Tuesday, July 25, 2000
Critics tell state to get the lead out
By Tim Bonfield
The Cincinnati Enquirer
Several groups are criticizing Ohio's Medicaid program and doctors statewide for failing to conduct blood tests to check for lead poisoning in poor children.
Federal rules require all 1- and 2-year-olds covered by Medicaid receive at least one blood-lead test a year. Medicaid is the government health plan for low-income people.
However, the Ohio average for testing eligible 1-year-olds is 32.5 percent and 22.2 percent for 2-year-olds.
Those rates were blasted in a July 14 letter to the directors of Ohio's Departments of Health, and Job and Family Services. The letter was signed by five organizations, including the Legal Aid Society of Greater Cincinnati and the pediatric lead clinic at Children's Hospital Medical Center.
“Not only are Ohio's extremely low lead testing rates unacceptable, but they could have been avoided,” the letter said. “As Ohio's own recent statistical reports say, other states have done better. In Michigan, 40 percent of at-risk children are tested and in New York, the testing rate is 70 percent.”
Jacqueline Romer-Sensky, director of the Department of Job and Family Services (which runs Ohio's Medicaid program), declined to comment. Spokeswoman Alicia Gray called the criticisms premature.
Some Tristate pediatricians say they routinely order blood-lead testing for 1- and 2-year-olds, be they in Medicaid or covered by private insurance.
“The state sends us reminders every six months or so. We do it routinely,” said Julie Appel, office manager for Forest Hills Pediatrics in Anderson Township.
The harmful effects of lead exposure in young children have been a growing issue for several years.
At high levels, lead in the blood can be lethal. At low levels, numerous studies have documented stunted growth, diminished IQ and behavior problems linked to the toxic metal.
Lead in the environment was much more common years ago, before laws required lead-free gasoline and barred lead from household paint.
Lead-based paint remains a problem in homes built before the late 1970s and appears to be most severe in low-income neighborhoods where old houses often are maintained poorly.
The potential expense involved in containing or removing lead paint from older homes has made this environmental issue even more controversial than concerns about asbestos.
Increasingly, strict laws require landlords to notify tenants, and home sellers to notify would-be buyers, if they know their buildings have lead paint.
In Cincinnati, laws require health inspections of homes and potentially mandatory repairs whenever blood tests reveal children have elevated lead levels in their blood.
Those laws aren't being followed or enforced strongly enough to satisfy child advocates.
The number of children with elevated lead levels in Ohio is not clear, in part because of the dispute over whether all children are getting tested.
In 1998 (the most recent data available), the Ohio Department of Health reported 7,039 of 123,944 children tested — or 5.7 percent — had elevated blood-lead levels. That figure includes many children who were not part of the Medicaid program and may not be considered at high risk for lead poisoning.
Figures on the percentage of Medicaid-eligible children with high blood-lead levels were not available.
“Parents have the right to know if their children are being poisoned so that treatment can be provided and further poisoning prevented,” the letter to state officials said.
To some, the issue goes beyond concerns about slow-moving bureaucrats.
Doctors are performing required well-child exams for high numbers of Medicaid children, but, in most cases, there is no record that required blood-lead tests were performed, according to a June 12 report on lead screening conducted by the Department of Job and Family Services.
“Some of the blame goes to doctors. They are getting kids into their offices, but not doing the testing,” Legal Aid spokeswoman Regina Campbell said.
Some question the allegations raised about doctors.
The three pediatricians with Forest Hills Pediatrics routinely order blood-lead testing for all young patients. The results are automatically reported to the state department of health, said Ms. Appel, the office manager.
She said she was surprised to hear other doctors may not be doing the tests.
In November, the state legislature set up a Childhood Lead Poisoning Prevention Workgroup to make recommendations on the lead-paint issue. The group includes several state agencies and representatives from social service, environmental and real estate interest groups.
“Their study is still in process. A report should be coming out in August,” said Ms. Gray, of the Department of Job and Family Services. “The departments involved consider this a serious issue and feel they cannot comment until the report comes out.”
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