Staying Ahead of the Curve

BY: DARRYL HOLLIDAY

We will spend whatever it takes. Whatever that cost is, we will pay it.”

Those were the words of Chicago Public Schools CEO Forrest Claypool at a community event in June, just as CPS began testing its more than 6,000 sinks and faucets for lead-contaminated water.

Anna Espinosa, 38, was in the audience that night. School officials had planned for a crowd at the Back of the Yards high school gym, fully expanding the orange bleachers toward the middle of the basketball court where a table was reserved for CPS, Department of Water Management, and Department of Public Health officials. But only a handful of parents, teachers, experts, and reporters showed up, so the attendees were relocated to a dozen chairs around the table.

Darryl Holliday

Claypool was soon peppered with questions.

”Why weren’t the meetings publicized widely?” one attendee asked.

“They were,” Claypool replied.

“Why did you wait to test until the media started investigating?” another asked.

“CPS launched this program, not the press,” Claypool said, bristling slightly at the insinuation.

And the exposure risks for CPS students from school fixtures? “Basically non-detectable,” Claypool assured those gathered on the court.

But the newly launched water testing was only one reason Espinosa attended the meeting that day. At the age of four, her autistic seventeen-year-old son had already been poisoned by lead in the family’s last home, she said, later telling reporters that the CPS officials she had just listened to were “full of it.”

Instead, Espinosa wanted to know what CPS would do for her son in his last years at Thomas Kelly High School. In other words, how does Chicago’s public school system plan to help students who were poisoned by lead as children and are now suffering the effects as young adults?

Darryl Holliday

While CPS works to find and eliminate lead-contaminated fixtures in its buildings, students who arrive at school already exposed to lead still have limited options for treatment. Though the city imposes mandatory lead screenings on children before they turn six years old, a review of departmental policy shows that CPS has no official or comprehensive policy on how to assess and assist lead-affected children. Considering the symptoms and their effects—ranging from low grades to violent behavior—and compounded by budget cuts, the public health crisis of lead poisoning extends beyond today’s water fountains. What schools do and do not provide to children affected by lead will shape the futures of thousands of young Chicagoans.

An Invisible Legacy

The symptoms of lead poisoning include a range of seemingly unrelated ailments like abdominal pain, constipation, sleep problems, headaches, loss of appetite, and memory loss. Many are relatively mild and can be individually overlooked, but, in the case of lead poisoning, could pave the way for a myriad of lifelong effects including irreversible brain damage, aggressive behavior, lowered IQ, growth delays, and poor grades. Recent reports even link childhood lead exposure with trends in violent crime.

“Those [effects] happen even at low levels of lead poisoning. So these kids get poisoned before [age] 5, and they get to school already with learning disabilities,” says Howard Ehrman, an environmental advocate, University of Illinois at Chicago professor and former top official at the Chicago Department of Public Health. “One of the problems we have, not only with lead poisoning but all possible learning disabilities, is the fact that CPS and most public schools have never funded or made it a priority for enough people to do proper testing and then put the children, based on the Americans with Disabilities Act, into the right programs to treat their learning disability.”

Symptoms of lead poisoning often do not become apparent until a child has difficulty in school. And while those effects are often translated as bad behavior and underperformance, in a time of citywide cuts and changes to school budgets, which critics say could shrink special education funds, the impact of untreated lead poisoning raises tough questions for communities already facing disastrous levels of unemployment, incarceration, and public school closures.

In 1999, Fuller Park was the community area with the highest incidence of elevated blood lead levels among children tested, with nearly two in five kids testing positive. By 2013, only 2.8 percent of kids tested there had elevated levels. The dramatic decrease can be tied to a number of factors including disuse of leaded gasoline, an increase in lead screenings, and cleanup of lead paint in homes. But lead is an “absolute neurotoxin,” according to Ehrman, meaning that babies affected in 1999—now high school students—are likely impacted by the exposure even today.

Among those students is Espinosa’s seventeen-year-old son, Moises, who was tested in 2005 and had a lead count of 4.9 micrograms per deciliter, Espinosa says, adding that she believes it was higher in the years before. She says he was likely exposed to lead-based paint in their home, which is how most children accidentally consume lead. But small amounts of lead can accumulate in the body from many different sources.

The family’s Back of the Yards neighborhood, where the CPS community meeting took place in June, is part of the New City community area. In 2013, 1.4 percent of children (ages zero to six) tested in New City had elevated blood lead levels, putting the neighborhood fifteenth among Chicago’s seventy-seven community areas. Espinosa’s son attended schools in McKinley Park, Brighton Park, and Pilsen during that same time frame, some of which had sinks or water fountains with lead-contaminated water during this year’s tests.

