(Plain Press, May 2018) On April 23rd, the Cleveland City Council Health and Human Services Committee met for a two and a half hour hearing designed to update committee members on the progress of the City of Cleveland’s interdepartmental task force in addressing the many children in Cleveland exposed to toxic levels of lead in their environment.
Committee Chair Blaine Griffin and members of City Council attending the hearing had suggestions as to how the City of Cleveland should tackle the city’s longstanding problem of children suffering from lead poisoning.
Griffin suggested better tracking and use of the State of Ohio’s data base on children in the city that have elevated lead levels. He called for looking at local ordinances where requirements for lead testing can be added. One such ordinance requires a medical exam for children entering day care. He suggested a mandatory lead test for children entering both day care and elementary school be required.
Another area Griffin suggested was making sure a work force was being developed so city departments and community organizations will have properly trained staff to be able to do the lead assessments and other tasks required to tackle this problem. Finally, Griffin said City Council members, administration officials and community activists should come up with recommendations for legislation to tackle the problem of lead poisoning based on best practices in other cities. Griffin called for “a package of legislation to address this comprehensively.”
Urging commitment to tackling the problem of lead poisoning, Griffin said, “This is huge – roll your sleeves up. This is a marathon, not a sprint. We must make sure we do this right so the next generation of Clevelanders are not affected like the last generation.”
Health and Human Service Committee Vice Chair Kerry McCormack said that prevention of lead poisoning was key. He urged committee members to think about what resources would be necessary from the city, private corporations, nonprofits and the state of Ohio to address the problem. McCormack called on all members of City Council and the Mayor to harass people with money to pitch in the needed funds.
Ward 14 City Council Representative Jasmin Santana spoke of her experience in identifying homes with lead issues for the Hispanic Alliance. Council Representative Santana said she often found the issues the family was dealing with were greater than lead. Tenants were dealing with lack of food, slum lords, bed bugs and no resources were available for families to go to another location while the lead was being abated – no hotel vouchers, she said.
Santana called for a solution to rents that are higher than families can afford and cited a need to address landlords with multiple properties that were not being taken care of properly.
Santana also noted that hiring inspectors that speak Spanish would save a lot of time spent in doing translations for tenants. She also called for letters to be sent to families noting high lead levels in children, be first translated into the first language of the families receiving the letter. She noted the Hispanic Alliance had to devote a lot of time to translation of letters for families.
Ward 1 City Council Representative Joe Jones noted that the city has had a problem with lead poisoning of children for over thirty years. He said despite budget hearings and city grants to alleviate the problem, there are still children with elevated lead levels everywhere.
Jones called for mandatory testing of children at birth. He said children need to be tested before they go to schools so that remediation can start immediately. “We can’t keep doing what we are doing. It is not working,” said Jones.
Ward 9 City Council Representative Kevin Conwell urged City Department of Public Health staff to walk the neighborhood with him and a group of community members to talk to residents and bring them information about how to prevent lead poisoning of their children.
Conwell further called for a registry of homeowners with lead problems in their houses. He urged legislation that modeled the registry after the nuisance registry. He said under such legislation, homeowners would be unable to rent or sell their property until they complied in abating the lead contamination in their property. He urged fellow members of City Council to “put a cloud on homeowners’ title if they don’t comply. We need teeth in legislation.”
Ward 10 Council Representative Anthony Hairston called for creating a strategic alliance of groups working on the issue of lead poisoning, much like the alliance to work on infant mortality. Hairston called for an effort to get the private sector and foundations to step up to make sure there was funding for the effort needed. He urged hospitals, now working with the schools, to add lead testing to the service they provide. Hairston also called for information on preventing lead poisoning and testing to be an important focus of community health fairs.
Ward 12 City Council Representative Anthony Brancatelli said that the City of Cleveland already had some “significant rules and laws already in place” that help residents to address lead poisoning. For example, he said “Every resident has the right to call an inspector to inspect their home for lead.”
While the hearing was designated as an update, Health and Human Services Committee Chair Blain Griffin stressed, several times, to City officials testifying at the hearing, that some of the new members of City Council want to engage this issue and would need to hear information that other committee members may have heard before.
Committee Chair Griffin said the agenda would focus on the work of the Public Health and Community Development Departments. Griffin promised a future meeting to address issues related to lead poisoning that had to do with the Building and Housing Department and code enforcement. He asked Development, Planning and Sustainability Chair Councilman Anthony Brancatelli to hold a joint committee hearing with the Health and Human Service Committee to receive testimony from the Building and Housing Department.
Griffin also told activists from nonprofit organizations working to address the issue of lead poisoning, “we do want to hear your input.” He promised “we will bring you in to have a discussion and an opportunity to testify.”
Griffin said the Health and Human Services Committee was interested in learning about best practices in other cities and said he sees the role of City Council to “Legislate, Educate and Activate.” He said he would like to see City Council come up with a package of legislation to address the issue of lead poisoning comprehensively.
