November 15, 2012 -- Greig Warner, lead risk assessor for the Multnomah County Lead Poisoning Prevention Program, sometimes goes a month without being called out to inspect a home suspected to be lead contaminated – and sometimes he visits as many as two families per day. “I've just been buried lately,” he said.
When a child's blood lead levels test at 10 micrograms per deciliter or higher, test results are automatically sent to the Oregon Department of Public Health. In Multnomah County, the Department of Environmental Health is notified and a home investigation is performed. The health department also requests that tests between five and nine micrograms per deciliter be sent to them for follow-up.
Warner will also visit the homes of families who have contacted him, as was the case when he spoke with The Lund Report.
Most of the families Warner sees are middle-class and upper middle-class, and most are homeowners. “In that respect, Multnomah County is very different from the rest of the country,” he said. “We've never had old, low-cost housing, like on the East Coast.”
The Samsons (an assumed name; the family spoke with The Lund Report on condition of anonymity) rent their Northeast Portland home, and their daughter – at nine months -- is younger than the children Warner typically visits.
The Centers for Disease Control and Prevention recommend routine blood lead testing for all children between the ages of one and six, but Jenny had blood work done the week before to determine whether her mother's thyroid medication was affecting Jenny through breastfeeding.
Her blood lead tested at 20 micrograms per deciliter – four times the level where the CDC now recommends action be taken – but she’s shown no symptoms of lead poisoning, which Warner said is common, especially with a recent likely exposure. Health problems start kicking in after longer exposures, he said.
Checking Out the Space
After arriving at the home, Warner started by asking Jenny's father, Jim, a series of questions about the family's lifestyle, including occupation, hobbies and whether Jenny routinely visits other places such as day care (Jim works from home, and a nanny helps care for Jenny during the day).
Most cases of lead poisoning Warner sees originate in the home – either due to chipping lead paint, or to imported clay pottery, or occasionally due to less likely suspects, like imported kohl eyliner. After the initial assessment, Warner walked around the house to test for lead on surfaces.
His process is twofold: first, he uses 3M LeadCheck strips, which turn bright pink if any lead is present in the surface. Second, on surfaces where lead is detected, he tapes off a square foot and cleans it with dust wipes, which are then sent to the lab to determine the amount of lead on the surface (in micrograms per square foot). Tests take about a week to process.
Explaining that he wears latex gloves not to protect himself but to prevent contamination of the test results, Warner said, “You've got to be really careful in this job, and remain calm.”
He’s seen families get upset and blame each other for their children's lead poisoning, threatening divorce in his presence – including immigrant and refugee parents who threatened to return to their home country with the children.
“We worry about a couple of IQ points, but what's that compared to parents getting divorced?” Warner said.
As Warner walked through the Samsons' home, the LeadCheck strips were white again and again, even on floors and kitchen cabinets with chipping paint. Finally, Warner stepped onto the back porch – where Jim and his wife keep the diaper pail. While Jenny is never on the back porch, the fact that both her parents go out there occasionally means lead dust is likely being tracked onto the floor, where she crawls, Warner said.
Next Steps for Lead Inspections
Warner – who will be submitting the results of the inspection to Jenny's pediatrician – said the department will make sure she is tested every three months.
“We will not close her file until the child goes below five,” Warner said, adding that every child he's worked with has seen blood lead levels drop. In some areas – for instance, on the East Coast – caseworkers see children testing again and again with blood lead levels of five or six. “I'd hate to see a chronic five or a chronic six.”
Most children's blood lead levels come down slowly over time – on average, Warner said, 1.6 micrograms per month. He’s noticed that in some immigrant and refugee populations, the levels come down more slowly – closer to .8 micrograms per month, possibly due to prior exposures to lead or to stress.
Warner added that good nutrition – particularly high levels of calcium, which the body stores the same way it stores lead – is a major factor in bringing blood lead levels down.
Since Jim and his wife, rent, rehabilitating the construction will most likely be the responsibility of their landlord – who will either scrape the paint on the porch floor, or put in a false floor. If the landlord fails to deal with the problem, he will be required to disclose to future tenants that there are dangerous levels of lead in the home. On the other hand, Oregon is a no-fault eviction state, and it’s possible for tenants to get the boot because they complained about a lead problem, Warner said.
For now, Jim said, he and his wife will remove the diaper pail and talk to the landlord about next steps.
“We really don't want to have to move,” he said.
Renovation Rules and Gaps
In 2008 – 30 years after lead was banned from use in paint in the U.S. – the Environmental Protection Agency issued a Renovation, Repair and Repainting Rule (http://www.epa.gov/lead/pubs/renovation.htm) that requires contractors to get Lead-Safe Certified if they work in any construction built before 1978. Classes advertised in the Portland area cost $250 for the first student and $199 for any additional students enrolled by the same company.
Speaking at the Tri-Regional Lead Conference in September, Nancy Kain, the regional lead coordinator for the EPA Region 9, said many homeowners are not informed about the rule or the dangers of lead poisoning. That can frustrate contractors who are underbid by non-certified businesses – not to mention homeowners who can become contaminated by unsafe remodeling practices.
In addition, the EPA is strapped for resources to monitor and enforce the rule. “The contractors that have been practicing lead-safe work are so frustrated,” Kain said. “They keep saying, 'Where's the EPA?'”
The EPA has been reaching out to local governments for assistance enforcing the rule – and members of the public can call the EPA's tip line if they suspect a contractor is using unsafe practices.
This article is the final installment in a series about lead poisoning. To read previous stories, click here and here. To reach reporter Christen McCurdy, click here.
Image for this story by Chrissy Wainwright (CC BY-NC 2.0) via Flickr.