“I couldn’t believe there was lead in my school [Perez Elementary], where I had grown up, and that there was lead in Pilsen Academy where [my children] went also,” she says.

Moises was diagnosed with autism at fifteen years old, and though scientists have not found a causal link between the toxin and autism, childhood lead poisoning has many of the same symptoms as Autistic Spectrum Disorder—and it has been found to contribute to autism severity in lead-poisoned children.

Espinosa’s message for parents today: “Keep insisting on getting the resources.

“There’s more resources out there to know where the lead is coming from, how they’re getting it, where you could go get more info, [and] how you could get more help,” she says.

CPS is scheduled to complete testing of 526 schools by the end of 2016, according to district spokesperson Emily Bittner, who noted that final results from all tested schools will be complete in early 2017. As of December 5, ninety-five school drinking fountains and eighty-nine sinks—thirty-two of which were in kitchens—tested above the EPA “action level” of fifteen parts per billion. Of the 184 fixtures above that level, all were shut down and more than 120 have been returned to service after pipes were flushed, repaired, capped, or replaced, according to school officials. The Chicago Park District went through a similar process this summer.

For many parents and city officials, the full array of park and school tests was worth applauding.

“I have to commend the Park District and CPS for being so aggressive and testing the faucets and the sinks within their buildings and outside,” says Chicago Department of Public Health commissioner Julie Morita. “I think it’s an extra step to ensure the safety of the water.” She added that CPDH is currently working with CPS to mail letters, informational packets, and the results of tests in their schools to parents.

“What we’ve said is that the risk is low and yet if people want to be tested, they should reach out to their health care providers,” she says.

As of December, CPS has spent $1.9 million and anticipates spending about $2.3 million total for the first-ever system-wide lead testing of school water fixtures, but when it comes to the root cause of lead, Ehrman says the city will continue to see cases of exposure until it removes the lead service pipes and fixtures that bring water into schools and homes around Chicago.

Leading the Way

Cuffe Academy kindergarten teacher Jeanine Saflarski says she’s happy with how the lead-affected water fixture in her kindergarten classroom was capped and fixed by CPS.

Of the 141 of fixtures tested at Cuffe in August, three tested positive for lead. Two sink faucets, both in pre-K classrooms, tested between twenty-six and twenty-nine parts per billion, significantly higher than the EPA’s “action level” of fifteen parts per billion. According to Bittner, the third fixture tested below that level and was flushed along with all other water fixtures in the district.

But zoom out further and a more concerning picture emerges. In 2013, 7.6 percent of children tested from the Auburn Gresham neighborhood, where Cuffe is located, had elevated blood lead levels, ranking ninth out of Chicago’s seventy-seven community areas. Though experts say Saflarski is unlikely to encounter a severely lead-affected child in her kindergarten classroom today, many of the thirteen-year-olds graduating from Cuffe’s eighth grade this year were born during a time when nearly twenty-one percent—more than one in five—of Auburn Gresham children under the age of six who were tested had elevated blood lead levels.

Saflarski says a teacher is trained to notice the smallest, earliest signs of a learning disability. “You do everything you can in the classroom to try to meet modifications and needs,” she says, adding that teachers have protocols in place for kids in need of special assistance such as speech and occupational therapy. The school system even gives teachers lists of children with medical needs like food allergies, she says, which is not the case for lead.

But even if parents were to disclose their children’s lead poisoning, there is no official protocol for what teachers should do. Younger children may be eligible for the state’s Early Intervention Program, but according to a 2012 report from the Centers for Disease Control and Prevention, “lead exerts long-lasting effects and the effect of lead on a child may not be demonstrable until the child is well into the elementary school years.” The CDC report lists research-backed recommendations for lead-affected people from infancy to the age of twenty-one, including specialized counseling to help with aggressive behavior, nutritional programs, chelation therapy in severe cases to decrease lead content in the blood, and individualized plans that identify, monitor, and assist children who have learning disabilities.

“I think it’s terribly concerning that CPS doesn’t have a policy,” Ehrman says. “The policy should include, number one, a memorandum of understanding, a formal agreement, between CDPH and CPS signed off by the mayor of the city of Chicago saying there will be integration of databases,” so that city agencies can share information to identify and help children affected by lead.

Many lead-safe schools recommendations are agreed upon by lead experts, and while CPS does not formally address any of these recommendations in its policies, the district “uses a process called MTSS (Multi-Tiered System of Supports) to identify any students with potential special needs,” according to Bittner.

But a comprehensive school policy on lead is not unheard of. The Connecticut State Department of Education, for example, has published policies designed “to clarify the role of schools in meeting the needs of children and families affected by lead.”

