I. Study Authority

During the 1993 Session, Senate Joint Resolution 245, patroned by Senator Elliot S. Schewel, established a nine-member joint subcommittee to study abatement of lead-based paint. Consisting of one Senate member, two members of the House of Delegates, one contractor currently engaged in lead-based paint abatement, one owner of rental property, the State Health Commissioner, the Director of the Department of Professional and Occupational Regulation (formerly, the Department of Commerce), the Commissioner of Labor and Industry, and the Director of the Department of Housing and Community Development, the joint subcommittee was charged with examining policy and planning issues related to such abatement, including prevention of lead exposure; public awareness of the risks of lead exposure and the need for abatement; appropriate training and demonstration of competency in proper lead abatement; and the licensure or certification of various groups, such as contractors, inspectors, project designers, and workers, to ensure the suitable application of work standards in lead abatement.

The joint subcommittee was directed to consult with the American Industrial Hygiene Association, the Virginia Pediatric Society, universities, public health professionals, environmental health consultants, lead-abatement workers, and laboratories performing lead analyses.

Senator Benjamin J. Lambert III served as chairman and Delegate Alan E. Mayer served as vice chairman. Others appointed to serve were Delegate William C. Mims, Mr. Steven C. Cochran, and Ms. Willette Joyner. Serving ex officio were Dr. Robert B. Stroube, Commissioner of Health, Ms. Bonnie S. Salzman, Director of the Department of Professional and Occupational Regulation, Ms. Carol Amato, Commissioner of Labor and Industry, and Mr. Neal J. Barber, Director of the Department of Housing and Community Development.

II. Lead Poisoning: A Big Problem for Little People

Recently, the Centers for Disease Control reported that an estimated "3 million children in the United States have lead concentrations above the danger level of 10 micrograms per deciliter of blood." The Agency for Toxic Substances and Disease Registry reported much higher estimates: 10 million children have blood levels of 15 micrograms of lead per deciliter of blood. The seriousness of these reports must be considered in conjunction with the fact that peeling, chipped or flaking paint is the most common lead-poisoning source. Lead can be ingested or inhaled in or around the home, school, day care center, or other facility from various sources, for example, tap water, ceramic dishes, or even the soil in the yard or playground.

As noted in SJR 245 of 1993, ingestion or inhalation of lead can cause severe symptoms, including headaches, anemia, abdominal pain, loss of appetite, loss of weight, stupor, convulsions, vomiting, and coma. However, symptoms may be absent or unobserved, or may mimic other illnesses, such as colic, flu, or intestinal disorders. When no symptoms are initially observed, such conditions as growth suppression, hearing disorders, speech and language delays, learning disabilities, and behavior problems may result and yet not become apparent until school entrance. Very young children may appear excessively irritable -- crying, fussing, and unfocused. But very young children can exhibit these symptoms under normal conditions. Although the symptoms can be unpleasant and serious, these manifestations are inconsequential as compared with the potential long-term effects of lead poisoning -- mental retardation, cerebral palsy, brain abnormalities, kidney damage, and, in severe cases, death.

Over the years, studies have demonstrated various findings in terms of estimated poisoning cases, blood levels considered dangerous, and the reversibility or irreversibility of the lead poisoning effects. Because young children habitually stick things in their mouths, they may ingest lead while the adults around them do not. Further, since children and developing fetuses are growing fast, lead is absorbed and metabolized rapidly, with permanent brain damage frequently resulting.

Although children are particularly susceptible to lead poisoning, all individuals can be affected. Again, lead-poisoning symptoms may mimic the symptoms of flu or various intestinal conditions and the poisoning can go undiagnosed or can be misdiagnosed. Therefore, months or years after the poisoning, the resulting learning disabilities, behavioral problems, growth slowness, cognitive disabilities, etc., may be shockingly traced to the undetected lead poisoning.

Children with lead poisoning have been reported to have high incidences of reading disabilities and behavioral problems and to fail in school seven times more often than other children. Although estimates of exposures among children are high throughout the general population (EPA estimates are one out of six children), among inner city children who may live in old, deteriorating structures, the estimates are horrendous, with one out of two children exposed.

Blood-level testing is the only sure way of detecting lead poisoning. The American Academy of Pediatrics has recommended testing of babies at nine to twelve months and at two years old. Earlier and more frequent testing is recommended for children living in old houses, i.e., any house built before 1980. Although the effects of lead poisoning are, in many cases, permanent and irreversible, a recent study published in the Journal of the American Medical Association found that moderately lead-poisoned children improved scores on intelligence tests following reduction of blood-lead levels.

III. Treatment and Prevention

The tragedy of lead poisoning is even more devastating because it is preventable. Further, treatment does not appear to be highly developed. Treatment is accomplished through a painful process called chelation (injections of compounds which will, hopefully, cleanse the body of the lead). Individuals may, however, prevent lead poisoning by such activities as:

• Routine blood-lead testing for children (not the older and less accurate test called FEP).
• Testing of paint, water, and yard soil.
• Flushing of tap water.
• Carefully controlled renovations of older homes (or any home).
• Cleaning of lead-contaminated areas with high-phosphate solutions, not by vacuuming.
• Good health habits, such as washing hands, not putting things in the mouth, storing food properly, and eating nutritious meals that are high in calcium and iron -- elements which help prevent lead poisoning by limiting absorption.

Over the last several decades, governmental prevention actions have served to decrease the overall lead exposure in the United States. In 1978, lead-based paints were banned by the federal government. However, among houses built before 1980, 75 percent have been decorated with leaded paint. There does not appear to be any pattern, with all levels and kinds of housing likely to be affected.

