Report 2000-013 Summary - May 2001
Department of Health Services:
Additional Improvements Are Needed to Ensure Children Are Adequately Protected From Lead Poisoning
Our follow-up audit of the Childhood Lead Poisoning Prevention Program (program) revealed that the Department of Health Services (department) made only limited progress in implementing our recommendations. As a result, the department still:
- Does not ensure California's children identified with lead poisoning receive the proper medical care
and are protected from further exposure.
- Is unable to determine the full extent of lead poisoning in California- having identified only about 10 percent of the estimated 38,000 children needing services.
- Lacks the enforcement authority needed to reduce or eliminate lead hazards.
Additionally, the department needs to address staffing shortages and projected funding shortfalls to avoid potential cutbacks in program operations.
RESULTS IN BRIEF
When children under the age of 6 are exposed to lead, a highly toxic metal, the consequences can be very serious. Childhood lead poisoning can interfere with the development of the brain, organs, and nervous system; even relatively small amounts of lead in blood can result in learning disabilities, behavioral problems, and lower IQ scores. Although childhood lead poisoning is completely preventable, according to the Department of Health Services (department), it is the most common environmental health problem affecting California's children. Nationwide blood-lead levels have been declining in recent years, but many children throughout the country still suffer from lead poisoning.
For more than a decade, California has struggled to identify and protect its lead-poisoned children. As early as 1986, the Legislature charged the department with determining the extent of lead poisoning among children in the State. In 1991 the Legislature set specific goals for protecting children from lead poisoning. It asked the department to evaluate all children for their risk of poisoning, to test those children who were at risk, and to provide case management for children who were found to suffer from lead poisoning. To date, the department has been unsuccessful in meeting these goals.
As a result of the department's difficulty in meeting its goals, thousands of lead-poisoned children may have been allowed to suffer needlessly. The department itself estimates that approximately 128,000 children between the ages of 1 and 5 have elevated blood-lead levels, with 38,000 having levels that would warrant case management, which entails coordinating needed medical, social, educational, and environmental services. Yet, as of January 2001, the department reported that it was providing case management to a mere 3,700 children-the only lead-poisoned children at that time whom it had identified as requiring these services. Thus, the department is clearly not fulfilling its responsibilities as mandated by the Legislature.
In April 1999 the Bureau of State Audits (bureau) issued a report concluding that the department had made little progress in protecting California's children from lead poisoning. Because that report raised significant issues, the Legislature felt that a follow-up audit was warranted. The current report describes the department's progress in implementing our 1999 recommendations and assesses the effectiveness of screening regulations that the department implemented. We conclude that the department still has made only limited progress in fulfilling its most critical missions related to lead poisoning and has not fully implemented all of our previous recommendations. Foremost, the department has fallen short in its responsibility to ensure that those children it has identified with lead poisoning receive the proper medical care and are protected from further exposure because it has not ensured that local programs are submitting to it all necessary information outlining services provided to lead-poisoned children and does not review the information it does receive.
Additionally, the department is still unable to gain a full understanding of the nature and extent of lead poisoning in California because of its stalled efforts to obtain approval of regulations requiring laboratories to report the results of all blood-lead tests. Also, it has not yet finalized a reporting system that would allow it to receive and track the results of all blood-lead tests electronically. Although the department was recently successful in implementing regulations establishing a standard of care that requires health care providers to conduct screening of children at age-appropriate intervals, the regulations have been in effect too short a time to evaluate their effectiveness in identifying lead-poisoned children. Furthermore, the department lacks a plan for monitoring, enforcing, and evaluating these regulations.
We also found that the department has been unsuccessful in its efforts to strengthen statewide enforcement authority to ensure the reduction or elimination of identified lead hazards. Furthermore, although the department has in place a curriculum for its lead-safe schools training program, it has yet to conduct this training for all the schools it has targeted. Finally, although the department has made improvements in conducting outreach and education about lead hazards, it has not yet finalized its state plan for conducting outreach to health care providers (providers).
The department's Childhood Lead Poisoning Prevention Branch (branch) has made some progress in implementing our 1999 audit recommendations, but its progress has been hampered by a lack of staff and by lawsuits that have diverted its attention away from its primary duties. The branch's ability to obtain adequate staffing and avoid future lawsuits is threatened by a projected funding shortfall that the department has yet to fully address. The department will need to address this funding issue to avoid potential cutbacks in program operations and lawsuits that may further hamper its ability to adequately protect California's children from lead poisoning.
To obtain adequate data on where and to what extent lead poisoning is a problem in the State and to ensure that it identifies and protects lead-poisoned children, the department should continue its efforts to take the following actions:
- Ensure that local programs submit all case management information outlining the services that have been provided to lead-poisoned children.
- Monitor local programs' activities to ascertain whether lead-poisoned children receive appropriate care.
- Adopt regulations requiring laboratories to report all blood-lead test results.
- Complete the testing and installation of software that will allow laboratories to electronically submit their results.
- Revise its screening regulations to include provisions for making providers accountable and for enforcing the requirements.
- Develop a plan to monitor and evaluate its screening regulations and statewide targeted screening policy.
- Seek legislation granting the department, cities, and counties the authority to investigate, order, and enforce the abatement of lead hazards.
- Finalize and implement a comprehensive statewide provider outreach plan.
The department agrees with our findings and states it will continue taking action to implement our recommendations as available resources permit.