The state Department of Health (DOH) needs to improve its monitoring of New York’s Lead Poisoning Prevention Program on the local level to ensure children with elevated blood lead levels are receiving required services, according to an audit released today by State Comptroller Thomas P. DiNapoli.
“Lead poisoning poses a major health risk to children and can cause anemia, hearing loss, lower IQs or even death,” DiNapoli said. “My auditors found the Health Department regional offices are not consistently conducting on-site reviews of local health departments that carry out the state’s lead prevention program. This is a serious issue and the department needs to make sure all lead-poisoned children get the services they need.”
DOH is responsible for administering the Lead Poisoning Prevention Program. The program, designed to develop and coordinate activities to prevent lead poisoning and minimize exposure to lead, is implemented through 56 local health departments. Blood lead levels are tracked through LeadWeb, a system used to carry out the required case management and follow-up activities for affected children. DOH’s regional offices are responsible for reviewing local health departments’ program implementation at least once every three years.
DiNapoli’s auditors looked at children identified with elevated blood lead levels during the period Jan. 1, 2014 through August 7, 2018 and follow-up activities done by the local health departments through March 19, 2019. The audit looked at the program’s administration outside New York City.
As of June 1, 2018, 27 of the 56 local health department reviews had not been done, and four departments had not been reviewed since 2010. Of the eight local departments visited, three were last reviewed between 2010 and 2013, with no future reviews scheduled. Only one had been cited by DOH prior to the audit scope for not maintaining proper case documentation and the same county department was deficient in providing required follow-up services at the time of the audit.
Local departments are required to identify and track children with elevated blood lead levels to ensure appropriate follow-up services are provided.
DiNapoli’s auditors reviewed a random sample of 400 cases and found 43 cases among five local departments where either nursing follow-up services were not provided (37) or documentation was insufficient to determine whether services were provided (6).
At the conclusion of the audit, DOH reviewed and acknowledged the findings for the 43 cases, but offered no explanation for why the services were not provided. DOH later said it coordinated a review of paper and electronic case files at the five local departments after the audit finished. However, DOH merely asked the local departments whether documentation existed to substantiate services had been provided to these children.
The report notes that in April 2019, state law was amended to lower the standard for elevated blood lead levels. The number of blood tests requiring follow-up during the audit period was just 31 percent of what it would have been if the current standard was in place then (24,989 tests compared with 80,946 tests). This underscores the importance of improved monitoring of local health departments moving forward, as they will be required to handle significantly more cases.
DiNapoli recommended DOH:
- Ensure that the risk of exposure to lead is minimized through compliance with program monitoring requirements that, at a minimum, includes: Working with regional office staff to ensure on-site reviews are completed within the specified time frames and reports are provided as required; and ensuring that local health departments are using all means available to them to ensure follow-up services are provided and tracked when elevated lead levels are detected.
- Implement the proper internal controls and quality assurance measures to provide adequate assurance that LeadWeb data is complete and accurate.
- Enforce the regulations requiring local health departments to perform follow-up services for all children with elevated lead levels as required by the amended law.
The department’s response, as well as the auditors’ comments, are included in the final audit.
Read the report, or go to: https://osc.state.ny.us/audits/allaudits/093019/sga-2019-18s12.pdf
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