In 1992, the Residential Lead-Based Paint Hazard Reduction Act was passed by Congress. This act, which amended Title X of the Housing and Community Development Act, includes inspection, control and abatement guidelines, and training regulations for lead-hazard related activities. In 1993, this act was funded. For states, the important provisions of the Act relate to training, certification, and accreditation programs. The Department of Housing and Urban Development grant programs that were funded by Congress in 1993 are conditioned on state laws addressing these matters, i.e., training and certification (or other regulation) of lead contractors and workers and implementation of lead-poisoning prevention programs.

IV. Joint Subcommittee Findings

The joint subcommittee found that Virginia's public agencies have already taken steps to alleviate lead poisoning, using federal grant money and shared resources. The Department of Health applied for and received a five-year grant of $2.3 million to expand its lead poisoning prevention activities in 1992, funded through the Centers for Disease Control under the Community-Based Childhood Lead Poisoning Prevention Program. On July 1, 1993) the Board of Health declared childhood lead poisoning a reportable disease in Virginia.

Through the CDC grant, screening and health education activities are being conducted, with five localities identified for assistance because of significant lead problems, i.e., Lynchburg, Norfolk, Petersburg, Portsmouth, and Richmond. Other areas have been identified as having a moderate risk for childhood lead poisoning, i.e., Accomac County, Alexandria, Arlington County, Danville, Hampton, Lee County, Newport News, Pittsylvania County, Roanoke, and Suffolk. Department of Health activities focused on lead-poisoning prevention, e.g., revised protocols for lead screening, case management, and hazard reduction, are being implemented by all local health departments. No treatment or abatement activities may, however, be supported through the CDC grant funds.

The subcommittee learned that the need for lead-poisoning prevention is great in Virginia. For example, the Department of Health estimates that almost half of Virginia's children under the age of six or approximately 283,951 children are at risk for lead poisoning (i.e., blood lead levels of 10 ug/dL or greater). Testimony indicated that 10 to 12 percent of the total population may be lead poisoned and that, in older areas, the lead-poisoning incidence may be as great as 40 to 50 percent. According to the Department of Housing and Community Development, 34,374 Virginia homes are estimated to have peeling leaded paint. The Comprehensive Housing Affordability Strategy (developed by the Department of Housing and Community Development) indicates that, based solely on age, as many as 787,158 housing units in the Commonwealth may have been painted with leaded paint and may, therefore, present lead-based paint hazards.

The joint subcommittee also noted that the Department of Housing and Community Development has applied for a three-year Lead Safe Homes Demonstration Program grant. As part of the grant activities, the Department plans to develop a flexible lead-based paint hazard identification and abatement protocol for inclusion in current housing rehabilitation programs and for addressing housing units identified by local health officials through the lead-poisoning education and screening program. The grant will afford the opportunity to evaluate the effectiveness of various abatement methods in terms of costs and efficiency of lead removal. In addition, the demonstration grant will fund the development, within the Virginia Department of Professional and Occupational Regulation, of a regulatory program for the training and credentialing of lead-abatement contractors, inspectors, and workers and expansion of community and household education concerning lead hazards, with emphasis on households where young children and identified lead hazards are present.

The Department of Housing and Community Development also plans to review and revise the relevant section of the State Building Code to update provisions on lead-based paint hazards. Because grant funds are conditioned on the development and implementation of a lead-abatement certification program, the enactment of state law authorizing the certification program's development became essential.

Pursuant to Residential Lead-Based Paint Hazard Reduction Act of 1992, the Environmental Protection Agency, the Federal Occupational Safety and Health Administration, and the federal Secretary of Health and Human Services must promulgate regulations on lead-based paint activities, such as training and certification of individuals engaged in lead-based paint work, approval and accreditation of training programs, encouragement of states' reciprocity, and a model accreditation program for state administration.

Upon receiving testimony concerning the status of lead poisoning among Virginia's children, the number of houses with peeling leaded paint, and the costs of lead-paint abatement, the joint subcommittee expressed its concern about the scope of the lead problem in Virginia and the need for long-term efforts to remediate lead-poisoning hazards and to prevent lead poisoning, particularly among young children. The only real lead-poisoning cure, the joint subcommittee concluded, is to prevent lead exposure. This can only be accomplished through multi-agency, cooperative, coordinated efforts and sharing of resources. Clearly, the funding currently available will not be sufficient to remove all lead from residential housing in Virginia.

The joint subcommittee noted, with gratitude, that the medical community has been cooperating in treating lead-poisoned children. Anecdotal reports suggest, however, that some individuals may dismiss the notion of lead poisoning among children of high-income parents, perhaps because of the high incidence of lead poisoning among children living in poverty and a lack of understanding that lead hazards may be present in the environment of any child living in an old house, regardless of economic status. Therefore, the current recommendations of the American Academy of Pediatrics must be implemented to prevent lead poisoning, i.e., that, in order to detect high blood-lead levels and take steps to prevent permanent lead-poisoning effects, testing be conducted of all babies at nine to twelve months and at two years, and that children at risk of lead poisoning, (living in houses built before 1980) be tested earlier and more often. All parents must also be educated to understand the dangers of lead poisoning, to recognize symptoms and at-risk conditions, and to be wise consumers of lead-abatement services.

V. Joint Subcommittee Recommendations

After consideration and discussion of the above findings, the joint subcommittee approved the following three recommendations:

1. That legislation enabling the development and implementation of a lead-abatement training and certification program within the Department of Professional and Occupational Regulation be introduced and approved during the 1994 Session of the General Assembly.

2. That the work of the joint subcommittee be continued in order to monitor and encourage lead-abatement efforts.

3. That the Commonwealth's pediatricians and other health professionals be requested to implement the recommendations of the American Academy of Pediatrics for preventing and detecting lead poisoning among children.