A coalition of doctors, lawyers, advocacy groups and others are urging the Indiana State Health Department to lower its blood sampling threshold triggering aid for children suffering lead poisoning.
It’s a move that could make Indiana children safer, Michigan City Mayor Ron Meer said. That’s especially true for children living in older housing, in which lead paint is often the culprit, he said.
Neighborhoods in Gary, Michigan City, East Chicago, Hammond and Whiting have recorded some of the highest rates of lead-poisoned children in the Region and the state, thanks to the area's aged housing stock and legacy of contamination from industry.
“It’s another layer of added protection,” said Meer, whose city was awarded $2.3 million from the federal government last year to eradicate lead paint from homes. "I don’t think the state should have more discretion than the federal government has. I think we need to aggressively address this.”
Since 2012, the federal Centers for Disease Control and Prevention have used a blood lead threshold of 5 micrograms per deciliter for children under the age of 6, recommending testing, an environmental assessment to identify potential sources of lead and nutritional and development counseling at that level.
Despite the change, Indiana and at least 18 other states still rely on a threshold of 10 mcg/dl, or twice as high as the CDC recommendation, before they qualify a child for case management.
In 2016, 359 children had a blood lead screening greater than 10 mcg/dl statewide, whereas 1,655 children had a blood lead screening above 5 but less than 10, according to ISDH data.
A petition was filed July 16 asking ISDH to update its regulations and align its action threshold with the CDC — which could mean more children receiving services they need sooner.
Lead poisoning has been shown to lower IQ and cause attentive deficit disorder and behavior disorders, particularly in young children, health officials have reported.
"Each day that goes by following the old standard is a risk that another child will be found to have lead at harmful levels yet be denied follow-up services," the petitioners wrote.
Meer, Hammond Mayor Thomas McDermott and South Bend Mayor Peter Buttitieg, who also is running for president, added their signatures to the petition.
Closing the gap
Akeeshea Daniels, a mother of three from East Chicago, signed the petition as a member of a local advocacy group. Her son, Xavier, lived out most of his childhood at the West Calumet Housing Complex in East Chicago, built on top of a former lead smelter in the 1970s, without ever knowing he had lead in his blood.
Daniels was one of 1,200 residents told they had to evacuate the complex in 2016 after EPA discovered dangerously high lead levels in the soil.
Around the time she moved away from the complex, Daniels received a box of health records from St. Catherine’s Hospital with the help of a Chicago housing attorney. One of the records indicate her son was tested for lead poisoning at age 3 in 2007, she said.
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“He was 9 (mcg/dl),” Daniels said. “He wasn’t at a 10, so no one told me. But he was a 9, so how much more did he need to have in his body for anyone to contact me?”
Mark Templeton, an attorney at the University of Chicago Law School's Abrams Environmental Law Clinic, said Daniels is just one example of how a lower threshold would have meant quicker intervention — when the services could have more impact.
"Moreover, parents and other community members might have started asking more questions earlier about the source of the contamination, which could have brought greater attention to the issues at the Superfund site and might have spared others from the effects of the contamination," Templeton said. "Unfortunately, East Chicago is not the only area in Indiana with lead contamination problems ..."
Petition seeks immediate action
The petition asks the state health department to use emergency powers to temporarily update the state’s case management standards while it prepares to permanently update the rule through the normal process.
The change could mean more children will qualify for additional and periodic retesting, management and monitoring.
The health department's executive board — which adopts department rules and regulations — approved ISDH’s recommendation to file an emergency rule in March 2018, suggesting the issue required immediate attention. But the rule never became effective, the petitioners wrote.
Under current regulations, local health departments are required to identify potential sources of lead exposure, arranging to test other young children in the home, assessing risks for pregnant woman in the home and notifying property owners of such hazards — but only when a child has an EBLL above 10, the petition states.
Janet McCabe, a professor at Indiana University’s School of Law, said the petition is one of “many, many aspects" of lead poisoning prevention.
“This is one. We think it’s important for Indiana to step in the world where the right (blood lead) level is recognized,” she said.
She said the change would result in additional expenses at local health departments, some of which would be offset by Medicaid reimbursements. Medicaid can reimburse departments for screenings, follow-up and environmental inspections.
“I appreciate the local health departments in Indiana, the responsible agencies here. They do not have enough resources. And they are having to make tough choices. I understand if, all of a sudden, they have three times as many kids they have to provide case management services for, where are the resources going to come from?” she said. “Part of this has to be finding additional resources and making sure local health departments are able to seek reimbursement from Medicaid.”
Jennifer O'Malley, spokeswoman for Indiana State Health Department, said the agency has been engaging in discussions about needed resources.
"That isn’t as simple as just changing a number because of the varying resources that exist among local health departments and because there is no one-size-fits-all solution," O'Malley said. "We are having ongoing discussions with partners and other states about what approaches to case management would work best in Indiana..."