The city of Flint, Michigan is in the midst of a major public health crisis, following the discovery of widespread lead poisoning in children. Given the lifelong mental and physical problems caused by even small amounts of lead in the bloodstream, public outrage has been justifiably fierce. And as the issue is elevated in the national conversation, many are learning that lead toxicity issues exist in communities across the United States.
Those wondering whether this is a problem in Washington, however, will have a hard time finding clear answers. For over a decade, Washington has been in violation of federal laws requiring universal lead screening for children on Medicaid. These children often live in low-income areas with old buildings, and are therefore most at risk – buildings constructed before 1980 often contain lead-based paints.
The state has resisted coming into compliance at every turn, according to a longtime attorney who has successfully litigated the matter.
“With the lead revelations coming in from Flint and around the country, we have every reason to suspect the same problems exist here,” says environmental lawyer David Bricklin, who has participated in years of discussions with Washington officials over the state’s failure to adequately support screening for low-income children. “There’s simply no excuse for how little testing we do.”
Roughly 3.5 percent children under six are currently tested in Washington every year. The national average is 11 percent. As far back as 1999, the state’s acting health officer admitted Washington lacks “an accurate picture of childhood lead poisoning.”
Last year Bricklin spearheaded a successful lawsuit against the Washington State Health Care Authority, the agency’s leadership, and Governor Jay Inslee on the issue. For nearly a decade, he and staff at the Center for Justice – a Spokane-based public-interest law firm – had threatened the state with this action. In 2007, Center for Justice attorney Rick Eichstaedt told the Seattle Times they were considering an approach used in Idaho, where a lawsuit forced the state to expand the testing.
The Washington lawsuit’s plaintiff was Virla Spencer, a mother of five children eligible for Medicaid services. Spencer lived in older, low-income housing, where she was concerned that dust from chipping paint could be poisoning her children. But when she requested that her children’s doctors perform tests, she was denied. This can occur because the reimbursement Medicaid provides for the screening is seen as too low by some doctors.
Spencer said the doctor told her: “We don’t really test for lead here in Washington.”
Bricklin says that “as soon as we filed the lawsuit, the state capitulated on it. They knew they were violating the law all this time.” Under the settlementreached last November, the state agreed that all Washington children covered by Medicaid would be eligible for lead toxicity testing if requested by a parent or guardian. The state currently has a proposal under review by the federal government, asking for exemption from the universal screening requirement in favor of a more targeted approach.
The state’s resistance to expand testing derives from a belief that lead poisoning is not a major issue in Washington, and that current test levels are sufficient. During negotiations, Bricklin says the state argued the cost of expanding testing to low-income children outweighed its benefits.
According to DOH’s Patrick, “we have a pretty reasonable sense of what’s going on out there already … Our elevated rates (of lead poisoning) are going down.”
However, a review of data from the U.S. Census Bureau, 2014 American Community Survey and the Department of Health Lead Registry shows that little to no lead testing is done in many counties with the highest risk – eastern Washington’s Garfield County being the most glaring example. This could create a sense that lead poisoning levels are better than they really are.
Proportion of pre-1950 housing and 2012 screening rates by county, Washington State vs. U.S. average. Sources: U.S. Census Bureau, 2014 American Community Survey and the Department of Health Lead Registry.
Furthermore, data from the DOH Lead Registry shows the number of children with extremely elevated levels of lead toxicity in 2014 tests was significantly higher than from 2008 testing.
Childhood lead screening tests and elevated results in children <6 years old in Washington State. Source: Department of Health Lead Registry
“It’s a travesty,” says Steven Gilbert, a professor at University of Washington and founder of the Institute of Neurotoxicology and Neurological Disorders. “We barely test, so we can’t say it’s not a problem. We don’t know.…Even low levels of exposure can mean a drop in IQ and reading scores for life.”
Lead poisoning can be derived from a variety of sources, but Nicole Thomsen, an investigator for Public Health — Seattle & King County, says the leading source of exposure is lead-based paint used in older homes, predominantly in low-income areas. Her organization managed lead-related cases for 656 children in King County between 2010 and 2015.
Thomsen says that roughly 60 percent of housing countywide is old enough to have “the potential to contain lead-based paint.” Statewide, officials estimate nearly 500,000 housing units present a risk.
For his part, Patrick hopes the state of emergency declared in Flint will wake people up to the need for proactive testing of their kids. This is particularly true in areas at higher risk, which the state has detailed in an interactive map.
Thomsen believes there needs to be a change of mindset across Washington, and a recognition that this could be a real problem here.
“While it’s true that we have relatively fewer cases of lead poisoning, we also have a lower testing rate… I believe we should be testing and over time. We’ll see if the data supports (that theory) or not. But in the meantime, we just don’t know and kids are potentially at risk.”
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Drew Atkins is the managing editor of Crosscut, and a frequent contributor. Send him your comments and news tips at drew.atkins@crosscut.com.
Lead photo by Alexi Ueltzen
