News Coverage
Screening for lead exposure shelved
For years, Washington state has been ignoring a federal law that requires all children insured under Medicaid to be screened for lead poisoning.
Published July 12, 2004
For years, Washington state has been ignoring a federal law that requires all children insured under Medicaid to be screened for lead poisoning.
The state instead has been relying primarily on doctors who test children they suspect have been exposed to lead.
Under rules adopted in 1989, all children enrolled in the federal health care program for the poor are considered at risk for lead poisoning and must be screened at 1 and 2 years of age.
But the Seattle Post-Intelligencer reported Saturday that last year, less than one-half of 1 percent of the 560,000 Washington children enrolled in Medicaid were screened.
"Nobody here in our community thinks it's worthwhile," Dr. Bill Robertson, a pediatrician and medical director of the Washington Poison Center, told the newspaper. "The reason is very clear. ... It's scientifically absolutely ludicrous to abuse children with needle pokes when the frequency of (high blood lead) elevation is so low."
Many states don't test children on Medicaid, though "the requirement is clear," said Arianne Callender, general counsel for the Environmental Working Group, a nonprofit research organization based in Washington, D.C.
The Academy of American Pediatrics supports targeted testing based on risks.
Children enrolled in Medicaid account for 60 percent of children found with elevated blood lead levels greater than 10 micrograms per deciliter, and 83 percent of children with elevated blood levels greater than 20, according to a 2000 report by the Centers for Disease Control and Prevention.
In 2002 and 2003, 12,454 children - from newborns to age 6 - were tested in Washington state. Of those, 158, or 1.2 percent, had elevated lead levels in their blood.
In a random 1999 survey, state health officials found that 0.9 percent of 1-to 2-year-olds statewide had high blood lead levels, measured at 10 micrograms per deciliter or higher.
The figure for Hispanic children in Central Washington was 3.8 percent. The state has supported increased screening there.
Washington's lead-testing practices are guided by state health policy, which relies on the discretion of health care providers, said Jim Stevenson, communications director for the Medical Assistance Administration of the state Department of Social and Health Services.
Robertson argued that what might be appropriate for other states -particularly on the East Coast where housing stock is much older - doesn't make sense for Washington.
"They do have lead poisoning out there," he said. "Out here we simply don't have that."
Washington state does not have a waiver exempting it from the rules.
Lead poisoning is usually related to lead-based paint or industrial soil contamination, though higher-than-acceptable levels have been found recently in water from public-school drinking fountains in Seattle. That contamination has been blamed on corroded plumbing fixtures in older buildings.
Lead exposure, especially for children 5 years old or younger, can lower IQ,impair hearing and reduce attention span. At high levels, it can cause brain damage.
A 1999 report from the General Accounting Office, the investigative arm of Congress, criticized Washington for the failure, saying health providers here do not support testing "because lead poisoning is not viewed as a significant problem," whereas states like Massachusetts have screened every child on Medicaid.
A report earlier this year by the Environmental Working Group estimated that 13,300 Ohio children were lead poisoned but weren't identified because of failures to screen.
There are no civil penalties for noncompliance by states, said Rod Haynes,spokesman for the regional district of Centers for Medicare and Medicaid Services.
Dr. Joel Kaufman, a University of Washington professor of environmental health and medicine, said he initially was concerned about lead screening in the state.
But "at this point in time in Washington state, universal screening of children does not seem to be necessary, based on what we know about the prevalence of lead in children," Kaufman said.
On the Net
Washington Poison Center: www.doh.
wa.gov/hsqa/emtp/poison.htm
Environmental Working Group: