The children were tested for lead poisoning last July, during a routine visit to the neighborhood health clinic. Drop-lets of blood from their forefingers were drawn into small tubes and sent off for analysis to a lab at the city of Houston's Department of Health and Human Services.
When the results came back, the children's parents, a young couple raising a family in a 90-year-old house not far from downtown, were shocked: Both the three-year-old girl and the five-year-old boy had tested at more than 10 micrograms of lead per deciliter of whole blood, which by federal standards meant that they had been poisoned. Though neither child showed any outward sign of illness, the dangerous toxin could be damaging their brains and nervous systems at a crucial stage of development.
The blood-lead level of the young boy -- nearly twice the amount considered poisonous -- prompted city health officials to inspect the family's home to identify the source of the problem. The result of that analysis shocked no one: The culprit was lead-based paint, by far the most common cause of lead poisoning in young children.
The family was in luck -- or so they thought. In early 1995, the city health department received more than $3.9 million from the federal government, which, along with another $1.7 million in local funds, was set aside to remove lead from contaminated homes.
The Lead-Based Paint Hazard Control Program, or LBPHCP, is aimed at low-income homeowners with children under the age of six who have tested positive for lead poisoning. The family in the 90-year-old house, which inspectors determined was infested with lead dust from paint around the windows, sills and doors, seemed like an ideal candidate for the program.
But almost a year after the children were found to be poisoned, and more than six months after inspectors identified the source, the family is still waiting for city contractors to remove the lead paint from their house and make it safe.
"We just kind of lost hope with regard to their help," says the children's mother, who asked that the family's name not be used in case city health officials decide to fulfill their promise. "We thought maybe they had just run out of money and shut down or something."
It only appears that way. The LBPHCP is alive, although its performance so far suggests long periods of suspended animation. Two years into the $5.6 million program, the city has performed lead-reduction work on just 22 homes -- less than $100,000 worth of abatement. And city records show that, as of April 10, only 27 additional homes have qualified for lead removal, either through blood screening of preschool children or community outreach.
City health officials have estimated that there are thousands of cases of elevated blood-lead levels among the city's poor, mostly minority children, some of them quite severe. The majority of those cases, health officials believe, are caused by tens of thousands of deteriorating inner city housing units built before 1960, when lead levels in paint were extremely high.
But at its current pace, the LBPHCP will fail to meet its goal to reduce lead-paint hazards in 400 homes by the August 1, 1998 deadline. If that happens, the city could be obligated to return a portion of its $3.9 million grant from the federal Department of Housing and Urban Development. It might also hurt the city's chances for additional federal assistance to address what the Centers for Disease Control consider one of the most prevalent -- and preventable -- pediatric health concerns in the United States.
City officials defend the program, pointing out that delays were caused by circumstances out of their control, such as the lack of a state certification program for lead-removal workers. Once that certification was in place, they say, the program was set back again when the city's Department of Housing and Community Development eliminated its housing rehabilitation program.
"This program was intended to be in cooperation with housing and community development," says Mike McDaniel, the LBPHCP project manager. "They were supposed to kick in over $1 million. But when they stopped their rehab program, we had to go to HUD with a new work plan. We're really just getting started on the abatement part of the program."
While symptomatic of other lead removal programs funded by HUD nationwide, bureuacratic hassles don't really explain the overall ineffectiveness of the Houston program. A review of LBPHCP records and interviews with current and former city health workers suggests a rudderless effort that has no clear set of priorities and suffers from duplication of effort and interdepartmental squabbling. Moreover, the program's top manager, McDaniel, has no background in environmental or childhood health. His hiring has all the characteristics of political patronage.
The result has been that many families with children suffering from high blood-lead levels have had to go on living in contaminated houses. Others have had lead paint removed even though their children do not have lead poisoning. And though there is no shortage of contaminated houses, abatement work has been performed on homes where lead paint inspections turned up insignificant amounts of lead.
City health officials are clearly having a hard time directing a sizable federal gift to those who need it most. But there may be a good reason for the failure of the LBPHCP to reach low-income families with lead-poisoned children: To improve their chances of getting the $3.9 million grant, those same city officials may have overestimated the incidence of childhood lead poisoning in Houston.
Once considered primarily an East Coast problem, the danger of lead-based paint has drawn increasing attention from local health officials since dangerously high levels of lead were detected in homes near the site of the city-owned Milby Bus Barn in September 1993. At the time, the site was undergoing a $6 million environmental cleanup in anticipation of a new housing development for low- and moderate-income families.
Testing of children in the adjacent neighborhood revealed that 20 percent had elevated blood-lead levels -- more than ten micrograms per deciliter of blood. Most of those, however, tested below 15 mcg/dl, meaning that parents were counseled on preventive measures, such as frequent hand washing and improved diet. According to the Centers for Disease Control, which set the guidelines for intervention and treatment of lead poisoning cases, that's usually enough to reduce blood-lead levels in most children.
