Residential Lead Abatement
Chapter V

Chapter Five
Findings and Recommendations

Background.  The harmful effects of lead hazards on children have been recognized for many years.  Since lead was banned in paint, gasoline, and food cans in the late 1970s, legislation at both the federal and state level has been aimed at pre-1978 housing as the major cause of lead poisoning among children today. The most common sources of exposure today are soil contaminated with lead and lead-based paint that has deteriorated into paint chips and lead dust.  Lead-contaminated dust can come from lead-based paint that is chipping, flaking or deteriorated or when such paint is scraped, sanded, or disturbed during home improvement projects.  Lead-contaminated dust can also be tracked into a home from exterior sources such as lead-contaminated soil as well as porches or stairs painted with lead-based paint. Children under the age of six are the focus of the legislation, since they are most vulnerable to the effects of lead.

Connecticut established a Childhood Lead Poisoning and Prevention Program (CLPPP) in 1987.  Although the Department of Public Health has carried out several prevention initiatives, the major focus of Connecticut’s lead law is on identifying children who are already lead-poisoned, inspecting their residences, and if lead hazards are found, requiring property owners to abate any lead considered harmful to the child.  This focus, as noted in Chapter Four, has not been particularly successful in Connecticut -- especially when the high number of lead abatement orders issued to property owners are compared to the low number of actual abatements occurring -- because it is a costly and difficult law to enforce. 

Prevention

 The program review committee believes the cornerstone of the childhood lead program should be the prevention of lead poisoning.  Chapter Two describes how the federal government shifted its policy focus towards lead poisoning prevention in 1992 through the passage of landmark legislation and the recent approval of comprehensive requirements in regulation form.  The intent of the committee’s recommendations presented in this chapter is to provide a number of strategies for increasing prevention activities, thus lowering the number of children with elevated blood lead levels.  To accomplish this, the committee finds the Department of Public Health needs to:

·       distribute more widely educational information on the dangers of lead;

·       establish a targeted lead screening program so children most at risk for elevated blood lead levels are identified early, provided with educational information, and interventions can be taken; and

·       establish voluntary essential maintenance practice guidelines for rental properties that include financial incentives to encourage property owners to control and/or eliminate lead hazards.  

Education.  Educating groups about the reasons lead hazards are dangerous to children and how to reduce their exposure to lead is a major activity of the state’s lead program.  Education and outreach efforts focus on four critical groups: 1) families; 2) health care professionals; 3) local health departments; and 4) home remodelers. Education and outreach is conducted directly by DPH staff, local health districts, and the Hartford and Yale Regional Lead Treatment Centers. 

The committee finds DPH has conducted several successful outreach initiatives over the past year. These include holding quarterly lead conferences with local health departments, health professionals, and invited child advocates; publishing and distributing a Lead Newsletter; distributing a “Comprehensive Guide to Prevention and Treatment”; and providing local health departments with a packet of form letters to send to parents and landlords to ensure consistency among towns.  In addition, several local health departments have had educational initiatives on lead awareness.  Since the educational materials produced are very useful to a wide variety of parties, the program review committee believes DPH should provide wider access to this valuable information. 

Furthermore, Connecticut General Statute §19a-111b requires the commissioner of DPH to institute an educational and publicity program informing the general public, teachers, social workers and other human services personnel, owners of residential property, and health personnel of the danger, frequency and sources of lead poisoning and the methods of preventing such poisoning.  To date, most DPH education efforts have been targeted to select groups rather than the public at large.  Therefore, the program review committee recommends:

the Department of Public Health establish an Internet web site providing online access to its Childhood Lead Poisoning Prevention Program.  At a minimum, the web site should contain Connecticut’s lead laws and regulations, general information about ways to protect children from lead hazards, information on financial assistance programs available to property owners to manage and/or abate lead hazards, statistics on screening and incidence rates, and how to request further information.  In addition, the department could use the site to gather information on the impact of lead poisoning on the citizens of the state.

The program review committee finds Connecticut is the only New England state besides Maine without a comprehensive web site devoted to the topic of lead poisoning.  A web site would widely disseminate Connecticut-specific information to many different groups and promote a greater awareness of the harmful effects of lead hazards on children.  In addition, a web site could provide the names of persons within DPH or local health departments to contact for additional information on the state’s lead laws, regulations, and guidelines.  The site would also offer a conduit to the department to receive data from local agencies on the impact of lead poisoning on the population. 