In fact, “developing school district policy and procedures regarding children who may be affected by lead” is first on a list of ten distinct ways schools can better serve lead-poisoned youth, according to the department’s website. Other points include educating school personnel, maintaining special-education resources, development of monitoring plans, and referral of lead-poisoned students to enrichment and eligible disability programs.

Likewise, school districts in Boston; Rochester, NY; and Columbus, OH all have posted, or are in the process of creating, policies for school-based lead safety. According to the University of California’s Lead-Safe Schools Guide, benefits of a policy include avoidance of unnecessary costs, open communication with parents, better-trained school employees, and evaluation of what works on a local level.

In Flint, MI, a class-action legal battle is currently underway alleging the local public school system is not providing services and interventions that could make a difference in the ability of lead poisoned youth to succeed.

“Since the full magnitude of this crisis became public in 2015, there have been federal and state inquiries, investigations, task forces, declarations, and appropriations. Yet there has been no effective response to address the needs of the thousands of children who attend Flint’s public schools,” the lawsuit alleges on behalf of fifteen children who were exposed to lead in Flint.

Espinosa, along with many other CPS parents, is worried about the same thing. If no cost is too high for the district to find and repair lead-contaminated sinks and drinking fountains in the schools, what about the costs of ensuring lead-poisoned children get the care they need?

This article was published in collaboration with the South Side Weekly. Additional reporting by Timna Axel and Enrique Perez. 

Paths to Contamination

BY: TIMNA AXEL AND ENRIQUE PEREZ

Lead, a soft and naturally occurring metal, is one of the best-studied toxic substances known to humans—it is especially harmful to the brain, kidneys, bone marrow, and other body systems of young children. Childhood lead poisoning has been dramatically reduced over the past few decades, as lead has been phased out from gasoline, food and beverage cans, house paint, and other common sources. In 1978, there were about 14.8 million poisoned children in the United States; by the early 1990s, that number had declined to 890,000 children. In Chicago, the rates of elevated blood levels in children have decreased from one in four to fewer than one in one hundred children tested.

Still, the Centers for Disease Control and Prevention in 2015 found close to 1,000 children in Cook County with elevated blood levels. Many more children likely go uncounted because their results fall under the CDC’s “reference level” of five micrograms of lead per deciliter of blood, but the reality is that any lead in the body can be dangerous.

Read on to follow two different paths to lead exposure that have been identified in the city, and how families and children are affected by the poison.

Paint in Homes

In 1978, the federal government banned the consumer use of lead-based paint, but more than 75 percent of houses and apartments in Chicago were built before 1970, according to the Metropolitan Agency for Planning, and the city itself estimates that a third of its housing stock has lead hazards in its paint or soil. Four to five times more children in Chicago are affected by lead poisoning in houses built before 1950 than in other cities, according to civil and environmental engineer Marc Edwards, who presented the information to the Centers for Disease Control and Prevention in 2010.

In most Chicago homes, deteriorating lead-based paint is the main issue as it chips and becomes dust, prominently gathering in areas like windows, porches, doors, and doorframes that are easily accessible to children. Paint dust was likely the culprit when Yasmine McCray was diagnosed with lead poisoning at two-and-a-half years old, says her mother Mary McCray. Yasmine had a blood lead level of eleven micrograms per deciliter, just above the level at which the Chicago Department of Public Health must be notified so that it can investigate possible lead hazards in the home.

Provisions are in place to make sure residents know about lead hazards when they move in: A lead disclosure form, which should be given whenever a residence is leased out or sold, should detail the location of the lead-based paint and the condition of the painted surfaces. Home buyers are also allowed ten days to conduct a paint inspection or risk assessment for lead-based paint hazards before they buy. But those regulations are hard to enforce, and often require buyers and renters to be discerning in a situation where they might not have much choice.

In the McCrays’ case, after Yasmine’s blood results came back, a CPDH inspector was sent to their home in Hyde Park. The inspector found old paint peeling on the walls, which were then scraped and repainted. Even so, the McCray family soon moved to Auburn Gresham. But the damage was already done: when McCray noticed that her daughter’s behavior had become overly hyper, a doctor drew the connection to lead exposure, she says.

Critics say that the city’s lead policies are reactive, not proactive. Inspections only take place if the owner or tenant requests them or if a child has high blood-lead levels and CPDH is alerted, as in the McCrays’ case. And children don’t get tested regularly for lead.

“The only two mandates for getting tested that I know of are: [Medicaid] has a mandate—I’m not sure how strictly it’s followed—and for entering the Chicago Public Schools system you’re supposed to have a blood lead test on file,” says Eric Potash, a lecturer at the University of Chicago’s Harris School of Public Policy. “But I also don’t know how rigorous that testing is. The big caveat with the CPS mandate is that most people don’t enter CPS until they’re five or six [years old] and then it’s way too late.”