He urged members of the administration and community activists that have recommendations, bring them to him or his committee staff member, Takasha Nutall. Policy Research Associate Takash Nutall can be reached by phone at 216-664-4548 or by email at email@example.com.
City of Cleveland Chief of Public Affairs Natoya Walker Minor called upon City Council members to educate the public about the dangers of lead poisoning and how to prevent it in every issue of their newsletters.
Chief Walker Minor, in her presentation to the committee, gave an update on the Healthy Homes Interdepartmental initiative of the City of Cleveland.
Walker Minor said the Healthy Homes partnership involved increased coordination between City of Cleveland Departments involved in addressing the issue of lead that is poisoning Cleveland’s children. She said city departments involved in the initiative included the Department of Public Health, the Community Development Department, the Department of Building and Housing, the Law Department, Public Utilities and the Water Department.
Chief Walker Minor told the committee that members from various departments were meeting twice a month for two hours to share their insights and referrals in addressing lead poisoning in Cleveland. Walker Minor said the group hopes to focus on measures that can prevent children from becoming poisoned with lead, as well as, a comprehensive focus on the entire issue of lead poisoning.
Director of the City of Cleveland Department of Public Health Merle Gordon, and Case Manager Theresa Davis-Bowling who works directly with families whose children have been poisoned by lead contamination, talked about the role that the Department of Public Health played in addressing lead poisoning of Cleveland’s children.
Director Gordon said the biggest need was to share educational materials with residents so they can learn what they can do to make sure their children are not put in harm’s way. The second thing people can do, she said, is to make sure their children are tested.
Director Gordon explained to committee members that Elevated Blood Levels (EBL) of lead in children are measured in micrograms per deciliter (mcg/dL). She said, “no lead is the goal.” If children are found with an EBL of 5-9 mcg/dL that raises a level of concern where the case worker will try to help the family identify and eliminate the source of lead. Gordon said EBL of 10 mcg/dL or more require a mandatory report by the Public Health Department to the State of Ohio. The Public Health Department then is required by law to investigate both the child’s health and assess the inside and outside of the home where the child is residing.
Gordon talked about the challenge of finding qualified inspectors to do the public health lead inspection in homes of children poisoned by lead. Gordon said that in 2015, there were only 5 qualified inspectors in the entire state of Ohio. There was no place in the state where a person could receive training and certification to do public health lead inspections. In addition, the city of Cleveland required inspectors to have a Sanitary Certification as well, she said.
Chief Walker Minor reported that currently Cuyahoga Community College (Tri-C) and the Cleveland Department of Public Health are collaborating on a course to train public health lead inspectors. Walker Minor said students in the Tri-C program are promising potential future lead inspectors.
Director Gordon noted that it is sometimes difficult to get into homes. When they do get in, public health lead inspectors do a very thorough lead inspection that takes about four hours. Responding to a question from Ward 3 Councilman Kerry McCormack, Director Gordon said that public health inspectors do not need the permission of a renter to enter the home, permission from either the parent or the property owner will suffice.
Director Gordon said if lead is found in the home, a report is issued. The parent and the home owner receive a copy of the report. Another report on the child’s health and wellbeing is issued and only the parent receives a copy of that report, said Gordon.
After the finding of lead, and issuing of a report, the property owner has up to 90 days to remediate the problem, said Gordon. She also noted that up to three 90 day extensions are possible. If the lead problem is not remediated, Gordon said a warning letter is sent. The next steps involve issuing an order of noncompliance, followed by an order to vacate the property. Gordon said an “Order to Vacate placard” is then placed on the property. Gordon said the various notices to property owners are sent by certified mail, and the goal is “to get the properties into compliance.”
Director Gordon said the inspections cover both the interior and exterior of the home. Inspectors especially pay attention to the areas around windows and door jams where paint dust is likely to be found. They take dust samples around windows and soil samples are taken, especially in areas where bare soil is exposed. Photos are taken of different surfaces in the house. Following the inspection, parents are advised on how to clean – wet moping and cleaning with wet rags – don’t use products like Pledge. Also, they are informed of how to borrow a special High Efficiency Particulate Air (HEPA) filter vacuum to safely suck up lead dust. She said tool loan programs sponsored by the City of Cleveland Community Development Department have the machines to loan out.
Case Manager Theresa Davis-Bowling explained a two-bucket method (one of clean water and one with soapy water) of cleaning surfaces such as window sills and door jams to assure you are not spreading lead dust. She said that using a dust removal spray such as Pledge just spreads the dust around and preserves it in oil.
Case Manager Davis-Bowling talked about how referrals of children with Elevated Blood Levels (EBL) come from a state data base that was rolled out in 2015. Investigations are required for children with EBL of 10 mcg/dL or higher, she said.
Case Manager Davis-Bowling said that most children in Cleveland that suffer from lead poisoning have been exposed to lead paint dust. She explained that children get the dust on their hands while playing in soil around the house, on the porch or other areas of a house where there is dust from lead paint. Children then are poisoned when they swallow lead coming from the dust on their hands, she said.
