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          2  CITY COUNCIL

 

          3

             CITY OF NEW YORK

          4  -------------------------------x

 

          5  THE TRANSCRIPT OF THE MINUTES

 

          6            of the

 

          7  COMMITTEE ON HOUSING And BUILDINGS

 

          8  -------------------------------x

                            September 12, 2003

          9                 Start:  10:07 a.m.

                            Recess: 3:25 p.m.

         10

                            City Hall

         11                 Council Chambers

                            New York, New York

         12

 

         13       B E F O R E:

 

         14              MADELINE PROVENZANO

                                           Chairperson,

         15

 

         16              COUNCIL MEMBERS:   Joel Rivera

                                            Tony Avella

         17                                 Gale Brewer

                                            Leroy Comrie

         18                                 Simcha Fidler

                                            Robert Jackson

         19                                 Melinda Katz

                                            Kendall Stewart

         20                                 James Oddo

                                            Charles Barron

         21                                 Bill Perkins

                                            Christine Quinn

         22                                 David Weprin

                                            Speaker Miller

         23

 

         24       LEGAL-EASE COURT REPORTING SERVICES, INC.

                         17 Battery Place -  Suite 1308

         25              New York, New York 10004

                              (800) 756-3410

 

 

 

 

 

 


 

                                                            2

 

 

          1

 

          2  A P P E A R A N C E S

 

          3

             Mary Jean Brown, ScD, RN

          4  Chief, Lead Poisoning Prevention Branch

             Centers for Disease Control and Prevention

          5

             Bruce P. Lanphea, M.D., M.P.H.

          6  Cincinnati Children's Hospital Medical Center

 

          7  Susan Klitzman, DrPH

             Associate Professor, Environmental and Occupational

          8  Health Sciences

             Hunter College, City University of New York

          9

             Martin Benitez

         10

             Janet Sanchez

         11

             Enrique Modesta

         12

             Adrian Rodriguez

         13

             John McCarthy

         14  Community Preservation Corporation

 

         15  Michael McGuire

             Mason Tenders' District Council

         16

             Michael McKee

         17  NYS Tenants And Neighbors Coalition

 

         18  Darryl Ramsey

             President

         19  Local 768

 

         20  Joel Shufro, Ph.D

             Executive Director

         21  New York Committee for Occupational

             Safety and Health

         22

             Public Advocate Betsy Gotbaum

         23

             Helen Daniels

         24  Black and Latino Property Owners

 

         25

 

 

 

 

 

 

 


 

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          1

 

          2  A P P E A R A N C E S (CONTINUED)

 

          3

             Martin Benitez

          4

             Jeannette Sanchez

          5

             Enriques Modesto

          6

             Andrea Rodriguez

          7  Northern Manhattan Improvement Corp

 

          8  Frank Ricci

             Rent Stabilization Association

          9

             Mitchell Pasilikin

         10  General Counsel

             Rent Stabilization Association

         11

             Manuel Castro

         12  Make the Road By Walking

 

         13  Jedidah Baptiste

 

         14  Christina Brito

 

         15  Michael McKee

             NYS Tenants and Neighbors Coalition

         16

             Michelle Alvarez

         17  Natural Resources Defense Council

 

         18  Eddy Dixon

 

         19  Camile Rivera

 

         20  Chris Rembold

             Sierra Club

         21

             Mark Caserta

         22  New York League of Conservation Voters

 

         23  Adriene Holder, Esq.

             The Legal Aid Society

         24

             Matthew Chachere

         25  NYCCELP

 

 

 

 

 

 

 


 

                                                            4

 

 

          1

 

          2  A P P E A R A N C E S (CONTINUED)

 

          3

             Irene Shen

          4  New York City Environmental Justice Alliance

 

          5  Cordell Cleare

 

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                                                            5

 

 

          1  COMMITTEE ON HOUSING AND BUILDINGS

 

          2                 CHAIRPERSON PROVENZANO:  Good

 

          3  morning. My name is Chairwoman Madeline Provenzano,

 

          4  I chair the Committee on Housing and Buildings. I

 

          5  would like to thank all of you for attending this

 

          6  hearing. This is a continuation of the last recessed

 

          7  hearing on proposed Intro. No. 101-A. The hearing

 

          8  was held on June 23rd. There's a sound problem.

 

          9                 Is this one working? Okay, let's get

 

         10  on with it.

 

         11                 Okay, as you know, we're continuing

 

         12  our deliberations on proposed Intro. No. 101-A, in

 

         13  relation to childhood lead poisoning prevention. We

 

         14  are once again expecting that this hearing will draw

 

         15  a large crowd of potential witnesses and observers.

 

         16  Please be mindful of any time constraints that are

 

         17  imposed and please be considerate of your fellow

 

         18  colleagues and of one another in general.

 

         19                 In order to move things along quickly

 

         20  and smoothly, all witnesses have been asked to be

 

         21  concise and to stay focused on the bill. I also

 

         22  reiterate my request that only one spokesperson

 

         23  testify from each group or organization.

 

         24                 Again, this could be a very emotional

 

         25  hearing, but I expect that it will be conducted in a

 

 

 

 

 

 

 


 

                                                            6

 

 

          1  COMMITTEE ON HOUSING AND BUILDINGS

 

          2  dignified manner. You may not agree with all of the

 

          3  comments made, but please allow everyone to testify

 

          4  without boos or heckling. The first part of this

 

          5  hearing on June 23rd went very well. It also went

 

          6  seven hours. I commended all participants on their

 

          7  patience and their courtesy, and, again, some of you

 

          8  that were here were here at the first hearing, and I

 

          9  again commend all of you and ask that you extend the

 

         10  same courtesy to others that you expect.

 

         11                 Today the Committee expects to hear

 

         12  from Dr. Mary Jean Brown from the Centers for

 

         13  Disease Control and Prevention, and from Dr. Bruce

 

         14  Lanphear from Children's Hospital Medical Center in

 

         15  Ohio, as well as from representatives of

 

         16  environmental interests, representatives of the real

 

         17  estate industry, tenants organizations and other

 

         18  interested persons.

 

         19                 Since this is a continuation of the

 

         20  first hearing, anyone who has already testified at

 

         21  the first hearing may not testify again.

 

         22                 We did contact all of those who had

 

         23  signed in at the first hearing and did not get a

 

         24  chance to testify, so they were given the

 

         25  opportunity and most of them will be testifying

 

 

 

 

 

 

 


 

                                                            7

 

 

          1  COMMITTEE ON HOUSING AND BUILDINGS

 

          2  today.

 

          3                 I am joined by the Speaker, and he

 

          4  would like to make a few comments before we begin.

 

          5                 SPEAKER MILLER: Thank you, Madam

 

          6  Chair, and let me thank you in advance for

 

          7  conducting this hearing in a dignified and fair

 

          8  manner, and to let everybody have their viewpoints

 

          9  be heard.

 

         10                 I just wanted to say a few thoughts

 

         11  before the hearing, and mostly I wanted to thank all

 

         12  the advocates on all sides of the issue who I met

 

         13  with over the summer and to look at this issue,

 

         14  which is I think the most pressing issue that the

 

         15  City Council is considering at this time. We need to

 

         16  address the issue of childhood lead poisoning, the

 

         17  terrible scourge upon this City and upon this

 

         18  country, but we have a responsibility to deal with

 

         19  this, not the least because the Court of Appeals has

 

         20  laid that upon us, and because we ultimately have

 

         21  the responsibility as human beings to our children

 

         22  who are being poisoned at unacceptable levels.

 

         23                 And having spent a great deal of time

 

         24  meeting with a lot of people this summer, you know,

 

         25  some important principles that I think are contained

 

 

 

 

 

 

 


 

                                                            8

 

 

          1  COMMITTEE ON HOUSING AND BUILDINGS

 

          2  in this legislation and should be contained in any

 

          3  legislation that is passed by this Council, and I've

 

          4  just spoken with some of you and I wanted to put it

 

          5  on record and in public.

 

          6                 First, I believe that it is

 

          7  absolutely necessary that any effective lead

 

          8  poisoning bill regulates lead dust. It's the main

 

          9  pathway to poisoning and we must treat it as the

 

         10  hazard that it is and for the first time in the

 

         11  City.

 

         12                 But you know, I just think we need to

 

         13  carefully craft it so that with regard to the

 

         14  responsibility of landlords for that lead dust, it

 

         15  is related to conditions that are within their

 

         16  control and in the apartments that are in their

 

         17  responsibility or in the buildings that are their

 

         18  responsibility.

 

         19                 It's also clear to me that Local Law

 

         20  38 was inadequate with regard to the notice and

 

         21  investigation requirements. I don't personally see

 

         22  why it is that we can't treat this issue just the

 

         23  same way that we treat the window guards

 

         24  notification requirements.

 

         25                 In fact, I don't see why we can't

 

 

 

 

 

 

 


 

                                                            9

 

 

          1  COMMITTEE ON HOUSING AND BUILDINGS

 

          2  just add the line. People are already having to do

 

          3  this, whether it's burdensome or not, and I heard

 

          4  different arguments about it, it's already being

 

          5  done, there's really no reason why we can't add a

 

          6  line and then it won't be burdensome at all, it will

 

          7  just be the same requirement that is already there.

 

          8                 I am very concerned about the time

 

          9  frames that were in Local Law 38, and I think we

 

         10  should be reviewing them for determining how to

 

         11  shorten them. I also think that there's a tremendous

 

         12  opportunity to better focus our time frames if we

 

         13  were to require all HPD inspectors to be equipped

 

         14  and trained to use XRF machines, so that an

 

         15  immediate determination can be made whether the

 

         16  deteriorating paint is lead-based paint.

 

         17                 If, as HPD has testified on a number

 

         18  of occasions, 75 percent of the cases in which there

 

         19  is an alleged lead paint -- or a lead paint

 

         20  violation that is issued, turn out in the end to not

 

         21  actually be lead paint deterioration, it seems to me

 

         22  that an enormous amount of time and energy is being

 

         23  wasted on the wrong types of cases and not enough is

 

         24  being focused on the right types of cases, and so it

 

         25  would be more reasonable to require shorter time

 

 

 

 

 

 

 


 

                                                            10

 

 

          1  COMMITTEE ON HOUSING AND BUILDINGS

 

          2  frames, if in three-quarters of the cases we're not

 

          3  going to have a lead paint violation at all because

 

          4  that's not lead paint, and this allows the City and

 

          5  landlords and everyone to focus better on conditions

 

          6  that are actually for certain endangering children.

 

          7                 I also believe that the workers who

 

          8  conduct the clean-up should be properly trained so

 

          9  that they don't exacerbate the problem and protect

 

         10  themselves from harm.

 

         11                 Having spent a lot of time on this

 

         12  issue, and I look forward to the hearing, I still

 

         13  think there are some areas where 101-A could be

 

         14  better focused in terms of dealing with primary

 

         15  prevention.

 

         16                 One simple measure that would be

 

         17  incredibly important would be for DOH, when it

 

         18  identifies a child as being lead poisoned, to be

 

         19  required to check the other apartments in the

 

         20  building, wherever that child is, to see whether or

 

         21  not there are conditions that are endangering other

 

         22  children in that building.

 

         23                 You know, this is critically

 

         24  important, it seems to me, since the likelihood is,

 

         25  and certainly having spent time talking to

 

 

 

 

 

 

 


 

                                                            11

 

 

          1  COMMITTEE ON HOUSING AND BUILDINGS

 

          2  pediatricians and health experts, it often actually

 

          3  is the case that if there is one lead poisoning

 

          4  building there are often going to be others, because

 

          5  if the landlord has allowed the situation to

 

          6  deteriorate in one apartment, there's a good chance

 

          7  they've allowed it to deteriorate in others.

 

          8                 So, I think that it would make sense

 

          9  in legislation to focus on sort of primary

 

         10  prevention on making sure that when we find one

 

         11  case, that we don't wait for the inadequate testing

 

         12  that's going on elsewhere to identify other cases,

 

         13  but that we go out and actually try to prevent them,

 

         14  which also brings me to another point which is I

 

         15  think that more needs to be done to increase testing

 

         16  for elevated blood levels in this City. We do not do

 

         17  a good enough job and some simple things, just

 

         18  requiring the Department of Health to mail a yearly

 

         19  reminder to pediatricians, notifying them of the

 

         20  State law regarding children being blood tested, and

 

         21  also looking at earmarking funds for education and

 

         22  testing in the lead belt area.

 

         23                 So, I think there's a lot of

 

         24  opportunity for this Council to work very

 

         25  thoughtfully and seriously to try to enact

 

 

 

 

 

 

 


 

                                                            12

 

 

          1  COMMITTEE ON HOUSING AND BUILDINGS

 

          2  legislation that will, and succeed in enacting

 

          3  legislation that will protect children.

 

          4                 I look forward to working with all of

 

          5  my colleagues here on the Council, with the

 

          6  advocates on all sides of this issue, and with the

 

          7  Administration as well, to try to make sure that we

 

          8  focus the cost of this bill on protecting children

 

          9  as effectively as humanely possible, and that to

 

         10  enact legislation that will in the end put this City

 

         11  where it belongs, at the front of protecting

 

         12  children from lead poisoning in this country.

 

         13                 So, I thank my colleagues. I

 

         14  apologize for taking the time of everyone before

 

         15  this hearing, and I look forward to hearing the

 

         16  testimony, as much as I can stay for.

 

         17                 Thank you.

 

         18                 CHAIRPERSON PROVENZANO: Thank you,

 

         19  Mr. Speaker.

 

         20                 Before we start I'd like to introduce

 

         21  members of the Committee.

 

         22                 To my left, Council Member Joel

 

         23  Rivera. I'm going to do the Committee first.

 

         24  Councilwoman Melinda Katz; Councilman Tony Avella.

 

         25  To my right, Council Member Robert Jackson. How are

 

 

 

 

 

 

 


 

                                                            13

 

 

          1  COMMITTEE ON HOUSING AND BUILDINGS

 

          2  you? And Councilwoman Gale Brewer.

 

          3                 We also have some of the Council

 

          4  folks here who are not on the Committee but are

 

          5  interested in what's going on. We have Council

 

          6  Member Charles Barron, Council Member Bill Perkins,

 

          7  Councilwoman Christine Quinn, and Chair of our

 

          8  Finance Committee, Councilman David Weprin.

 

          9                 COUNCIL MEMBER PERKINS: Madam Chair,

 

         10  before we begin I'd appreciate your indulgence to

 

         11  make some opening remarks as the prime sponsor of

 

         12  Intro. 101-A.

 

         13                 CHAIRPERSON PROVENZANO: All right.

 

         14                 COUNCIL MEMBER PERKINS: Thank you

 

         15  very much for your graciousness. I appreciate it.

 

         16                 First let me start by extending my

 

         17  appreciations to the Speaker for effectively

 

         18  endorsing 101-A in his opening remarks. It seems as

 

         19  if the research that he has done has shown him that

 

         20  we are on the right track, and I very much

 

         21  appreciate that and I say that in all sincerity, and

 

         22  as he pointed out, look forward to working with him,

 

         23  the Administration, the advocates, et cetera, in

 

         24  making sure that this law is actually passed by this

 

         25  Council.

 

 

 

 

 

 

 


 

                                                            14

 

 

          1  COMMITTEE ON HOUSING AND BUILDINGS

 

          2                 So, it's about time that we are

 

          3  standing up on behalf of the children and their

 

          4  health as opposed to crafting legislation that

 

          5  speaks to the needs simply of the landlords.

 

          6                 Local law was struck down by the

 

          7  State's highest court because the Council failed to

 

          8  comply with the Environmental Quality Review Act.

