Few kids are
tested, leaving thousands in need of help
by Marsha Low, Detroit Free
Press,
January 23, 2003
Fewer
than 20 percent of poor Michigan children on Medicaid are tested for lead
-- despite being at the highest risk for poisoning, and despite a federal
mandate that they get screened.
And just 11 percent of all
Michigan children under 6 are tested, according to state health officials.
"Testing is not particularly
painful or expensive, and so there's no valid reason not to test a child,"
said Dr. William Weil, a member of the American Academy of Pediatrics'
environmental health committee and a professor emeritus of pediatrics at
Michigan State University. "It's better to err on the side of safety and
until we learn to do that, thousands of children will suffer needlessly."
Early detection could prompt
the removal of lead hazards fromhomes, day-care centers and schools. And
that could save thousands of children from irreversible brain damage, loss
of hearing and vision, stunted growth and behavior problems.
But because so few are tested,
health care workers in 2001 identified just 4,771 Michigan children with
lead poisoning. They estimate, however, that 22,000 are poisoned and in
need of help.
At least 19 states have passed
laws requiring all children be tested for lead. Michigan is not among
them.
In Michigan, only 11 percent of
children under age 6 were tested in 2001, a slight increase from 1998 when
9 percent were screened, according to the most recent numbers available
from the Michigan Department of Community Health.
A 1998 report by the U.S.
General Accounting Office estimated that nationally, 11 percent of all
children were lead tested.
One reason for the low rate of
testing, child advocates say, is that too many doctors think of lead
poisoning as a disease only of the poor and that their wealthier patients
are immune. Even doctors who treat poor kids often are unaware that
Medicaid requires them to screen all children whose care is paid for by
the government-funded health program.
Parents also need to do more,
the advocates say, to educate themselves about lead and request that their
children are tested. Too often parents assume that if they live in an
affluent or suburban neighborhood, they don't need to be concerned.
At a recent Macomb County
health seminar, for instance, parents were more interested in black mold
than lead. Yet 52,306 of Macomb County's 320,276 homes were built before
1950, making them at high risk of having lead paint problems.
"In these classes people always
come for mold, never lead," said Matthew Bezanson, the seminar instructor,
who works for Sherlock Homes Inspection. "I have to start all the classes
talking about lead because most people aren't interested and I'd never get
the information out otherwise."
Poor children most at risk
While lead is widespread in old
buildings -- regardless of a family's income -- poor children are
considered at greatest risk of lead poisoning because they are more likely
to live in deteriorating homes. These children also are more likely to
have poor diets, making them more susceptible to absorbing lead than
children who eat meals high in calcium, iron and other nutrients. That's
why all Medicaid children are supposed to be tested for lead.
But like most states, Michigan
has never come close to screening all of these children.
While state and federal tax
money goes to pay doctors or managed care plans to perform the tests, they
are rarely done. Last year, the Bush administration tried to
eliminate the requirement that Medicaid children be tested for lead, but
child advocates successfully argued that doing so would only worsen the
situation.
Only 10 percent of the nation's
Medicaid children under age 6 were lead screened in 1999, according to the
Centers for Medicare & Medicaid Services.
In Michigan, 19percent of
Medicaid children ages 1-5 were lead tested in 2001. That'sup from
5percent in 1999, when the American Academy of Pediatrics and
several advocacy groups sued Michigan health officials over their failure
to give lead and other health screening tests to the state's295,000
Medicaid children ages 1-5.
After more than three years of
legal wrangling, the case will move forward in U.S. District Court in
Detroit soon.
State Health Department
officials blame the HMOs that treat Medicaid children for not better
training doctors to perform required tests. They say doctors are ill
informed about lead screening and treatment. And they say preventive care
is not a priority for low-income parents.
"Improvements will take time,
effort, toil and trust -- and it will not happen overnight," said Doug
Paterson, director of the state Health Department's Bureau of Children and
Family Programs. "Even when we get the medical providers on board, getting
the consumer on board takes time and is hard."
But some HMOs manage to screen
far more children for lead than others. Officials at Community Choice
Michigan, which screened 39 percent of its Medicaid children under age 2
and 32 percent of those ages 3-6 in 1999, said they have developed
training programs and newsletters for doctors, educational materials for
patients, and have installed computer programs that help track patient
records.
"We're providing our patients
and our health-care providers with the same information about what must be
done so there is no lack of understanding or confusion," said Sharon
Fuller, maternal child coordinator for the Okemos-based HMO.
Many child health advocates say
universal testing -- not just for poor children, but for all children --
is the solution. It would mean that all children would be tested for lead
at ages 1 and 2, and that parents must show proof of the tests before they
could be enrolled in day care or school.
Across the country 19 states
enforce universal testing, according to the National Conference of State
Legislatures, and most have experienced significant gains in diagnosing
and treating poisoned children.
In Delaware, universal
screening began in 1995. Last year 90 percent of the state's children
under age 6 were screened, said Dr. Har Ming Lau, director of Delaware's
Office of Lead Poisoning Prevention. Before universal screening, just 17
percent were lead tested.
The result, he said, is one of
the nation's lowest rates of lead poisoning. Last year, 1.7 percent of
Delaware children had blood-lead levels of 10 or above -- a poisoning rate
half the national average.
"I think we were very fortunate
to have had the universal screening law go into effect," Lau said. "This
law has enabled us to work with the medical community closely, especially
since the arrival of HMOs."
State health officials in
Michigan are skeptical of the approach.
"You assume that every child
must be screened, and we think that's wrong," said Geralyn Lasher,
spokeswoman for the Michigan Department of Community Health. "We know
every child needs to be immunized. And we know that at-risk kids should be
screened for lead, but that's not the case for everyone. It would be a
waste of resources to screen every child in the state."
Vermont health officials
disagree. That state passed a law mandating universal lead testing of all
1-year-olds in 1994 after studies found that 61 percent of the state's
homes were built before 1978 and that many children were at risk for lead
poisoning.
Testing rates have improved,
with 70 percent of the state's 1-year-olds receiving lead tests in 2001
compared with 26 percent in 1994. Further progress is expected after the
state updated its law in 2000 to include screening of all 2-year-olds,
said Sheri Lynn, program coordinator for Vermont's Childhood Lead
Prevention Program.
"In Vermont, universal
screening has been a great success. We now have landlords and home owners
properly taking care of their properties, and ultimately that means we now
have fewer children who are exposed to lead hazards," Lynn said.