Finally, homeowners need to be provided with better information on the availability of state or local financing to manage and/or abate lead from their properties.  Information should include the availability of financing, the name of the state or local agencies administering the programs and their phone numbers, and general eligibility criteria.

Notification of landlords.  Under C.G.S. §19a-110(d) any child who had a lead screening test with results equal to or greater than 10 mcg/dL must be reported to the commissioner of the public health and the local director of health in the town where the child resides.  The statute further requires the local health director to provide information concerning the dangers of lead poisoning, precautions used to reduce risk, and state policy regarding lead abatement to the parent or guardian of a reported child.

The program review committee believes the provision of this information is critical in educating parents on steps they need to take to minimize their child’s exposure to lead hazards.  Landlords would also benefit greatly from similar educational materials when a child of a tenant has a BLL equal to or greater than 10 mcg/dL.  If notification were provided to landlords of tenants with elevated BLLs, it would allow the landlord to take measures that might prevent a child’s blood lead level from rising, and, therefore, preclude more extensive lead abatement requirements.  Therefore, the committee recommends:

C.G.S. §19a-110(d) be amended to require local health departments or districts that receive a report of a child under the age of six with a blood lead level equal to or greater than 10 mcg/dL to provide the owner(s) of the property with educational materials on how to reduce lead hazards in housing.  The Department of Public Health shall develop and furnish the educational materials to be provided.

While this recommendation requires property owners be notified, it does not require any action be taken.  The intent of this recommendation is to provide property owners with an opportunity to reduce a child’s exposure to lead hazards through simple preventative measures, thereby reducing the possibility of a child’s BLL from rising and thus triggering the resultant costly and restrictive order of lead hazard reduction.

Definition of Lead Poisoning

The program review committee finds there is a significant amount of confusion surrounding the concept of “lead poisoned.”  Prior to 1991, the Centers for Disease Control (CDC) considered any child with a blood lead level equal to or greater than 25 mcg/dL to have lead poisoning.  After 1991, CDC moved away from a specific definition of lead-poisoning to the term “level of concern” for individuals with a blood lead level equal to or greater than 10 mcg/dL.  While this broadened the concept of lead danger, it has resulted in an imprecise determination of lead poisoning. 

The issue is further complicated by the fact the Department of Public Health’s Childhood Lead Prevention Program recently issued guidelines that define lead poisoning as “a venous blood lead level equal to or greater than 10 mcg/dL.”[1]  Meanwhile, the regulations define an elevated blood level as 20 mcg/dL; while the statutes do not include a definition of lead poisoning. 

The statutes call for the state to follow CDC guidelines for assessment of the risk of lead poisoning, screening, and treatment and follow-up care for individuals with lead poisoning, but the law does not define a blood lead level for lead poisoning.  Under CDC guidelines (shown in Chapter One, Table I-1), different blood lead levels require different responses from state and local health departments.  However, the committee finds Connecticut law does not provide a clear explanation.

Connecticut General Statutes §19a-111 requires DPH to follow guidelines issued by the CDC.   Based on CDC’s 1997 guidelines, the committee finds the statutes need to be revised to be consistent with current CDC guidelines.  Therefore, the program review committee recommends:

the commissioner of public health define in regulation the terms “elevated blood lead level” and “lead-poisoning,” in conjunction with recognized professional medical groups and the Centers for Disease Control, and the responses required in accordance with guidelines issued by the Centers for Disease Control.

C.G.S. §19a-111 shall be amended to require an epidemiological investigation for a confirmed concentration of lead in whole blood equal to or greater than 20 mcg/dL for a single test or 15-19 mcg/dL on two tests taken at least three months apart.

This recommendation requires DPH to explain terms that are commonly used, but are not defined in statute or regulation and, therefore, can be misconstrued.  In addition, as shown in  Chapter One, Table I-1 (page 5), CDC recommends an environmental investigation at blood lead levels of 20 mcg/dL or greater, or two tests at least three months apart of 15-19 mcg/dL.  Thus, the recommendation revises the statutes so the level at which an epidemiological investigation is required, which includes an environmental investigation, is consistent with CDC guidelines.