The city has limited resources when it comes to lead inspection, says David Jacobs, an adjunct associate professor at the University of Illinois at Chicago School of Public Health.

“The Chicago Department of Public Health has ten [lead] inspectors, which is ridiculously low considering the number of units. It is estimated that there are 5,000 to 10,000 units with lead hazards in Chicago,” he says. A department spokesperson says it conducts between 800 and 1,000 home inspections every year.

Another factor is an ongoing change in public housing. As cities like Chicago have torn down housing projects and moved toward Section 8 vouchers over the past twenty-five years, low-income families have become more at risk. Public housing units were inspected regularly for lead due to federal oversight, but Section 8 housing is not held to the same standards, says Howard Ehrman, a doctor and environmental activist who was a former top official in the Department of Public Health.

With limited city resources, researchers are looking for ways to predict when and where children are at risk for lead poisoning, in order to concentrate efforts on the hardest-hit communities. Potash is working with graduate students to build a predictive model based on data, such as building inspections for lead hazards, locations where children have been poisoned by lead in the last twenty years, rates of renting and homeownership, and whether or not people in a neighborhood have health insurance.

Potash says his model can predict households that likely contain lead hazards and have children younger than one year old. They are now running a pilot outreach program, partnering with the CDPH, landlords, and other agencies (including integrating with electronic medical record systems) to alert at-risk households and provide inspection information and remediation services.

“The CDPH only has resources to help a couple thousand kids each year,” says Potash. “By using the model to target the resources, you dramatically improve the efficiency and effectiveness by something like three times that much. You could potentially help three times as many kids.”

Water in Parks

This October, Chicago Park District officials announced that all of its drinking fountains and sinks had been tested for lead. The results: at least one fixture in forty-four percent of the District’s parks had lead levels that matched or exceeded fifteen parts per billion, the action level set by the Environmental Protection Agency at which water systems are required to step up their corrosion control or replace pipes. Specifically, fourteen of 544 indoor fixtures and 445 of 1,891 outdoor fountains tested above this level and were immediately turned off.

While contaminated fountains were found in parks throughout the city, certain neighborhoods like Auburn Gresham, where every park contained fixtures with elevated lead levels, were especially hard-hit.

This was news to McCray, who moved away from her lead-contaminated Hyde Park home to Auburn Gresham, and whose kids had been playing on the jungle gym at Foster Park. Three of the park’s outdoor fountains had elevated lead levels, testing showed. At Mahalia Jackson Park, about 1.5 miles away, both drinking fountains had elevated levels of lead, with one testing at 361 parts per billion. Two other Auburn Gresham parks, Dawes Park and O’Hallaren Park, also had contaminated fixtures.

Yasmine’s pediatrician didn’t recommend any medical treatment for the lead in her blood, but she has been tested every year since her diagnosis. McCray says her lead level has decreased over time, and she is now ahead of her class at school. Still, she worries about her kids drinking lead-contaminated water at the parks: “What if they get lead from the sprinklers?” she says.

While most studies show that exposure to lead-contaminated water is not likely by itself to elevate blood lead levels in most adults, there is a danger to infants and pregnant women who may be using the water. Pregnant women especially are at “the most sensitive time” for lead poisoning from water, says Helen Binns, a pediatrician who directs the lead evaluation program at Lurie Children’s Hospital of Chicago.

Fountains that the Park District did not shut off may be dangerous even if they didn’t exceed the EPA’s “action level,” Binns says. She and other lead experts agree that the EPA level is meant to be an engineering marker, and that no level of lead is safe inside the human body. “The fifteen parts per billion of lead in water is not a health-based standard. We would prefer that it be two, or something really low,” Binns says.

There is no federal regulation requiring water testing for park facilities. Nevertheless, a few U.S. cities have conducted similar tests of parks and other public facilities, including Portland, OR, and Ithaca, NY, both announced around the same time this summer.

The Park District has not yet identified why so many of its water fixtures have elevated lead levels, and the situation could get worse in the winter when all fixtures are turned off—unused fixtures are more likely to have contaminated water, which is why health departments recommend people regularly flush their pipes. Still, city officials emphasize that the results show no system-wide contamination.

“If it were because of the water that was coming through the pipes themselves, we would expect all of the faucets within a school or a park to be affected,” says Dr. Julie Morita, commissioner of the Chicago Department of Public Health.

As of late November, Jessica Maxey-Faulkner, spokeswoman for the Park District, could not provide details about whether the district is working with Department of Public Health or Water Management officials to determine how to prevent future lead contamination at the water fountains. The Chicago Park District is still investigating the cause of the contaminated fountains, Maxey-Faulkner says.