While lead paint was banned in 1978, older homes still have deteriorating lead paint, she noted. Davis-Bowling said lead dust can come from other sources such as toys, make-up, eye liner, remnants of leaded gasoline in the soil, manufacturing plants and painted pottery.
Davis-Bowling described the process she goes through once she receives a referral that a child has lead poisoning. The process begins with an in depth eight-page questionnaire that delves into how a child is doing in school; the family’s resources for food; whether the family has health insurance; and an assessment of safety at home.
Davis-Bowling said she often finds families in severe crisis where the home is not safe or there is no food and dealing with lead poisoning is not the number one priority. She said helping the family deal with pressing issues such as safety and food, makes parents more receptive to dealing with lead poisoning.
Case Worker Davis-Bowling said in cases where a child’s EBL is 45mcg/dL or higher, the child will have to be hospitalized for Chelation therapy until the EBL can be lowered. It generally takes 5-7 days. Children may be in the hospital for that long. The hospital may take images of their stomach and colon to determine if items such as rocks have been ingested. Poor nutrition and household with no food, may result in children swallowing things they shouldn’t.
Hospitalized children may require state assistance to find a safe place to stay when they emerge from the hospital. Davis-Bowling said of 16 hospital cases in 2015, two were repeat cases. She also said that sometimes the primary residence is not the source of the lead, and secondary residences, schools or day care locations may have to be checked.
Children testing positive for lead poisoning are monitored by the Department of Public Health until they reach age 18 or until they have two consecutive blood tests of 5mcg/dL or less in a six-month period, said Davis Bowling.
Gordon gave some indication of the number of cases referred to the City of Cleveland Department of Health from the State of Ohio. She said 11,000 children were referred to the department in the period from 2003 to 2013 for EBL of 5mcg/dL or higher. In 2016, out of 22,889 local children tested, the State of Ohio referred 1,563 children to the Cleveland Department of Public Health for elevated blood levels. Of those, Gordon said 1,109 had EBL or 5-9 mcg/dL, and 454 had EBL of 10mcg/dL or higher.
The level of remediation is not keeping up with the number of children being poisoned. In 2017, Director Gordon said 16 properties were issued Letters of Compliance. Most of them participated in the Community Development Departments’ Lead Abatement Program, she noted.
With Case Western Reserve students and faculty now testing many students in some Cleveland elementary schools, the number of children being referred is expected to increase. Director Gordon emphasized the importance of getting to children and families to before children are poisoned and educating parents on what they can do to prevent their child from getting lead poisoning. “Getting to children and families before children are poisoned is the only way this truly works,” said Gordon.
Gordon urged getting the word out to children and families about simple cleaning techniques and simple things we can to do lower the chances that a child will get lead poisoning. She also urged increased testing of children, learning ways to test for lead yourself at home, learning about dietary measures that can be taken to lower a child’s risk of absorbing lead, and washing hands and toys frequently.
Committee Chair Blaine Griffin echoed Gordons concern with prevention and education urging all Councilmembers to include information in their newsletters about lead poisoning, how to address it, and preventive measures that can be taken.
Following the presentation by the Department of Public Health, City of Cleveland Director of Community Development Tania Menesse provided information on the role the Community Development Department played in remediating lead in and around Cleveland homes. Her testimony highlighted why it is so difficult and expensive to remediate homes after lead has been discovered in or around the home.
Director Menesse described the department’s Lead Based Paint Hazard Control Program. To qualify for the program, Menesse said both the occupant and the structure must meet eligibility requirements. The application involves income eligibility of tenants, and requirements of landlords. The household must have a child under the age of six or a pregnant mom and the housing structure must be in reasonable shape – needing less than $20,000 in work.
Menesse said the average cost to abate a unit is $10,250 and the program caps the abatement amount at $10,372. She said if the total cost exceeds that amount, landlords are asked to contribute. Menesse said it can be a challenge to get all the information required by the application. She said families often need assistance to get birth certificates required by the application.
Once the application is completed a meeting is held with the family to give them instructions on how to cover up items to prepare the house for remediation. Menesse said several community partners help with the program including Community Housing Solutions that provides HEPA Vacuums; Environmental Health Watch that helps with risk assessment, inspections and family education; and Lutheran Metropolitan Ministry that helps with health education.
Menesse said the Federal Housing and Urban Development grant used for lead abatement requires that all the violations on a house be addressed as well as the lead problems and that the abatement last for 20 years. This often means putting vinyl siding on houses and replacing windows.
Menesse pointed out a recent house that needed a new porch that was expensive to replace. She said the cost often runs way over the amount allocated by the program. Sometimes other Community Development Block Grant funds are used to make the house safe for occupancy.
Councilman Anthony Brancatelli noted that “rehabbing is incredibly hard to do in an occupied dwelling.”