News Coverage
Butler County 10th in state in unreported lead cases
Published May 3, 2004
HAMILTON - Butler County ranks 10th in the state in the estimated number of unreported child lead poisoning cases, according to a study released today by a national non-profit group.
Statewide there are an estimated 13,000 unreported lead poisoning cases. In Butler County only 11 of an estimated 387 cases were reported, according to the Environmental Working Group, which conducts environmental investigations.
EWG blames the numbers on the failure of health care providers to test children.
"Ohio health care providers have failed to identify about two-thirds of lead poisoned children. Only one in seven children have been tested," said EWG's Arianne Callender, the report's author.
For example, federal law requires Medicaid eligible children be lead tested by their health care providers. Many of these providers receive payment for the lead testing but fail to ensure the test is actually done, according to the study.
The EWG identified six such health care providers, including CareSource, which services Butler County. Only 14 percent of Medicaid eligible 1- and 2-year-olds are screened, according to the EWG.
"It's a problem and we recognize it as a problem," said Dr. Terry Torbeck, chief medical officer for CareSource. "The articles out there are saying HMOs are being paid to do it and they're not. We're not withholding doing it, it's just not being accessed by members as much as it should."
CareSource already promotes lead testing in its newsletters and provides transportation for routine child care checks.
Torbeck acknowledged that providers sometimes don't automatically check children during visits, as is required by law.
"Provider education is not where it should be. Most physicians should be aware enough to do the test automatically. But there is an underawareness of the importance. There is also a member problem because they are not really aware of the significance of lead toxicity," Torbeck said. "A lot of them think this used to be a problem but isn't any more."
CareSource is continuing to look for ways to improve the testing rate, including allowing testing to be done on-site, he said.
A new Ohio law went into effect in April mandating the testing of children who live in state designated "high-risk ZIP codes."
Local health officials said the new law will likely prompt health care providers to increase testing rates. Nine of those "high risk" ZIP codes are in or overlap into Butler County. Hamilton, Middletown and Oxford all contain neighborhoods in which 5 percent of children or more are estimated to have lead poisoning, according to EWG.
Of the 11 Butler County cases reported in 2002, four were in Hamilton, four were in Middletown and three were elsewhere in the county, according to the Hamilton Health Department.
Local health departments were not surprised that cases are being missed.
David Winfough, Middletown health commissioner, said the number of unreported cases according to EWG "seems a little high, but I really couldn't say. I wouldn't say we do a good job of screening." Although the health department does some testing, that primarily is left up to health care providers, he said.
"I think there are many children eligible who should be screened who have not been screened," said Susan Irvine, public nursing administrator for the Hamilton Health Department. She said EWG's numbers seem reasonable.
Winfough and Irvine did not blame the health care providers and neither had heard of specific complaints about Medicaid.
The most common source of lead poisoning is lead-based paint contained in housing built prior to 1978, according to EWG. Lead is most dangerous to children under 6 years old.
The law requires health departments to report cases to the state for intervention if the child tests above 10 micrograms per deciliter.
However, EWG argues even low levels can cause reduced IQs and attention spans, learning disabilities, and a wide range of other health effects, it said. Some studies even link high lead levels to greater rate of delinquency in later years, said Dr. Bruce Lanphear, a University of Cincinnati physician and national expert on lead poisoning.
EWG is seeking to reduce the federal criteria to five micrograms per deciliter, and wants mandatory reporting and public disclosure of all results, not just those above 10.
Lanphear said the key to reducing lead poisoning in children is to educate the community and make efforts to avoid children living in lead-contaminated housing.
Local health officials agree.
"More education is always beneficial for families. I think ... people don't always think about taking their children for a blood test, but its important with consequences that can last for a lifetime," Irvine said. "In Hamilton you're at high risk just because of the ZIP code you're in. If parents don't know if they're child has been tested, they should ask."
The Middletown Health Department is spearheading an effort to get $124,627 in state grant money for county-wide childhood lead poisoning programs, Winfough said.
The money will be used to expand and improve services to ensure that young children living in the high-risk areas of the county will be screened. It also will provide education about environmental lead clean-up, as well as an outreach program to educate Medicaid providers and the school systems about their requirements under Ohio law.
On the Web: http://www.ewg.org/reports/ohiolead