 

          9                 In their ruling the court admonished

 

         10  the City by stating that the number of lead poisoned

 

         11  children was "alarmingly high," and we know from the

 

         12  testimony of the Administration that over 4,000

 

         13  children continue to be lead poisoned, and 95

 

         14  percent of them are children of color, particularly

 

         15  in the African American, Latino and Asian

 

         16  communities.

 

         17                 So, hopefully today we will come to

 

         18  the end of what has thus far been a public health

 

         19  nightmare, though we are doing this in the Housing

 

         20  Committee, hopefully today we'll begin the end of

 

         21  this nightmare.

 

         22                 Unfortunately, progress has been made

 

         23  on protecting children, but Local Law 38 was clearly

 

         24  a step backwards. Not only did the court deem it

 

         25  invalid, but also was -- blatantly accommodated

 

 

 

 

 

 

 


 

                                                            15

 

 

          1  COMMITTEE ON HOUSING AND BUILDINGS

 

          2  landlords at the expense of the health of our

 

          3  children.

 

          4                 As a result, the problem is still all

 

          5  too prevalent.

 

          6                 We are in a crisis and now we have an

 

          7  opportunity to finally set the record straight,

 

          8  comply with the court's orders and do the right

 

          9  thing for our children.

 

         10                 I look forward to hearing the

 

         11  testimony today and I know that once again the case

 

         12  for Intro. 101-A will be as strong as ever. Thank

 

         13  you very much.

 

         14                 CHAIRPERSON PROVENZANO: Thank you,

 

         15  Councilman Perkins.

 

         16                 Our first testifier will be Mary Jean

 

         17  Brown, from the Center for Disease Control and

 

         18  Prevention. She's the federal rep, and we thank you

 

         19  for coming.

 

         20                 DR. BROWN: Good morning. I'm Dr. Mary

 

         21  Jean Brown. I am the Chief of the Lead Poisoning

 

         22  Prevention Branch at the Centers for Disease Control

 

         23  and Prevention.

 

         24                 I have been involved in childhood

 

         25  lead poisoning and its prevention since 1982. As a

 

 

 

 

 

 

 


 

                                                            16

 

 

          1  COMMITTEE ON HOUSING AND BUILDINGS

 

          2  public health nurse, as an assistant director of the

 

          3  Massachusetts Lead Poisoning Prevention Program and

 

          4  as a scientist. I have a doctoral degree in maternal

 

          5  and child health from the Harvard School Public

 

          6  Health, where until recently, I was on the faculty.

 

          7                 I have conducted applied research and

 

          8  evaluated the effectiveness of housing policies,

 

          9  parental education and other strategies to prevent

 

         10  lead exposure.

 

         11                 I appreciate this opportunity to

 

         12  speak to you today about CDC's role in preventing

 

         13  lead poisoning.

 

         14                 CDC is mandated to support

 

         15  comprehensive programs, to prevent lead poisoning in

 

         16  children. CDC funded state and local programs are

 

         17  part of an interdisciplinary federal effort

 

         18  encompassing programs administered to health and

 

         19  human services, the Department of Housing and Urban

 

         20  Development and the Environmental Protection Agency.

 

         21                 Recently CDC and its state and local

 

         22  partners have begun to shift efforts from solely

 

         23  providing direct services, blood lead testing and

 

         24  case management, to primary prevention of lead

 

         25  poisoning, by taking measures to prevent children

 

 

 

 

 

 

 


 

                                                            17

 

 

          1  COMMITTEE ON HOUSING AND BUILDINGS

 

          2  from being exposed in the first place.

 

          3                 Primary prevention is crucial to our

 

          4  meeting the healthy people 2010 objective of the

 

          5  nation's Blueprint for Action to Improve the

 

          6  Public's Health of eliminating lead poisoning by the

 

          7  end of the decade.

 

          8                 The steady decline in the proportion

 

          9  of US children with elevated blood lead levels

 

         10  between 1980 and 2000 is a true public health

 

         11  success.

 

         12                 The most recent estimates from 1999

 

         13  to 2000 indicate that approximately 434,000 children

 

         14  are 2.2 percent of the United States childhood

 

         15  population less than six years old, has elevated

 

         16  blood lead levels of ten micrograms per deciliter or

 

         17  greater. In New York City in 2000, the estimate was

 

         18  1.9 percent of young children.

 

         19                 However, this improvement has not

 

         20  been realized uniformly across communities, and

 

         21  there remain areas where we know that the risk for

 

         22  lead exposure is disproportionately high.

 

         23                 To eliminate lead poisoning, we must

 

         24  focus efforts to prevent children from being exposed

 

         25  to lead in these areas at highest risk.

 

 

 

 

 

 

 


 

                                                            18

 

 

          1  COMMITTEE ON HOUSING AND BUILDINGS

 

          2                 Blood lead screening is an important

 

          3  element of a comprehensive strategy to eliminating

 

          4  lead poisoning and CDC recommends that screening be

 

          5  targeted to those children who are most at risk.

 

          6  These would be children living in neighborhoods with

 

          7  a high concentration of poverty and old poorly

 

          8  maintained housing, as well as children between the

 

          9  ages of 12 and 36 months.

 

         10                 Blood lead levels tend to be highest

 

         11  in this age group. CDC also recommends screening of

 

         12  children age 36 to 72 months of age who live in

 

         13  high-risk areas, if they not been tested previously

 

         14  or have previously elevating.

 

         15                 As children grow their risk for lead

 

         16  exposure decreases because they have less hand to

 

         17  mouth activity, because their absorption of lead is

 

         18  decreased, and because they spent less time at home.

 

         19  There are a few health benefits to routinely

 

         20  screening children after the age of six, and the

 

         21  Center for Disease Control does not recommend it.

 

         22                 In addition, routine screening of

 

         23  children after six years of age may deflect

 

         24  resources away from children who are most at risk.

 

         25                 In addition to blood lead screening,

 

 

 

 

 

 

 


 

                                                            19

 

 

          1  COMMITTEE ON HOUSING AND BUILDINGS

 

          2  CDC also makes recommendations regarding the medical

 

          3  and environmental follow-up of children identified

 

          4  with elevated blood lead levels. Although lead-based

 

          5  paint was banned from residential use in 1978, it

 

          6  remains the most prevalent source of lead exposure

 

          7  for children in the United States.

 

          8                 Repairing lead paint hazards, such as

 

          9  loose and peeling paint and lead paint on high-risk

 

         10  surfaces, such as windows and doors and other areas

 

         11  where paint is subject to abrasion is crucial to

 

         12  preventing new cases of lead poisoning because these

 

         13  surfaces shed paint and contaminate house dust and

 

         14  soil.

 

         15                 Dust lead levels have a strong and

 

         16  direct association with resident children's blood

 

         17  lead levels, because infants and toddlers come into

 

         18  contact with substantial amounts of lead dust during

 

         19  normal hand-to-mouth behavior.

 

         20                 In order to prevent children from

 

         21  being exposed to this hazard, CDC recommends that

 

         22  dust lead testing be conducted as part of

 

         23  environmental investigations of children with

 

         24  elevated blood lead levels, and for clearance

 

         25  testing following the lead hazard remediation work

 

 

 

 

 

 

 


 

                                                            20

 

 

          1  COMMITTEE ON HOUSING AND BUILDINGS

 

          2  or other work that disturbs lead paint.

 

          3                 However, the value of continued dust

 

          4  testing in homes where paint is intact or where

 

          5  remediation and proper clean up have been conducted,

 

          6  as demonstrated by clearance dust testing, is

 

          7  unclear, and such testing may deflect needed

 

          8  resources from areas where the lead hazards are more

 

          9  immediate.

 

         10                 In addition to dust testing, we must

 

         11  ensure that lead paint removal and repair is

 

         12  conducted safely.

 

         13                 It is essential that all workers who

 

         14  disturb all painted surfaces, including home

 

         15  renovators, be familiar with lead-safe work

 

         16  practices and the clean up of lead paint debris and

 

         17  dust generated by the activity.

 

         18                 Educational efforts should include

 

         19  formal training of lead paint abatement contractors

 

         20  and workers who will be removing large amounts of

 

         21  leaded paint as part of their job.

 

         22                 However, less formal and more

 

         23  widespread education of do-it-your-selfers and

 

         24  handymen is also required to prevent them from

 

         25  unwittingly exposing resident children to lead

 

 

 

 

 

 

 


 

                                                            21

 

 

          1  COMMITTEE ON HOUSING AND BUILDINGS

 

          2  contaminated dust.

 

          3                 The CDC remains committed to

 

          4  supporting state and local efforts to limit

 

          5  children's exposure to lead. This involves

 

          6  maintaining ongoing efforts to screen children at

 

          7  high risk for exposure and provide follow-up

 

          8  services to children with elevated blood lead

 

          9  levels.

 

         10                 Primary prevention of exposure both

 

         11  through education and outreach and control or

 

         12  elimination of lead hazards in those --  I'm sorry.

 

         13  Elimination of lead hazards should first focus on

 

         14  those units where the risk for exposure is known to

 

         15  be highest, such as poorly maintained older housing

 

         16  and in housing where children have repeatedly been

 

         17  identified with elevated blood lead levels. To

 

         18  achieve the national goal of eliminating childhood

 

         19  lead poisoning by 2010, it is absolutely crucial

 

         20  that we focus our resources on those neighborhoods

 

         21  where children are at greatest risk.

 

         22                 Thank you for allowing me to make

 

         23  these comments, and I'm happy to answer any

 

         24  questions.

 

         25                 CHAIRPERSON PROVENZANO: Thank you

 

 

 

 

 

 

 


 

                                                            22

 

 

          1  COMMITTEE ON HOUSING AND BUILDINGS

 

          2  very much. Do we have any questions?

 

          3                 COUNCIL MEMBER BARRON: Yes, I have a

 

          4  question.

 

          5                 CHAIRPERSON PROVENZANO: Okay, Council

 

          6  Member Barron.

 

          7                 I was looking for Committee members,

 

          8  you know, but since there are none. Ut-oh.

 

          9                 COUNCIL MEMBER BARRON: I'll defer to

 

         10  you.

 

         11                 COUNCIL MEMBER JACKSON: Good morning,

 

         12  Doctor. And thank you for coming and giving

 

         13  testimony regarding this very important issue.

 

         14                 I'm a member of the Housing

 

         15  Committee, and I have attended the hearing last June

 

         16  and sat through all of the testimony and

 

         17  subsequently the court decision by the highest court

 

         18  in New York State, the Court of Appeals, rendered a

 

         19  decision that basically threw out Local Law 38, and

 

         20  even though I have not read, but have you seen the

 

         21  New York City Independent Budget Office report

 

         22  concerning --

 

         23                 DR. BROWN: No, I'm sorry.

 

         24                 COUNCIL MEMBER JACKSON: So you can't

 

         25  answer any questions on that then? Not on the

 

 

 

 

 

 

 


 

                                                            23

 

 

          1  COMMITTEE ON HOUSING AND BUILDINGS

 

          2  budget, no. I'm sorry.

 

          3                 Okay. Now, concerning your experience

 

          4  and knowledge about lead dust, it is a given that

 

          5  lead dust is a terrible hazard for young children.

 

          6  Am I correct? Am I wrong?

 

          7                 DR. BROWN: Lead dust is highly --

 

          8  high levels of lead dust are highly associated with

 

          9  high blood lead levels for children.

 

         10                 COUNCIL MEMBER JACKSON: Okay. And,

 

         11  now, in your testimony you referred to, I think

 

         12  it's, and I'm reading from page two, where you

 

         13  indicate that there were 434,000 or 2.2 percent of

 

         14  US children less than six years of age had elevated

 

         15  blood levels of more than 10 -- what do you call it?

 

         16                 DR. BROWN: Micrograms per deciliter.

 

         17                 COUNCIL MEMBER JACKSON: Micrograms

 

         18  per deciliter.

 

         19                 Now, what is the effect of children

 

         20  with less than ten percent? Let's say seven, six,

 

         21  five? What's the effect on that on children's body

 

         22  and brain development? If you have any knowledge on

 

         23  that?

 

         24                 DR. BROWN: In its 1991 statement, the

 

         25  Centers for Disease Control recognized that we have

 

 

 

 

 

 

 


 

                                                            24

 

 

          1  COMMITTEE ON HOUSING AND BUILDINGS

 

          2  not been able to identify a threshold at which

 

          3  adverse health effects in children don't occur. We

 

          4  have not found a threshold below which lead causes

 

          5  no effects.

 

          6                 Right now the Advisory Committee to

 

          7  the Centers for Disease Control on Lead Poisoning

 

          8  Prevention is looking at scientific evidence.

 

          9                 There have been several reports of

 

         10  effects below ten micrograms per deciliter on

 

         11  children, including their educational attainment and

 

         12  intellectual development. This work group is looking

 

         13  at a large number of studies to see if across the

 

         14  studies we can identify these effects, that the

 

         15  Committee will report back to us in October, and at

 

         16  that point we'll begin to have conversation about

 

         17  what policies need to be put in place to address

 

         18  this.

 

         19                 COUNCIL MEMBER JACKSON: The level of

 

         20  ten is a CDC --

 

         21                 DR. BROWN: It is our recommendation

 

         22  at which there should be an intervention for an

 

         23  individual child.

 

         24                 COUNCIL MEMBER JACKSON: And if you

 

         25  have any knowledge about assuming that there was

 

 

 

 

 

 

 


 

                                                            25

 

 

          1  COMMITTEE ON HOUSING AND BUILDINGS

 

          2  Intro. 101 was law right now, and there was strict

 

          3  enforcement of that, in your opinion, would that

 

          4  cost the owners of the buildings and apartments a

 

          5  lot of money, or do you have any value as to whether

 

          6  or not it would be the cost of doing the strict

 

          7  enforcement, if you have an opinion on that?

 

          8                 DR. BROWN: I am not familiar enough

 

          9  with all of the aspects of the law 101-A. I was

 

         10  asked to testify today on CDC.

 

         11                 COUNCIL MEMBER JACKSON: Okay.

 

         12                 DR. BROWN: I can tell you that my own

 

         13  research suggests that allowing children to become

 

         14  repeatedly lead poisoned, particularly in units

 

         15  where we know children have been poisoned in the

 

         16  past, is far more expensive in the longrun and

 

         17  society in general than doing the kinds of clean-up

 

         18  that are generally recommended for these units.

 

         19                 COUNCIL MEMBER JACKSON: Oh. Well, I

 

         20  thank you for your opinion.

 

         21                 DR. BROWN: Thank you.

 

         22                 CHAIRPERSON PROVENZANO: Council

 

         23  Member Barron.

 

         24                 COUNCIL MEMBER BARRON: For the life

 

         25  of me, I really can't understand why children who

 

 

 

 

 

 

 


 

                                                            26

 

 

          1  COMMITTEE ON HOUSING AND BUILDINGS

 

          2  record under ten who you can sit here and say will

 

          3  be adversely damaged, are not included in these

 

          4  numbers. I mean, it just doesn't make any sense to

 

          5  talk about ten, when you know five can create severe

 

          6  brain damage. So, we shouldn't be looking at numbers

 

          7  that ignore the depth and breadth, because once we

 

          8  look at the real impact of lead on children, and

 

          9  then we come to hearings with the true impact, the

 

         10  numbers will increase, the severity of the problem

 

         11  will be clear, and I just don't understand why that

 

         12  is not included in your research and findings and

 

         13  your testimony?

 

         14                 DR. BROWN: I think when we consider

 

         15  the adverse health effects of blood lead levels less

 

         16  than ten, it is important that we also consider very

 

         17  limited benefits. And we have scientific evidence of

 

         18  the very limited benefits from the effectiveness of

 

         19  any strategy that we come up with to lower these

 

         20  blood lead levels.

 

         21                 I am not suggesting that we ignore

 

         22  children at these levels. What I am suggesting is

 

         23  that we get serious about primary prevention and not

 

         24  wait til a child has a blood lead level of five or

 

         25  ten.