Sonja Vodehnal, who runs the health department's Childhood Lead Poisoning Prevention Program, which conducts blood testing and medical case management, says that's been the case in Houston.
"We have been very successful just with that kind of intervention," Vodehnal says. "Just making the effort to go out to their homes, pointing out the source of the lead and educating Mom, the levels start coming down. And that's what we want."
Vodehnal's program, known as CLPPP, was launched in 1992 and is funded by annual grants from the CDC. Each week, city health workers visit more than a half-dozen inner city health clinics to take blood samples from preschool children, most of them from poor black and Hispanic families. To date, Vodehnal estimates her program has collected more than 41,000 samples, which have been assembled in a computer database.
Though the CDC consider any blood-lead level above ten mcg/dl a matter of concern, the agencies' so-called "action level" is 15 mcg/dl. At that point, they recommend an environmental inspection of the child's home and, if necessary, removal of the hazard. At blood levels above 25 mcg/dl, children are referred to the Harris County Hospital District for medical evaluation, which may result in chemical chelation therapy to reduce the amount of lead in the body.
At higher levels, children could require immediate medical treatment or even hospitalization, though such poisoning cases are rare in Houston. Vodehnal estimates that fewer than 20 children screened by her program have had to be hospitalized. For the most part, she says, "kids here suffer from relatively low levels of lead poisoning."
The bad news from the Milby Bus Barn produced a run of news reports about the dangers of lead-based paint, which even at modest blood levels has been associated with decreased intelligence and learning disabilities in children. Though blood test results from the east side were cause for alarm, no one knew the scope of the problem citywide; screening of children in other areas had just begun and results were inconclusive.
Yet the media invariably hyped the potential for widespread lead poisoning, particularly when it was learned that the city's environmental health division had failed to apply for a federal grant that year to remove lead-based paint from private homes. (A year earlier, in 1992, the division applied for the same grant it later received, but was turned down.)
Faced with some unwanted publicity, Mayor Bob Lanier ordered up a task force to examine ways to, as he put it, "make Houston lead-safe." The group charged the city's health and housing departments with the responsibility of jointly devising a "lead-based paint hazard control" strategy that would land a federal grant in 1994.
One former high-ranking official of the health department says the city's decision to pursue the federal grant "came about because the press was pushing the city to do something. It became like somebody's stepchild. The only person who wanted it seems to have been the mayor."
Among the task force members was Mike McDaniel, who had worked as a volunteer on Lanier's 1991 campaign. McDaniel joined the city payroll in mid-1992, after resigning as the assistant director of maintenance and landscaping at Texas Medical Center. Though his official city title was administrative supervisor, McDaniel was known within the administration as an "executive assistant," a status reserved for select Lanier supporters who wanted a job. (McDaniel's salary is about $44,000 a year, though he might feel cheated to know a former Lanier "executive assistant," Doug Williams, now earns $112,000 as assistant to the mayor's chief of housing and inner city development, the unpaid Michael Stevens.)
McDaniel was assigned to the environmental health division as City Hall liaison for the division's assistant director, Ricky Quevedo. While no one knew what his duties were, he immediately gained a reputation as a braggart who cited his ties to Lanier to impress others.
Involved from the start with the LBPHCP program, McDaniel wasn't hired as project manager until the city had already sent off its grant application to HUD. That was probably wise, considering McDaniel had none of the necessary qualifications, such as knowledge of public health issues and experience in environmental management and lead detection. Instead, the city told HUD it would follow its usual selection process to find the right candidate, but until then, Quevedo would act as project manager.
When Quevedo retired, he was replaced by current assistant director Bob Tannis, who says he "hired" McDaniel to run the program because he was the only one who knew anything about it.
"I didn't want to bring this program on board as a complete learning experience, which was basically where we were," Tannis says. "We started at ground zero, and we didn't want to have to learn any more than we knew we'd have to learn."
Indeed, while the state Department of Health has done some screening for childhood lead poisoning, the results have never moved health officials to take action. Aside from Houston, none of the state's larger cities ever bothered to apply for the federal assistance available, and for good reason. Almost all of the HUD grants awarded in the first two years of the federal lead abatement program went to the Northeast, where city and state governments have long been aware of the problem and had already taken steps locally to reduce the risks to children.
Despite the reservations of some staff members, McDaniel and other city health officials did a commendable job convincing the feds that Houston did, in fact, have a lead poisoning crisis on its hands. The grant application to HUD "estimated" that as many as 39.5 percent of children in Houston may have a blood-lead level above ten mcg/dl, while another 12.8 percent may have levels above 15 mcg/dl.
