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June 14, 2007

State Audit Details Weaknesses in
Childhood Lead Poisoning Prevention Efforts

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Lead poisoning continues to be an extremely serious environmental threat for young children in New York State, but thousands of children are not screened for lead exposure and improvements are needed in the Department of Health’s (DOH) Childhood Lead Poisoning Prevention Program, according to an audit and policy report issued today by State Comptroller Thomas P. DiNapoli.

“Lead poisoning is one of the most serious health issues our children face today. It’s also one of the most preventable. But thousands of children across New York are not screened for lead exposure,” DiNapoli said. “Children exposed to lead often require medical treatment, and they often end up in special education programs. Beside the avoidable tragic impact on children, there’s also an impact on taxpayers, who have to pay for these services. Every effort must be made to ensure that all children are getting screened for lead exposure.”

Children under the age of three are particularly vulnerable to lead poisoning, and lead poisoning disproportionately affects low-income children from racial and ethnic minorities living in older, poorly-maintained housing. Elevated blood lead levels can result from even limited exposure to small amounts of lead and can trigger stomach ailments, kidney damage, anemia, hearing loss and convulsions. High blood lead levels can also result in learning disabilities and behavioral problems. The effects of lead poisoning are irreversible.

The principal source of lead exposure is lead-based house paint and the contaminated dust it generates when it peels, chips or is disturbed when painted surfaces are prepared for repainting. Although lead-based paint has been banned for decades, it can still be found in many older residences. Recent news reports have also detailed the potential for lead poisoning due to high levels of lead in children’s jewelry and other consumer items – including “I Love NY” mugs sold at the New York State Museum. (Museum officials said that the mugs will no longer be available for sale.)

The Comptroller’s audit of the Childhood Lead Poisoning Prevention Program examined a range of issues including whether children under the age of six are properly screened, if testing labs are reporting results in a timely manner, if day care facilities are obtaining certificates of lead screening for the children in their care and whether DOH is providing effective oversight of county health department lead poisoning prevention efforts.

State law requires children to be screened for elevated blood lead levels at ages one and two. Through an analysis of computer databases, auditors identified 133,477 children that were not screened for lead poisoning from April 2002 through December 2004. Auditors also found that 99,000 out of 1.4 million children, who were at least two years old, had received only one of the two required lead screenings. In their written response to the audit, DOH challenged auditors’ methods of data analysis, which auditors disputed. Auditors noted that even though their methodology for calculating screening rates was different than DOH, both agencies reached similar conclusions. DOH’s complete response is included in the audit.

Auditors also found:

  • In an analysis of records for more than two million children with elevated blood levels, about ten percent (201,000) of blood lead level screening test results were not reported to DOH by laboratories within five business days as required.
  • Although officials at agencies with oversight of day care facilities – State Office of Children and Family Services and New York City Department of Health and Mental Hygiene – said that they check to determine that certificates of lead screening are obtained from every child in day care as required by state regulations, 14 of 32 surveyed facilities (43.8 percent) reported that they did not require documentation of lead screening.
  • Site visit reports for 39 out of 58 counties (New York City’s five boroughs are treated as one county) were not completed in a timely manner. Reports for six of the counties were submitted as much as two years late.

Auditors noted that children who are identified as having elevated blood lead levels are generally receiving follow-up interventions from DOH and other agencies, including follow-up testing, explanation of test results, medical treatment, nutritional counseling, developmental screening and other services.

The U.S. Department of Health and Human Services’ Centers for Disease Control and Prevention (CDC) provides oversight and policy for childhood lead screening and treatment. CDC sets the blood lead level of concern, 10 micrograms per deciliter, at which intervention by health agencies and health care providers is triggered.

The CDC has called for the elimination of lead poisoning among children six years old and under by 2010, and State DOH introduced a plan in 2004 to meet this goal. Although the incidence of lead poisoning would drop considerably under the plan, DOH has acknowledged that lead poisoning among young children will not be eliminated by 2010 if current trends persist.

Click here for a copy of the audit.

Click here for a copy of the policy report.



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