 

 

 

 

 

 

 


 

                                                            27

 

 

          1  COMMITTEE ON HOUSING AND BUILDINGS

 

          2                 COUNCIL MEMBER BARRON: Well, I

 

          3  understand all of that. But what do you mean

 

          4  benefits? I mean, when you look at a child who has

 

          5  five, four, three, and the damage it's doing them,

 

          6  they need to be dealt with, and dealt with in a very

 

          7  serious way, and not be excluded.

 

          8                 DR. BROWN: No, that's not what I'm

 

          9  saying. What I'm saying is that if I look at a child

 

         10  with a blood lead level of four, I have nothing that

 

         11  I have been able to demonstrate that will reduce

 

         12  that blood lead level. The only way is to prevent it

 

         13  in the first place.

 

         14                 COUNCIL MEMBER BARRON: Well, I agree

 

         15  with prevention, just the numbers here would

 

         16  increase tremendously if we told the true story of

 

         17  the dangerous impact of lead paint on children.

 

         18                 DR. BROWN: I think you can tell that

 

         19  story without necessarily labeling children as lead

 

         20  poisoned, and I think we could get ahead of this

 

         21  disease if we get serious about primary prevention.

 

         22                 I also know that communities that

 

         23  have lots of children with blood lead levels greater

 

         24  than ten are also those communities that have the

 

         25  most children with blood lead levels greater than

 

 

 

 

 

 

 


 

                                                            28

 

 

          1  COMMITTEE ON HOUSING AND BUILDINGS

 

          2  five, and being serious about addressing lead paint

 

          3  hazards, independent of a child's blood lead level,

 

          4  is the only way we can get ahead of this.

 

          5                 COUNCIL MEMBER BARRON: Thank you very

 

          6  much.

 

          7                 CHAIRPERSON PROVENZANO: Thank you.

 

          8  We've been joined by Council Member Stewart in back

 

          9  of me, and the next questioner will be Council

 

         10  Member Rivera, he's a member of the Committee.

 

         11                 COUNCIL MEMBER RIVERA: Thank you very

 

         12  much, Ms. Brown, for joining us here today. We are

 

         13  not experts on the City Council so we depend on

 

         14  experts like yourself to inform us what would be the

 

         15  best protocol to follow.

 

         16                 One of my questions is, should the

 

         17  childhood lead poisoning intervention level be

 

         18  lowered in children? And if so, what affect would it

 

         19  have on the cases?

 

         20                 DR. BROWN: Okay, while we have

 

         21  concluded as early as 1991 that there was no

 

         22  threshold that has been identified below which there

 

         23  are no harmful effects of lead, and since then a

 

         24  number of new studies have come out documenting the

 

         25  adverse effects. We have a working group at the

 

 

 

 

 

 

 


 

                                                            29

 

 

          1  COMMITTEE ON HOUSING AND BUILDINGS

 

          2  Centers for Disease Control, the Advisory Committee

 

          3  on Childhood Lead Poisoning Prevention, that is

 

          4  reviewing the scientific evidence of these health

 

          5  effects of less than ten micrograms per deciliter.

 

          6                 A finding of adverse effects across a

 

          7  large number of studies will raise important

 

          8  questions about what, if any, changes CDC should

 

          9  make in its recommendations for medical and

 

         10  environmental intervention of an individual child.

 

         11                 In considering these changes, we also

 

         12  need to consider the research that demonstrates that

 

         13  there is limited benefit and limited effectiveness

 

         14  of interventions to lower blood lead levels once

 

         15  children have been exposed. Taken together with

 

         16  these recent reports of children with adverse health

 

         17  effects at levels less than ten micrograms per

 

         18  deciliter, these studies add further weight in the

 

         19  need for accelerating the expansion of primary

 

         20  prevention activities.

 

         21                 Primary prevention activities do not

 

         22  rely on the diagnosis of an individual child having

 

         23  an elevated blood lead level, but rather focus on

 

         24  identifying and correcting lead hazards before

 

         25  children are exposed.

 

 

 

 

 

 

 


 

                                                            30

 

 

          1  COMMITTEE ON HOUSING AND BUILDINGS

 

          2                 Shifting our focus to primary

 

          3  prevention does not require changing the

 

          4  intervention levels for individual children, nor

 

          5  does it prevent using this as one tool for

 

          6  identifying populations of children at highest risk.

 

          7  In fact, continuing to focus our efforts on those

 

          8  populations and those communities is extremely

 

          9  important.

 

         10                 COUNCIL MEMBER RIVERA: Now, my second

 

         11  question is, with modern technology, I've heard some

 

         12  stories about the modern technology cannot

 

         13  accurately read lead levels at .7; is that true?

 

         14  Where do we stand in terms of modern technology,

 

         15  being able to read the lead levels?

 

         16                 DR. BROWN: That's the level of lead

 

         17  in paint, 0.7 milligrams per centimeter squared.

 

         18                 COUNCIL MEMBER RIVERA: And does that

 

         19  technology allow us to read it at that level

 

         20  accurately? Or does it --

 

         21                 DR. BROWN: The technology has all

 

         22  been standardized to use the level of 1.0 milligrams

 

         23  per centimetered squared. And in fact, if you go

 

         24  into these houses where children are lead poisoned,

 

         25  the level of the lead in paint is usually much

 

 

 

 

 

 

 


 

                                                            31

 

 

          1  COMMITTEE ON HOUSING AND BUILDINGS

 

          2  higher than that.

 

          3                 Lowering the acceptable level of

 

          4  paint will also increase the error that is

 

          5  unavoidable with this technology. So, you're going

 

          6  to get a lot more questionable results that will

 

          7  require more expensive kinds of testing.

 

          8                 And, again, this deflects resources

 

          9  away from areas where we know that the levels are

 

         10  very high, we know that the hazards are very

 

         11  immediate.

 

         12                 COUNCIL MEMBER RIVERA: In your

 

         13  studies, have you seen that children that have been

 

         14  affected with 0.7 micrograms of dust, have they had

 

         15  the same levels of damage to their brain or to their

 

         16  neurological systems as children with 1 gram?

 

         17                 DR. BROWN: I am not aware of any

 

         18  studies that have looked at an association between a

 

         19  particular level of lead in paint and a particular

 

         20  lead level in children. So, I can't answer that

 

         21  question.

 

         22                 COUNCIL MEMBER RIVERA: Thank you very

 

         23  much.

 

         24                 CHAIRPERSON PROVENZANO: Thank you.

 

         25                 Council Member Perkins.

 

 

 

 

 

 

 


 

                                                            32

 

 

          1  COMMITTEE ON HOUSING AND BUILDINGS

 

          2                 COUNCIL MEMBER PERKINS: Thank you

 

          3  very much.

 

          4                 Thank you, Ms. Brown, for your

 

          5  attendance today and your testimony and your focus

 

          6  on early intervention, obviously that's in all

 

          7  health matters of great value and of great concern.

 

          8                 In your article on costs and benefits

 

          9  of enforcing housing policies to prevent childhood

 

         10  lead poisoning, written I guess in the December

 

         11  issue of medical decision-making, November/December

 

         12  2002, you do cite that lead blood levels below five

 

         13  are very, very bad in this, you make mention of that

 

         14  in this article, that there are effects that

 

         15  children have even at five?

 

         16                 DR. BROWN: I think what I said was

 

         17  that they were effects in children at levels less

 

         18  than ten, no?

 

         19                 COUNCIL MEMBER PERKINS: Well, it says

 

         20  here five.

 

         21                 DR. BROWN: As low as five?

 

         22                 COUNCIL MEMBER PERKINS: Yes.

 

         23                 DR. BROWN: I'm sorry. I wrote this

 

         24  four years ago.

 

         25                 COUNCIL MEMBER PERKINS: Okay.

 

 

 

 

 

 

 


 

                                                            33

 

 

          1  COMMITTEE ON HOUSING AND BUILDINGS

 

          2                 DR. BROWN: Yes. And I don't think

 

          3  I've contradicted that today.

 

          4                 COUNCIL MEMBER PERKINS: No, I just

 

          5  want to be clear that you have established that

 

          6  there are those effects, and what I guess is of

 

          7  concern is that you seem to suggest that even though

 

          8  those effects are taking place at that level,

 

          9  there's no need to intervene until the child is even

 

         10  more deeply poisoned, and that seems to be kind of a

 

         11  contradiction. It's almost as if to say the child is

 

         12  not sick enough, the child is not poisoned enough

 

         13  for any intervention, and especially since most of

 

         14  the science, medical science and whatnot is now

 

         15  saying that at any level, it's a big problem.

 

         16                 DR. BROWN: Well, and I think that's

 

         17  the point I'm trying to make, is that if at any

 

         18  level it's a big problem, allowing it to get to a

 

         19  level is a poor idea. And while we can find effects,

 

         20  if we look at large numbers of children we will find

 

         21  effects in some children at fairly low levels

 

         22  considering historically what blood lead levels have

 

         23  been in the past. We have not been able to design an

 

         24  intervention that effectively decreases those

 

         25  levels.

 

 

 

 

 

 

 


 

                                                            34

 

 

          1  COMMITTEE ON HOUSING AND BUILDINGS

 

          2                 COUNCIL MEMBER PERKINS: But early

 

          3  intervention would suggest that we intervene early,

 

          4  even at five.

 

          5                 You're saying on one hand early

 

          6  intervention should come later.

 

          7                 DR. BROWN: No, what I am saying is

 

          8  that we should be serious about primary prevention

 

          9  and intervene before a child is exposed, perhaps

 

         10  before he's born.

 

         11                 COUNCIL MEMBER PERKINS: But then wait

 

         12  until it's exposed to a higher level than five?

 

         13                 DR. BROWN: If I have to label the

 

         14  child as lead poisoned, and I have to tell his

 

         15  parents that we're going to do something that will

 

         16  effectively lower that blood lead level, that will

 

         17  require their own vigilance and work and expense to

 

         18  them, the parents, then I want to be sure that the

 

         19  interventions that we recommend are in fact

 

         20  successful in doing that. We have not been able to

 

         21  find one that is.

 

         22                 COUNCIL MEMBER PERKINS: Let me switch

 

         23  to this question of the budget, because in this same

 

         24  report you seem to indicate that strict enforcement

 

         25  of lead saves about $50,000 per apartment; are you

 

 

 

 

 

 

 


 

                                                            35

 

 

          1  COMMITTEE ON HOUSING AND BUILDINGS

 

          2  still holding to that?

 

          3                 DR. BROWN: No. That study was

 

          4  conducted in the Northeastern part of the United

 

          5  States, and I looked at -- triple deckers, so we

 

          6  were looking at buildings that typically had three

 

          7  units in them, and what we found was that if you

 

          8  address the lead hazards in all three units, you

 

          9  will prevent a large number of future children from

 

         10  having blood lead levels, and I was looking at ten

 

         11  as the level of concern, and that that would save

 

         12  over the 60 year or so life, economic life of those

 

         13  children, employment life of those children, we save

 

         14  about $50,000 per unit. Those benefits can seem

 

         15  quite modest, it's about $110 a year per child,

 

         16  unless you multiply them by the hundreds of

 

         17  thousands of children who are poisoned in this

 

         18  country every year.

 

         19                 COUNCIL MEMBER PERKINS: So you're

 

         20  still firm on that number, though? I mean that it's

 

         21  a significant savings if we do this?

 

         22                 DR. BROWN: It's a significant

 

         23  savings. There are lots of variables that went into

 

         24  that that we could talk about.

 

         25                 COUNCIL MEMBER PERKINS: All right,

 

 

 

 

 

 

 


 

                                                            36

 

 

          1  COMMITTEE ON HOUSING AND BUILDINGS

 

          2  thank you.

 

          3                 CHAIRPERSON PROVENZANO: Okay, thank

 

          4  you.

 

          5                 We've also been joined by Council

 

          6  Member James Sanders, and Council Member Stewart,

 

          7  you have some questions? Why don't you go ahead.

 

          8                 COUNCIL MEMBER STEWART: Thank you.

 

          9                 Madam Chair, I have one simple

 

         10  question, and I think if our focus is on prevention

 

         11  of lead poisoning in our children. The approach I

 

         12  feel that we should use is that the multiple

 

         13  dwellings, there should be inspection before any of

 

         14  those apartments are being invented. Why wait until

 

         15  the child is poisoned to seek correction? Why not go

 

         16  into these multiple dwellings and inspect them? Just

 

         17  as we register these apartments, we can inspect them

 

         18  just the same, with cars that we put on the road, we

 

         19  do inspection, and we register these cars. The same

 

         20  way that we register multiple dwellings, why can't

 

         21  we go in there and inspect them before we rent it to

 

         22  any child that is under the age of seven, if we're

 

         23  dealing with prevention?

 

         24                 I feel the focus should be on that,

 

         25  and not so much of trying to correct, we should try

 

 

 

 

 

 

 


 

                                                            37

 

 

          1  COMMITTEE ON HOUSING AND BUILDINGS

 

          2  to prevent more than we're trying to correct. What

 

          3  is your comment on that?

 

          4                 DR. BROWN: I think that it's very

 

          5  important that we correct lead hazards in high risk

 

          6  housing first. So, I think that the first thing to

 

          7  do is to find those areas where the lead hazards are

 

          8  most immediate. That can be done either by knowing

 

          9  where children have been lead poisoned in the past.

 

         10  I can't speak to New York City specifically, but I

 

         11  do know many places in the country where a public

 

         12  health nurse can walk down the street and say there

 

         13  were three children poisoned in that house last year

 

         14  and the year before, and four poisoned children in

 

         15  that house in the last five years, and those would

 

         16  be the houses that I would start with.

 

         17                 A house that has poisoned a child in

 

         18  the past is the best predictor that it will poison a

 

         19  child in the future. We know where the high risk

 

         20  areas are.

 

         21                 The next step is a resource issue,

 

         22  and it's not something that CDC can comment on, but

 

         23  clearly we do see immediate lead hazards before

 

         24  children get lead poisoned. It's not only less

 

         25  expensive, but it's more compassionate.

 

 

 

 

 

 

 


 

                                                            38

 

 

          1  COMMITTEE ON HOUSING AND BUILDINGS

 

          2                 CHAIRPERSON PROVENZANO: Thank you.

 

          3                 Council Member Sanders.

 

          4                 COUNCIL MEMBER SANDERS: Thank you,

 

          5  Madam Chair.

 

          6                 Thank you, Dr. Brown for being here.

 

          7  It is good that someone representing such a

 

          8  prestigious organization is here to speak on this

 

          9  subject.

 

         10                 I'm glad that I heard you speak and

 

         11  point out that prevention, as Benjamin Franklin said

 

         12  it so many years ago, "an ounce of prevention is

 

         13  better than a pound of cure." So, until we have a

 

         14  cure, a real cure for this problem, it seems to me

 

         15  that prevention should be our primary task.

 

         16                 Now the question becomes what is the

 

         17  most effective means of prevention.

 

         18                 Seemingly to me, as you have stated

 

         19  earlier, that we should look at those buildings that

 

         20  have had the most problems. We should look at all of

 

         21  these places that have created the problems and put

 

         22  our main energy there, but we must also of course

 

         23  look to see the age and conditions of all buildings

 

         24  to ensure these things.

 

         25                 Is there any one guideline, is there

 

 

 

 

 

 

 


 

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          1  COMMITTEE ON HOUSING AND BUILDINGS

 

          2  any one thing that you would want the people of New

 

          3  York, and especially this Council, to know to aid us

 

          4  in our deliberations.

 

          5                 DR. BROWN: I think there are a few

 

          6  factors that can help target the resources. The

 

          7  resources are limited. They are not, there are more

 

          8  resources for primary prevention of lead hazards

 

          9  than there ever have been, but there are still

 

         10  limitation, so we have to be focused and careful.