Unfortunately, the city arrived at those estimates using studies that, in some cases, were a decade old. A more accurate picture of the problem was reflected in data collected by Vodehnal's CLPPP project. By the time the city applied for the federal grant in mid-1994, nearly 17,000 children had been tested. Slightly more than 3,100 children, less than 19 percent, had elevated blood levels -- too many, of course, but significantly fewer than the nearly 40 percent estimated by the city.
Moreover, in the majority of those cases, the blood-lead levels were below 15 mcg/dl. An analysis earlier this year by the University of Texas School of Public Health bears that out -- and offers another challenge to the city's representation of the lead poisoning problem. Using the CLPPP samples collected between 1992 and 1996, the analysis showed that of some 30,950 children screened citywide, just more than 1,000 -- or fewer than 4 percent of the total -- had blood-lead levels above 15 mcg/dl.
More significantly, in the seven inner city neighborhoods targeted by the $3.9 million HUD grant, 5.1 percent of children had blood-lead levels above the CDC threshold for abatement -- again, far below the nearly 13 percent estimated by the city in 1994.
Compared to the lead poisoning problem in other cities, Houston is fortunate. In Baltimore, for instance, the "vast majority" of inner city children have blood-lead levels above ten mcg/dl, says Amy Spanier, the program director for that city's lead hazard control program.
"We've got a larger problem on our hands," Spanier says. "If we could start thinking about abatement at levels of 15, that would be a great luxury. As it is, our screening rarely allows us to get to children below 20."
One former employee of the Houston health department says the city probably knew going in that the problem was relatively small compared to other HUD grantees. So, he says, officials scouted for ways to "crunch the numbers" to make Houston a more viable candidate.
"They were breaking it down by census tracts near the city health centers," says the former employee, who worked on the program before leaving the city. "Like, in census tract 310, they might report there were 188 children and 486 pre-1940 homes. They were making it out like there were 188 children living in 486 pre-1940 houses. It doesn't say that. It says the entire census tract has 188 children. Everything was done to give a sense of urgency to the thing so the city could get that lead-based paint grant."
The city's LBPHCP was scheduled to begin in early 1995, when the grant was officially awarded. But McDaniel immediately found himself struggling to get the program up and running. Like other HUD grantees, Texas did not have a certification program for lead-removal contractors, although a bill to establish one was on the state Legislature's agenda that session.
Until it was passed, however, the city had the option of using contractors certified in other states. But although other cities did so, McDaniel chose not to go that route. At the time, a health department spokesperson, apparently forgetting that the well-being of preschool children was at stake, said the hiring of out-of-state contractors would be "an unwise use of resources."
In February 1996, shortly after the certification process was in place, the city's original plan -- a combination of lead abatement and rehabilitation of 150 owner-occupied homes in select inner city neighborhoods -- was scuttled when the Lanier administration decided to shut down the housing rehabilitation program, ostensibly to replace it with something more "efficient." That cut the proposed amount to be spent on each home -- roughly $27,000 -- by half.
The planned expenditure was cut even further, to about $6,000 per home, following a series of meetings over the next two months with the mayor's staff. At the same time, it was decided to increase the number of houses targeted for abatement from the original 150 to 400. Not coincidentally, perhaps, the changes came shortly after Lanier announced his Homes for Houston program, which aims to construct or rehabilitate 25,000 housing units by the year 2000.
According to McDaniel, under the new LBPHCP work plan, all houses that receive lead abatement will be counted toward the Homes for Houston goal.
Whether the mayor's pet housing project can tally 400 lead-safe homes or will have to settle for fewer than that remains to be seen. The first abatement didn't begin until last October, more than one year behind schedule. In the six and a half months since, only 21 more have been completed.
Ironically, that grand total of 22 houses equals the number of homes from which the city housing department removed lead-based paint in a 12-month period in 1993-94. The amount of money set aside for the work -- $150,000 -- was criticized as ridiculously inadequate, though there were nearly 100 other homes inspected that were ineligible, most of them because they contained only small amounts of lead-based paint.
While the housing department's effort was carried out on a modest scale, it was a model of efficiency compared to the federally funded LBPHCP. For one thing, it was accomplished using resources the city already had at its disposal. By contrast, almost one-third of the HUD grant will be used to pay the salaries of the LBPHCP employees -- almost all of whom were already working for the city -- as well as for 15 staff trips to Washington, D.C., for "training." The program also required a significant outlay for computers, printers, mobile phones, lead-detection equipment, leased automobiles and other tools of the trade.
Because of the early delays, McDaniel was forced to appeal for a 16-month extension in order to meet the HUD grant's requirements. That raised the overall cost of running the program while siphoning money originally earmarked for actual abatement. Once budgeted at $4 million, that amount has been cut back to about $2.8 million, including the cost of relocating residents during abatement.
