerome Paulson, associate professor of pediatrics and public health at George Washington University. “I don’t think child lead poisoning is as much a priority of this administration as they told us it would be. There’s been a lot of process and a lot of talk, but nothing has changed in the way services are delivered to the children of the District, and to me that’s the bottom line.”

A year after our article focused attention on the problem, here is how the DC government still fails to protect children from lead and what needs to be done to repair the system. Mayor Fenty has acted boldly to reform DC’s public-school system; he should consider similarly bold steps to protect the children who attend those schools.

Earlier this year a local physician told Dr. Muriel Wolf, senior pediatrician at the Child Health Center at Children’s National Medical Center, that a routine checkup on a one-year-old boy had revealed a blood-lead level of more than 40 micrograms per deciliter (mcg/dl). This is four times the current “action level” of 10 mcg/dl for lead poisoning established by the Centers for Disease Control and Prevention (CDC).

The boy’s doctor asked Wolf, an expert in the field and an associate professor of pediatrics at George Washington University medical school, to take over the youngster’s care. She learned that the family recently had moved into an older home in the District, and she suspected that it might be the source of the child’s lead exposure.

Dr. Wolf reported the case to DC’s Department of Health, as required. This triggered a chain of events that exposed how weak the city’s response is to childhood lead poisoning, why so many District children are so badly damaged by lead, and why DC lags behind other major cities in ridding itself of this scourge.

The major culprit is lead-based paint. Youngsters are exposed in their homes when lead dust, created when lead paint deteriorates or when lead-painted windows and doors are opened and closed, gets on their hands, which they may put in their mouths. Sometimes toddlers eat peeled lead-paint chips, which taste sweet. The federal government banned lead in paint in 1978, but about 90 percent of DC homes were built before then, so much lead paint remains.

Lead is readily absorbed in the bloodstream and moves into the developing brain, where it causes irreversible harm at levels even below the CDC’s action level. Lead interferes with the synthesis of neurotransmitters vital for normal brain development.

When DC health-department inspectors visited the child’s home, they found evidence of peeling paint and paint dust. The next step was to determine whether the peeling paint was lead-based, as Wolf suspected.

“You cannot treat a lead-poisoned child unless that child is removed from the source of the contamination,” Wolf says. “You can’t undo the damage that’s been done, but you can prevent more damage from happening with treatments that decrease his blood-lead levels.”

Here is where the cracks continue to exist in DC’s lead-remediation “system.” Even though Department of Health inspectors reported the peeling paint, they were not authorized to test it for lead. That responsibility went to the lead-based-paint program that until July 2006 was part of the Department of Health. But the lead-based-paint program was transferred from the health department to the District’s newly formed Department of the Environment (DOE), one of four DC agencies that play major roles in child lead issues.

At the time, child advocates voiced concerns that the transfer would compound divisions that have plagued antilead efforts. But things turned out even worse than they feared when the lead-based-paint program declared that it would no longer perform any lead-risk assessments. Managers of the program said they no longer had legal authority to perform assessments once it had been shifted out of the health department. This meant no District agency could or would inspect that home—or any other home—to determine if it was the source of a child’s lead exposure.

The bureaucratic impasse continued for several months, during which some 120 lead-risk assessments went undone. These were added to the 140 or so backlogged cases from previous years. These “cases” represent young children with elevated blood-lead levels who likely were exposed in homes they were still living in—and that the city would no longer check for lead hazards.

After months of pressure from lead-poisoning-prevention advocates, on February 1 of this year the health department hired a private contractor to carry out 100 lead-paint-risk assessments, which essentially consist of obtaining paint and dust samples throughout a house and testing them for lead content. The contract was for $242,000—or $2,400 per assessment. The contractor will also train city employees to perform lead-paint-risk assessments, but critics say the city paid too much for the inspection services.

By the end of June, according to the Department of Health, 41 of the 120 backlogged residences had been assessed for lead—and 39 were found to contain lead hazards. The city sent “notice of violation” letters to property owners. Meanwhile, as backlogged cases are addressed, new ones are added each month to a system already straining to catch up.

The family of the boy seen by Wolf did not wait for the city to decide who, if anyone, would do the lead-risk assessment. “Fortunately, this family had enough financial resources to move out of their home almost immediately and into one we knew did not present a lead hazard,” Wolf says. Many families can’t afford to do that, notes Wolf, who also worries that another family with children might have moved into the vacated house.

“I don’t know if that house has ever been made lead-safe,” she says, “but given my past experience, I doubt it.”

Gina Lagomarsino, senior policy adviser for healthcare in the Mayor Anthony Williams administration, which left office at the beginning of 2007, was briefly coordinator of the city’s antilead efforts. She has seen up close how DC fails to protect children from lead.