Lead Screening

The Centers for Disease Control issues the primary federal recommendations on screening young children for lead poisoning.  The most current screening guidlelines were published in November 1997 in a document called “Screening Young Children for Lead Poisoning: Guidance for State and Local Public Health Officials”.  In its guidelines, CDC recognizes lead exposure is highly variable around the country, with some children at considerable risk and others at very low risk.  Studies have shown children living in older housing or who are poor are at higher risk of elevated blood lead levels and need to be screened.  If their blood lead levels are elevated, appropriate interventions should be taken.  Not all of the children living where risk for lead exposure has been demonstrated to be extremely low need to be screened, thus saving valuable resources.[2]

To determine which children should be screeened, CDC recommends state and local health departments assess local data on lead risks and develop a lead screening plan.  The CDC document provides detailed guidance for state and local health departments in establishing their state lead screening plans, including advice on assessing lead risks, engaging affected constituents in the process of developing recommendations, and communicating screening recommendations clearly.  Table V-1 shows the major factors that should be considered in selecting a screening recommendation.

For states in the process of collecting information and developing plans, CDC provides an “interim policy” for use by state health departments.  If states do not adopt CDC’s interim policy or develop their own plan, CDC recommends continuation of its 1991 recommendation of universal screening for all children ages six months to 72 months.  If the interim policy is adopted, CDC cautions it should only be used as a short-term measure until a plan based on local data can be adopted. 

Basic interim recommendation.  CDC’s interim policy recommends child health-care providers use a blood lead test to screen all children at ages one and two, and children 36-72 months of age who have not previously been screened, if children meet one of the following criteria: 

·       they reside in a zip code where greater than 27 percent of the housing was built before 1950;

·       they receive services from public assistance programs for the poor, such as Medicaid or the Supplemental Food Program for Women, Infants, and Children (WIC);  or

·       their parent or guardian answers "yes" or "don't know" to any question in a basic personal-risk questionnaire consisting of these three questions:

1.     Does your child live in or regularly visit a house built before 1950?

2.     Does your child live in or regularly visit a house built before 1978 with recent or ongoing renovations or remodeling (within the last six months)?

3.     Does your child have a sibling or playmate who has, or did have, lead poisoning?

CDC’s 1997 screening policy sought to better identify poisoned children by devising screening recommendations based on risk factors.  The program review committee believes the state needs to identify high-risk geographic areas or populations and develop a targeted lead screening program.  Therefore, the committee recommends:

the Department of Public Health adopt CDC’s interim policy recommendation until the department establishes a permanent statewide health plan for lead screening.  DPH shall follow the steps recommended by CDC to develop the state plan.  The plan shall include: 

·       data demonstrating the appropriateness of dividing the state into targeted screening areas;

·       recommendations for screening by geographic area;

·       dissemination of screening recommendations for each area; and

·       a program evaluation component.

A draft plan shall be submitted to the Public Health Committee for comment by January 1, 2001, and a final plan shall be adopted by June 1, 2001.  The plan shall be updated biennially and revised every five years, based on the latest screening data. 

In addition, for both the interim plan and subsequent plans, DPH shall calculate screening, incidence, and prevalence rates based on municipal birth rates for the year rather than census data.

The goal of screening is to identify children who need individual interventions to reduce their blood lead levels.  Connecticut’s screening data indicate the highest incidence of lead poisoning is concentrated in urban areas, with five towns (Bridgeport, Hartford, New Haven, Waterbury, and New Britain) accounting for 76 percent of the children identified with lead levels equal to or greater than 20 mcg/dL.  A targeted screening policy would center efforts in areas where they are most needed.

Reimbursement for blood lead testing.  The program review committee finds the vast majority of lead screens are analyzed by the state public health laboratory within DPH.  Table V-2 compares the number of lead screens analyzed by the state laboratory and private laboratories for FY 97 and FY 98.  According to the Department of Public Health, the cost to the state lab is $18 per test.  The total FY 98 cost was nearly $1 million.

The state laboratory analyzes all lead screens free of charge, even though most children are covered by either the Medicaid program, the state HUSKY program, or private insurance.  Connecticut should seek third-party reimbursement for services that are a covered benefit by an individual’s health plan.  Connecticut General Statute §38a-535 requires mandatory coverage for preventive pediatric care and the committee believes lead screening tests would be covered under this provision.