 

         11                 So, the first place to go as you

 

         12  indicated, those buildings where we have a history

 

         13  of problems in the past.

 

         14                 Then the buildings next door, or the

 

         15  buildings around the corner, in neighborhoods where

 

         16  old housing, usually housing built before 1950,

 

         17  poorly maintained housing, and rental properties

 

         18  where the turnover of families is such that there's

 

         19  more opportunity to poison kids because you have

 

         20  more children going through the units. That's where

 

         21  I would focus my efforts.

 

         22                 COUNCIL MEMBER SANDERS: Thank you

 

         23  very much.

 

         24                 Thank you very much, Madam Chair.

 

         25                 CHAIRPERSON PROVENZANO: Council

 

 

 

 

 

 

 


 

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          1  COMMITTEE ON HOUSING AND BUILDINGS

 

          2  Member Perkins.

 

          3                 COUNCIL MEMBER PERKINS:

 

          4  Congratulations, Councilwoman Madeline Provenzano.

 

          5                 CHAIRPERSON PROVENZANO: Also to you.

 

          6                 COUNCIL MEMBER PERKINS: Thank you.

 

          7                 Doctor, I would like to know, you

 

          8  point out that intervention does not always

 

          9  introduce blood lead levels, but can it help -- but

 

         10  it can help stop it from getting worse, correct?

 

         11                 DR. BROWN: I think the jury may still

 

         12  be out on that.

 

         13                 In the randomized trials of

 

         14  interventions that I've looked at, the progress of

 

         15  children who were in the control group, those who

 

         16  did not get the intervention, the decline of their

 

         17  blood lead levels over time have been the same as

 

         18  those children that were in the intervention group.

 

         19                 In addition to that, recent studies

 

         20  of children at admittedly higher levels have

 

         21  received a chelating agent called suximer. Half the

 

         22  group got the chelating agent, the other half

 

         23  didn't. When they were tested at the age of five or

 

         24  six, there was no difference in the intellectual

 

         25  achievement in the children who were treated,

 

 

 

 

 

 

 


 

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          2  compared to the children who were not treated. So,

 

          3  again, waiting for children to have blood lead

 

          4  elevations and then doing something is not going to

 

          5  get us ahead of the game.

 

          6                 The only way to get ahead of the game

 

          7  is to be serious about primary prevention.

 

          8                 COUNCIL MEMBER PERKINS: Thank you

 

          9  very much.

 

         10                 CHAIRPERSON PROVENZANO: Are there any

 

         11  other questions?

 

         12                 Having none, we thank you very much.

 

         13  We really appreciate your coming up today.

 

         14                 DR. BROWN: Thank you.

 

         15                 CHAIRPERSON PROVENZANO: We've been

 

         16  joined by Council Member Leroy Comrie, a member of

 

         17  the Committee.

 

         18                 And the next person to testify will

 

         19  be Bruce Landphear, the Director of the Children's

 

         20  Environmental Center at Children's Hospital Medical

 

         21  Center, Cincinnati, Ohio.

 

         22                 Welcome.

 

         23                 DR. LANPHEAR: Thank you very much for

 

         24  inviting me to come and share a perspective on

 

         25  protecting children from lead poisoning. I'd like

 

 

 

 

 

 

 


 

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          1  COMMITTEE ON HOUSING AND BUILDINGS

 

          2  first to point out that this is quite an honor. As a

 

          3  physician trained in public health, New York City

 

          4  has a long history of being at the forefront of

 

          5  public health, of protecting children from hazards,

 

          6  like lead poisoning, like housing hazards. I think

 

          7  today we're at a point where you can make some

 

          8  decisions where retain or maintain that position or

 

          9  perhaps fall back.

 

         10                 I would also like to point out that

 

         11  your a bell weather city, what you do here today

 

         12  will have a ripple effect across the country.

 

         13                 Up until yesterday, I didn't quite

 

         14  understand why New York City's blood lead levels

 

         15  seem to come down just a little bit faster than some

 

         16  other major cities, like Chicago, Philadelphia,

 

         17  Rochester.

 

         18                 In talking to Matt Chinchere, I think

 

         19  I understand now why. In 1960, New York City banned

 

         20  the use of lead-based paint in housing. That banning

 

         21  was essential, I think, to the kind of progress

 

         22  you've seen. Now we've got a much more difficult

 

         23  problem, contamination from decades of lead-based

 

         24  paint.

 

         25                 CHAIRPERSON PROVENZANO: Could I

 

 

 

 

 

 

 


 

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          2  interrupt you just one minute?

 

          3                 DR. LANPHEAR: Yes.

 

          4                 CHAIRPERSON PROVENZANO: I understand

 

          5  you're supposed to be joined by Martin Benitez.

 

          6                 DR. LANPHEAR: I don't believe so. Is

 

          7  that next?

 

          8                 CHAIRPERSON PROVENZANO: Okay.

 

          9                 DR. LANPHEAR: We're good.

 

         10                 CHAIRPERSON PROVENZANO: We're good.

 

         11  Okay, I'm sorry. Continue.

 

         12                 DR. LANPHEAR: I also appreciate the

 

         13  opportunity to share my perspective through slides

 

         14  and to have a few extra minutes to do so.

 

         15                 I think this is important because

 

         16  most of us really think that lead exposure or lead

 

         17  toxicity is a problem of children. That's just the

 

         18  tip of the iceberg.

 

         19                 I hope everybody can see this. This

 

         20  is a cartoon from the 1700s depicting the common

 

         21  manifestation of lead poisoning, abdominal colic,

 

         22  and you can see the demons wrenching this woman's

 

         23  abdomen apart.

 

         24                 At this point lead poisoning was

 

         25  primary disease of workers, and it wasn't until the

 

 

 

 

 

 

 


 

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          2  beginning of the 1900s that it was discovered that

 

          3  childhood lead poisoning was a distinct entity, as a

 

          4  result of lead-based paint that was in disrepair,

 

          5  the damage from floods in Australia.

 

          6                 In New York City, as in many other

 

          7  major cities, hundreds of children every year in the

 

          8  1960s were lead poisoned and developed brain

 

          9  encephalopathy or brain swelling. Some of these

 

         10  children developed a coma. Anywhere from one out of

 

         11  four or half of these children died. At that time it

 

         12  was thought if you survived that acute lead

 

         13  poisoning, you were fine. But then physicians,

 

         14  pediatricians in Chicago in this case began to ask

 

         15  questions and look at children who had been lead

 

         16  poisoned but survived, and what they found is that

 

         17  as many as 22 percent of those children developed

 

         18  mental retardation; 20 percent had seizures; two

 

         19  percent developed a picture that resembled cerebral

 

         20  palsy or blindness. And as a result, a number of

 

         21  scientists and a number of studies began to be

 

         22  conducted to try to ask questions about whether

 

         23  there might not be adverse effects at lower and

 

         24  lower levels.

 

         25                 This is a series of studies that

 

 

 

 

 

 

 


 

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          1  COMMITTEE ON HOUSING AND BUILDINGS

 

          2  tried to estimate the impact of lead exposure in a

 

          3  population of children and each of these numbers

 

          4  represents the effect on children's IQ of increasing

 

          5  blood lead levels from 10 micrograms per deciliter

 

          6  to 20 micrograms per deciliter, so anywhere from

 

          7  about a 1.3 drop in IQ to almost a 6. Drop in IQ.

 

          8                 There were critics of these studies.

 

          9  Not surprisingly, many of them were funded by the

 

         10  lead industry, and one of the major criticisms was

 

         11  that these wide estimates, anywhere from 1. Drop in

 

         12  IQ to almost a 6. drop clearly meant that this was

 

         13  not a real problem, that these were not true effects

 

         14  from lead exposure.

 

         15                 Still as a result of those studies

 

         16  and others, the CDC consistently and incrementally

 

         17  lowered their blood lead levels of concern until

 

         18  most recently, as already pointed out, in 1991 they

 

         19  set it at 10 micrograms per deciliter.

 

         20                 They realized that already there was

 

         21  some evidence that there were effects below ten, but

 

         22  it wasn't enough to be definitive.

 

         23                 What I'd like to point out here is

 

         24  that even CDC recognized that there may in fact be

 

         25  adverse consequences below ten microgram per

 

 

 

 

 

 

 


 

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          1  COMMITTEE ON HOUSING AND BUILDINGS

 

          2  deciliter, there is no systematic attempt to go out

 

          3  and answer that question.

 

          4                 There is no systematic public health

 

          5  effort to try to answer whether there could in fact

 

          6  be damage of blood lead levels less than ten.

 

          7                 Still, as pointed out, blood lead

 

          8  levels fell dramatically. From the 1970s to the

 

          9  early 1990s, blood lead levels fell by over 90

 

         10  percent. A proportion of children who had blood lead

 

         11  levels over ten fell by 90 percent.

 

         12                 Now, what that means, it's kind of a

 

         13  bittersweet success, but that means is that many of

 

         14  you who had children who might have been one to six

 

         15  in the 1970s, or were between the ages of one to six

 

         16  in the 1970s had blood lead levels over ten, almost

 

         17  90 percent of us did.

 

         18                 About seven years ago, when I was

 

         19  doing research in Rochester, New York, these studies

 

         20  came out showing these dramatic reductions and blood

 

         21  lead levels. Many of my advisors told me, get out of

 

         22  this line of research, there's not going to be any

 

         23  funding. The problem is going away. Besides that,

 

         24  there's not going to be any funding to do this kind

 

         25  of research again.

 

 

 

 

 

 

 


 

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          2                 And I really had to step back and ask

 

          3  the question, was it time to get out of lead

 

          4  poisoning prevention research? This is very

 

          5  difficult research. A lot of people don't appreciate

 

          6  it, even when you do it.

 

          7                 Asthma is easier to sell. I can get

 

          8  grants pretty easy to do asthma research. It's very

 

          9  difficult to get funding to do lead research.

 

         10                 So, I had to ask myself, was it time

 

         11  to jump ship? Was the problem gone? And after five

 

         12  years, these were my conclusions:

 

         13                 First, that lead toxicity is still

 

         14  epidemic in many part of the United States.

 

         15                 Second, it remains a major

 

         16  environmental justice problem.

 

         17                 Third, there is increasing evidence

 

         18  of adverse effects below ten micrograms per

 

         19  deciliter. Which, by the way, doesn't surprise any

 

         20  of the people who have been studying lead for five

 

         21  or more years.

 

         22                 And, finally, it's a systemic toxin,

 

         23  and it's associated with numerous adverse conditions

 

         24  and diseases in humans.

 

         25                 This is a map of Rochester. It's been

 

 

 

 

 

 

 


 

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          1  COMMITTEE ON HOUSING AND BUILDINGS

 

          2  done in every City, including New York City, and you

 

          3  can see with the increasing darkness of the red

 

          4  neighborhood, that in some cases, in 1995, one in

 

          5  two children in these neighborhoods had a blood lead

 

          6  level of over ten.

 

          7                 Overall in the City, in 1995 one in

 

          8  three children in Rochester had a blood lead level

 

          9  of over ten. One in three children.

 

         10                 Now, it has come down. We did a

 

         11  reanalysis and in 2000 it was only one in five.

 

         12                 We also know, and this, again, is

 

         13  from our studies in Rochester, that if you look at

 

         14  African-American children, their blood lead levels

 

         15  are two or three times higher than their white

 

         16  counterparts, even after taking into account

 

         17  differences in socioeconomic status, mounting (sic)

 

         18  behaviors, lead contaminated dust, lead contaminated

 

         19  soil.

 

         20                 What do we know about effects below

 

         21  ten microgram per deciliter?

 

         22                 Well, the first study we did was to

 

         23  take the National Health and Nutrition Examination

 

         24  Survey, which is a nationally representative study,

 

         25  and we asked the question: After taking into account

 

 

 

 

 

 

 


 

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          1  COMMITTEE ON HOUSING AND BUILDINGS

 

          2  other kinds of factors, like mother's education,

 

          3  household income, race, child sex, iron status, do

 

          4  we see inverse relationships? Do we see harm as a

 

          5  result of having a higher blood lead level? And

 

          6  indeed we did. We looked at these four academic

 

          7  abilities, or cognitive outcomes. Math and reading,

 

          8  which you all are very familiar with, for those of

 

          9  you who have kids, or who maybe remember taking it

 

         10  in school, digit span, which was a measure of

 

         11  short-term memory, I'll give you five numbers and

 

         12  you give them back to me, forward and backward. And

 

         13  then block design, as a measure of puzzles or visual

 

         14  spacial skills, and in each case we saw that there

 

         15  were negative effects of lead exposure in the

 

         16  nation's children.

 

         17                 To put that into a little bit

 

         18  different perspective, and to help perhaps

 

         19  understand the magnitude of that, if we took a

 

         20  population of children with a blood lead level of

 

         21  two and a half micrograms per deciliter, and we

 

         22  compared that to a population of children with blood

 

         23  lead levels of ten micrograms per deciliter, the

 

         24  estimated deficits in reading scores due to lead

 

         25  exposure was 15 points.

 

 

 

 

 

 

 


 

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          1  COMMITTEE ON HOUSING AND BUILDINGS

 

          2                 Now, 15 points is huge, reading like

 

          3  IQ is measured on a scale of 100. So, this is a huge

 

          4  effect, and that's, again, after taking into account

 

          5  other factors.

 

          6                 Now, from a scientific perspective,

 

          7  this had some limitations. We weren't able to, for

 

          8  example, take into account mother's IQ score, we had

 

          9  to rely on a surrogate marker, income or mother's

 

         10  education level. And, so, this by itself was still

 

         11  of some concern, but needed to be replicated.

 

         12                 But perhaps even more striking is if

 

         13  you look at this graph. Now, if you just focus on

 

         14  reading for a moment, which is across the entire

 

         15  sample of children, for every one microgram per

 

         16  deciliter increase in blood lead level, there is

 

         17  about a one point drop in the reading scores of

 

         18  those children.

 

         19                 But as we looked at children with

 

         20  lower and lower blood lead levels, that is, for

 

         21  example, if you look at the less than five group of

 

         22  children, instead of a one point drop, there was

 

         23  over a one and a half point drop, so that there

 

         24  seemed to be a greater reduction in reading scores

 

         25  for each incremental change in lead exposure at the

 

 

 

 

 

 

 


 

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          1  COMMITTEE ON HOUSING AND BUILDINGS

 

          2  lower blood lead levels, which was a little bit

 

          3  surprising, but troubling. Again, because that study

 

          4  had some limitations. We had to wait for some

 

          5  additional evidence.

 

          6                 This was a study that came out in the

 

          7  New England Journal in April of this year, and we

 

          8  did the same basic thing, but now we're looking at

 

          9  IQ scores instead of reading. And for the total

 

         10  sample of children, 172, we found evidence of a

 

         11  deficit after taking into account a number of other

 

         12  factors that may impact children's intellectual

 

         13  abilities, and we found about a six point drop in

 

         14  IQs for every ten microgram per deciliter increase

 

         15  in blood lead levels, on average, and the children

 

         16  in this study had blood lead levels anywhere from

 

         17  less than one to about 35. But once again, what was

 

         18  extremely troublesome and worrying is that when we

 

         19  looked at the children whose blood lead levels never

 

         20  exceeded or met ten micrograms per deciliter, we

 

         21  found evidence that there was a drop as high as ten

 

         22  IQ points in that first ten microgram per deciliter

 

         23  increase in blood lead levels. That's at levels

 

         24  below the CDC level of concern.

