Few Poor Children Tested for Lead

D.C. Medicaid Providers Blamed in New Lawsuit Filing

By Neely Tucker

Washington Post Staff Writer

Sunday, July 28, 2002; Page C04

Nearly 80 percent of the District’s poorest infants and toddlers were not screened last year for blood—lead poisoning, in violation of Medicaid guidelines and despite a six—year-old federal court order that has sought to . . improve medical care for. the city’s most vulnerable children, an advocacy . group has charged.

In motions filed this month in U.S. District Court in Washington, the plaintiffs in a landmark class-action suit say the city’s Medicaid providers are failing to screen most children even when they come in for checkups.

Medicaid guidelines state that all children covered should be tested for heightened levels of lead twice in their first two years.

The plaintiff’s motions, using the city’s statistics, say that fewer than 22 percent of the 29,000 D.C. children younger than 5 who are enrolled in Medicaid had been screened for lead in their bloodstreams. Doctors failed to test 54 percent of. all Medicaid children ages 1 to 2 who were in their offices receiving checkups, although the screenings are required by federal law, one of the motions states.

The motions ask immediate action to change the situation. They want another court order to force the city to screen all children and payment by the city of a $500 fine for each child who. came into a doctor’s office last year but was not screened. The money would go into a fund to provide for more blood—lead screening.

“I don’t know what the problem could be, unless providers haven’t been informed they need to do it,” saidKathleen Nillian, one of the lawyers representing the plaintiffs in the class-actioncase, known as Salazar v. D.C. The motions were filed July 3. The city missed a July 15 deadline to respond.

Peter Lavallee, spokesman for theD.C. corporation counsel’s office, which is handling the lawsuit, said his agency could not comment on pending litigation .

The Salazar suit was filed.iri 1993 and exposed vast failings in the city’s medical care system for low-income children, leading U.S. District Judge Gladys Kessler to place the system under her oversight in 1996.

The D.C. Department of Health now contracts with several private health care organizations to treat the city’s Medicaid.patieflts. According to federal standards, children covered by Medicaid are to be screened for lead levels twice before age 2, or, failing that, at least once by age 5.

The pages of charts and tables in the recent court motions show that the city’s success in monitoring lead levels in children has risen only slightly. Blood—lead screening moved from 7 percent of children in .1999 to

21 percent last year.

City health records have shown that at least 6.5 percent of a.ll.D.C. children younger than 6 have elevated blood-lead levels. Doctors have said for years that the lead, which primarily comes from paint in older or run-down houses, is the nation’s worst environmental health threat to children. High levels of lead in children can cause behavior and learning disorders, severe neurological problems, coma and death.

Each year, a few hundred District children are found to have high levels of lead in their bloodstreams,. and several are hospitalized, according to city health records.

Health officials have acknowledged that the issue is likely to be more widespread than reported, but it cannot be documented because of the city’s poor record-keeping.

Although 95percent ofthe city’s houses were built before 1978, when the use of lead—based paint was banned, the city’s screening data for lead levels in children was not con~puterized until 2000. Earlier data are considered unreliable, city officials have acknowledged.

screening is imperative for low-income children, advocates say, because a disproportionate number of the nation’s impoverished and minority children are exposed to lead-based paint. A 2000 study by the General Accounting Office found that 83 percent of the nation’s reported cases of blood—lead poisoning were in children on Medicaid. .

The motions also say that Medicaid children are receiving grossly inadequate dental care, again in violation of federal standards. The plaintiffs are asking Kessler to order that system fixed as well.