In addition, C.G.S. §19a-26 authorizes the commissioner of public health to establish a schedule of fees directly related to operating costs or fair market value for such laboratory services.  The statute forbids the commissioner of DPH from charging local directors of health and local law enforcement agencies for laboratory services and gives the commissioner the discretion to waive charges for others if, in the determination of the commissioner, public health requires such services be furnished without charge.  Given that the potential source of  revenue for the state is almost $1 million per year if insurers were charged for lead screening tests, the program review committee recommends:
 

as authorized under C.G.S. §19a-26, the commissioner of public health shall establish a schedule of fees for lead screening analysis performed by the state laboratory.  DPH shall seek reimbursement for services performed by the state laboratory from Medicaid, HUSKY, and private health insurers for lead screenings and diagnostic evaluations for lead poisoning for children under six years of age including, but not limited to, confirmatory blood lead testing.  The state laboratory shall seek reimbursement beginning no later than October 1, 2001.  Beginning no later that October 2, 2001, the state Department of Social Services shall pay for lead screenings and diagnostic evaluation services where a child under the age of six is eligible for medical assistance under the HUSKY plan.  The Department of Public Health shall pay for lead screening and diagnostic evaluations for lead poisoning where the child is not covered by any health insurance.

As state resources become more and more scarce, it is critical other funding sources be identified and cost containment become a critical feature of the system.

Essential Maintenance Practices

As noted in the Chapter Two, the National Conference of State Legislatures (NCSL) drafted a model lead law, based on recommendations of a national task force established under Title X of the federal Housing and Community Development Act of 1992.  The model law calls for the establishment of “essential maintenance practices” (EMPs) for rental property owners.  The maintenance practices are a set of “benchmark standards” that identify the steps rental property owners need to take to control lead hazards.  For well-maintained properties, which are considered low risk, a set of EMPs would apply.  They are aimed at keeping paint intact and are considered low cost.  The task force’s recommendation is included in the new HUD regulation as one of the seven evaluation and hazard reduction strategies for federally owned or assisted properties.

Although the program review committee believes the HUD regulation will drive much of lead hazard control since all federal housing programs will be affected, the establishment of voluntary standards in Connecticut will help property owners reduce a tenant’s risk for lead poisoning and provide rental property owners with guidance on how to ensure their properties are lead-safe.  Although the employment of essential maintenance practices is strictly voluntary, the committee recommends:

the commissioner of public health develop voluntary guidelines establishing essential maintenance practices in pre-1978 housing for risk reduction of lead-based paint hazards that contain toxic levels of lead as defined in §19a-111-1 (59) (A) and (B) of the Lead Poisoning Prevention and Control Regulations.  In addition, the state shall initiate a tax credit program to support essential maintenance practices as well as lead abatement.  The tax program – beginning in 2001 for the tax year 2001 – shall provide a tax credit on payment of state income tax to:

·       owners of rental properties built prior to 1978 who provide written certification from a lead inspector, certified pursuant to C.G.S. §20-475 or C.G.S. §20-476, that the property is safe from lead hazards; and

·       owners of rental properties who have abated lead in pre-1978 rental properties, have received a certificate of clearance from a certified lead inspector, and have not received public financial assistance for the abatement.  To receive the certificate, the level of lead dust cannot exceed the levels defined in §19a-111-4(e)(2) of the Connecticut Lead Poisoning Prevention and Control Regulations.

Only residential structures with six or fewer dwelling units will be eligible for the credit.  The amount of the tax credit shall be $1,500 annually per building, up to a maximum of six buildings.  Written certifications shall be submitted with the state income tax filing.  Tax credits shall be on the payment of state income tax.  If no state income tax is owed by the property owner, he or she shall not be eligible for a tax credit.  Written certification shall be valid for a period of two years, at which time the rental property owner would be eligible to recertify. 

An emerging consensus over practical, cost-effective measures to protect children from lead hazards in their homes further emphasizes the importance of responsible property management and the need for enforceable housing quality standards.  As an added incentive for rental property owners, the program review committee is recommending owners that implement essential maintenance practices or abate lead from their properties be eligible for a tax credit.

Massachusetts and Rhode Island both offer tax credits as an incentive to manage or abate lead in residential housing.  In Massachusetts, the tax credit is up to $1,500 for the actual cost of covering or removing lead and $500 for implementing interim controls, which are similar to essential maintenance practices.  The committee obtained data regarding the Massachusetts program.  For the 1995 tax year, the last year of available data, the Massachusetts program cost about $2.8 million in tax revenue.  The committee estimates the costs would be similar in Connecticut, based on the following assumptions:

·       Massachusetts has about three million tax filers, and Connecticut has about 1.2 million filers.