Some of that money has shifted to so-called "management in place." That means instead of reducing the amount of lead in homes, the city plans to buy mops, buckets, sponges and detergent and distribute them to 100 families with lead-poisoned children. The program will also spring for the price of a subcontractor to teach families how to use their new cleaning supplies to reduce the hazards of lead paint.
The most significant change was the adjustment in the actual abatement strategy. Actually, it's no longer abatement, but something called "paint stabilization," which, until last year, was frowned upon by HUD as unreliable. Some windows, doors and exterior siding will be replaced with new materials as needed, says McDaniel. But most of the lead-contaminated surfaces will simply be sanded smooth and coated with latex paint.
"I have not replaced a single baseboard in a home, I've painted them all," McDaniel says. "A lot of the wood trim around the doors and windows, same thing. I don't replace it. If it's not deteriorating and peeling, I don't have to, and I haven't had to so far."
Matt Ammon is HUD's grant liaison in Washington. He says the federal agency hands out guidelines for abatement but leaves how it is actually carried out to the individual programs. "In the follow-up a year after the program is done, they'll be able to tell what worked and what didn't," Ammon says.
But Sonja Vodehnal, who collects the data on blood-lead levels for the Childhood Lead Poisoning Prevention Program, says paint stabilization is a "Band-Aid" approach.
"If we really want to get rid of this problem and eradicate it like smallpox," Vo-dehnal notes, "then painting over it is not really the solution."
If it sounds like taxpayers -- not to mention families with children suffering from lead-based paint poisoning -- deserve a little more from a $5.9 million effort than mopped floors, new paint and a slew of frequent flier miles, consider how the LBPHCP has carried out its responsibilities so far.
In its grant application, the city pledged to give highest priority to families with children who were seriously lead poisoned. But seven of the 22 abatements performed so far have been on homes where children have blood-lead levels below 15 mcg/dl -- an amount that, according to the Centers for Disease Control, can be managed and reduced without abatement. Three of those houses were home to children whose blood-lead levels were below ten mcg/dl, meaning they weren't considered poisoned at all.
McDaniel defended that work in an interview with the Press -- or at least he tried to. He pointed out that he has authority to order an abatement even though the child in the home may not be poisoned. A few minutes later, however, he insisted that "our policy at this time is that we want to see some level of poisoning" before the work is scheduled.
The project manager also could not say why lead removal work was carried out at several homes that appeared to contain low amounts of lead or where the inspections had been inconclusive.
"We had never done this before, and we really didn't have much of a clue as to what was going to take place," he explained. "What I did was look at what other programs were doing, and instead of trying to recreate the wheel, I tried to mold it to fit the needs I thought we would have."
Despite the existence of an alphabet soup of well-funded federal programs, what exactly those needs are is unclear. The apparent incoherence of the program might reflect a shortage of families that meet minimum guidelines for abatement. Or, perhaps, the LBPHCP and the CLPPP have failed to find them.
Some who are familiar with both operations suggest that one problem is the lack of coordination between the two programs. Ideally, they would complement each other: The CLPPP identifies families with lead-poisoned children; the LBPHCP removes the lead from their homes. But a source who worked on the LBPHCP before leaving the city says, "The ability of those two to work together has been questionable. There are too many people with something to say, and when they got around the table, they'd argue with each other. The job is divided, which makes the bureaucracy more difficult to function."
The best indication of the LBPHCP and the CLPPP's inability to coordinate their efforts is a report called the Lead-based Paint Hazard Control Referral Report. It lists the addresses of nearly 300 homes identified by both programs for possible lead removal. The document's title notwithstanding, McDaniel says the addresses aren't referrals, but merely offer "a snapshot of our day-to-day operation."
If that's the case, his operation is hard-pressed to find a sufficient number of homes from which to remove lead hazards. The majority of cases on the report -- an inexplicable 63 percent -- are labeled "inactive," meaning they are not eligible for the program.
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Only 72 houses were listed as "active," but fewer than 30 of them have actually qualified for abatement. The rest have yet to undergo environmental inspections or are having their owners' income status verified. Cur-iously, only five of those "active" cases originated with the CLPPP, which might explain why at least 50 of the houses identified on the referral report are not homes to lead-poisoned children.
So why doesn't McDaniel rely on the extensive data on lead-sick children that's already been collected by the CLPPP? "We had a referral process from [Vodehnal] at one time," he explains. "But it never really jelled. The people who work for her had a little different idea of how I should operate. It was kind of a flaky deal to begin with."
Vodehnal was careful not to criticize McDaniel's program, saying that he now has direct access to her database "so they can search through on their own." These days, she limits her contact with the LBPHCP to a weekly e-mail report of new cases. The rest of the time, she's busy locating Houston children who are lead poisoned, while hoping that greater care and education will make them harder to find.
Wish her luck.