2  CITY COUNCIL



             CITY OF NEW YORK

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




          6            of the




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

                            September 12, 2003

          9                 Start:  10:07 a.m.

                            Recess: 3:25 p.m.


                            City Hall

         11                 Council Chambers

                            New York, New York



         13       B E F O R E:


         14              MADELINE PROVENZANO




         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




                         17 Battery Place -  Suite 1308

         25              New York, New York 10004

                              (800) 756-3410













          2  A P P E A R A N C E S



             Mary Jean Brown, ScD, RN

          4  Chief, Lead Poisoning Prevention Branch

             Centers for Disease Control and Prevention


             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


             Martin Benitez


             Janet Sanchez


             Enrique Modesta


             Adrian Rodriguez


             John McCarthy

         14  Community Preservation Corporation


         15  Michael McGuire

             Mason Tenders' District Council


             Michael McKee

         17  NYS Tenants And Neighbors Coalition


         18  Darryl Ramsey


         19  Local 768


         20  Joel Shufro, Ph.D

             Executive Director

         21  New York Committee for Occupational

             Safety and Health


             Public Advocate Betsy Gotbaum


             Helen Daniels

         24  Black and Latino Property Owners
















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



             Martin Benitez


             Jeannette Sanchez


             Enriques Modesto


             Andrea Rodriguez

          7  Northern Manhattan Improvement Corp


          8  Frank Ricci

             Rent Stabilization Association


             Mitchell Pasilikin

         10  General Counsel

             Rent Stabilization Association


             Manuel Castro

         12  Make the Road By Walking


         13  Jedidah Baptiste


         14  Christina Brito


         15  Michael McKee

             NYS Tenants and Neighbors Coalition


             Michelle Alvarez

         17  Natural Resources Defense Council


         18  Eddy Dixon


         19  Camile Rivera


         20  Chris Rembold

             Sierra Club


             Mark Caserta

         22  New York League of Conservation Voters


         23  Adriene Holder, Esq.

             The Legal Aid Society


             Matthew Chachere

         25  NYCCELP














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



             Irene Shen

          4  New York City Environmental Justice Alliance


          5  Cordell Cleare






















































          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














          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














          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














          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














          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














          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














          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














          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














          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.














          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














          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














          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














          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.














          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,














          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














          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














          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














          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














          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














          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














          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














          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.














          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














          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














          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.














          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














          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.














          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.














          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.














          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














          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,














          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














          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.














          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














          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














          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,














          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














          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














          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














          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














          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














          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.














          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














          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














          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.














          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














          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














          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














          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














          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














          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














          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














          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














          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.














          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














          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.














          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














          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














          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














          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














          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














          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














          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














          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,














          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














          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














          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,














          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,














          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














          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.














          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














          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














          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.














          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.














          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














          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














          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














          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,














          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














          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














          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














          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














          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?














          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














          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














          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














          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














          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














          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














          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














          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














          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














          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














          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














          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














          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.














          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,














          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.














          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














          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