·       Approximately 2,000 filers in Massachusetts file for the tax credit annually.

·       The Massachusetts program is more restrictive than the program proposed for Connecticut.

·       Therefore, since Connecticut’s program would be less restrictive, the committee estimates a similar number of filers as in Massachusetts will file for the full credit in Connecticut.

·       If 2,000 filers claim the $1,500 credit, it would cost $3 million.

The committee believes a tax credit program is good public policy.  Use of credits is a relatively inexpensive way to encourage rental property owners to manage or remove lead in their rental units.  As shown in Chapter Four, other financial assistance programs have spent millions of dollars to abate fewer than 1,000 units in Connecticut.  This provides another way to financially support lead prevention and abatement efforts. 

Financial Assistance   

Currently there are few programs available to assist property owners who are under an order to abate lead from housing and/or soil.  As noted in Chapter Four, the Department of Economic and Community Development (DECD) had directed a 1995 HUD grant to five municipalities.  As of November 3, 1999, only 421 units had received clearance out of a total goal of 700 units projected in the department’s initial grant application.  HUD has extended the grant time frame for the third time -- to June 2000 -- to allow the state more time to expend the grant dollars.  In addition, DECD also submitted another grant application to HUD in May 1999 for $4 million to conduct lead hazard control in 342 privately owned dwelling units.  However, HUD announced the awards in October and DECD was not selected as a grantee.  Further, the demand for assistance for the state-funded Hazardous Materials Program is high, with 100 individuals on the waiting list for program funding.

Thus, with the lack of HUD funding and limited state funding for lead abatement, competition among property owners for financial assistance will be fierce.  The program review committee recognizes that rental property owners who have implemented Essential Maintenance Practices and have obtained a valid certification from a lead inspector may still be at risk of a lead order.  If a child’s blood lead level is 20 mcg/dL or above, the regulations require more extensive abatement occur -- defective paint, lead-based paint friction surfaces, and moveable parts of windows in the child’s dwelling.  The program review committee believes rental property owners who have voluntarily implemented Essential Maintenance Practices should be given an extra level of protection by receiving priority funding for lead abatement, if they do receive an abatement order.  Therefore, the committee recommends:

DECD amend the state Hazardous Materials Program regulations to give funding priority to rental property owners who are under a lead order and have a valid certificate from a lead inspector certified under C.G.S. §20-475 or C.G.S. §20-476 that they have met the Essential Maintenance Practices guidelines.

As will be discussed in the next chapter, some states are exploring or have already implemented Medicaid waivers to obtain Medicaid reimbursement for lead prevention and abatement activities not typically covered under the Medicaid program  Several states have implemented caser management activities under their Medicaid programs, and Rhode Island received a Medicaid waiver that provides reimbursement for window replacement in eligible units.

However, the program review committee believes receiving Medicaid reimbursement for case management activities, environment inspections, or submitting a Medicaid waiver for window replacement are complicated areas that need further exploration, including how a program would need to be designed to receive HCFA approval.  In addition, Connecticut already operates a state program for window replacement under its Energy Conservation Loan Program.  However, the program review committee believes the possibility of obtaining additional revenues should be pursued.  Therefore, the committee recommends: 

the Department of Social Services explore the feasibility of extending Medicaid reimbursement for lead prevention services not currently covered and report its findings by October 1, 2000, to the public health, human services, and appropriations committees.

            The financial incentives recommended by the program review committee encourages prevention activities be implemented by rental property owners, but add focus by financially assisting property owners who abate the lead in rental units.  The intent is to create lead-safe environments that minimize children’s exposures.

State Law and Regulation

A major policy issue at both the federal and state level is how to protect children from lead hazards while ensuring an adequate supply of moderate- and low-income housing.  Lead abatement requirements can place significant financial burdens upon owners that can result in the abandonment of property.  The committee recognizes thousands of property owners face sizable financial risk if a child under the age of six has a blood lead level that requires an environmental inspection.  For this reason, the program review committee recommended earlier in this chapter that the state advocate and increase prevention activities so children are identified early, and low-cost strategies can be used to manage lead hazards.