 

         25                 Now, it's been pointed out this was

 

 

 

 

 

 

 


 

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          1  COMMITTEE ON HOUSING AND BUILDINGS

 

          2  just yet one more study, and there are only 101

 

          3  children. Should we take action based upon that

 

          4  small sample of children, and I'll come back to that

 

          5  in just a minute. Let me give you a graphic of that,

 

          6  and I hope this helps to make the point clear.

 

          7                 What we know from that study is that

 

          8  the deficit linked with lead exposure seems to occur

 

          9  much more rapidly at lower blood lead levels than at

 

         10  higher blood lead levels.

 

         11                 Having a blood lead level of 15 is

 

         12  worse than having a blood lead level of five, this

 

         13  data suggests. But going from five to ten appears to

 

         14  be more harmful, at least related to IQ scores, than

 

         15  going from 15 to 20.

 

         16                 So, here's two studies, and then in

 

         17  response to the New England Journal article, David

 

         18  Bellinger who is -- actually, David Bellinger and

 

         19  Herb Needleman, who are at Boston and Pittsburgh,

 

         20  looked, or reanalyzed their data, and, so, now in

 

         21  addition to the first two studies, we have a third

 

         22  study with 48 children, and what they found is, for

 

         23  children whose blood lead levels never exceeded ten

 

         24  micrograms per deciliter, again after taking into

 

         25  account all of these other factors, they estimated

 

 

 

 

 

 

 


 

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          2  that there was about a 15 point drop in that first

 

          3  ten microgram per deciliter increase in blood lead

 

          4  level.

 

          5                 Now, you might say, well, gee, these

 

          6  are all new findings. We don't really know that

 

          7  they're real. Are they spurious? Are they consistent

 

          8  with the earlier literature? And in fact, they are

 

          9  entirely consistent.

 

         10                 The problem was in the past, all of

 

         11  our children, all of us had blood lead levels that

 

         12  were so high that we could never ask questions about

 

         13  whether there were adverse effects below ten.

 

         14                 If you look at this slide, and I'm

 

         15  going to get up, because I think I need to point to

 

         16  it, what I'm going to suggest is that the studies

 

         17  that were done in the past that had children with

 

         18  mean blood lead levels or average blood lead levels

 

         19  that tend to be lower, in some cases below ten, the

 

         20  deficits were much steeper than those with studies

 

         21  with higher blood lead levels.

 

         22                 So, here you can see that studies

 

         23  with children less than ten, the deficit, that is as

 

         24  blood lead levels increased the IQ scores fell much

 

         25  more rapidly than those studies that had children

 

 

 

 

 

 

 


 

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          1  COMMITTEE ON HOUSING AND BUILDINGS

 

          2  who had higher average blood lead levels.

 

          3                 So, what we're seeing is entirely

 

          4  consistent with these earlier studies.

 

          5                 We are in the middle of an

 

          6  international collaboration, and this is real

 

          7  exciting. Mostly because all of these scientists are

 

          8  volunteering their time, they shared their raw data

 

          9  from studies that were done in Boston, Mexico City,

 

         10  Port Pieri, Cleveland, Cincinatti, Rochester and

 

         11  Yugoslavia. And what we're doing is we're pooling

 

         12  those studies together, because that will allow us

 

         13  to have a larger sample size and we hope even more

 

         14  definitive one way or the other about the effects of

 

         15  lead exposure.

 

         16                 Now, this is a very controversial

 

         17  area of research, and I have been asked by this

 

         18  Committee not to reveal these findings. But what I

 

         19  can do is point out two things that I think will

 

         20  give you enough of a hint of what we're finding.

 

         21                 First of all, if you again look at

 

         22  Boston and Rochester, that is the groups with the

 

         23  lowest blood lead levels, you see the steepest

 

         24  decrement.

 

         25                 Now, that's important, because Boston

 

 

 

 

 

 

 


 

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          2  was a study of more fluent white families, Rochester

 

          3  was a study that involved both white and African

 

          4  American families and tended to be less affluent.

 

          5  So, now we're seeing the same finding in different

 

          6  groups of children, and that's important because

 

          7  often times people say, yeah, but maybe it's only in

 

          8  one group of kids or another. That doesn't bear out.

 

          9                 I think what you also can see, maybe

 

         10  if you cross your eyes, since I can't share the

 

         11  data, you can see pretty much the same kind of shape

 

         12  we've seen in the New England Journal Medicine

 

         13  Article studies.

 

         14                 Now, this slide doesn't come across

 

         15  real well. These are three cartoons, and there are

 

         16  dots that get more concentrated as you go from this

 

         17  cartoon to this cartoon.

 

         18                 This cartoon represents a lead

 

         19  poisoned individual, and there are roughly 400, 500

 

         20  dots representing the amount of lead in his body or

 

         21  her body.

 

         22                 In this case, this is a human of

 

         23  about 20 to 30 years ago. That is the normal level

 

         24  at the time. I shouldn't say normal. The typical

 

         25  level of lead exposure at the time, and this is the

 

 

 

 

 

 

 


 

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          2  amount of lead, one dot right in the middle, that's

 

          3  estimated to represent a preindustrial human.

 

          4                 So, even at levels of two micrograms

 

          5  per deciliter, which is about where children are

 

          6  today in this country, we estimate that they are

 

          7  still ten to a hundred times more heavily exposed

 

          8  than our preindustrial ancestors.

 

          9                 So, we may think that one or two

 

         10  micrograms is low. It sounds low, doesn't it? It's

 

         11  almost zero. At least on the microgram per deciliter

 

         12  scale. But evolutionarily speaking, it's actually

 

         13  quite high.

 

         14                 I also wanted to talk a little bit

 

         15  about the fact that now we focus most of our

 

         16  attention on neurobehavioral affects of lead

 

         17  exposure in children. That's really just the tip of

 

         18  the iceberg. Some of the more troubling data coming

 

         19  out in the last five or six years is suggesting that

 

         20  lead exposure or having a higher blood lead level or

 

         21  a higher bone lead level as associated with higher

 

         22  rates of delinquent behaviors of conduct disorders

 

         23  and even of criminal behaviors.

 

         24                 And perhaps one of the strongest

 

         25  scientifically speaking studies, Ken Dietrich found

 

 

 

 

 

 

 


 

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          2  that the amount of lead a child was exposed to in

 

          3  utero and during early childhood were both risk

 

          4  factors, after taking a whole host of other factors

 

          5  into account for self-reported delinquent behaviors.

 

          6                 For example, the children in this

 

          7  group reported on average four and a half more

 

          8  episodes of delinquent behaviors in the previous 12

 

          9  months that were assumed based on this analysis to

 

         10  be due to lead exposure itself. Four and a half

 

         11  episodes. Each of those would have been grounds for

 

         12  an arrest.

 

         13                 In other study done in the 1950s,

 

         14  other than being male, the strongest single

 

         15  predictor of criminal behavior was a childhood

 

         16  history of lead poisoning.

 

         17                 Now, this study by Rick Nevin, I

 

         18  actually ignored for a couple of years, because

 

         19  scientifically speaking it's kind of weak, it's an

 

         20  ecologic study. But as these other studies have come

 

         21  in, I've begun to put more weight to it.

 

         22                 What this study did is they looked at

 

         23  the amount of lead exposure over the past century,

 

         24  and they lagged it by 21 years.

 

         25                 They lagged it by 21 years because as

 

 

 

 

 

 

 


 

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          2  you've already heard, children are most heavily

 

          3  exposed in the first two to three years of life, but

 

          4  they're most likely to perform violent acts, or to

 

          5  commit homicide between the ages of 15 to 25. And,

 

          6  so, what Rick found is, when he looked at the

 

          7  relationship of lead exposure, lagged 21 years, and

 

          8  the murder rate, there was this striking

 

          9  correlation.

 

         10                 Now, this is hard to study, as you

 

         11  can imagine, trying to look back in time. But we

 

         12  really don't understand what many of the factors

 

         13  that led to this epidemic of crime, and again, there

 

         14  is evidence both from other studies and the animal

 

         15  literature.

 

         16                 There's also some other studies that

 

         17  raise serious questions about what are the leading

 

         18  causes of diseases in adults.

 

         19                 Joel Schwartz estimated that for

 

         20  every one microgram per deciliter reduction in adult

 

         21  blood lead levels, there would be in the United

 

         22  States 635,000 fewer people with hypertension, 3,200

 

         23  fewer heart attacks every year, 1,300 fewer strokes

 

         24  every year, and all together 3,300 fewer deaths

 

         25  every year.

 

 

 

 

 

 

 


 

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          2                 Now, if that's true, we should see a

 

          3  rather dramatic decline in cardiovascular disease

 

          4  over the past 30 years or so. And we have.

 

          5                 Now, it depends who you ask why that

 

          6  is. If you ask the pharmaceutical companies, because

 

          7  we've got better drugs, you ask the interns, because

 

          8  we've got better treatment, probably a number of

 

          9  factors, but there is considerable evidence that

 

         10  lead exposure is in fact one of those.

 

         11                 The leading physician of the 1900s,

 

         12  William Osler, at the turn of the century, 1900,

 

         13  just began to see cases of angina, of heart attacks,

 

         14  this is a relatively new phenomena.

 

         15                 Tooth decay. We estimated that about

 

         16  two and a half million children have tooth decay in

 

         17  the United States as a result of lead exposure that

 

         18  otherwise wouldn't.

 

         19                 And finally, this is particularly

 

         20  troubling. Does everybody know what the acceptable

 

         21  level of lead of an adult woman is? Forty micrograms

 

         22  per deciliter. Now, we know that we should start

 

         23  thinking about that woman differently when she's

 

         24  pregnant, but of course, it's very hard to all of a

 

         25  sudden tell a woman when she's pregnant to stop

 

 

 

 

 

 

 


 

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          2  having a blood lead level of whatever you were

 

          3  allowed before. What this study for Mexico City

 

          4  found is that, again after taking other factors into

 

          5  account, if you compare pregnant women with blood

 

          6  lead levels of less than five to pregnant women with

 

          7  blood lead levels of ten to 14, considerably lower

 

          8  than what is allowable, there was about a five-fold

 

          9  increase in spontaneous abortion or miscarriage.

 

         10  Five-fold increase. This is huge. And yet, we ignore

 

         11  it. We don't know it.

 

         12                 Well, how did we get to this point?

 

         13  This is really troubling stuff. Over the past

 

         14  century there has been a very concerted effort of

 

         15  deceptive advertising. We knew back in 1908 from the

 

         16  Queens lead study that prevention is easy. Paint

 

         17  containing lead should never employed, where

 

         18  children, especially young children, are accustomed

 

         19  to play. And I should point out, AJ Turner, this

 

         20  physician and another Turner, first focused on

 

         21  educational efforts. They spent the first four years

 

         22  trying to educate moms not to let their kids put

 

         23  their fingers in their mouths.

 

         24                 After four years Turner said, look,

 

         25  this isn't the way to do it. Take lead out of paint.

 

 

 

 

 

 

 


 

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          2  That was 1908.

 

          3                 As a result of that, a number of

 

          4  countries, France, Belgium and Austria banned the

 

          5  use of lead-based paint in 1909. The State of

 

          6  Massachusetts banned it in 1921 but it was repealed

 

          7  by the lead industry. Greece, 1922 and so on.

 

          8                 I didn't put the United States on

 

          9  here, or even New York City, because we ran out of

 

         10  slide space. And yet, despite those early warnings,

 

         11  despite the fact that there is an international

 

         12  treaty calling for the banning of lead-based paint

 

         13  in 1921, you can see that there were thousands and

 

         14  thousands of tons used in the United States from in

 

         15  the early 1900s, continuing in some cases out into

 

         16  the early, or into 1980.

 

         17                 There was a voluntary reduction

 

         18  again, as you can see from the slide, in the 1940s,

 

         19  mostly because there was a tremendous need for lead

 

         20  for the war effort. But subsequently the lead

 

         21  industry found an even more effective way to

 

         22  disseminate in the environment, as you all know,

 

         23  through leaded gasoline.

 

         24                 There is a website that we put

 

         25  together in collaboration with two of your finest

 

 

 

 

 

 

 


 

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          2  historians in New York City at Columbia University.

 

          3  This tries to catalog the century of deceptive

 

          4  advertising, the focus that the paint industry had

 

          5  on marketing to children. For two reasons: One is it

 

          6  gave the message that lead-based paint was safe, and

 

          7  it also recognized that these children would grow

 

          8  up, and if you gave them beautiful coloring books

 

          9  and beautiful paint books, they would remember that

 

         10  and go back and buy lead-based paint.

 

         11                 So, they learned decades before the

 

         12  tobacco industry that the way you sell your product

 

         13  is to market to children.

 

         14                 And then finally, Warner Mayer, who

 

         15  was president of the Lead Industry Association said

 

         16  in 1984, "our victories have been a deferral of

 

         17  implementation of certain regulations."

 

         18                 One of the things that I think is

 

         19  important as these lead suits spread across the

 

         20  country, is that the paint and pigment industry, the

 

         21  lead industry, is spreading their accusations of

 

         22  blame.

 

         23                 In the past they used to just blame

 

         24  mothers by not doing an adequate job cleaning their

 

         25  houses, by not washing their kids' hands. Now for

 

 

 

 

 

 

 


 

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          2  those landlords and real estate investors, they're

 

          3  spreading the blame and they're starting to blame

 

          4  the landlords and the real estate investors.

 

          5                 An element of prevention. I think

 

          6  we've already talked about some of these, but I

 

          7  think it's worth pointing out.

 

          8                 In public health we think of three

 

          9  types of prevention; education, enforcement and

 

         10  engineering.

 

         11                 The vast majority of our efforts for

 

         12  lead poisoning prevention are what? Who would hazard

 

         13  to guess? Education, enforcement or engineering?

 

         14  Education. Why is that? Is education more effective?

 

         15  What we know from the work place studies is that

 

         16  engineering is always more effective when you're

 

         17  dealing with an environmental hazard. So, why are we

 

         18  focusing on education? Why do we rely on moms? Why

 

         19  do we give them brochures? Why do we give them mops

 

         20  and stop there? Because it's inexpensive. It's not

 

         21  because it's more effective.

 

         22                 And then the other way to think about

 

         23  prevention is primary secondary and tertiary

 

         24  prevention, and I think we've talked enough about

 

         25  that so that you all know the vast majority of our

 

 

 

 

 

 

 


 

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          2  efforts on secondary and tertiary prevention. That

 

          3  is, we wait for the child to be exposed or poisoned.

 

          4                 This is a photo that I have on my

 

          5  wall to remind me of the absurdity of that. This is

 

          6  a canary cage, and the miners would send the canary

 

          7  in the cage down into the mine shaft. If the canary

 

          8  stopped singing, or if the canary died, they knew

 

          9  that there was toxic gases down in the mine shaft

 

         10  and they wouldn't go down there that day.

 

         11                 This is how we protect children from

 

         12  lead contaminated houses. We let children live in

 

         13  houses that may or may not be lead contaminated, and

 

         14  we test them, and then we think we've done a good

 

         15  job, but we have not yet protected that child.

 

         16                 So, why primary prevention? First,

 

         17  all the evidence, and it's considerable, indicates

 

         18  that the adverse effects of lead are persistent.

 

         19  They're systemic. As you already heard, chelation

 

         20  does not appear to be a way that we can resolve this

 

         21  because it did not lead to benefits for children who

 

         22  had blood lead levels between 20 and 45 micrograms

 

         23  per deciliter.

 

         24                 There's no discernible threshold for

 

         25  the adverse effects of lead exposure. Now, what that

 

 

 

 

 

 

 


 

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          2  means is, if I put it a little different way, over

 

          3  95 percent of children in this country never achieve

 

          4  a blood lead level of ten, and since there's no

 

          5  apparent threshold that over 90 percent, perhaps 95

 

          6  percent of children who are harmed by lead exposure

 

          7  never achieve a blood lead level of ten micrograms

 

          8  per deciliter. And yet, most cases we don't

 

          9  intervene until a child has a blood lead level of

 

         10  15, let alone ten, in terms of environmental

 

         11  interventions. And then finally, prevention is cost

 

         12  beneficial.

