Milwaukee failed to protect lead-poisoned children by massive neglect and missteps

A damning state report finds Milwaukee's lead poisoning prevention program has failed to take even some of the most basic steps to protect the city's children.

The draft report by the state Department of Health Services looked at 108 lead-poisoning cases reported to the city's troubled Childhood Lead Poisoning Prevention Program between 2012 and 2017.

It found more than 90% of the cases were closed before the amount of lead in kids' blood had dropped to levels deemed safe by the state. Some of these children, in fact, still had dangerously high lead levels.

Regulators also said the city failed to do full risk assessments — or at least provide documentation — of possible lead hazards at the homes of lead-poisoned children in any of the cases under review. These assessments should include visual inspections, testing for lead hazards and corrective orders.

In a quarter of the cases, there was no record that an investigator even visited the primary residence of a child with elevated levels of lead.

And, more broadly, the city's basic protocol for intervening in cases involving lead-poisoned children doesn't meet the minimum requirements set by state law, according to the report, which was obtained by the Journal Sentinel.

Bruce Lanphear, a leading health sciences expert at Simon Fraser University in British Columbia, said Milwaukee residents should "absolutely" be concerned by the findings in the state report.

"Clearly, there are problems within the program itself in terms of following through with children who have clear-cut lead poisoning," Lanphear said, pointing to issues of documentation, nursing oversight and environmental inspections.

Lanphear said many health departments are failing to keep up with new guidelines calling for greater emphasis on lead poisoning prevention. But he said the state report shows that Milwaukee has more serious management issues than most.

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The findings represent a stunning reversal for a program often touted in the past by local and state officials as a national model.

"Milwaukee certainly isn’t an example to look to, but in years past it was," said Ald. Michael Murphy. "But something obviously changed in the management within the Health Department, and it resulted in these terrible outcomes for children."

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Mayor Tom Barrett's administration has been given until June 30 to develop a plan to correct the problems identified by the state.

The state also ordered Milwaukee officials to review all 491 lead-poisoning cases reported to the city from 2012 to 2017 to make sure the children received nursing care and thorough inspections and removal of lead hazards from their houses.

"DHS found a number of children who did not receive required case management and follow-up, and properties that did not receive the environmental investigations and remediation needed to ensure a lead-safe environment," the report concludes.

Interim Health Commissioner Patricia McManus said in a statement, "I concur with the findings of the state’s audit of the City of Milwaukee Health Department’s Childhood Lead Poisoning Prevention Program (CLPPP). The health and safety of the children in Milwaukee must be our first concern. I remain committed to working with the state to improve our lead program and ensure we are in compliance with state laws and obligations."

Widely used in water pipes until the 1950s and in the solder connecting copper piping until the 1980s, lead can flake into drinking water, damaging a child's growth and ability to learn.

Each year, 25,000 Milwaukee children are tested for lead poisoning and an average of 3,000 per year are found to have elevated levels in their blood. Lead paint is widely considered to be the primary source of lead poisoning in Milwaukee.

The state's top public health agency launched its review of the Milwaukee Health Department earlier this year, following the sudden exit of former health commissioner Bevan Baker amid revelations about serious problems facing the city's lead programs.

A report released by the city in January found that staffing shortages, inadequate training, high turnover and poor coordination contributed to the failure by its lead prevention program to follow up with thousands of families who had lead-poisoned children — or at least failed to document that work.

Barrett said the new state review confirmed many of those findings from the January report.

"That’s why we have invested so much effort in corrective action, and we continue to prioritize the health of children in Milwaukee to make sure we are doing everything that is appropriate," the mayor said.

Karen McKeown, state health officer and administrator of public health at the state Department of Health Services, said the city has been "very transparent" throughout the review.

Still, McKeown said, "anytime we see children with elevated lead levels we want them to receive appropriate follow-up, and so if that’s not happening that is certainly concerning.

"Our guidance would say that you should follow a child longer than they were following," McKeown added.

The city program has two basic components — public health nurses who monitor and ensure treatment for children with elevated lead levels in their blood, and environmental investigators who identify potential sources of lead in homes and issue corrective orders.

The 14-page state report found problems in both areas. The state looked at about one-fifth of the cases reported to the city during the six-year period under review.

In the nursing program, the state said the case openings and closures "did not follow minimum state requirements." In particular, the report said:

The city could provide complete files in only 46% of the 108 cases. Seven cases had neither a computer nor a paper file.

Overall, 16 lead-poisoned children had no home visit from a public health nurse or a health services assistant.

Of the 70 cases that were officially completed and closed, 64 did not meet the state’s minimum requirement for closure. That standard requires a child have two tests, taken six months apart, in which the lead level is less than 15 micrograms per deciliter of blood.

In 30 cases, children had blood lead ranging from 15 to 36.3 micrograms when the case was closed. In 11 other cases, the child’s blood level increased to 15 or more micrograms after the case was closed but it was not then reopened.

The report also found that in mid-2016, the city appeared to de-emphasize cases of children with lead levels of 15 to 19.9 micrograms, though that is required under state law.

The state reviewed 12 such cases referred to the city after that date. The city provided no public health nurse visits in 11 of those cases. The one child who did receive home visits from a nurse got that referral only after the child's lead level topped 20 micrograms.

"These children, beginning around June 1, 2016, were no longer being provided the environmental investigations and PHN (public health nursing) case management required for a child with an identified EBLL (elevated blood lead level)," the report said.

The city's environmental program also had its share of problems.

For instance, the report found:

More than one-fifth of the cases had no computer notes or a paper file for the primary address of a child with lead poisoning.

A quarter of the initial primary addresses of lead-poisoned children had no record of an environmental investigation being conducted. The same was true with half of the new primary addresses and supplemental addresses for these Milwaukee kids.

None of the 108 cases reviewed by the state had documentation showing that a full lead risk assessment had been conducted for the homes of lead-poisoned children. There were no completed clearance reports in any of these cases, either.

Lead abatement orders in more than a quarter of the cases were closed without proof that the matters had been dealt with. In another 13 homes, investigators found lead hazards but issued no orders.

"Reviewers found that many files did not have enough documentation to determine if hazards were found by the environmental investigator," the report said. "Conclusions could not be drawn about the status of a property."

Beyond that, the report says many corrective orders included only window work and porches, even though pictures in the file showed deteriorated paint and dust wipes indicated more lead hazards.

The city chose not to do an environmental assessment on the home of one child referred to Child Protective Services. Another case was closed when a new owner didn't comply with existing orders.

Also, the report said health service assistants appeared to be ineffective in some cases and may have delayed the decline of one child's blood lead level.

"No single environmental investigation file reviewed by DHS was complete and able to fully support the actions and decisions of the MHD investigators," the report said in its summary.

Murphy said he was frustrated things don't seem to be improving at the beleaguered agency.

"Now the question is, since the report by the Health Department was just issued in January, have the recommendations of that report and findings been followed up upon ... and unfortunately I don’t think they have," Murphy said. “Progress has not been to the level that you would want to see as it relates to the health care of these children.”