However, the committee also finds a targeted, coherent, and comprehensive regulatory program is needed to reverse the dangers of lead poisoning in children. Strong and clear regulatory action is necessary when prevention efforts are unsuccessful and a child has a high blood lead level.  Local health departments must have the authority to order property owners to manage and abate lead hazards to ensure children under the age of six are protected from continued exposure.  To adequately carry out its public health and safety mission, the state must also collect information concerning the nature and degree of lead in the housing stock.

Management information systems.  To properly carry out its public health and safety responsibilities, the state must be able to identify and track the location and level of lead poisoning found in residences.  The state must also combine this information with the known impact on children to adequately assess the strength of its regulatory policy.  Both precise regulations and detailed information are necessary to build and maintain a successful and dynamic state lead prevention program.

As noted in Chapter Four, the lead prevention program maintains two methods for tracking childhood lead poisoning cases.  First, the surveillance unit of the program maintains the lead surveillance system (LSS) as part of the Childhood Lead Poisoning Prevention Program.  The system contains information on children under the age of six who have been tested for elevated blood lead levels.  However, the committee finds there are several limitations to the database.  These include:

·          the system does not distinguish between new lead poisoning cases and those carried over from a prior year;

·          data are maintained on a calendar year basis rather than for birth cohorts and, therefore, screening rates for age-specific populations can be lower;

·          no information is collected on children’s health insurers or family income, therefore, making targeted screening more difficult; and

·          although required by statute, race/ethnicity data are incomplete, therefore, incidence rates cannot be compared among various ethnic groups. 

Another unit in the department, the Lead Management Unit (LEMU) receives and compiles the statutorily required quarterly lead reports from local health departments and districts.  These reports track lead inspection and abatement activities within each local health department or district.  Currently, the LSS and the database maintained by LEMU are separate and distinct.  The database used by DPH for tracking lead inspection and abatement activities within each local health department or district has limitations, some of which were identified in Chapter Four.  The program review committee finds:

·       data are reported in aggregate, so it is impossible to know the status of a specific property, such as the length of time it takes for an inspection to be conducted and if lead is found, for abatement to be completed;

·       discrepancies exist in the database between the number of inspections that identified lead hazards and the number of properties requiring abatement;

·       screening data maintained by the LSS could not be matched with LEMU inspection and order data; individual names and addresses are not reported to LEMU; and

·       data are self-reported by health departments/districts and are not audited. 

DPH has recognized the limitations of its databases and hired a consultant to evaluate the LSS.  The consultant’s report was issued in September 1999.  Overall, the report found the database was inadequate, inflexible, and did not meet the needs of the department.  As noted by the consultant, the system is used, or should be used, to provide statistical data regarding the geographic distribution and variance over time of high blood lead levels, monitor local health departments to ensure they are doing proper follow-up of cases, that educational materials are being disseminated, and that statutory requirements and timelines are being met.  The consultant’s report identified three things a system should do: 

·            maintain a comprehensive and accurate record of all blood lead tests statewide including demographic and geographic information;

·            link the blood lead tests to identifiable individuals for both initial and follow-up screenings; and

·            maintain environmental inspection and abatement information linked to individuals with elevated blood lead levels. 

It concluded the LSS in its current form is inadequate in supporting the missions of public health.  The program review committee cited similar shortcomings with the department’s databases in Chapter Four and concur with the consultant’s findings.  The committee, therefore, recommends: 

the Department of Public Health establish a single database for its Childhood Lead Poisoning Prevention Program.  The database shall have the capability of integrating case-specific screening, case management, and environmental data. 

The committee finds there is also no system for DPH to routinely collect, aggregate, and compare the results of epidemiological investigations performed by local health departments.  Although the Department of Public Health recently issued a 10-page “model” epidemiological form to the 108 health departments/districts in the state, its use is optional, and no information has to be reported.  Thus, for those local health departments that are performing epidemiological investigations, the depth and breadth of the investigation varies among departments.  Therefore, the committee recommends:

C.G.S. §19a-111 be amended to require local health departments to use a form prescribed by the Department of Public Health for epidemiological investigations.  The department shall distribute the form and collect the necessary information from local health departments concerning epidemiological investigations on its web site.  The department shall evaluate the results of the investigations conducted and report the results of the evaluation to the Public Health Committee by January 31, 2001.