 

         13                 Bill Lanergan at Mount Sinai has

 

         14  estimated that the annual cost of lead poisoning to

 

         15  this country is $43 billion. $43 billion. Now, he

 

         16  couldn't take into account some of these other

 

         17  factors like delinquency and criminality and tooth

 

         18  decay because some of those studies haven't been

 

         19  done repetitively enough to say with confidence if

 

         20  those are real. So, that's an underestimate. So, why

 

         21  haven't we done more?

 

         22                 What about prevention of childhood

 

         23  lead exposure. I think the recipe is rather

 

         24  straightforward, first identifying the sources of

 

         25  lead exposure in the child's home. But I can go to

 

 

 

 

 

 

 


 

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          2  every one of your homes, and I can measure lead and

 

          3  house dust, and then probably 15 and 20 percent I

 

          4  can measure lead and the water in your home. And if

 

          5  you have a yard, I can measure soil and I'll find

 

          6  lead in every case.

 

          7                 So, it's not a question of whether

 

          8  lead is there. That's a done thing. The question is

 

          9  when is it unacceptably high. And, so, we need to

 

         10  identify unacceptable levels of lead and

 

         11  contributing sources.

 

         12                 We need to test whether the

 

         13  interventions that we use are beneficial to

 

         14  children, or whether they might not even be harmful.

 

         15  And then, finally, we need to develop and implement

 

         16  regulations and screening programs, which is exactly

 

         17  what you're struggling with right now.

 

         18                 So, what are the pathways or the

 

         19  sources? I think we said this again and again. Most

 

         20  important, overall important sources, lead

 

         21  contaminated paint. But as you can see, with each of

 

         22  these arrows, this is a type of analysis called

 

         23  pathway analysis that for the most part, except for

 

         24  about five percent of kids who put paint chips in

 

         25  their mouths, most children get exposed to lead

 

 

 

 

 

 

 


 

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          2  contaminated paint through ingestion of house dust.

 

          3                 Now, each of these arrows, the width

 

          4  of each of those arrows represents the relative

 

          5  contribution, so paint lead is a more important

 

          6  source of lead in house dust than in soil lead, but

 

          7  they both contribute. Playing outside, a child

 

          8  putting soil or dirt in their mouth also is a

 

          9  contributor. Income I think is probably fairly

 

         10  obvious, and no matter what we tried to do to take

 

         11  into account other factors, like socioeconomic

 

         12  status, calcium intake, iron intake,

 

         13  African-American race or black race is the second

 

         14  strongest risk factor, and we couldn't get rid of

 

         15  that from our statistical models.

 

         16                 If we're going to focus on primary

 

         17  prevention, you have to start early, presumably

 

         18  before birth. If you wait until six months of age,

 

         19  you've already missed your opportunity because

 

         20  children's mounting behaviors and increasing

 

         21  mobility come together and you can see in the first

 

         22  12-month supply, the blood lead levels go up

 

         23  dramatically.

 

         24                 The reason being that the frequency

 

         25  of certain mounting behaviors, the frequency of the

 

 

 

 

 

 

 


 

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          2  percent of certain mounting behaviors like putting

 

          3  the mouth on the windowsill, a child at six months

 

          4  of age just sort of sits there.

 

          5                 Around nine to 12 months of age they

 

          6  start to stand up, and then they often times will

 

          7  hold on the windowsill and put their mouth on the

 

          8  windowsill. So, we could actually even begin to see

 

          9  how sources change over the first two years of a

 

         10  child's life.

 

         11                 So, what about lead standards? I

 

         12  think that's where we need to shift and begin to

 

         13  think really carefully, if we're going to focus on

 

         14  primary prevention, so far we've relied on the EPA's

 

         15  residential lead standard. They set a standard of 40

 

         16  micrograms per square foot on floors, and 250 on

 

         17  sills. And the way we measure lead, for those of you

 

         18  who aren't familiar with it, I essentially take what

 

         19  looks like a baby wipe and a 12 square inch template

 

         20  and I make an S shape motion, fold it over and make

 

         21  another S shape motion, and then I analyze that

 

         22  light for lead, and the amount of lead in that wipe

 

         23  over the floor area gives me this answer.

 

         24                 Now, how did they arrive at 40

 

         25  microgram per square foot? I'm not entirely sure,

 

 

 

 

 

 

 


 

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          2  but they used our research, and it's a little

 

          3  confusing. But let me step back for a minute and say

 

          4  what do we know about these controlled trials?

 

          5                 The one thing that we need to be

 

          6  careful of, because we know this happened in the

 

          7  past, is that we would send people into the homes to

 

          8  fix it up, to take the lead out, and in some cases

 

          9  we would scrape it and contaminate the floor. And,

 

         10  so, you can make the problem worse. These first

 

         11  three studies found that for children whose blood

 

         12  lead levels at baseline were 25 micrograms did find

 

         13  some overall benefit, and showed some lowering of

 

         14  their blood lead levels. But now we're beginning to

 

         15  ask questions about how do we protect children who

 

         16  have at baseline lower blood lead levels, and I

 

         17  think you can imagine that for these children who

 

         18  are most highly exposed, and are actually older, and

 

         19  so may be growing out of some of those mounting

 

         20  behaviors, we may need to be more careful with

 

         21  children who start out with lower blood lead levels,

 

         22  or who are younger. And in fact, the only study that

 

         23  included children with blood lead levels below 25

 

         24  found that paint abatement was associated with an

 

         25  increase in blood lead levels. So, we have to be

 

 

 

 

 

 

 


 

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          2  careful.

 

          3                 What can we do to prevent that? Well,

 

          4  I think we all know why blood lead levels increase

 

          5  in children. As a result of abatement, you can get

 

          6  rather striking increases in floor dust, in the

 

          7  amount of lead in floor dust.

 

          8                 But I want to point out two things

 

          9  here besides that. The second is that, if you look

 

         10  at this, this is very high risk Baltimore housing,

 

         11  and had contained children with lead poisoning.

 

         12                 The median floor lead level in that

 

         13  very high-risk housing that poisoned kids, was 35.

 

         14  Not too far off from what the EPA said is their

 

         15  health-based standard.

 

         16                 And in fact, in our Rochester study,

 

         17  which is represented on this red line, we found that

 

         18  at 40 microgram per square foot, about 15 to 20

 

         19  percent of kids would be expected to have a blood

 

         20  lead level over ten. So, how did EPA arrive at this?

 

         21  Forty microgram per square foot? Because at five or

 

         22  ten we already see about five percent of kids having

 

         23  a blood lead over ten.

 

         24                 Well, I'll tell you, they

 

         25  misrepresented my data. They misrepresented the

 

 

 

 

 

 

 


 

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          2  study from Rochester, because the EPA has this

 

          3  dilemma. They had to take economic considerations

 

          4  into account, as well as to protect children's

 

          5  health.

 

          6                 And guess what? Time and again, when

 

          7  you go back and look at history, and if there is

 

          8  economic considerations that compete with children's

 

          9  health, guess who wins? Guess who won?

 

         10                 There was some concern that in

 

         11  Rochester, because we found at this time floor dust

 

         12  lead levels of 200 on floors were set, as the normal

 

         13  or acceptable, that was pretty much pulled out of

 

         14  thin air. It was thought to be feasible to attain

 

         15  back in 1988. It wasn't based on scientific

 

         16  evidence.

 

         17                 So, when we found 40, people said no

 

         18  way. There's no way that can be normal or low,

 

         19  because we know that the last time we set a standard

 

         20  it was 200.

 

         21                 One of the scientists who did a peer

 

         22  review on our study said maybe the dust in Rochester

 

         23  is different. So, we did a pooled analysis which

 

         24  pulled together 12 studies from across the country

 

         25  and essentially showed the same thing, that is,

 

 

 

 

 

 

 


 

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          2  below 40 micrograms per square foot there's a lot of

 

          3  activity and a lot of potential for damage in

 

          4  children, and to put that a little different way, if

 

          5  we look at children whose floor dust lead levels are

 

          6  below two and a half micrograms per square foot.

 

          7                 Now, right now, don't forget, you're

 

          8  talking about a standard at 40 and that's what the

 

          9  EPA has set. Below two and a half micrograms per

 

         10  square foot as a comparison group, and for children

 

         11  who have floor dust lead levels between five and 25,

 

         12  they're already at four times increased risk to have

 

         13  a blood lead level over ten.

 

         14                 Now, this is despite the fact that

 

         15  we've already started asking them questions about

 

         16  are there effects below ten. So, the 40 microgram

 

         17  per deciliter, the 40 microgram per square foot

 

         18  floor standard is inadequate to protect children

 

         19  from having blood lead levels over ten, now we have

 

         20  evidence coming out and saying there's adverse

 

         21  effects below ten.

 

         22                 Out of all the different things that

 

         23  we've told moms to do over the past 15 or 20 years,

 

         24  only one of them has been proven to be of benefit

 

         25  from the standpoint of these kinds of interventions,

 

 

 

 

 

 

 


 

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          2  and that's dust control.

 

          3                 It didn't seem to change the overall

 

          4  mean blood lead level of children, but when we

 

          5  looked at all the studies together, there is over a

 

          6  50 percent reduction in children having blood lead

 

          7  levels over 15 and over 20.

 

          8                 So, dust control was somewhat

 

          9  beneficial, and clearly was -- dust is clearly an

 

         10  important source of lead for children.

 

         11                 What I think the other conclusion we

 

         12  can make from this is just going in and doing house

 

         13  cleaning is not enough. You've got to find ways to

 

         14  reduce ongoing contamination of that house dust from

 

         15  peeling paint, from an active lead smelter, whatever

 

         16  the source might be.

 

         17                 So, what are some of the implications

 

         18  I would suggest? First is we need to shift or expand

 

         19  our emphasis from screening children to screening

 

         20  houses, yards and water. And I think this has

 

         21  already been suggested. When might you do that?

 

         22  Before you provide federal subsidies for rental

 

         23  properties. Before you buy a house, after any

 

         24  renovation project or even moderate renovation

 

         25  project, you may want to do wipe testing in that

 

 

 

 

 

 

 


 

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          2  home. Because it actually can be quite misleading.

 

          3  If I go in and I repair old paint, now it looks like

 

          4  it's in good shape, doesn't it? I might have

 

          5  actually contaminated the floor. So if I just rely

 

          6  on a visual inspection, I might miss the fact that

 

          7  as the father, I've gone in to fix up the nursery,

 

          8  and I just set the stage for poisoning my own child.

 

          9  And, in fact, that's one of the worst problems with

 

         10  the EPA standard as it is. It provides an illusion

 

         11  of safety. It's not adequately protective for

 

         12  children.

 

         13                 The other reason that this is so

 

         14  critical is that it shifts us away from using

 

         15  children as the trigger, as the biological indicator

 

         16  of when there are lead hazards present. As long as

 

         17  we continue to rely on that child having an elevated

 

         18  blood lead level, and knowing that the effects of

 

         19  lead exposure on average are persistent, it's a

 

         20  failed system.

 

         21                 Now, there is a place for screening

 

         22  children, but it should be seen as a safety net, it

 

         23  seems to me. Where have we failed to protect

 

         24  children by reducing exposures before they live in a

 

         25  house or an apartment.

 

 

 

 

 

 

 


 

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          2                 But if we rely on those standards, of

 

          3  course they have to be based upon real data. They've

 

          4  got to be driven by science and not politics.

 

          5                 We do need trials, and I would

 

          6  suggest randomized trials to make sure that the kind

 

          7  of things we're doing are effective in preventing

 

          8  exposure.

 

          9                 Dr. Brown raised some questions about

 

         10  the effectiveness of the interventions we have

 

         11  today, and I agree 100 percent with her. The way I

 

         12  like to think about it is sort of like chemotherapy

 

         13  for cancer. Nobody wants chemotherapy. It's toxic

 

         14  stuff. But in the absence of anything better, we've

 

         15  got some things that we can do to prevent children

 

         16  from being exposed.

 

         17                 HUD guidelines I think are very

 

         18  reasoned, as long as we use a lower dust lead level,

 

         19  not 40 micrograms per square foot on floors, not 20

 

         20  micrograms per square foot on floors. I think we

 

         21  need to try to achieve something less than ten to

 

         22  protect children.

 

         23                 We certainly do need more studies to

 

         24  examine adverse effects of lead exposure at blood

 

         25  lead levels below ten or five, but I don't think we

 

 

 

 

 

 

 


 

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          2  need to wait for those studies to be completed to

 

          3  take action. I think we know enough. Throughout

 

          4  history, whenever there's been uncertainty, we've

 

          5  aired on the side of protecting industry, protecting

 

          6  the status quo. The evidence is too compelling, it

 

          7  seems to me, not to take action.

 

          8                 And then, finally, while housing is

 

          9  clearly the most important source, I think we need

 

         10  to go a step further. We need to eliminate all

 

         11  non-essential uses of lead and develop regulations

 

         12  to control lead emissions, whether that's from lead

 

         13  smelters, power plants, and whatever source it is.

 

         14  Denmark two years ago led a charge to eliminate all

 

         15  non-essential uses of lead over the next decade, and

 

         16  I think we're at that stage as well.

 

         17                 Let me just end with two quick

 

         18  quotes. The first: Over 25 years ago Donald Baltrap

 

         19  said "until effective standards for the domestic

 

         20  environment are devised, it is likely that children

 

         21  will continue to be employed as biological

 

         22  indicators of substandard housing.

 

         23                 We haven't come too far from this.

 

         24  And then finally, Flo said it first, as she always

 

         25  does, the connection between health and the dwelling

 

 

 

 

 

 

 


 

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          2  of the population are one of the more important that

 

          3  exist. The picture on the bottom is by Jacob Riss,

 

          4  somebody you all know, and I would just like to end

 

          5  there by saying that I hope this has been of some

 

          6  help in your deliberations to try to retain your

 

          7  status as one of the leaders and at the forefront of

 

          8  protecting children from lead poison.

 

          9                 CHAIRPERSON PROVENZANO: Doctor, thank

 

         10  you.

 

         11                 Two things. Do you have any written

 

         12  testimony? Did you bring any written testimony?

 

         13                 DR. LANPHEAR: I can provide it.

 

         14                 CHAIRPERSON PROVENZANO: Yes, to the

 

         15  Committee.

 

         16                 DR. LANPHEAR: Yes, e-mail.

 

         17                 CHAIRPERSON PROVENZANO: The second

 

         18  question, just to clarify for the record, when you

 

         19  started you said that you were asked by the

 

         20  Committee to testify to clarify some points. Could

 

         21  you just say what Committee that was?

 

         22                 DR. LANPHEAR: Maybe I misspoke. I was

 

         23  asked to come to represent the group that Matthew

 

         24  Chechere is involved with.

 

         25                 CHAIRPERSON PROVENZANO: Oh, okay.

 

 

 

 

 

 

 


 

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          2  Because usually when they say Committee, they mean

 

          3  the Housing and Buildings Committee. So, we just

 

          4  needed to clarify that for the record.

 

          5                 DR. LANPHEAR: Yes.

 

          6                 CHAIRPERSON PROVENZANO: Thank you

 

          7  very much.

 

          8                 Speaker Miller has a question.

 

          9                 SPEAKER MILLER: Thank you for that

 

         10  very comprehensive presentation. I wanted to just

 

         11  sort of ask if you could more succinctly respond

 

         12  directly. Were you here when the representative of

 

         13  the Center for Disease Control was?