“The whole process of dealing with a lead-poisoned child in the District is like an assembly line,” Lagomarsino says. “Initially there’s a referral of a child with elevated lead levels. One city agency is supposed to see that the child gets treated, and another agency investigates the house. If the house is the lead source, you may have to move the family temporarily and remediate the house. Enforcement for any lead-paint violation then goes to a third agency, the Department of Consumer and Regulatory Affairs (DCRA). Because the responsibility lies with so many different city agencies, each one deals only with its part. The end result is that no one really owns the entire process.”

The chasms between city agencies that deal with child lead—“jaw-dropping,” in the words of one newly arrived city official—also produce finger-pointing among the agencies, each blaming another for failures. This could be overcome if the District government regarded childhood lead exposure as a priority. Why hasn’t it?

GW’s Paulson says lead poisoning is much less a problem than it was 40 or 50 years ago—which itself is part of the problem.

“We don’t have children dying of lead poisoning every year anymore,” he says, “and the situation is better than it once was, so I think there’s a feeling that we’ve solved the problem. Ironically, what we have learned in the intervening years is that blood-lead levels that we used to think were acceptable and safe can and do harm kids. Levels below the CDC action level have been shown to reduce IQ. What we’ve learned is, there is no level of lead that is safe.”

Because children with blood-lead levels below the action level are not counted, the number of children actually harmed each year by lead is unknown.

Before she left her District position, Lagomarsino, now a consultant with the Brookings Institution, wrote a lengthy memo for the incoming Fenty administration urging it to make child-lead poisoning a priority. The District, she said, needed to find a way to coordinate and make more rational its antilead efforts—such as putting all the city’s lead agencies into one department. She said streamlining the city’s lead response would directly support Fenty’s stated priorities of improving the performance of DC schools and reducing juvenile crime.

Some efforts have been made, but the system has been so bad for so long that there has been little real progress, child anti­lead advocates say.

“I understand it takes time for a new administration to get up and running,” says Paulson, “but I’m concerned because we’re not seeing changes in the behavior of the city employees who deal with lead issues. Some people who have been obstacles remain in their jobs. It’s either time for people to change—or time to change people.”

“I don’t doubt people when they say nothing has changed in the delivery of services to children,” says Carter Hewgley, program analyst in the office of the city administrator and point man on child lead for the Fenty administration. “I wish positive change could be immediate. But we are putting in place some very difficult reforms, and you may not see positive outcomes until years down the road.”

“I see people in the Fenty administration who are earnestly trying to make a difference,” says Linda Lewis, chair of the Lead Screening Advisory Committee, which advises the health department, “but there has been so much dysfunction in the way the city has dealt with this problem that we are still stuck in history. Can they ever pull this together and make it work? I don’t know, but it sure didn’t happen in the first 100 days.”

Many people contend that the only solution to the city’s bureaucratic ineptitude is to have a lead coordinator working out of the mayor’s office. Because authority would emanate from the mayor, this coordinator could persuade—or coerce—city agencies that have years-old disputes and resentments to cooperate. Philadelphia has a “lead czar” who does that, with considerable success. Fenty, who declined to be interviewed for this article, has said he is philosophically opposed to naming single-issue “czars.”

“There needs to be a sense of mission about this issue,” says Lagomarsino. “There needs to be someone in this government who goes to bed at night and wakes up every morning thinking about lead.”

Instead, Fenty wants the DOE director to coordinate lead efforts by getting DC agencies to cooperate.

“I know a lot of people want us to name a lead czar to get the agencies talking to one another,” says Hewgley, “but a czar really doesn’t fix the problem. So we’re focusing on demanding accountability and communication between the agencies to make the system work. It’s harder, slower, and more frustrating this way, but in the long term I think this is how you really fix the problem instead of working around it.”

Says Paulson: “We’re willing to say to the Fenty administration, if you have a system without a czar that will prevent things from falling through the cracks, then the onus is on you to make sure they don’t. If that’s what you want, go for it. But do it.”

Early this year, Mayor Fenty named Corey Buffo acting director of the Department of Environment and head of an interagency task force on lead. Buffo held meetings in an effort to get agencies communicating with each other.

“To his credit, I think Corey worked hard to organize these meetings and get the agencies together,” says Ralph Scott, community project director for the nonprofit Alliance for Healthy Homes and member of the Lead Screening Advisory Committee, “but I think he was hoodwinked a bit by some of the agencies that gave glib reports that made it appear something was happening when it really wasn’t. They’d announce numbers, but then when they were checked closely, the numbers would turn out to be made of sawdust.”

Scott cited one meeting at which the health department, a past source of suspect numbers, reported that it had closed several home-inspection cases. When questioned closely, it turned out that some cases were labeled “closed” because health inspectors never had gotten access to the residences to investigate them.

“At first I think Corey believed there was a lot more progress than there actually was,” Scott says, “but he came to realize there were lots of holes and misinformation about what was going on.”

Just as Buffo was gaining a clearer understanding of the problems, he was replaced; Fenty named George Hawkins to head the DOE and coordinate antilead efforts. Hawkins became the seventh person to head the interagency meetings since the middle of last year, when the advocacy community finally convinced the Williams administration to hold them. Hawkins promises to end the “musical chairs” that helped undermine interagency cooperation.