Information collected during the epidemiological investigation is important because it contains child-specific information.  It ensures local health departments are thorough in their investigation, particularly if there are multiple sources of exposure.  In addition, this information could be used by DPH for planning purposes to improve the lead program by understanding what is occurring in the community, for better target-screening, or for public education campaigns.  

Both these new systems should be integrated into the department’s web site that was recommended earlier in this chapter.  The web site could provide the electronic conduit for the management of data from local sources as well as provide for the distribution of forms necessary to collect the data.

Regulatory program.  In discussions with DPH and at the program review committee’s October 1999 public hearing for this study, the Connecticut Property Owners Association presented testimony regarding its opposition to the proposed regulations.  (See Appendix H for a list of all of their objections to the proposed regulations.)   Concerns of the association included:

·       C.G.S. §19a-111 requires an epidemiological investigation be conducted upon a report of a blood lead level of 20 mcg/dL or greater.  As part of the investigation, rental property owners believe the statute requires local health departments to conduct isotopic analysis to determine the source of the abnormal burden of lead in the child’s body.  If isotopic analysis indicates the source of the lead is not the child’s residence, the property owners argue the property should not come under the statute’s requirements;  

·       A provision within the proposed regulations that required a lead inspector privately hired by the property owner to report his or her findings to the local health department or district. (After the Regulation Review Committee rejected the proposed regulations, DPH revised this provision to state the local health department or district must be notified an inspection was performed, but the lead inspector would only have to furnish the lead report upon request of the health department/district); and 

·       A provision that requires residents be temporarily relocated by the owner to suitable accommodations during abatement activities, unless occupancy is specifically permitted by the local director of health and stated within the abatement plan.  The rental property owners believe this provision contradicts the statute (C.G.S. §19a-111), which states the local health director may permit occupancy in said residential unit during abatement if, in his judgement, occupancy would not threaten the health and well-being of the occupants. 

A definition of an “epidemiological investigation” contained in current regulation states the epidemiological investigation that local health departments/districts are required to perform may include isotopic analysis of lead-containing items.  However, according to a memo issued by the Office of Legislative Research in 1996,

isotopic tracking is a technique for identifying the source of a material by analyzing the isotopes (atomic weights) of its component chemicals.  While most lead has an atomic weight of 207 (i.e., it weighs 207 times as much as hydrogen, the lightest element) it has other isotopes with different atomic weights.  Scientists can sometimes identify the source of a sample by comparing its isotopic ratios to those of a known source, such as a mine.  The CDC does not believe this technique is practical to identify the source of lead poisoning because such analyses rarely produce definitive results as to the source of the lead.  Due to these difficulties, HUD does not use or endorse the use of isotopic tracking to determine whether abatement is required, manage lead poisoning cases, or determine liability for such poisoning.[3]  

Under the new HUD regulations, when deteriorated lead-based paint is found in a child’s residence, the presumption is that it is a lead hazard and a potential source of  poisoning.  Furthermore, no states surveyed by the program review committee conducts isotopic analysis; those states, like Connecticut, presume if a child has an elevated blood lead level, deteriorated paint is the source or potential source of the elevated level and must be managed or abated.

Based on the opinion of CDC, the new HUD regulation, and other states’ lead programs, the program review committee does not recommend isotopic analysis be performed on a child with an elevated blood lead level.  However, the committee is concerned epidemiological investigations, as required under the law when a child has a blood lead level equal to or greater than 20 mcg/dL, are not being done by all local health departments.  In response to questions raised at the committee’s public hearing in October, the state DPH indicated 28 percent of the 94 local health departments recently audited did not conduct epidemiological investigations.  During information-gathering interviews, the committee was told anecdotally that most local health departments focus on the environmental aspects of the dwelling and do not perform the epidemiological investigation. 

            The department began its efforts in 1996 to achieve broad consensus on a new set of regulations that more clearly define its lead program.  As noted earlier, achieving consensus has been difficult, and the new regulations have yet to be adopted.  The program review committee believes several regulatory changes are necessary to more clearly define the program.  These changes, however, must be considered in conjunction with improved data collection and program information.  The regulatory changes, along with improvements in data collection and analysis, will provide the state with a targeted cost-effective program that is fair to all parties and protects the public’s health and well-being.