 

         14                 DR. LANPHEAR: Dr. Brown, yes.

 

         15                 SPEAKER MILLER: Can you just kind of

 

         16  respond sort of directly what your views were on

 

         17  that testimony with regard to the importance of

 

         18  primary prevention, vis-a-vis, you know, in relative

 

         19  to the question of intervention and at what levels?

 

         20                 DR. LANPHEAR: As scientists we often

 

         21  like to see things confirmed again and again. I

 

         22  think there is enough compelling evidence, both

 

         23  published in the medical and biomedical literature

 

         24  and soon to be published, that indicates there are

 

         25  no safe levels of lead in blood.

 

 

 

 

 

 

 


 

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          2                 I think we can come up with some very

 

          3  specific things we can do to prevent children's

 

          4  exposure, very specific tests, including wipe

 

          5  testing in homes, including testing water in homes.

 

          6                 It may be a more important source in

 

          7  many cities. So, I think we're at a point where we

 

          8  have enough evidence to take aggressive action to

 

          9  reduce lead exposure from whatever sources.

 

         10                 SPEAKER MILLER: So what I understood

 

         11  her to be saying was that, you know, if everything

 

         12  else was equal, she's got a dollar to spend, she'd

 

         13  rather spend it on prevention rather than

 

         14  correction. I hate to summarize somebody's testimony

 

         15  in one sentence.

 

         16                 What I understood her to be saying is

 

         17  that the focus for this Committee, for this Council,

 

         18  should be on primary prevention and if you could

 

         19  just sort of respond to that, what your thoughts

 

         20  are?

 

         21                 DR. LANPHEAR: I agree. I think the

 

         22  vast majority of children who are damaged by lead

 

         23  exposure never have a blood lead level over ten

 

         24  micrograms per deciliter, and children who have

 

         25  blood lead levels over that will also be benefitted

 

 

 

 

 

 

 


 

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          2  by primary prevention efforts.

 

          3                 Moreover, the medical therapy we

 

          4  have, except at very high blood lead levels, over 60

 

          5  or 70, do not appear to be a magic bullet to resolve

 

          6  the problem. So, we've got to rely on reducing the

 

          7  exposure in the first place, on primary prevention.

 

          8                 SPEAKER MILLER: Thank you.

 

          9                 CHAIRPERSON PROVENZANO: Council

 

         10  Member Comrie.

 

         11                 COUNCIL MEMBER COMRIE: Thank you,

 

         12  Doctor, for your comprehensive presentation.

 

         13                 At one point in your testimony you

 

         14  said that the lead levels that are presently used as

 

         15  the standard needs to be lowered, but you never

 

         16  indicated as to what you thought an acceptable new

 

         17  standard would be.

 

         18                 DR. LANPHEAR: I think the question

 

         19  is, and the balance is, and I think Dr. Brown tried

 

         20  to capture this, is pediatricians don't want to be

 

         21  in a position where a child with a blood lead level

 

         22  of 2.3 comes into their office and they're told that

 

         23  the child is lead poisoned.

 

         24                 So, clinically dealing with one child

 

         25  can be very difficult. We don't want to label

 

 

 

 

 

 

 


 

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          2  children. At the same time, what I worry about,

 

          3  unless we lower the action level, there is no

 

          4  perceived threat. And if there's no perceived threat

 

          5  as a society, we're not going to take the necessary

 

          6  action.

 

          7                 Is five micrograms per deciliter low

 

          8  enough? I don't know. I think there's enough

 

          9  evidence to lower it to that level. At the same time

 

         10  we need to be able to articulate that there does not

 

         11  appear to be any safe level.

 

         12                 But I think we need to do something

 

         13  to make sure that people recognize that this is

 

         14  clearly a threat, even though blood lead levels

 

         15  have, for the most part, fallen below ten micrograms

 

         16  per deciliter, which is the current action level.

 

         17                 COUNCIL MEMBER COMRIE: So you're

 

         18  saying that in your opinion, no level is a safe

 

         19  level, and you have document -- and you presented

 

         20  documentation to that effect, or you have

 

         21  statistical analysis to that effect?

 

         22                 DR. LANPHEAR: I think we can say with

 

         23  some certainty that there is effects below ten. We

 

         24  can also say that if you look at the data, there did

 

         25  not appear to be safe levels. That is more of an

 

 

 

 

 

 

 


 

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          2  interpretation or an extrapolation of the data.

 

          3                 COUNCIL MEMBER COMRIE: Okay, thank

 

          4  you.

 

          5                 You did talk about secondary effects

 

          6  and other things that have happened to people that

 

          7  are lead poisoned, but I think I might have stepped

 

          8  out when you talked about prevention. Did you agree

 

          9  with Dr. Brown on her prevention ideas? Or is there

 

         10  any other idea that you would say that would be an

 

         11  effective preventative measure?

 

         12                 DR. LANPHEAR: I think there's about

 

         13  five or six things we could do. From the standpoint

 

         14  of housing, at the time you buy a house, at the time

 

         15  you evaluate a home for federal subsidies, at the

 

         16  time you do a painting job or renovation work,

 

         17  whether that's a contract, or whether you do your

 

         18  own work, at each stage that should be an

 

         19  opportunity to go in and make sure that you haven't

 

         20  created a problem, at least in the older housing. I

 

         21  think we need to do a better job at determining what

 

         22  levels of lead and water and dust and soil are truly

 

         23  safe for children. I think we need to find ways to

 

         24  reduce all the other sources, whether it's from

 

         25  powerplants, whether it's from lead smelters,

 

 

 

 

 

 

 


 

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          2  whether it's from wheel weights. There is a variety

 

          3  of sources that are present throughout that we

 

          4  really don't even think about.

 

          5                 COUNCIL MEMBER COMRIE: Thank you.

 

          6  Thank you, Madam Chair.

 

          7                 CHAIRPERSON PROVENZANO: Thank you.

 

          8  Council Member Barron.

 

          9                 COUNCIL MEMBER BARRON: I was

 

         10  thoroughly impressed by your presentation. We should

 

         11  just take a unanimous vote today, have the Speaker

 

         12  have an emergency meeting tomorrow with the full

 

         13  City Council, all of us should vote it out and

 

         14  arrest any landlord that's against it.

 

         15                 Arrest them. Any landlord that is

 

         16  against this need to be arrested.

 

         17                 But on a very, and I'm very serious

 

         18  about that, too, but on a more serious note, I don't

 

         19  think we should have prevention versus intervention.

 

         20  I don't think that should be an argument. I think

 

         21  both are critical to this issue.

 

         22                 And I just want to ask another

 

         23  question. I curious about the study that you

 

         24  couldn't reveal information to us on, why not, and

 

         25  is there something pertinent in there that would

 

 

 

 

 

 

 


 

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          2  move this process even further?

 

          3                 DR. LANPHEAR: It won't in any way

 

          4  contradict anything I said today. In fact, it's very

 

          5  consistent. Lead research and lead policy has been

 

          6  very contentious and controversial. We have on the

 

          7  panel two people who have had battle with one

 

          8  another. One of them was accused with scientific

 

          9  fraud, it took five years to clear their name. So,

 

         10  it's a very contentious area, and, so, to honor

 

         11  their wishes, I just can't reveal it at this point.

 

         12                 COUNCIL MEMBER BARRON: Thank you very

 

         13  much.

 

         14                 CHAIRPERSON PROVENZANO: Council

 

         15  Member Jackson, and then Council Member Perkins.

 

         16                 COUNCIL MEMBER JACKSON: Doctor, I

 

         17  want to thank you for your presentation, and it is

 

         18  obvious to me that you are dedicated to your

 

         19  research, and on behalf of the people of New York

 

         20  City, I want to thank you for coming and providing

 

         21  testimony and evidence about this particular matter.

 

         22  It's very, very important in the deliberation of

 

         23  this particular matter.

 

         24                 In one of the slides that you showed,

 

         25  you showed that from 1970 to 1990 there's been a

 

 

 

 

 

 

 


 

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          2  drop as far as CDC's recommended level of

 

          3  intervention from 40 I believe in 1970 to ten in

 

          4  1990. If we follow that trend, then can I assume

 

          5  that whenever the next recommendation will come out

 

          6  that it will be less than that, based on all of the

 

          7  information and evidence that below ten, what is it,

 

          8  micro --

 

          9                 DR. LANPHEAR: Micrograms per

 

         10  deciliter.

 

         11                 COUNCIL MEMBER JACKSON: Micrograms

 

         12  per deciliter, it's harmful to children?

 

         13                 DR. LANPHEAR: I can't say. I was

 

         14  nominated for the CDC Lead Advisory Committee, who

 

         15  will be coming out and making that recommendation;

 

         16  however, representatives of the national lead

 

         17  industry visited with Tommy Thompson before I was

 

         18  approved and were able to get me kicked off the

 

         19  panel. So, since that panel is making the

 

         20  determinations, the only thing that I can do at this

 

         21  point is try to do the science and provide it in a

 

         22  timely manner.

 

         23                 And despite not being able to share

 

         24  the pooled analysis today with you here, we did

 

         25  present it to the CDC's working group about two or

 

 

 

 

 

 

 


 

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          2  three weeks ago.

 

          3                 COUNCIL MEMBER JACKSON: Now, as

 

          4  someone that is a lay person, as far as the only

 

          5  information I know about this is what has been

 

          6  presented and what I've read in the newspapers and

 

          7  what have you, and you know that everything you read

 

          8  in the newspaper is not true, that's obvious. But

 

          9  I've listened to all of the evidence, and let me

 

         10  just ask a stupid question, if I may ask.

 

         11                 Could the paint industry not include

 

         12  any lead whatsoever? I mean, they did that, we

 

         13  banned it in 1960. What was the positive effects, or

 

         14  what was the effects of landlords -- or excuse me,

 

         15  the paint industry, putting lead in paint? Why was

 

         16  that needed?

 

         17                 DR. LANPHEAR: Yes. There were

 

         18  alternatives. Even in the 1880s in England, there

 

         19  were advertisements for non-lead-based paint,

 

         20  because it was non-toxic. So, there were

 

         21  alternatives.

 

         22                 On the other hand, the lead industry

 

         23  argued, and there's some truth to it, it's a good

 

         24  product, the only problem is it happens to be toxic.

 

         25  But there have been alternatives throughout the past

 

 

 

 

 

 

 


 

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          2  century, and it was mostly because of the marketing

 

          3  strategy that the White House and schools and houses

 

          4  across the United States used lead-based paint,

 

          5  there were alternatives.

 

          6                 COUNCIL MEMBER JACKSON: And I guess,

 

          7  finally, let me just ask this question. I live in an

 

          8  apartment building, and if I were to take the test

 

          9  that you indicated, as far as on the floor or on the

 

         10  sill, tell the average individual that lives in an

 

         11  apartment building, if they want to test their

 

         12  apartment with that wipe, what would it cost to do

 

         13  that type of test, to wipe, to see if in fact what

 

         14  level of lead paint or lead dust is in their unit,

 

         15  especially if they have children?

 

         16                 DR. LANPHEAR: There's two answers to

 

         17  that. Right now if you wanted to be more confident

 

         18  in the results, you would hire somebody to come in

 

         19  and probably that would cost around $200 or so, and

 

         20  it might differ, depending upon the City and state

 

         21  that you live in.

 

         22                 You can also get home test kits

 

         23  through the mail.

 

         24                 COUNCIL MEMBER JACKSON: Through the

 

         25  mail?

 

 

 

 

 

 

 


 

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          2                 DR. LANPHEAR: Through the mail. Now,

 

          3  the only thing I say with some caution is we haven't

 

          4  validated that families can accurately assess their

 

          5  own homes for lead hazards. We are doing a study in

 

          6  Cincinatti to try to prove that.

 

          7                 I think it seems very reasonable for

 

          8  people to try to do that. There are instructions

 

          9  that you get along with that. If the levels are

 

         10  higher than you'd like, and, again, I'd suggest over

 

         11  five or ten, then at that point maybe you could

 

         12  justify somebody going out and bringing somebody in

 

         13  that might cost a couple hundred dollars.

 

         14                 COUNCIL MEMBER JACKSON: Well, you can

 

         15  get them in the mail. Are they free?

 

         16                 DR. LANPHEAR: No, they cost ten to

 

         17  $20.

 

         18                 COUNCIL MEMBER JACKSON: Ten to $20.

 

         19                 DR. LANPHEAR: Yes. One other thing,

 

         20  though, and that is, as we start thinking about

 

         21  multi-unit dwellings, there are one-day training

 

         22  courses, and, so, as landlords or maintenances

 

         23  workers do renovations, they can be trained to do

 

         24  these as well, but you don't have to necessarily

 

         25  come in and have a certified environmental

 

 

 

 

 

 

 


 

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          2  laboratory do them. And, so, there are ways to make

 

          3  it less expensive for investors.

 

          4                 COUNCIL MEMBER JACKSON: Thank you

 

          5  very much, Doctor.

 

          6                 CHAIRPERSON PROVENZANO: Thank you.

 

          7                 Council Member Perkins.

 

          8                 COUNCIL MEMBER PERKINS: Thank you

 

          9  very much.

 

         10                 First, let me take a moment to

 

         11  remember that one of the 37 sponsors of Intro. 101-A

 

         12  was James Davis, and I just wanted to take a moment

 

         13  to acknowledge the fact that his mother is with us

 

         14  here today, and we appreciate her presence as a sign

 

         15  of support for her son's work and the work of this

 

         16  City Council.

 

         17                 Secondly, in case you haven't heard,

 

         18  you are welcome to be here, even though the

 

         19  Committee may not have invited you, you are

 

         20  nevertheless highly welcomed by this City Council

 

         21  for the extraordinary work that you've been doing on

 

         22  this matter, and obviously for the rather in-depth

 

         23  and extraordinary presentation you made.

 

         24                 And as the credit to the movement,

 

         25  the NYCAP movement (phonetic), that they reached out

 

 

 

 

 

 

 


 

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          2  to you and made the effort to make sure you were

 

          3  here to provide us with necessary information for us

 

          4  to make the very historic and important decision on

 

          5  behalf of the children.

 

          6                 CHAIRPERSON PROVENZANO: May I just

 

          7  interrupt to clarify?

 

          8                 As I said to you, Doctor, it was just

 

          9  to clarify for the record, the Committee does

 

         10  welcome you, even though you are not here at our

 

         11  request, and we did enjoy your presentation.

 

         12                 COUNCIL MEMBER PERKINS: Let me just

 

         13  first point out that, I find it awfully cynical when

 

         14  those of us in policy-making positions, government,

 

         15  elected officials, balance budgets with needs.

 

         16                 Very often, when you do that, needs

 

         17  lose out because we claim we have a fiscal problem,

 

         18  a budgetary problem.

 

         19                 One of the things that has happened

 

         20  in this Council under the leadership of this

 

         21  Speaker, is that recently we were able to avoid that

 

         22  in the fiscal crisis, making sure that the needs of

 

         23  the people of the City of New York are met, despite

 

         24  the fact that the Administration, the Mayor's

 

         25  Office, wanted to close senior citizen centers and

 

 

 

 

 

 

 


 

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          2  other essential services.

 

          3                 So, I always take a pause when people

 

          4  try to tell me that one need that everyone

 

          5  acknowledges is necessary to deal with, may not be

 

          6  able to be met because of some fiscal or budgetary

 

          7  constraints.

 

          8                 Generally speaking, what we decide to

 

          9  do with those dollars, we can do, and in fact, very

 

         10  often we can do both. And in this case, I think we

 

         11  can both do the early prevention, as well as the

 

         12  early intervention.

 

         13                 In that regard, I just want to make

 

         14  sure that I'm clear, from your point of view, versus

 

         15  the point of view of the representative of CDC, as

 

         16  to whether or not early intervention, at the levels

 

         17  that you describe, as well as she describes, are

 

         18  harmful to children. Do you think that intervention

 

         19  at that level is helpful?