Skeptics contend that the head of a city department deals with so many issues that lead will not get the attention it deserves. But there is an even more fundamental flaw in the Fenty concept, says Lewis, a longtime child advocate:

“The real problem is that the head of one agency can’t tell another agency head what to do because he or she doesn’t have the authority. So in practical terms, the concept of one department head getting the others to do things simply won’t work.”

Hawkins says he’ll coordinate the city’s lead programs, but “the outcomes that are necessary in this effort will come directly from the mayor and city administrator.”

“Coming up very soon,” Hawkins adds, “the mayor and the city administrator will call together all of the agencies necessary to implement a lead response. When this occurs on one day in one room, there will be agreement as to what the lead strategy is, and commitments by each of the agencies to the mayor and city administrator as to what needs to be done.”

Maybe that will happen. Meanwhile, little has changed. Members of the Joint Committees to Eliminate Lead Poisoning in DC, an umbrella organization of antilead groups, remain unconvinced of the mayor’s commitment. On May 2 they requested a meeting with Fenty; in late June the mayor’s scheduling assistant informed them that Fenty was unavailable because his schedule “is quite dense at this time.”

In the meantime, 20 or more children turn up each month with elevated lead levels.

As in the past, most of the victims are disadvantaged, but not all of them. “We are seeing a new demographic on the rise tied to the housing boom,” says Harrison Newton, program director of the nonprofit LeadSafe DC. “These are children of young, upper-income parents who move into older, expensive homes and create a lot of lead-paint dust during renovation. We have one case of a nine-month-old District child with lead levels over 20 mcg/dl who was exposed after his family bought a $900,000 house and renovated the kitchen. We’ve seen several similar cases.”

This case and hundreds more underscore the District’s most unconscionable failure: It almost always learns of a lead hazard after a child is poisoned. “The children are the canaries in the coal mine,” says Wolf.

The Fenty administration is placing stock in a new lead-poisoning-prevention law it is proposing. DC attorney general Linda Singer is helping to draft the proposed law, which will supersede the 2000 amendments to the DC lead law in which lead-paint provisions were weakened at the behest of real-estate interests.

“The new law will not be the silver bullet,” Hewgley admits, “but we want a law that won’t impede our ability to effect change and will give us more flexibility to achieve lead abatement.”

The proposed law will not go before the city council for a vote until September at the earliest. More than anything, Hewgley and others say, the new law needs to facilitate prevention efforts. The law is expected to create a registry of pre-1978 housing. Owners of these “high risk” properties would be required to prove their property is “lead safe” before a child moves in. The law would require properties where city inspectors find deteriorated paint to be checked for lead hazards. If they’re found, workers would have to do repair and cleanup according to lead-safe work practices. Another provision would allow nonprofit outreach workers to do lead dust-wipe testing in homes. The wipes are sent to a lab to determine whether a dangerous lead level is present. Under current law, only certified lead-risk assessors are permitted to perform this simple task.

“In the District, a major problem is that there have been no consequences for property owners who don’t make their rental units lead-safe,” says Lagomarsino.

Money from the US Department of Housing and Urban Development as well as from DC has been available to qualified landlords to remediate their properties. But enforcement has been so lax, property owners have seemed so indifferent, and so little money has been used to remedy lead hazards that the District was in danger of losing the HUD funds last year.

Attorney General Singer insists that lax enforcement is a thing of the past. “I can tell you, child lead issues are a very high priority in this administration, and with the great cooperation we’ve gotten from other city agencies, we’ve already filed our first cases against landlords who aren’t complying with lead-abatement orders,” she says.

At the end of June, Singer said three landlords had agreed to a consent order to remediate their properties, and she had plans to bring another dozen cases.

Enforcing the law is a significant step; child advocates hope that it will spur other landlords to make their properties lead-safe before they’re cited for violations.

There are other positive signs. Dr. Carlos Cano, who left the federal government to become deputy director at the DC Department of Health 18 months ago, is establishing a Lead and Environmental Hazards Bureau to concentrate on prevention. It’s been slow going because of the District’s cumbersome personnel bureaucracy; it took more than six months to hire a director.

Another problem Cano wants to fix is the health department’s screening statistics for children. They’ve been so unreliable, Paulson says, that he has “no idea” how many DC kids are harmed by lead every year. Cano admits that much of the screening data has been “questionable.”

Cano has brought in an information-technology specialist to manage the “lead tracks” data system that promises to keep accurate information on the number of District children screened for lead and on the test results.

Will these efforts succeed in protecting children in the nation’s capital from being poisoned by lead?

“Unlike many of the District’s problems, child lead poisoning can be eliminated,” Newton says. “So far, the new city administration has taken some positive steps. Many more are needed, and the commitment has to be sustained for many more years because that’s what it’s going to take.”