Privately contracted lead inspections.  Connecticut General Statutes §19a-111b(3) requires any person who detects a toxic level of lead to report such findings to the commissioner.  As noted above, the proposed regulations require lead inspectors privately hired by a property owner to notify the local health department/district if they are hired by a property owner to conduct an inspection.  The committee  finds this requirement creates a disincentive for property owners to voluntarily inspect their properties for lead hazards.  In addition, the requirement leaves too much discretion to local health departments/districts to decide whether or not to request a lead report and creates potential for great variation among the 108 departments/districts.  Therefore, the program review committee recommends:

C.G.S. §19a-111b(3) be modified and section 19a-111c-3(3)(d) of the proposed regulations be clarified that reporting requirements do not apply when property owners privately hire a lead inspector to inspect their property for lead-based paint or soil.

            The program review committee believes if a property owner voluntarily hires a lead inspector to inspect his/her property for the presence of lead-based paint, it should remain a private transaction.  However it is important to note, both Title X and state law requires disclosure of known LBP hazards upon sale or lease of residential property.  Thus, if a property owner sells or rents the property, he/she would still be required to disclose known lead hazards to the potential buyer or tenant.

Relocation. Current statutes allow local health departments/districts to permit occupancy in a dwelling during abatement if occupancy would not threaten the health and well-being of the occupants.  The proposed regulations require residents to be relocated during abatement unless the local health director specifically permits occupancy, which must be stated in the abatement plan.  Criteria to permit occupancy must include: abatement is limited in scope; access to work area is adequately restricted; and lead dust is contained.

The committee supports this provision of the regulation.  It protects a child with an elevated blood lead level by specifically requiring the local health director to use established criteria to determine if continued occupancy is safe during abatement.  This provision does not preclude families from being allowed to remain in their units; it only requires an active decision by the local health department.

The committee finds the Department of Public Health does not collect information on:

·       the number of families relocated from their residences because of abatement orders;

·       the reason(s) relocation was required;

·       the length of time of the relocation;

·       the cost of relocation; and

·       who has borne relocation costs.  

As noted earlier, a successful regulatory program must be supported by a comprehensive database.  Improvements in the department’s management information system addressed in this section along with information on relocation of families are important factors for DPH’s lead program.  A key role should be played by DPH in this area to ensure application of the regulation is uniform among local health departments. 

Intact LBP surfaces.  Current regulations require all lead-based chewable surfaces, moveable part of windows, and surfaces that rub against moveable parts of windows be abated, when a child has a BLL of 20 mcg/dL or greater, even if the paint is intact.  Under the proposed regulations, discretion is given to directors of local health departments to permit intact chewable surfaces (such as window sills, baseboards, and trim) to be placed in a lead management plan, rather than abated, if no teeth marks are  evident.  HUD’s new regulation considers a chewable surface a lead-based paint hazard only if there is evidence a child under the age of six has chewed on the painted surface or there are signs of paint abrasion or damage.

The committee believes the proposal gives too much discretion to local health departments to determine whether chewable surfaces need to be managed or abated.  In addition, implementation of this requirement would vary from town to town and would make compliance difficult.  If a child does not exhibit mouthing behavior (i.e., young children tend to chew surfaces and put their fingers in their mouths), regulations should not require unnecessary treatments of intact lead-based paint on chewable surfaces.  Therefore, the committee recommends:

Section 19a-111c-2(d)(4) of the proposed regulations should be deleted and the following language be substituted: “Chewable surfaces are required to be treated only if there is evidence that a child less than six years of age has chewed on the painted surface or there is paint abrasion or damage.”

A more important factor, according to the results of research over the last 10 years cited by HUD, is the finding that lead in house dust is the most common pathway of childhood lead exposure.  The measurement of the statistical relationship between levels of lead in house dust and lead in the blood of children is significant.  It is important, therefore, that resources be placed where they will have the greatest impact, such as identifying and reducing lead dust where it exists.

Summary

            Given HUD regulations, CDC guidance, and other states’ lead laws, the program review committee believes targeted prevention should be the focus of Connecticut’s efforts.  However, if that strategy fails, the state needs a precise and comprehensive regulatory program to protect children with elevated blood lead levels from lead hazards.  As recommended earlier, allowing property owners to institute essential maintenance practices and providing notification to landlords on lead hazards before a child’s blood lead level reaches an actionable level could go a long way in preventing lead poisoning.  However, if prevention fails, property owners need to address lead hazards to lessen a child’s exposure, and the state needs to impose the appropriate regulatory remedies.

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