 

         20                 DR. LANPHEAR: There is certainly

 

         21  evidence, particularly from the dust control

 

         22  studies, and I think there are other measures that I

 

         23  would take in my home, if I had lead and water for

 

         24  example, or lead in the soil, to try to make the

 

         25  soil, or make the water with lead less accessible to

 

 

 

 

 

 

 


 

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          2  my child.

 

          3                 COUNCIL MEMBER PERKINS: If the child

 

          4  has a level of five, is there something positive

 

          5  that could be done for that child?

 

          6                 DR. LANPHEAR: The most rigorous

 

          7  scientific evidence would suggest that dust control,

 

          8  making sure dust lead levels are below five or ten

 

          9  is the single most important thing we can do, and,

 

         10  so, the way you find that out is you use the wipe

 

         11  test, and I think most people today would recognize

 

         12  that the single most important test, and that helps

 

         13  to distinguish not so much whether there is

 

         14  lead-based paint in the walls, there might be

 

         15  lead-based paint in my 1911 house, it might be ten,

 

         16  12 layers back, it may not be accessible. What the

 

         17  wipe test does is it gives me a measure of

 

         18  accessibility of that lead to my child, or it gives

 

         19  me a measure of the hazard to my child.

 

         20                 COUNCIL MEMBER PERKINS: So the answer

 

         21  is yes?

 

         22                 DR. LANPHEAR: Yes.

 

         23                 COUNCIL MEMBER PERKINS: Thank you

 

         24  very much.

 

         25                 CHAIRPERSON PROVENZANO: Thank you

 

 

 

 

 

 

 


 

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          2  very much. We appreciate you being here.

 

          3                 The next person to testify is Susan

 

          4  Klitzman. She's an Associate Professor, Urban Hunter

 

          5  Health Program at Hunter College. I'm an alumni of

 

          6  Hunter, so welcome.

 

          7                 DR. KLITZMAN: Great. It's still

 

          8  morning, I guess, so good morning, Committee Chair

 

          9  Provenzano and Speaker Miller, and other

 

         10  distinguished members of the City Council.

 

         11                 As Councilwoman Provenzano mentioned,

 

         12  my name is Dr. Susan Klitzman. I have over 20 years

 

         13  of public health experience in the field of

 

         14  environmental health.

 

         15                 Currently I'm an Associate Professor

 

         16  of Environmental and Occupational Health Sciences at

 

         17  Hunter College and the City University of New York.

 

         18  I'm also a member of the New York City Board of

 

         19  Health.

 

         20                 From 1997 to 1999, I served as

 

         21  Assistant Commissioner for Environmental and

 

         22  Occupational Disease Prevention with the New York

 

         23  City Department of Health.

 

         24                 As part of my responsibilities, I

 

         25  managed the Childhood Lead Poisoning Prevention

 

 

 

 

 

 

 


 

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          2  Program.

 

          3                 I also have coauthored numerous

 

          4  articles and reports on lead poisoning issues

 

          5  affecting New York City, and I appreciate the

 

          6  opportunity to speak before the Housing and

 

          7  Buildings Committee about preventing childhood lead

 

          8  poisoning in New York City.

 

          9                 As you know, New York City is now at

 

         10  the crossroads of childhood lead poisoning

 

         11  prevention.

 

         12                 As you've heard, tremendous progress

 

         13  has been made over the last three decades in

 

         14  reducing both the number of children with lead

 

         15  poisoning, as well as the severity of the problem.

 

         16                 Virtually no children in the City

 

         17  develop severe acute lead poisoning anymore, as Dr.

 

         18  Lanphear described, as occurred previously. Still,

 

         19  hundreds develop mild lead poisoning every year, so

 

         20  mild in fact, that they generally don't have any

 

         21  symptoms.

 

         22                 As you've heard, new research has

 

         23  shown that even mild lead poisoning can permanently

 

         24  damage a young child developing nervous systems.

 

         25                 With a recent court decision striking

 

 

 

 

 

 

 


 

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          2  down Local Law 38, there is a pressing need to put

 

          3  into place a new workable law and program that will

 

          4  prevent those children at highest risk from

 

          5  developing lead poisoning, and, yet, this task has

 

          6  remained elusive.

 

          7                 Fortunately, there is a wealth of

 

          8  scientific data to aid in this effort.

 

          9                 You're undoubtedly familiar with

 

         10  reports from the Department of Health and Mental

 

         11  Hygiene's blood lead surveillance system, which show

 

         12  that the children who are most likely to develop

 

         13  lead poisoning in the City, are between one and five

 

         14  years old, and live in neighborhoods with the oldest

 

         15  dilapidated housing, such as parts of Central

 

         16  Brooklyn and Southeast Queens.

 

         17                 From my experience in managing the

 

         18  lead poisoning prevention program, the majority of

 

         19  these children were exposed to lead paint hazards

 

         20  inside their homes. An effective plan for preventing

 

         21  child for lead poisoning in New York City, also

 

         22  needs to make use of National data too, such as that

 

         23  compiled by the US Department of Housing and Urban

 

         24  Development, which shows that lead hazard control

 

         25  methods to prevent lead poisoning are effective in

 

 

 

 

 

 

 


 

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          2  lowering dust and blood lead levels on a long-term

 

          3  basis.

 

          4                 The current bill before the Council,

 

          5  Intro. 101-A, contains many important provisions for

 

          6  protecting young children from lead poisoning, such

 

          7  as requiring that landlords regularly inspect their

 

          8  dwellings for lead paint hazards, using trained

 

          9  personnel to repair peeling lead paint, requiring

 

         10  that the work area be thoroughly cleaned afterward,

 

         11  and requiring that dust lead clearance testing be

 

         12  conducted to make sure that cleaning has been

 

         13  effective.

 

         14                 At the same time, many would argue

 

         15  that the bill contains other provisions whose

 

         16  relevance to New York City or effectiveness, has not

 

         17  been demonstrated.

 

         18                 For example, removing soil or using

 

         19  the standard of 0.7 milligrams per centimetered

 

         20  squared, instead of the current federal standard of

 

         21  1.0 milligrams per centimetered squared.

 

         22                 Expending resources on such

 

         23  questionable practices may actually divert attention

 

         24  from those children at highest, and partly for these

 

         25  reasons, I believe that efforts at developing a new

 

 

 

 

 

 

 


 

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          2  plan remain stalled.

 

          3                 So, an important question is how to

 

          4  break the stalemate. I believe we need to

 

          5  incorporate the best available data and public

 

          6  health principals into a sound policy that will

 

          7  protect those children at greatest risk.

 

          8                 It must include the following

 

          9  elements:

 

         10                 - repairing peeling paint and doors

 

         11  and window frames with abraded lead paint.

 

         12                 - focusing on homes where children

 

         13  under age six live.

 

         14                 - utilizing trained personnel for

 

         15  controlling lead paint hazards.

 

         16                 - thoroughly cleaning the work area

 

         17  after repairs are completed.

 

         18                 - conducting clearance testing to

 

         19  verify that it is properly cleaned.

 

         20                 - and requiring that lead paint

 

         21  hazards are corrected and verified as quickly as

 

         22  possible.

 

         23                 I urge the Council to act quickly to

 

         24  enact a policy that will focus on these key

 

         25  elements. Such an approach will help to assure that

 

 

 

 

 

 

 


 

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          2  the City continues on its successful path in

 

          3  addressing childhood lead poisoning.

 

          4                 I would be pleased to answer any

 

          5  questions.

 

          6                 CHAIRPERSON PROVENZANO: Thank you,

 

          7  Doctor.

 

          8                 Do we have any questions?

 

          9                 Council Member Jackson.

 

         10                 COUNCIL MEMBER JACKSON: Doctor, I

 

         11  want to thank you for coming in and giving

 

         12  testimony. I was reading along with you while you

 

         13  were reading your testimony, and I'm going to the --

 

         14  you indicated utilizing trained personnel for

 

         15  controlling lead paint hazards, and would you agree

 

         16  that it would be best to use a trained and certified

 

         17  by a board that individuals have met certain

 

         18  qualifications and that they are certified by either

 

         19  the City or a State agency that they're expected to

 

         20  use this protocol, rather than just having someone,

 

         21  for example, an owner, train people and they're not

 

         22  certified by a board such as the New York City

 

         23  Department of Health or HPD or DHCR or the New York

 

         24  State Department of Health?

 

         25                 DR. KLITZMAN: I feel it's very

 

 

 

 

 

 

 


 

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          2  important that personnel are trained.

 

          3                 I also feel that it's important that

 

          4  there's some standard or verification that training

 

          5  has occurred and that the person is competent.

 

          6                 How you choose to do that is an

 

          7  administrative decision and there are a number of

 

          8  ways that it can be accomplished; however, the

 

          9  objective of documenting the training has occurred,

 

         10  and that the person is competent to perform the work

 

         11  is what is most important.

 

         12                 COUNCIL MEMBER JACKSON: Yes, I

 

         13  totally agree with you, but what I'm soliciting is,

 

         14  you explained some of the things in the process in

 

         15  order to make sure that things are done, but what

 

         16  I'm asking you, based on everything that you know,

 

         17  and you're entire knowledge base and life history,

 

         18  and your opinion, I'm asking you an opinion on

 

         19  whether or not a certification would be best overall

 

         20  to ensure that the protocols were followed out, and

 

         21  having a board to certify that employees are trained

 

         22  in all of the areas for abatement and/or cleaning or

 

         23  following all the protocols. So, I'm really, I'm not

 

         24  asking you to reiterate the standards, I'm asking

 

         25  you an opinion, so if you can express an opinion; if

 

 

 

 

 

 

 


 

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          2  you can't, just say you can't.

 

          3                 DR. KLITZMAN: I feel that there

 

          4  should be some external standard, an independent

 

          5  standard that a person has to meet. It could be

 

          6  certification by a board or an agency, but it should

 

          7  be some independent standard that has to be met. I

 

          8  hope that answers your question.

 

          9                 COUNCIL MEMBER JACKSON: It does.

 

         10  Thank you very much, Doctor.

 

         11                 Thank you, Madam Chair.

 

         12                 CHAIRPERSON PROVENZANO: Any other

 

         13  questions?

 

         14                 Thank you very much.

 

         15                 COUNCIL MEMBER JACKSON: Madam Chair,

 

         16  are we on a break or what?

 

         17                 CHAIRPERSON PROVENZANO: No, no

 

         18  breaks.

 

         19                 COUNCIL MEMBER JACKSON: I see

 

         20  everybody is getting up and leaving.

 

         21                 CHAIRPERSON PROVENZANO: That's their

 

         22  choice. We're going on.

 

         23                 We're just looking for someone to

 

         24  possibly shut this down, by press an off button or

 

         25  something? Oh, there you are, okay.

 

 

 

 

 

 

 


 

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          2                 Oh, you left your computer, too,

 

          3  okay.

 

          4                 And remember that you're getting us

 

          5  testimony, right? Okay, thank you.

 

          6                 Since we're probably looking at

 

          7  another couple of hours, although I don't plan on

 

          8  going past about 2:00 or 2:30, we will now put on

 

          9  the clock. So, the folks that will be testifying

 

         10  from here on will be on a three-minute clock.

 

         11                 The next folks to testify will be

 

         12  Martin Benitez. And we need one more chair up there,

 

         13  because we'll probably be testifying in groups of

 

         14  three. Jeannette Sanchez and Enriques Modesto.

 

         15                 We only need three chairs, we only

 

         16  have three people testifying. Okay, who will be

 

         17  first?

 

         18                 Okay, just remember to identify

 

         19  yourself when you start to speak, okay? You're on.

 

         20                 MR. RODRIGUEZ: (In Spanish.)

 

         21                 CHAIRPERSON PROVENZANO: Excuse me.

 

         22  Could we just ask you, because you're the

 

         23  interpreter, do the interpretation now, because some

 

         24  of us understand, but some of us don't, and we do

 

         25  want to -- and also keep to the three-minute clock,

 

 

 

 

 

 

 


 

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          2  because even though people left the room, they're

 

          3  all going to be back, we have a lot of people to

 

          4  testify. And I see that it's a very emotional story,

 

          5  but I don't know what he's saying.

 

          6                 MS. RODRIGUEZ: My name is Andrea

 

          7  Rodriguez --

 

          8                 CHAIRPERSON PROVENZANO: I don't think

 

          9  you're on. Why don't you use his mic.

 

         10                 MS. RODRIGUEZ: (Through the

 

         11  interpreter.) My name is Andrea Rodriguez, from

 

         12  Northern Manhattan Improvement Corporation.

 

         13                 CHAIRPERSON PROVENZANO: Thank you.

 

         14                 MS. RODRIGUEZ: I'll translate up to

 

         15  the point where he stopped.

 

         16                 CHAIRPERSON PROVENZANO: Fine.

 

         17                 MR. BENITEZ: (Through the

 

         18  interpreter, Ms. Rodriguez.) My name is Martin

 

         19  Benitez. I am the father of four children: Juan, who

 

         20  is 15 years old, Jose who is 11 years old, Martin

 

         21  who is eight, and my daughter Jazmin who is four

 

         22  years old.

 

         23                 Jose was poisoned ten years ago when

 

         24  we were living on Himrod Street in Bushwick. He had

 

         25  a blood lead level of 30 micrograms per deciliter.

 

 

 

 

 

 

 


 

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          2  When the landlord found out about his poisoning, he

 

          3  told us to leave the apartment.

 

          4                 We wanted to avoid these problems, so

 

          5  we left and moved to 1729 Grove Street in Ridgewood,

 

          6  Queens, but our problems with lead poisoning did not

 

          7  end there.

 

          8                 In October of 2000, my youngest child

 

          9  Jazmin was hospitalized with a blood lead level of

 

         10  119. The Health Department inspected our home on

 

         11  Grove Street, and ordered the landlord to remove the

 

         12  lead hazards.

 

         13                 The landlord tried to evict us, but

 

         14  we knew our rights. We stayed in the Manhattan lead

 

         15  safe house for five months while the repairs were

 

         16  being done in the apartment, and while my daughter

 

         17  continued to receive treatment for the poisoning.

 

         18  After five months, the Department of Health told us

 

         19  it was safe for us to move back into her home on

 

         20  Grove Street. They told us the lead hazards were now

 

         21  gone.

 

         22                 We thought we could trust the Health

 

         23  Department but we were wrong. Although Jazmin's

 

         24  blood lead level had been monitored almost every

 

         25  month since age one, her blood lead level has never

 

 

 

 

 

 

 


 

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          2  dropped below 14. She is now four years old, and

 

          3  this past May she was hospitalized for the second

 

          4  time, when her blood lead level went back up to 58.

 

          5                 The Health Department has now found

 

          6  new lead violations in our home. This is the same

 

          7  home on Grove Street that the Health Department

 

          8  inspected and cleared in 2001, the same home that

 

          9  the Health Department said was safe to move into

 

         10  again. How could this happen?

 

         11                 MR. BENITEZ: (In Spanish.)

 

         12                 CHAIRPERSON PROVENZANO: Excuse me.

 

         13  Again, why don't you continue it in English, please.

 

         14                 MS. RODRIGUEZ: And this time the

 

         15  landlord succeeded in evicting us. With nowhere to

 

         16  go, we moved into a room into a relative's house,

 

         17  only to be told by the Health Department that we had

 

         18  to move into the Manhattan lead safe house again,

 

         19  only for 60 days. Our 60 days ran up last week, back

 

         20  in a room without a permanent home.

 

         21                 Jose now is in the sixth grade and

 

         22  has learning disabilities. I know it's because of

 

         23  his lead poisoning. I'm afraid what will happen to

 

         24  Jazmin, how her severe lead poisoning will affect

 

         25  her performance in school and her quality of life in